View original document

The full text on this page is automatically extracted from the file linked above and may contain errors and inconsistencies.

L 5>2ö
m 33






Bureau Publication No. 33



tc s
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis

U .s^c

#3 3


Letter of transmittal ........................................., ............................................... ............
P a r ti. Children’s health conferences......................... ................................................. 13-18
Conferences at the county seat.......... .....................................................................
Conference in rural communities............................................................................
Results of the conferences................................................................ .......................
Part II. The lowland county su rvey........................................................................... 19-57
Characteristics of the township................. ................................................. ...........
Findings of the survey..................................................................
Economic status of fam ilies................................ ........................................... v 20-23
Land tenure................................................ ~ . . . ........................................
Crops and acreage.......................................................................................
Cost of cotton production................ . ................................... ...................
Credit system s.........................................................................................
Crop disposal................................
Farm labor............................................................................ ............. . .......
Home conditions.............................
White fam ilies.......................................................
Negro fam ilies......................................
P r iv ie s ................. ..............
Water supply........................................................................................
'2 5
Flies and mosquitos............................................................................
Disposal of w aste..................................
Maternity care.........................................................................................
Facilities for medical, hospital, and nursing care................
Maternal deaths......................................................
Prenatal care...............................
Attendant at birth.............................
Mid w ives......................................... .................................................. I
Postnatal care....................................................................
Nursing care in confinement....................................................................
Rest before and after confinement..........................................................
Mother’s usual work.....................................
Infant care.............................................................................
Infant mortality........................
Age at death and mother’s statement of cause of death............
Stillbirths and miscarriages..............................................................
Infant feeding........................
Physical condition of children from 1 to 15 years of age........................... 39-42
General health...............
Mortality of children from 1 to 15 years...........................
Home remedies............................................................................................
D iet.........................
Federal Reserve Bank of St. Louis



Part II. The lowland county survey—Continued.
Findings of the survey—Continued.
School la w ............................................................. - - *......... . . . . ----School term and attendance. . . . . . . . ...... ......................................
Attitude of parents toward education................ ............. ---------School facilities.......................................... .
— ------White schools............................. — ..............................- - -----Buildings and equipm ent— .......
Sanitation....................................- ................
School a c t i v i t i e s . . . . : . . . . . . . . . . . . - - - - .......... - - - .........
Negro s c h o o ls........... ................ ........ ■
— ¿v----- . . . . . . -----High schools....................................................... ....... - - - - - Farm-life schools................................................... ......................
Moonlight schools.............. ............................................ ............
Children’s farm and other work........... — - - .................. .
Chores....... ......... ................................... ............. ................... . - ........
Field work............................................. ............... .............................
Working hours........................................................... — - - ...............
Wages when at work away from hom e............................... .
Recreation and social life ............... ........... ............................................
White families.........................................................
Negro fam ilies...................................... .............. ..
Part III. The mountain county su rvey— ......................... ........ ...........
Characteristics of the townships.................................................. .
Findings of the su rvey— ..........................................................- ............»--■
Economic status of fam ilies...........................................
Farm acreage................................ - ............. ......... - - -------- - - - - - - Land tenure.......................... .......................... ..................... ..
Fam ily incom e..................................................... - ........... — . . . . . .
Farm expenditures............ .......... ..................... ................. - - - - - Methods of purchasing................... .............................................. ..
Disposal of crops and other produce.................................- - - - - Home conditions..................... ............... ..................................................
- - - - --- - - - -— -Sanitation. . . : ................................. - ------- - — . . . . . . . . —
Water supply................................... ......... ....................... - P rivies........................................................ - ......... . — . . . . :
Disposal of refuse----- ....------. . . . . . ................. ................. F lies....................................................... ................... .................
Maternity care. —........................................................ - - - - ..................
Facilities for medical, hospital, and nursing c a r e ..............
Maternal deaths........................................... ....................... .
Prenatal care........................................................ .....................
Attendant at birth............................................. ........................
M idwives.........................................................- .................
Postnatal care................................................. ...........- ...........
Nursing care in confinement...... ................................................. Rest before and after confinem ent........................................ .
Mother’s work....................................................................................
Infant care............................................ ................................................—
Infant'mortality.......................- ......... .............................
Age at death and mother’s statement of cause of d ea th ..
Stillbirths and miscarriages.............. .'....................................
Infant feeding................................................................... •.................
Federal Reserve Bank of St. Louis


43- 49
' 71






Part III. The mountain county surveys—Continued.
Findings of the survey—Continued.
Physical condition of children from 1 to 15 years of a g e . . . . . : . . : A. , . . . 76-80
General health...................... ............... ...................................................
Mortality and mother’s statement of causes of d e a th ........................
Medical care................ .......... ....... ... . . . . j . . . . . . j. . . . . . .
Home remedies........ .................................................... ..
D iet................................................ ........ .............................................
Education.... ................. ............... ............... ......... ........ .................
School term and attendance..................... ...............................................
Attitude of parents toward education.............. ; .............. .................... - 81
Need for medical inspection of schools___............................................
School facilities................. ....................... .................... . . : ___
The school and the comm unity........................-......................... ......
Children’s farm and other work. . . . . ...... .................... ...........‘ ..............
Field work..............'........................................................... .
Chores.......................................................................... ..
Working hours_____ ......................... ......... . . . . . . . . . . . . . . _
Wages when at work away from home.-............ ............... ...... _ _ _
Recreation and social life.................... ..................... .
_ ■
Part IV. Summary and conclusions.............................................. . _
Part V. Appendix. The State and its relation to child w elfare.........................101-118
State board of health........................ ............
Organization..................................... .......................................
Birth registration...................................•
Educational campaigns.........................
Hookworm, typhoid, and pellagra campaigns..........................................
Soil pollution work......... ............. .......................... ; . . . . . . . . . t:
Postgraduate c lin ic s ...................................... •. v i . . . a <>.«. . . . . . . . .
Public-health nursing....... ............................... ; .............. ....
Registration of mi dwi ves. . . . . : ». . . . . . . . . . . . . . . . . . . . . . . . . . .
Prevention of blindness in infancy.....................................................
Quarantine for infectious diseases......................................
iq 5
Physical examination of school children.................... ..
“ County u n its” ..................... ......... . . . ’......................... .
- jgg
Agricultural activities....... ....................... .................................... ......
County and home demonstration a g e n t s . ___ ; ...........................
Boys’ and girls’ clubs..................
Farmers’ institutes..............- ..................... ....................... .
Rural credits and farm loan associations......... ............ ..............................
County fairs....................................................
Community service leagues............ .................... .................. ..
Home-county study clubs of University of North Carolina.. . . . . . . . . . .
Laws relating to child labor....... ............................ ...........; L
Laws relating to school attendance.................... ............... ................... . . . .
Child-caring institutions and a gen cies..-,-... , ................ .. . . . . . .............. 111-114
Facilities for dealing with juvenile offenders........ ....................... ............
Institutions for defective children.............................................................
Provisions for homeless and dependent children.................... ...................
State board of charities and public welfare........ ........................................
Federal Reserve Bank of St. Louis



Part V. Appendix. The State and its relation to child welfare—Continued. Page.
Schedule used in visiting families during survey...............................................
Midwife schedule............................................................ ..........................................
School-survey schedule............................................................................................

Plates I to X V .............
Plates X V I to X X X I
Federal Reserve Bank of St. Louis

Face page
Face page


U. S.

D epartm ent of L abor,
C h i l d r e n ’s B u r e a u ,

Washington, September 25, 1918,
S i r : Herewith I transmit a report entitled “ Rural Children in
Selected Counties of North Carolina.” This study was made at
the request of the North Carolina State Board of Health in cooper­
ation with State and local authorities and volunteer organizations.
The purpose was to secure information as to the rural child_his
well-being, surroundings, needs, and opportunities.
The study was under the direction of Dr. Frances Sage Bradley
with the assistance of Miss Margaretta A. Williamson.
J u l i a C . L a t h r o p , Chief.
Hon. W il l ia m B. W i l s o n ,
Secretary of Labor,

Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis

This inquiry into the conditions surrounding rural children was
undertaken with the purpose of studying at first hand the everyday
life of the rural child of the South, at home, at work, at school, and
at play—his health, environment, needs, and opportunities. Since
three-fifths of the children of the United States are rural children, it
is obvious that the problems of the rural child must meet with careful
consideration in any program of child conservation.
At the request of the Sto,te board of health it was decided to con­
duct the study in North Carolina, which may fairly be considered a
typical Southern State, with its characteristic population, customs,
climate, soils, and crops. The inquiry was necessarily confined to
definite and limited areas, and an effort was made to choose sections
representative of rural conditions in different parts of the State.
North Carolina is clearly divided into an eastern coastal plain of
low-lying land, intersected by many streams, partly swamp land but
mainly sandy and fertile loose loam soils; a central or piedmont
region of higher altitudes and a greater variety of fertile soils;1 and a
western or mountainous region in the heart of the Appalachian sys­
tem. Cotton raising is the leading industry of the coastal and pied­
mont regions; in the mountains little crop farming is done and the
chief dependence of the people is live-stock raising and the develop­
ment of timber interests.
A lowland county, lying at the junction of the coastal and pied­
mont sections, was selected as representative of conditions in the
cotton belt, and a mountain county in the extreme western part of the
State was chosen as a typical mountain county embodying charac­
teristics not only of western North Carolina, but also of other moun­
tainous sections of the Southern Appalachian system.
The inquiry was initiated in the lowland county by a children’s
health conference and a child-welfare exhibit at the county seat, and
followed by a series of conferences in each township of the county.
Following the children’s health conferences an intensive detailed
house-to-house study of the children was made in one rural township
of the lowland county (in the cotton belt), and in three smaller rural
townships of the mountain county.
i Thirteenth Census of the United States, 1910, Vol. V, Agriculture, p. 895.

Federal Reserve Bank of St. Louis



In the townships chosen every home in which there was a child
under 16 was visited; the survey included in the lowland county
township 127 white families with 340 children, and 129 negro fami­
lies with 404 children under 16; in the three townships of the moun­
tain county 231 white families with 697 children under 16 were
visited. The inquiry, which was made in 1916, covered a period of
approximately three months in each county. During this time the
bureau agents lived in homes in the townships visited father than
maintaining headquarters at the county seat, in this way gaining a
somewhat fuller experience of particular rural conditions and prob­
lems than could otherwise have been possible. In the lowland county
a Ford car was used for travel; in the mountains, owing to the condi­
tion of the roads (with the exception of the main road to the county
seat), the agents rode horseback.
Whenever possible the mother was interviewed, otherwise the
father, grandmother, or other nearest relative. Information was
obtained concerning various phases of child care, together with a
comprehensive history of each family in its relation to the well-being
of the children of the family. The questions covered the number of
children the mother had borne; the number lost, with the causes of
their deaths; the mother’s prenatal, obstetrical, and postnatal care;
distance from physician; nursing care; infant feeding; diet of older
children, their physical condition, education, work, and recreation;
the mother’s household and farm duties; and the housing, sanitation,
arid economic status of the family.
The inquiry was confined to normal children, no attempt being
made to cover dependency, delinquency, illegitimacy, or other
problems of abnormal children except a brief survey of State facilities
for their care.
Certain phases of child welfare were covered by supplementary
studies. Information as to the neighborhood midwives of the four
townships was obtained by visiting every midwife who had attended a
case within the past five years; a test of birth registration was made
and also a brief survey of school facilities in the townships covered.
During the course of the inquiry, various State and other organiza­
tions—the State board of health, State board of education, State
university, State Normal and Industrial College, States ^Relations
Service of the United States Department of Agriculture, and the
staff of an important farm journal—were most helpful in their cooper­
ation, assisting in choosing the counties to be studied, in planning the
work, and helping to assemble material for the report.
Local officials and organizations in the counties chosen—the county
physician, county superintendent of schools, county medical society,
women’s clubs, and the press—also showed an active interest in the
inquiry and gave every possible assistance.
Federal Reserve Bank of St. Louis



The success of such an inquiry necessarily depended upon the good
will of the community, especially of the families interviewed. Moth­
ers in the. sections visited showed the same desire to secure the best
possible results in rearing their children and the same cordial interest
in the efforts of the Children’s Bureau to study the problems of child­
hood that have been found elsewhere. A friendly, hospitable recep­
tion was accorded at every home, both mothers and fathers, giving
every possible assistance. In fact notes, messages, and remon­
strances were sent by mothers whose homes had not yet been reached
and who feared they might be overlooked. At one home a note was
found pinned to the front door, directing the agents to the field where
the mother would be found at work.
The results of the inquiry fall under the five following heads:
(1) Children’s health conferences, (2) and (3) the survey of conditions
surrounding children in the lowland and mountain counties, (4) sum­
mary and conclusions, and (5) the State and its relation to child
welfare (see Appendix, p. 101).
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis


The children’s health conferences, held first at the county seat
and later in rural sections, were a series of consultations of physicians
with mothers concerning the physical development of their children
and were in charge of a physician from the Children’s Bureau.
The purpose in view in holding the conferences was (1) to call the
attention of mothers to methods of improving the condition of their
children, (2) to demonstrate to the communities the value of periodic
examination and sustained supervision of young children, and
(3) to stimulate local authorities to various forms of follow-up work
as suggested by the conference.

The conference met with a cordial response from local organizations.
The mayor, clergy, school officials, and other prominent citizens
offered every possible assistance. The civic association, the county
medical society, local hospitals, and other organizations gave prac­
tical expression of their interest in the work.
Ample publicity was obtained through the courtesy of the State
and local press, which gave generously of their space; also through
the health bulletins of the State board of health. A letter addressed
to all mothers of young children was sent through the cooperation
of schools into every home where there was a child. Attractive
cards announcing the conference appeared in the windows of schools,
churches, stores, railway stations, and elsewhere. Notices announc­
ing the conference and inviting mothers to bring their young children
to it were read from every pulpit. To attract the school children,
a prize of a five-dollar gold piece was offered by the Children’s Bureau
for the best composition written by a child under 12 on the conference
and its accompanying exhibit.
The conference at the county seat was held at a rest room main­
tained by the civic association for the use of rural women from the
surrounding country when they come to town to do their Saturday’s
shopping. It extended over 10 days, including two Saturdays, in
order to reach as many as possible of the rural women. After the
conference for white: children, one was held for negroes in an assembly
hall of their own, with negro doctors and nurses assisting the Children’s
Bureau physician.
Federal Reserve Bank of St. Louis



Children under 6 years of age, brought by their parents, were
examined by a physician of the Children’s Bureau or by local physi­
cians. Each child was weighed, measured, and examined, and
the mother given a record of his present condition with written
suggestions for his improvement; when necessary the mother was
urged to take the child to her own or the best available local physician.
The examinations were conducted in view of the audience, that the
mothers might observe and profit by the practical demonstration,
but with a partition of netting separating the examining room from
the audience, to protect the child from the crowd and confusion
It was made clear that the conference was neither a contest nor a
clinic. No prizes were offered, and there was no other incentive
than the desire of parents for finer children; nor were sick children
admitted, or those recently exposed to communicable diseases. The
conference was intended rather for the average child who though
apparently well is yet rarely free from defects which may often be
corrected if discovered in time.
Accompanying the conference was a child-welfare exhibit of
material, part of which had been prepared by the Children’s Bureau
and part loaned by various organizations or constructed (under the
direction of the agents of the bureau) by local women’s clubs.. A
set of panels covered such subjects as prenatal care, infant care,
infant mortality, and the visiting nurse. A series of charts on flies,
typhoid fever, and malaria was loaned by the State board of health
and one on the care and eruption of teeth by a local dentist. Models
added greatly to the value of the exhibit. An electrical device
showing the infant mortality of the State was loaned by the State
board of health; in a village of 100 miniature homes lights went out,
one by one, as babies died, showing the infant mortality for the State.
Another electrical model warned against the danger of “doping”
the baby. A sleeping basket, bathing equipment, and suitable
clothing for the baby of a family of limited means were shown; also a
homemade playing pen and simple homemade toys. In a glass case
was displayed a home with flies and mosquitoes breeding in the
neglected back yard and outhouses. A homemade fireless cooker,
iceless refrigerator, and flytrap were loaned by the home demonstra­
tion agent of the Department of Agriculture.
The care and preparation of modified milk for the baby was demon­
strated by a nurse from a local hospital, and a representative of the
home economics department of the State Normal Industrial College
demonstrated food values and the preparation of food for the growing
Federal Reserve Bank of St. Louis



In a series of informal talks, the physician of the Children’s Bureau
discussed with the mothers such subjects as prenatal care, obstetrical
care, care of the baby and the young child, care of the sick child,
school lunches, medical inspection of the schools, and the value of a
visiting nurse.
Through the courtesy of the local moving-picture houses a Chil­
dren’s Bureau film, “ A Day in a Baby’s Life,” was shown; also publichealth slides loaned by the State board of health and other organiza­
• -v
The attendance at the conference was drawn not only from the
county seat but from the surrounding country as well, farmers leaving
their fields in the midst of the busy plowing and planting season and
driving 12 and 15 miles to bring their children for examination.
Doctors came with small patients, parents brought children, and
teachers came for help with their problems. A number of mothers
and babies were brought into the conference each day from a near-by
mill village by the manager of the min. One father at first thought
the conference only an excuse for the mothers to go to town and re­
fused to have his child examined, but when he saw the record given
his brother’s child he insisted that his own son be brought for exam­
ination. The mothers admitted that they carried their babies’
records around in their pockets and compared notes at leisure
The attendance often taxed the accommodations to the utmost, and
the increasing number of children brought for examintion was per­
haps the best evidence of its growing hold upon the public. One
hundred and forty children were examined at the white conference
and 49 a t the conference for negroes. The value of the conference,
however, can not be measured wholly by the number of children
examined. Not only those who brought children for examination,
but also many others—children and adults—were in attendance;
and the interest they displayed in all that was said and done can but
lead to good results.

After the conference at the coùnty seat, each of thè 12 townships
of the county was visited and an afternoon or evening conference
held. In 1 township, because of the crowd, it was necessary to
repeat the white conference; and in 2 townships a second one for
negroes had to be arranged; in all, 27 rural conferences were held, and,
in addition, 4 in small mill villages.
As a rule the district school was the chosen meeting place, though
occasionally the church was selected when it was more centrally
located or would better accommodate the crowd.
Federal Reserve Bank of St. Louis



As at the county seat, the conference was cordially received in
rural communities, preachers, -teachers, doctors, and other leading
citizens all assisting in every possible way; Several ministers came
repeatedly to ask that their districts be included in the circuit.
More than one good negro meeting was due to the efforts of the negro
midwife. Like the preachers and the teachers she is an autocrat in
her community, and mothers naturally shy about bringing children
for examination would obey her arbitrary summons. One was heard
to insist that the mother “ take that child to the doctor and see what
makes her have sore eyes.” (At a later private interview this mid­
wife was urged to write to the State board of health for a proper
solution of silver nitrate with instructions for its use.)
In a preliminary visit to the townships, prominent persons had been
consulted in regard to convenient dates and places for conferences.
Window cards had been placed in the windows of country schools,
churches, and stores, or tacked to conspicuous trees. Notices had
been read in schools,> and Sunday schools. In one com­
munity publicity had been secured by a flourishing woman’s club.
For the most part, however, the news traveled by word of mouth—
the usual medium of communication in rural districts.
The rural conference differed from that held in the county seat
only in size and in the ability of the agents to meet the mothers on a
more intimate footing in their own immediate neighborhood than in
the more formal town conference. The mothers felt freer to ask ques­
tions and compare experiences with their neighbors and friends.
Although it was obviously impossible at the rural conference to use
the original exhibit previously described, with its electrical devices, a
small traveling exhibit of miniature models was shown, covering the
essential points of the care of the young child—his bathing, clothing,
sleeping, and feeding. Most of the time was spent in examining the
children and demonstrating methods (and results) of applying wellknown principles of hygiene,, within reach of every woman. At
night meetings, using a simple acetylene equipment, slides were
shown which, with a short informal talk, never failed to arouse
Considering the sparcity of the population—many families not
having a neighbor in sight—the attendance was most unexpected.
Twenty-seven conferences were held with an average attendance of
78 at the white and 87 at the negro meetings. Twenty-two hundred
and six rural persons were reached, exclusive of those attending the
conferences at the county seat, and 162 children were examined.
As at the county seat, the audiences included all classes. There
were represented the children Of the prosperous planter, of his tenant,
and of his day laborer. Many were brought by parents for advice
in regard to feeding problems; others came with a physician who
Federal Reserve Bank of St. Louis



wished to confirm a diagnosis. At one meeting two adopted children
were brought by their foster mother. On the way from a rural con­
ference a father signalled the agents, as they drove past his house
(apologizing, as he said, for “ flagging the train”) and begged their
advice concerning his little lame boy who could not be brought to
the conference. At a negro meeting, a colored elder who had come
too late for the “ scenery” (stereopticon slides) but in time for the
talk, expressed his appreciation of the work being done for his race.
In their enthusiasm the negro audiences often refused to be dismissed,
and were left to discuss the new doctrine after the close of the meeting.
Following one of these conferences, a mother and her two children
who had missed the meeting the night before were found at the door
the next morning waiting to have the children examined - b e f o r e the
agents took an early train.

The results of the conference were seen on every side. Mothers
were made more observant and more critical of their children and a
general stock taking by the mothers of this section followed. A
father who had brought a poorly developed child to the conference
was heard to say several weeks later, “ My wife couldn’t go, but I went
and took it all in, and we’re raising our baby like the doctor said.”
Parents who had brought a child to one conference would often appear
at a neighboring conference with a second or third child of their own
or one of a neighbor’s. Following the conference, many children
received the attention of dentists and throat specialists; and others,
whose needs had previously not been recognized, were brought into
touch with their family physicians.
Many practical evidences of the work were seen in driving through
the country. Babies heretofore kept indoors were found sleeping on
the porch or out under the trees in homemade cribs. Mothers showed
with pride their own or their husbands’ modifications or adaptations
of models seen in the exhibit. Playing pens, homemade toys, fireless
cookers, iceless refrigerators, and flytraps were made by many. An
ambitious teacher who was developing a domestic science depart­
ment for mothers and young girls had reproduced in her school
models seen in the exhibit.
Vhe agents also indorsed the project of installing an incinerator at
the county seat for the disposal of garbage and waste. The incine­
rator has now been in operation for over a year and is helping to
convert an attractive town into one that is also healthful and sanitary.
During the conference of the Children’s Bureau at the county seat
the agents had an opportunity to join in an effort to crystallize public
opinion upon the value of a visiting nurse. So convincing were the
63721°— 18——2
Federal Reserve Bank of St. Louis




results of tlie first few weeks of this nurse’s service, that after the
negro conference the negro population secured pledges-of almost the
entire salary of a negro nurse, the white people supplementing the
The response to the conferences in rural sections' showed how
eagerly the services of a public-health nurse for rural districts of the
county would be welcomed. Such conferences as were held by the
Children’s Bureau, chiefly as demonstrations, might be held at inter­
vals by a public-health nurse, as a part of her routine. Informal
talks with Ihe mothers at the conferences also revealed certain
particular needs of the community-which a public-health nurse would
be able to meet, such as prenatal care and assistance at confinements,
advice as tp the care and feeding of the young child, examination of
school children for physical defects with follow-up visits in the
homes to make sure that the necessary treatment is secured, and the
education of the community in the importance of hygiene and
The children’s health conferences proved a successful means of
introducing the inquiry of" the Children’s Bureau in the State and
secured the interest of various organizations to whose helpful coopera­
tion the bureau is indebted for much of the material contained in
this report.
Federal Reserve Bank of St. Louis

P L A T E I.— A T T H E C H I L D R E N ’S H E A L T H C O N F E R E N C E .

P L A T E I I — A C H I L D R E N ’S H E A L T H C O N F E R E N C E A T A N E G R O C H U R C H .
Federal Reserve Bank of St. Louis

Federal Reserve Bank of St. Louis

P L A T E V.— O U T - O F - D O O R B A B Y IN A H O M E M A D E C R IB .
Federal Reserve Bank of St. Louis


VI.— g o o d s a n d - c l a y r o a d t h r o u g h

Federal Reserve Bank of St. Louis

th e

p in e

w o o d s

IS T H E “ M O N E Y C R O P ” IN T H E L O W L A N D S -


JOl____ _____ '
P L A T E V III. — S A N D Y P L A IN S O F T H E L O W L A N D C O U N T Y .

PtL A T E IX.— T I M B E R L A N D S A R E F A S T D IS A P P E A R IN G .
Federal Reserve Bank of St. Louis

P L A T E X.— A P R O S P E R O U S P L A N T A T IO N H O M E .

P L A T E X L — A N E G R O T E N A N T ’S C A B IN W IT H
Federal Reserve Bank of St. Louis


P L A T E X II.— D R I L L E D W E L L C O N V E N IE N T L Y N E A R T H E H O U S E .



Federal Reserve Bank of St. Louis


J 1

, V - :

P L A T E X IV .— A T H R E E - T E A C H E R W H IT E S C H O O L .

P L A T E XV.— N E W O N E - T E A C H E R N E G R O S C H O O L .
Federal Reserve Bank of St. Louis



During the course of the rural conference local citizens were con­
sulted in regard to the characteristics of the various townships of the
county, and a township thought to be a typical rural section of the
cotton belt was chosen for intensive study.
' \ ■, _ ,

The township lies 6 to 14 miles from the county seat, which is the
nearest town, and consists of open country along the bank of a broad
swift stream. The land is low, level, and, except along the river
bottom, is sandy and porous. The soil, debilitated by years of
exclusive cotton growing, demands heavy and expensive fertilization
in order to produce a good yield.
The climate is warm and humid, with the long summers especially
adapted to cotton raising. The Weather Bureau records for the
county seat, over a period of 28 years, show a mean temperature of
44° in January and 79° in July, with a «ninimum of —5° and a
maximum of 103°-for the year.
Farming is the chief, industry and is pursued under a system of
tenancy. Good water power is utilized only for small grist and saw
mills. Great piles of sawdust mark'the site of mills which have cut
out most of the timber, and the forests have given way largely to
The township has two main roads of sand-clay construction, main­
tained in good condition, which lead to the county seat. The other
roads, however, are for the most part neglected; so also are the
bridges, except one of steel construction. There are no railroads
within the township. Rural free delivery of mail is available for all
the families, and a few homes have telephone connections.
The history of the township dates back to the colonial period when
the Cape Fear section was settled by Scotch Highlanders.1 The
Scotch strain and a preponderance of Scotch names have persisted
in this section down to the present time. There has been practically
no immigration of other nationalities and the population is uniformly
• native-born American, about evenly divided between the whites and
1 McLean, J. P.: Scotch Highlanders in America, p. 102. Helman-Taylor Co., Cleveland; John Mackay,
Glasgow, 1900.
Federal Reserve Bank of St. Louis



negroes. The county has a rural population density of 27.9 persons
to the square mile,1 which also probably approximates the population
density of the township. It is a considerably more thickly settled
area than the average rural section in the United States, which has a
density of 16.6 persons to the square mile,2 but is more sparsely
settled than the rural sections of the South Atlantic States for which
the average rural density is 33.8.2

Land tenure.

The families in the neighborhoods visited fall roughly into three
distinct social economic groups—landowners, white tenants, and *
negro tenants. Approximately three-fifths of the white families are
owners of the land on which they live; of the negro farmers, only one
in four is a landowner. Various systems of tenancy are found, the
“ half-share” basis being the most common. This is an arrangement
by which the tenant and the landlord each gets half the crop; if
the landlord supplies the stock, he and the tenant each furnish half
the fertilizer; where the tenant supplies stock, the landlord furnishes
all the fertilizer.
By far the majority of tenants are “ croppers,” rather than cash or
standing rent tenants; an occasional family, however, pays rent out­
right—usually in cotton $t the rate of one 450-pound bale of lint
cotton for 12 acres of land under cultivation.
Crops and acreage.

The average farmer confines his operations to the raising of cotton
and corn and a garden patch. Some also have a small acreage in
tobacco, peas, small grain, peanuts, or sorghum cane. Cotton is the
money crop and this section of the country, like other parts of the
South, is suffering from an overcultivation of cotfon at the expense
of food and feed crops.
The country visited has a soil well adapted to cotton raising, except
for a small area of sand hills. Cotton production per acre averaged
seven-tenths of a bale on the white farms visited and three-fifths on
negro farms.
Little produce is sold except cotton and cotton seed, and, rarely,
tobacco, corn, stock, butter, chickens, and eggs. One of the most
successful farmers of the township, however, makes it a rule to sup­
port his family on crops other than cotton, saving the profit on cot­
ton always for enlarging his farm business. He finds it better to
plant more corn, beans, etc., rather than cotton alone, which varies
more in price than any other crop.
1Thirteenth Census of the United States, 1910, Vol. I ll, Population, p. 298.
* Thirteenth Census of the United States, 1910, Vol. I, Population, p. 55.
Federal Reserve Bank of St. Louis



About half the white and oyer four-fifths of the negro farms of the
township are “ one-horse” farms, with approximately 25 acres in
cultivation—often 15 in cotton and 10 in com. With cotton pro­
duction averaging well under a bale an acre, the limited one-horse
crop is a poor dependence at best, even when operated by the farm
owner who gets the whole of the crop made; when operated by a tenan t
on half shares, the family money income may dwindle to four or five
bales of cotton, with a total cash value (at the time of the inquiry) of
from $200 to $300.
Cost of cotton production.

Cotton is an expensive crop to produce; due to lack of a croprotation system, a good yield is impossible without heavily fertilizing
the land. One ton to every 3 acres is the rule, which with fertilizer
at $28 and $30 a ton at the time of the inquiry represents a consider­
able investment. Moreover, it is a handmade and not a machinemade crop, and labor is an appreciable item; help hired for “ chop­
ping” and picking cotton amounted to something like $6 or $7 a
bale at the time of the inquiry. Ginning added another $2 a bale if
ginned in'town, $2.50 if at one of the neighborhood gins.
Credit systems.

The average farmer begins the season heavily in debt for his fertil­
izer which he buys “ on time,” payable in the fall of the year after the
crop is made. Where a tenant is making a crop, the landlord gives
his note for the fertilizer and the tenant settles with, him at the end
of the year; also, the average tenant family has to be “ carried” by
merchant or landlord for groceries and provisions used during the
spring and summer. By the time the crop is gathered at the end of
the season, its money value has been largely anticipated, and the
clear profit remaining after the debts incurred during the farm season
have been paid off leaves but a slim financial support for the family
during the coming 12 months. “ We feel rich after the crop is sold,”
one farm tenant expressed it; “ rich till we get to the people we owe.”
That the various systems of credit in the purchase of groceries and
small goods are working to the detriment of the community is the
opinion of many in the neighborhood. Some families, of course,
pride themselves on always paying cash; others pay cash through the
autumn and winter as long as the family income holds out and then
buy “ on time,” payable with 6 per cent interest in the autumn after
the crop is made. Chickens and eggs, and occasionally other pro­
duce, are traded at the country stores. The landlord usually keeps
a commissary where such supplies as meat, com meal, rice, sugar,
simp, coffee, snuff, and tobacco may be had and charged to the
tenant at the same rate of interest he would pay at the country
store. These accounts are long-time credits, payable in the fall of
Federal Reserve Bank of St. Louis



the year. Aside from the interest on the account, the time price is
almost invariably higher than the cash price. A farmer who had
bought “ on time” last year is trying to pay cash this year, for from
one-fourth to one-third is added to the price when he buys on time.
For instance, he had bought a sack of “ shipped stuff” on time for
$2.50; on the same day at the same store his father bought a sack for
$1.60 cash. Another farmer finds it cheaper to borrow money to carry
him through the summer, about $50 at 10 per cent, than to buy
“ on time,” paying 25 cents more on the dollar besides the 6 per cent
interest when the bill is paid in the autumn. Sometimes a crop lien,
or written contract with the crop as security, is required before the
merchant will “ run” a customer; often, however, the agreement is
by word of mouth if the merchant feels reasonably sure of getting his
pay. The negro farmer, more commonly than the white, buys on
credit and suffers particularly from the high credit prices; a crop
lien, too, is more likely to be required of him. One man explained
that since the legal rate of interest is 6 per cent, only 6 per cent ^
appears on the note, but, in addition, one pays about 10 cents on
the dollar more for supplies bought on time. A negro woman who
“ owes out” about $20, pays 10 per cent—6 per cent interest and 4
or 5 per cent “ what they call premery” (premium).
Another who had made 7 bales of cotton on half shares had no
idea how much it brought, for the landlord took it all, including the
seed, to square her debts. One negro family got supplies from the
landlord’s country store; they turned over all their cotton and seed
to him; he settled with them in February and gave them $50 as
their share of the crop (they had made 9J bales of cotton on half
--shares and the landlord had supplied them with flour, sugar, “ strip
meat,” and rice). “ When fall comes, there’s not much in it for
you,” said one tenant. The tenant family rarely keeps an account
of its expenditures, depending upon the records in the landlord’s
The installment plan, though in many ways filling a real need,
also adds to the financial burden of many families because of the
higher prices charged for installment purchases. Sewing machines
are often bought in this way, also stoves, crayon portraits, books,
and even medicines from the patent medicine man on his monthly
rounds. A $25 sewing machine, at $2.50 down and $2 per month,
costs the family $40 to $50. A mule is almost invariably bought on
the installment plan; few families can afford the expense of paying
outright the $250 to $300 cash price. Cooperative this
township, except in a few isolated cases, is practically unknown.
Federal Reserve Bank of St. Louis



Crop disposal.

Cotton is usually marketed at the county seat, 6 to 14 miles
away; tobacco is shipped to several points where it brings a better
price than on the local market. Often the landlord buys his tenant’s
crop, almost invariably in the case of negro tenants. He can afford
to hold his cotton for higher prices while the tenant must sell im­
mediately to pay his debts.
Farm labor.

Among the tenant farmers, after a man has finished working his
own crop, he, and sometimes his wife and children also, hire out for
a few days at farm labor, to supplement their scant income. Farm
labor, at the time of the inquiry, was poorly paid, 75 cents a day
for a grown man, 50 cents for a grown woman, and 25 to 50 cents
for children. Cotton picking is piecework, paid at the rate of 50
cents per 100 pounds picked, with 200 pounds per day as a good

W h i t e F a m i l i e s .—The children’s home environment varies widely
according to the social and economic status of* the family. The
typical home of the prosperous planter is a big, comfortable farm­
house, with a generous brick fireplace at each end—a traditional
southern home, with its large cool rooms, deep verandas, fine trees,
sturdy old scuppernong vines, and, in the distance, well-kept cotton
The tenant’s children are not so well provided for. The average
tenant family occupies an unpainted, clapboarded cottage of four
small rooms, ceiled inside but not plastered, often with no shade
around the house—a hot, sandy little plat of ground. One family
of tenants visited lived in a little rough shack in the midst of the
woods, with insufficient cleared space around the house to admit
any breeze. Flies, mosquitoes, and gnats were numerous though
the family kept a bucket of pitch burning on the porch. Another
tenant cottage—a rude shack of upright boards—is the home of
father, mother, and five small children; the mother called it “ shanty­
ing” and was anxious to move in the autumn. “ The crop is too
inconvenient, the water is bad (a dug well, open and unprotected, and
only 12 feet from the house), the crib’s too near, and there’s a pond
back there,” summed up her objections to the place.
The farm tenant frequently moves from farm to farm in the hope
of bettering his poverty-stricken condition, but usually not straying
far from the neighborhood where he was bom. The Unstable nature
of his tenancy and the lack of any permanent interest in his sur­
roundings discourage any attempt on his part to improve his cottage
or its grounds.
Federal Reserve Bank of St. Louis



The sawmill hand is even more of a will-o'-the-wisp* moving con­
stantly as the sawmill exhausts the surrounding timber. A mother
whose husband “ followed the sawmills" complained that “ it was
move every time the wind blows; if I was to say 36 times since I
was married, I wouldn’t miss it."
N e g r o F a m i l i e s .—Negro housing accommodations are almost
uniformly poor. The commonest type of negro home is the oldfashioned log cabin of one, two, or three rooms* daylight showing
between the logs. Such a house is hot and stuffy in summer with
the sun beating in, while in winter it is almost impossible to heat it,
even with the cracks chinked with mud and a roaring fire in the open
fireplace. A cabin like this leaks in stormy weather and leaves the
floor damp for a day or two afterwards. There is usually some
attempt at decoration, gay-colored chromos, crayon portraits, and
ornaments of various sorts within and flowers without on every
side—four-o’clocks, sunflowers, weeping Mary, and tiger lilies.
Rooms are incredibly small and stuffy, ydth low ceilings; often a
cabin originally one-roomed has been cut up by thin partitions into
two, three, or even four tiny rooms. Some cabins are windowless,
many have windows without glass panes, heavy solid wood shutters
taking their place. A number of negro homes were badly crowded
for space; one-fourth of the families visited had five or more persons
to a sleeping room. At one home, a small room, half the original
room, with no window and absolutely dark, contained two beds
where five persons slept. In another cabin an entire family of 12
slept in one large room with a curtain stretched from side to side.
P r i v i e s .;—Sanitary conveniences are deplorably lacking at many
white as well as negro homes. More than half the white families
visited had no toilet of any description on their premises. One
family of tenants explained that there had been a privy on the
place wThen they came, but it was so filthy that it had to be torn
down; another tenant, who upon moving into the present hopse had
obtained a promise from the landlord to build a privy* had already
lived there a year without, one. More than one family frankly
prefers to have no privy, disliking the idea of accumulated filth and
not appreciating the dangers of soil pollution. Many families, howeve r,recognize the importance of the privy in safeguarding the family
health. Where a privy is present it is commonly of the open-in-back
surface type, usually dependent upon the scavenging services of
chickens and hogs, which have easy access through the open back;
occasionally the privy is built on the side of a hill with the contents
draining into the “ branch." Some families, however, have the privy
cleaned and the contents buried with reasonable frequency, and,
some attempt disinfection by the use of lime, dirt, sulphur, or wood
Federal Reserve Bank of St. Louis



Four-fifths of the negro families visited were without a privy;
often where there was one it was not in use, so little was its impor­
tance understood as a sanitary precaution against disease. “ Yes’m,**
said a negro woman, “ there’s one there, but nobody uses it but
company.” One family “ never fools with one; if you use it yoir
have the bother of keeping it clean.” A negro woman with higher
standards, however, induced her husband to build one for her, though
she was the only member of the family who desired it or ever used it.
W a t e r S u p p l y .— Although only one of the homes visited had a
pump and sink inside the kitchen, white families were as a rule pro­
vided with a drilled well and iron pump within'a few feet of the
kitchen door. This type of well is usually satisfactory, the iron pipe
protecting the water from contamination; occasionally a drilled well
gives bad water because it has not been drilled to a sufficient depth.
Twenty-two of the 129 negro families and an occasional white
family were dependent upon the dug well—not only open and un­
protected from dust and dirt but also exposed to contamination
from drainage, a particular risk in a neighborhood so lacking in sani­
tary conveniences. One tenant family carried water from the
drilled schoolhouse well; they have an open well in the yard, but the
water is not good. One negro woman had entire confidence in her
own method of purification. “ I put me a fish in the well and he
cleanses the water,” she said.
The wState board of health, in its pamphlet on “ Plans for Public.
Schoolhouses,” comments upon the dangers of the open-topped
Open-topped wells are always dangerous and should never be used. During the
course of a single year a tremendous amount of dirt, leaves, bugs, and other insanitary
material gets in open-topped wells. Sometimes toads, lizards, snakes, and small
domestic animals find their way into such wells. A good iron pump is infinitely
safer than chains or ropes and buckets. In the case of open-topped wells the buck­
ets, chains, and water in the well are very frequently polluted by dirty hands.1

Only an occasional family uses spring water, for springs are un­
common in this section of the country. A negro family carried
water' from a spring one-eighth of a mile away; it is not only far
from the house but evidently unfit for use, being full of decaying
matter and in no way protected from surface contamination. An­
other spring gets so low that it had to be walled in with boards to
make the water rise high enough to be dipped with a pail. . Rarely
one finds the old-fashioned well sweep, picturesque but insanitary,
with its “ old oaken bucket.”
F l i e s a n d M o s q u i t o e s .— Flies and mosquitoes in this neighbor­
hood constitute a real pest during the summer months. Flies are
numerous because of-lack of toilets, open-in-back, exposed privies, 1 Plans for Public Schoolhouses, p. 33, issued from the office of the State superintendent o i public
instruction, Raleigh, N. C.
Federal Reserve Bank of St. Louis



accumulations of manure, insanitary disposal of garbage and other
refuse, and also because, in many cases, the stable and hogpen are
located too near the house. Scattered ponds and some swamp lands
are responsible for the prevalence of mosquitoes, which during the
summer months make life almost unendurable after dark. Late in
the afternoon a road through the woods can scarcely be traveled
without a great branch as a weapon to beat off the mosquitoes.
The average family, white or negro, is without screens of any
description. Only 19 of the white homes out of 127 visited, and no
negro homes were adequately screened, i. e., with screens at both
doors and windows. Several had screened the doors or, the doors
and kitchen windows. Fly paper and fly traps are used to some
extent. Many families “ smoke out” mosquitoes, using a bucket of
smoking coals, pitch, or rags on the porch or doorstep.
D is p o s a l o f W a s t e .—Garbage is fed to the hogs and chickens;
other refuse is disposed of variously—burned by the more careful
families, by others hauled off to the woods, thrown in the ditch,
hauled to the swamp, swept out -to the edge of the yard, thrown
down an old well, hauled off to fill in low places, thrown in the
thicket, burned around the iron pots used for boiling clothes,' or
thrown into a mill pond.
Manure is allowed to accumulate in the stables and constitutes a
prolific breeding place for flies. “ Most any day you can see the flies
just a-weaving in that manure,” said one mother; at this home every
rain washes down into the manure pile, keeping it wet much of the
time. It is usually removed only twice a year—spring and autumn—
to be used as fertilizer for corn and potatoes. Aside from some
half dozen farmers, who see to it that the manure pile is kept covered
with straw, there is no effort at guarding against flies from this
source. The State board of health in a leaflet o n “ Flies,” for distri­
bution in rural communities, advises having the manure hauled out
and away from the stable regularly twice a week from April 15 to
November 15, and once a week from November 15 to December 15,
and from March 15 to April 15.

The care of the mother during her pregnancy and confinement
should be a matter of vital concern to any community. A recent
bulletin of the Children’s Bureau shows that in 1913 childbirth caused
more deaths among women 15 to 44 years old than any disease except.
tuberculosis.1 This bulletin further points out the close relation be­
tween the deaths of infants occurring in the first days and weeks of
i Meigs, Dr. Grace L.r Maternal Mortality from all Conditions Connected w ith Childbirth in the United
States and Certain Other Countries, pp. 7 and 9. U. S. Children’s Bureau Publication No. 19, Miscellaneous
Series No. 6 , Washington, 1917.
Federal Reserve Bank of St. Louis



life and the proper care of the mother before ai\d at the birth of her
baby; also the fact that each death at childbirth is a serious loss to the
country, since the women who die from this cause are lost at the time
of their greatest usefulness to the State and to their families. More­
over, the loss to the community occasioned by a failure to safeguard
women at this time can be by no means adequately measured by the
deaths occurring at childbirth. Many women endure a lifetime of ill
health which they date from a particular confinement when for va- rious reasons proper obstetrical and nursing care were lacking.
During the inquiry 79 white and 86 negro mothers—who-had given
birth to a child, live or stillborn, within five years previous to the
agent’s visit—were interviewed with especial reference to maternity
care at their last confinement.
The early marriage age of the average rural woman of this section
gives her a long childbearing period. Two-thirds of the white
mothers visited had married at 22 years of age or younger, nearly
half at 20 or younger; of the negro women, about three-fifths had
married at 20 or younger—-more than one-third at 18 or younger.
Small families are uncommon in this section of the country, and it is
" the exceptional mother who has not borne a number of children.
Approximately three-fourths (74 per cent) of the white mothers,
married 10 years or more, and almost nine-tenths (89 per cent)
of the negro mothers, had had six or more pregnancies.
The rural woman of this section has not yet realized that she is
entitled to skilled attention, in her confinement, and faces the perils
of childbirth with undue serenity. Until the mother herself demands
as her due (with her husband’s recognition of the necessity for the
expense) skilled medical and .nursing care during pregnancy and
confinement, there can be little hope of improved standards of
maternity care for rural communities.
Lack of medical care was frequently mentioned as a serious
drawback to country life. One young father wished “ the Govern­
ment would do something about it” ; he thinks there should be at
least one doctor in every township. That the Government should
send medical experts through the country especially for women and
children was the opinion of another who wanted to know why his
wife has never been well since their second baby was born.
Although 27 physicians are resident in the county,1 this is an
inadequate medical service for a population of 33,719,2 since it
means an average of 1,249 persons to each physician, which is
nearly twice the average—691 3—for the United States. Moreover,
since 19 of the 27 physicians are concentrated at the county seat,
1 American

Medical Directory, 1916.
* Estimate of U. S. Bureau of the Census for 1916.
* Bulletin of the American Medical Association, Jan. 15, 1917, p.
Federal Reserve Bank of St. Louis

114 .



and the other 8 are scattered in small villages and through the
rural sections, there ’is a decided lack of available medical service
in various parts of the county. In the township covered by the
survey no physician is resident, and the families are from 3 to 14
miles'distant from the'nearest doctor; not an excessive distance
perhaps, but because of scant telephone, connection and bad roads
during part of the year the doctor is often inaccessible when sorely
Facilities for medical, hospital, and nursing care.

The distance of the family from the physician is in many cases so
great that medical assistance is called in only if the patient’s condition
is critical. Only 5 of the 127 white families visited and 15 of the 129
negro families were within 5 miles of a doctor; more than one-fourth
were 10 miles or more from their nearest physician. Distance is not
the only obstacle in obtaining a physician. A swift river, which
must be crossed in a small bateau and which at times is impassable,
forms a natural barrier, entirely cutting off the people of one com­
munity- for part of the year from their nearest physician.
A strong county medical society has been in existence for some
years and has been active in its support of public-health measures.'
Hospital facilities in the county are exceptional; there are two good
general hospitals located at the county seat, one with 70 and the
other with 25 beds. Each hospital maintains a training school
for nurses.
A woman’s club at the county seat is maintaining a public-health
nurse, whose work at the county seat and in the surrounding mill
villages has been so productive of results that a negro nurse for the
negro population has recently been employed by that race. As yet,
however, both nurses have confined themselves largely to the area
adjacent to the county seat and little public-health nursing in rural
neighborhoods has been attempted. The township of the survey
is entirely beyond the territory covered by either nurse.
Maternal deaths.

The county had in 1916 an alarmingly high maternal mortality
from causes connected with childbirth; 14 deaths (4 white and 10
negro) occurred during that year,1 a rate of 41.5 per 100,000 popula­
tion.2 It is impossible to determine whether this rate is sporadic
or usual, since mortality statistics for the State and its counties are
not available earlier than 1916, when the State was admitted to the
Census’s area of death registration.
Moreover, in considering a small area and a small number of
deaths, the rate is often misleading. However, with due allowance
for error, mortality from causes connected with childbirth is exces1Information supplied by the bureau of vital statistics, North Carolina State Board of Health.
8 Based on an estimate of the U. S. Bureau of the Census in 1916 of 33,719 for the county.
Federal Reserve Bank of St. Louis



sively high. The rate in this county (41.5) is markedly higher
than in the mountain county (21.9),1 or in the State as a whole
(24.7),2 and is nearly three times as high as the 1915 rate (15.2)
for the entire death registration area of the United States.3
Analysis of the county maternal mortality shows that though
the rate for white women (17.3) is slightly higher than the average
for the registration area of the United States (15.2),8 the high total
rate for the county is due to the abnormally high rate (93.9) among
negro women. This higher rate of maternal mortality among negro
women is in accord with the rates for the total area of death regis­
tration for which, in 1915, the death rate from causes pertaining to
childbirth was 14.6 for white women as contrasted with 25.9 for
negro women.3 Puerperal septicaemia (childbed fever), a disease
recognized years ago as largely preventable, caused the death of
two of the negro women.
It is only recently in this country that public attention has been
directed to the high mortality from childbirth and to a consideration
of its underlying causes. A bulletin of the Children’s Bureau on
Maternal Mortality finds that the fundamental factors responsible
for the lives of women lost in childbirth in this country are “ first,
general ignorance of the dangers connected with childbirth and the
need of skilled c ^ e and proper hygiene in order to prevent them;
second, * * ^difficulties related to the provision of proper ob­
stetrical care ” 4—a conclusion which is apparently true of this com­
munity as well as of the country as a whole.
Prenatal care.

The necessity for supervision and care of the mother before the
birth of her child is becoming recognized in cities and towns; in this
community, however, prenatal care is negligible.
A fair standard for adequate medical prenatal care would probably
embrace the following points:5
1. A general physical examination, including an examination of
the heart, lungs, and abdomen.
2. Measurement ■of the pelvis in a first 'pregnancy to determine
whether there is any deformity which is likely to interfere with birth.
i See p. 68.
»Information supplied by bureau of vital statistics, North Carolina State Board of Health,
a Mortality Statistics, 1915, p. 59. U. S. Bureau of the Census, Washington, 1917. Sum of the rates
there given for “ puerperal fever” and “ other puerperal affections.”
* Meigs, Dr. Grace L.: Maternal Mortality from all Conditions Connected with Childbirth in the United
States and Certain Other Countries, p. 24. U. S. Children's Bureau Publication No. 19, Miscellaneou
Series No. 6. Washington, 1917.
* Outlined after consultation with Dr. J. Whitridge Williams, professor of obstetrics, Johns Hopkins
University. See Maternal Mortality from all Conditions Connected with Childbirth in the United States
and Certain Other Countries, pp. 12, 13. U. S. Children’s Bureau Publication No. 19, Miscellaneous
Series No. 6. Washington, 1917.
Federal Reserve Bank of St. Louis



3. Continued supervision by the physician, at least through the
last five months of pregnancy.
; Monthly examination of the urine, at least during the last five
According to this standard, none of the mothers visited can be said
to have had adequate prenatal care. Pelvic examinations were un­
known, urinalyses rare, and in the majority of cases the physician
knew nothing of the case until called to deliver the woman. Of the
79 white mothers for whom this information was obtained, 21, or less
than one-third, saw a physician before confinement, and only 12 had
urinalysis. Of the 86 negro mothers, 2 saw a physician before con­
finement and 1 reported urinalysis. When a negro midwife is to have
the case, she occasionally stops in to see how the mother is progress­
ing. Eight white mothers and 27 negro mothers had seen a midwife
in this way, which can not, however, be considered prenatal care.1
Scant provision is made for the approach of childbirth. Com­
monly a physician or a midwife is notified through the husband,
mother, or other messenger of the expected date of confinement.
Many, however, fail even to make this provision, and^ finding the
doctor out on a call, much valuable time is lost hunting a substitute*
The more prosperous families engage both a physician and a mid­
wife—the midwife to serve as nurse and to come several days before
confinement is expected, to be present in case of Hergency.
Attendant at birth.

Two-thirds of the 79 white mothers were attended in confinement
by a physician; that is, these mothers had engaged a physician,
though in 10 cases he was late and arrived after the baby was born.
The negro mothers were almost invariably dependent upon the mid­
wife ; only .5 of the 86 negro mothers had a physician, and in 1 of these
cases the doctor was late. One had neither doctor nor midwife in
attendance. Among the more ignorant of the negroes there was even
some prejudice against doctors. “ No’m,” said one, “ I had me a
good woman every time.”
Besides the difficulty in obtaining a physician because of distance,
bad roads, and scarcity of telephones, cost is an important factor in
determining the attendant engaged for confinement, many families
considering the expense of a physician prohibitive. A midwife
charges from $2 to $3, and, in addition to obstetrical services, renders
other assistance, such as washing the clothing and bedding used, and
cooking, cleaning, and helping in the care of the home and children.
Many experiences were reported by the mothers illustrative of the
hazards of childbirth in a community where medical care is not
always available.
i See p. 29.
Federal Reserve Bank of St. Louis



A mother of three children, living on a comfortable farm of 150
acres; is 10 miles from the doctor. He has been engaged for every
confinement but has always arrived too late. The first child was born
unexpectedly and fell, striking its head on a chair; it had spasms
before morning and died in three days.
Another mother became ill in the evening. A^pessenger crossed
the river in the bateau for the doctor and found he had gone on
another case. The doctor did not reach his patient until the next
morning and delivery was delayed until he came, the mother suffering
greatly. The baby was stillborn—a shoulder presentation.
In another instance, a child who, according to the mother’s story,
was alive when labor began was lost because the midwife was unable
to manage the case and the doctor, who was out when called, could
not be reached in time. When he arrived an hour after the delivery
he found a stillborn child.
A mother, frightened at losing the previous baby when only 3 days
old, sent for a doctor to attend her eighth confinement. He failed
to arrive in time and the baby, prematurely born, died in three hours.
A mother of eight children, attended by a midwife at the first three
confinements, decided to have a doctor thereafter. A doctor was
engaged for each of the next three confinements but failed to reach her
in time. When the last two children were born she had only neighbors
present, though able and willing to pay for professional service.
A negro woman told of the long hard labor she had had, with the
midwife unable to relieve the situation; the “ white folks” for whom
she and her husband worked sent for a doctor, but before he could get
there from the county seat, a distance of 7 miles, the baby was born
M i d w i v e s .—Although according to tradition there were two white
midwives in this section a number of years ago, to-day this service
is drawn entirely from the negro race. Eight midwives were inter­
viewed 7 women and 1 man—ranging in age from approximately 45
to 70 years. The practice of midwifery is often handed down from
mother to daughter, as the profession of medicine is from father to
son. Caste lines are sharply drawn among the midwives, two of the
number doing the “ quality” work.
Training for midwifery had in every case been limited to nursing
for or assisting local physicians. Those interviewed had practiced
from 6 to 26 years, all but two for over 15 years; only three of the
eight interviewed were registered with the State board of health.1
All are illiterate; one only can read and none can both read and write.
In spite of illiteracy, however, some are women of good judgment and
long experience, and with a certain amount of training gained
through occasional nursing for physicians.
1 See p. 104 for summary of law requiring registration of midwives.
Federal Reserve Bank of St. Louis


r u r a l c h il d r e n .

Few of the midwives gave any prenatal care beyond dropping in for
an occasional friendly call. None attempted a physical examination
or urinalysis. Four reported that they advised the mother in case of
any complications to apply to the doctor, though on general principles
home remedies are recommended—salts, oil, “ black draught,” cream
of tartar, and burdock for sluggish bowels; and peach-tree leaves,
boneset, life everlasting, or mullein for sluggish kidneys. One mid­
wife advises tea of “ cidyus elder” to reduce the swelling of hands and
feet. Some claim that single tansy is especially efficacious for
threatened miscarriage.
Although the more prosperous families employ the midwife as a
nurse, often having her in the house several days before confinement,
in the majority of her cases she is the only attendant and is not called
until the woman is in labor. Her preparation usually consists of
washing her hands and putting on a clean apron. Two midwives
claimed that they used bichloride tablets, though neither had any
in the house at the time of the interview; one reported the use of
creosol and carbolic acid, -and one a kind of “ lady powders,” the name ,
of which she could not remember. Three reported that they clipped
and cleaned their nails. Four own bags or satchels also used for
various purposes by other members of the household. None carry
their own scissors and only one attempts sterilization of those found
at the patient’s home. Among the items reported in their equip­
ment were ball thread, tansy, ergot, and half a dozen triturated
tablets given one midwife by a doctor. For the most part they depend
upon herbs and supplies found at the home of the patient.
The preparation of the mother for her confinement depends largely
upon the circumstances of the family; one midwife insists upon a
clean bed before and after confinement, though this was usually
considered an unnecessary waste of linen. The proverbial old quilt
is used by all but one, and one saves washing for her patient by
using old rags with which she says she “ can keep the bed clean for
nine days.”
The care of the mother consisted for the most part in copious
drafts of tea from time to time, made of pepper, catnip, sweet fennel,
mint, wormwood, or tansy. One midwife insists that she gives no
medicines, that “ if the woman needg medicine she needs a doctor.”
All admit two or more examinations during labor. One sees to it
that all windows are kept closed, and another thinks it “ against a
woman to have too much air.”
Prophylaxis of the new-born baby’s eyes consists of washing with
boracic acid by two, catnip tea by three, catnip tea and camphor by
one, and plain water by two. No midwife had as part of her equip­
ment the nitrate of silver furnished now on request by the State
board of health. For sore eyes one washes them with breast milkr
Federal Reserve Bank of St. Louis



while another advises against its use, for in her opinion it poisons
babies’ eyes; two bind bruised house leak on sore eyes at night.
The cord is tied with twine or with various forms of cotton—ball,
hank, or skein thread; one uses ravelings from a flour sack, and one
The later care of a baby is usually left to the family, though five
midwives indorse catnip tea, two soothing sirup, two whisky, four
paregoric, and all give oil in some form. One especially recommends
giving the baby a piece of fat meat to suck to clear the bowels. For
sore mouth, sage tea, or honey and borax followed by a dose of oil,
are advised.
Postnatal care.

The country doctor, serving a large area, finds it impossible to give
his patients the same after care that is possible with the city physician.
Moreover, the mothers commonly have not recognized the need ior
after care. In about half the cases attended by physicians, however,
a visit had been made after the confinement, usually once only,
though in eight cases the physician had made two or more postnatal
visits. In 29 of the 56 cases (51 white and 5 negro) attended by a
physician, obstetrical service was considered complete when the
woman was delivered.
The midwife, if within walking distance, expects to see her patient
two or three times, or until the baby’s navel is healed. If, however
she lives at a distance, as often is the case, the care of the mother and
child is left entirely in the hands of her family or neighbors. Of the
108 mothers attended by midwives (28 white and 80 negro), in 77
cases (almost three-fourths), the midwife either remained in the
home a few days or returned at least once after confinement.
Nursing care in confinement.

Nursing care during confinement is almost invariably untrained.
None of the mothers visited had had the services of a trained nurse;
only two employed a “ practical” nurse. In a number of families—
18 white and 15 negro—a midwife had been engaged to remain in the
home after confinement to render nursing services. In a majority
of cases, however, the mother was dependent upon untrained nursing,
either by a member of the family, a relative who had come for that
purpose, or by the neighbors, who are always ready to lend a helping
hand. The neighbors were “ mighty good,” said one mother, “ they
never missed a day but five or six of them came in, and they were
always ready to help cook a meal or do anything.” One negro woman
had as her only dependence her grandfather and her son of 14;
another had only her husband at night, no one in the day time.
Federal Reserve Bank of St. Louis



Rest before and after confinement.1

To some extent the amount of rest a mother can have before and
after confinement is determined by the time of the year or by the
stage of the cotton crop upon which depends the livelihood of the famiily. If confinement occurs during the plowing and planting time,
or while all hands are chopping or picking cotton, it is impossible for
a woman to have the amount of rest she would be able to secure at a
more opportune season.
Housework is commonly continued up to the date of confinement.
Although, generally speaking, ordinary household duties may be
pursued with advantage by many pregnant women, the lack of
conveniences in rural districts makes the care of the household a real
burden. The mother’s share of “ chores” (such as milking, churning,
and taking care of the chickens and garden) and of field work is
usually lightened, at least, and often is taken over entirely by other
members of the family. A number of mothers—18 white and 49
negro women—in addition to their household duties continued with
the usual chores and field work until they were confined, making no
change in their toilsome daily program because of the approaching
One mother had done a washing the day before her second baby
was born; she is a regular field hand and chopped cotton all day,
5 days a week, up to the day before confinement. Another, a mother
of five children, continued her housework, field work, and chores up
to the date of confinement, and the morning of the day the baby was
born picked 45 pounds of cotton and cooked a big dinner for her
family of seven. A negro woman worked until that night, hoed
potatoes, and had all her crop “ right clean.” Another, who had
always kept on with her work up to the time of confinement, had
had seven pregnancies, of which one resulted in stillbirth and five
miscarriages (four to six months’ term). “ I went because I had it
to do, but I wasn’t able,” said a negro mother of six children who
continued field work until three days before confinement. Her baby
was born in September and her daily work that autumn, in “ cotton­
picking time,” included getting up before dawn to cook breakfast
and dinner together (dinners are taken along to the field), and then a
long day in the cotton field, picking cotton from “ sun to sun.”
I t was uncommon to find women doing heavy farm work, and it is
probably true that outside work in moderation is good for many
pregnant women. Yet continued daily field work, in the glare and
intense heat of this lowland country, in addition to housework, may
not only add to the discomfort of pregnancy and the danger of con­
finement, but lessen the mother’s ability to produce sound, vigorous
i See following section on “Mother’s Usual Work.”
Federal Reserve Bank of St. Louis



Rest after confinement is equally uncertain, also depending some­
what upon the season of the year. Many of the white mothers reported
nine days in bed and 27 were in bed for a longer period. Negro
mothers were oftep up in three to five days; almost three-fifths were
out of bed within a week. Housework is resumed soon after the
mother is out of bed, chores more gradually. Among the white
mothers field work is usually discontinued for the rest of the season.
Negro women commonly return to the field in a month’s time, leaving
the baby at home with the older children, or occasionally taking the
baby along to be deposited in a box of rags or on a pile of fertilizer
bags at the edge of the field.
Mother’s usual work.

Rural women of this section as a rule are burdened with a multi­
tude of duties in the house and on the farm and only rarely have
assistants other than the girls of the family. In addition to the
cooking, cleaning, scrubbing, washing, ironing, sewing, milking,
churning, care of chickens and garden, and canning and preserving
the average woman also works side by side with her husband in the
field helping to plant, cultivate, and harvest the crop.
Housework must usually be done without the services of hired
help; only three of the women visited kept a servant regularly. In
fact, indoor help is difficult to secure during the “ chopping” season,
while in “ cotton picking time” it is practically impossible, km.ce the
negro women available for domestic service not only earn more money
in the cotton field but also prefer field work with its greater oppor­
tunity for sociability.
An absence of household conveniences makes housework doubly
hard. With the exception of sewing machines there are practically
no conveniences for facilitating women’s work. The majority of
the homes have few of the modern improvements for cooking, which
is done usually on a wood stove, with fuel provided from meal to
Washing is commonly done in the open, the wash place consisting
of a bench for the tubs and a big iron pot with a fire under it for
boiling the clothes. Only six of the mothers visited used washing
Old-fashioned implements are used for churning and butter making.
Sweeping often is done with a homemade broom of short bunches
of sedge grass for the house, or twigs for the yard, bound together
with a hickory withe.
Carrying water is an arduous task. Only one of the -homes visited
had a pump and sink inside the kitchen, though white families are
usually provided with a pump on the porch or within a few feet of
the kitchen door. At a number of the homes, however, the water
Federal Reserve Bank of St. Louis



supply was at some distance from the house, which necessitated a
considerable waste of the mother’s time and strength.
One-fifth of the white families and over one-third of the negro
families carried water over 50 feet;.an occasional negro family car­
ried water as far as a quarter of a mile. A number of tenants had
no water on their immediate premises and had to carry it from the
landlord’s well. A mother who carried water something like 200
yards thought it was partly responsible for so weakening her that
she lost her twin babies.
Field work, almost always on the “ home farm,” is general for both
white and negro women. Of the 117 white married mothers, 90 had
worked in the field before marriage (72 from early childhood) and
82 after marriage, though a number explained that since marriage
their field work has been irregular, only occasional help in the busy
season. Of the 89 negro mothers, 87 had done field work before
marriage (74 from early childhood) and 85 after marriage. A
grandmother, speaking for her married daughter insisted that “ she
picked cotton when she was 5 years old, she’d fill her little sack and
empty it into mine.”
Other forms of gainful work are uncommon among the women of
this section. Before marriage some few had taught school or worked
in the cotton mills; after marriage some had helped in their hus­
bands’ stores; a few negro women had hired out for domestic service.

Infant mortality.

By “ infant mortality” is meant the deaths of infants under 1
year of age. An “ infant mortality rate” as computed in the infant
mortality studies of the Children’s Bureau is the number of infants
out of each 1,000 born alive within a given period who die during
their first year of life. In this rural township, of the 520 white
children live-bom over one year before the agent’s visit, 25 (1 child
in 21) had died before reaching their first birthday, an infant mor­
tality rate of 48.1; of the 528 live-born negro children, 34 (1 in 16)
had died at less than one year, an infant mortality rate of 64.4.1 The
infant mortality rates for children of both white and negro mothers
in this rural community are considerably lower, i. e., more favorable,
than any found in the cities and towns which have been studied by
the Children’s Bureau; also much lower than in the mountain county
which has a rate of 80.4.
t Computed on the basis of all children bom alive at least one year previous to the agent’s visit, it is
obvious that children only a few months old at the time of the agent’s visit could not be included, since
some of these may have died afterwards before they were a year old.
Federal Reserve Bank of St. Louis



A survey of a rural county of Kansas1 shows a rate of 55 per 1,000,
computed upon the same basis as the North Carolina rate. A com­
parison of the findings of these rural surveys with the findings of
infant mortality studies in cities and towns, tends to confirm the
impression that rural conditions are distinctly more favorable th'vn
urban conditions to infant life.
A g e a t D e a t h a n d M o t h e r ’s S t a t e m e n t o f C a u s e o f D e a t h .—

The information obtained from the mothers as to the cause of the
deaths of their babies was meager and unsatisfactory. Of the 25
white infant deaths, in 9 cases the mother did not know what had
been the cause; of the 16 remaining, 7 had died of gastro-intestinal
disorders, according to the mother, 4 of respiratory diseases, 2 were
defective at birth, 1 had had an abscess of the liver, 1 measles, and
1 kidney trouble. Of the 34 negro infant deaths, in 13 cases the
mother had not known the cause of death; of the 21 remaining, 6
had died of gastro-intestinal diseases, 4 of respiratory diseases, and
5 because of prematurity or congenital defect; the mother’s ill health
and mother’s overwork were said to have caused the loss of 2, 2
were smothered in bed, 1 had fallen and broken its arm and leg,
and 1 died during birth.
In this community, as in the cities and towns previously studied by
the Children’s Bureau, the greatest infant Toss occurred within the
early months of life. Of the 25 white infant deaths 16 had occurred
within the first three months (9 within the first two weeks), 3 were
between 3 and 6 months old, and 6 were over 6 months old at the
time of death. The proportion of white infant deaths in these age
groups approximates the average for the death registration area of
the United States. Among the negroes there is a somewhat higher
proportion of deaths in early infancy, i. e., within the first three
months (24 out of 34, or 71 per cent), than the average for the death
registration area (63 per cent).2 Of the 34 negro infant deaths 24 oc­
curred within the first three months (17 during the first two weeks),
3 were between 3 and 6 months old, and 7 from 6 months to 1 year.
S t i l l b i r t h s a n d M i s c a r r i a g e s .— Among the white mothers, 3.9
per cent of their pregnancies had resulted in stillborn children and
3.6 per cent in miscarriage. Negro mothers had lost 3.5 per cent
of their children through stillbirths and 5.4 per cent by miscarriage.
The percentage of stillborn children, both white and negro, in this
community is considerably larger than in the rural county of Kansas
studied by the Children’s Bureau where only 1.8 per cent of the
issues were stillbirths.3 The white mothers of this community had
1Moore, Elizabeth: Maternity and Infant Care in a Rural County in Kansas, p. 41. TJ. S. Children’s
Bureau Publication No. 26, Rural Child Welfare Series No. 1. Washington. 1917.
2Mortality Statistics* 1915, p. 645. IT. S. Bureau of the Census, Washington, 1917.
3Moore, Elizabeth: Maternity and Infant Care in a Rural County in Kansas, p. 30. U. S. Children’s
Bureau Publication No. 26, Rural Child-Welfare Series No. 1. Washington, 1917.
Federal Reserve Bank of St. Louis



lost a slightly smaller proportion of children by miscarriages (3.6 per
cent) than the mothers of the Kansas county (5 per cent). The
number of negro miscarriages (5.4 per cent), however, was approxi­
mately the same as in Kansas.
A comparison with the rates of stillbirths and miscarriages found in
the Children’s Bureau inquiries in cities and towns 1 shows a slightly
higher stillbirth rate for both white and negro mothers of this North
Carolina township than was common in the cities and towns, and a
slightly lower rate of miscarriages among the white mothers, but a
somewhat higher rate among negro mothers.
Infant feeding.2

Methods of infant feeding in this community are largely a matter
of tradition, the mothers depending upon the advice of neighbors and
friends, since in the majority of cases it is impossible for the distant
physician to supervise the feeding of his rural patients.
Breast feeding is universal. The rural mother as a rule is well able
to nurse her child. Of the 78 white babies for whom feeding records
were secured all were breast fed through the first 5 months; with the
exception of 2 babies weaned, 1 at 6 months and 1 at 9 months, all
were nursed during the entire first year. Of the 86 negro babies, all
were breast fed during their first 2 months, all but 8 during their
entire first year. Nursing is usually continued for 18 months,, often
until the child is 20 or 24 months old, or until another pregnancy
interrupts lactation. Of the 35 white babies that had been weaned
at the time the mother was visited, only 3 were 12 months or less at
the time of weaning, 16 were between 13 and 18 months, 12 between 19
and 24 months, and 4 were 25 months or over. Forty negro babies
had been weaned, 12 at 12 months or less; 16 at 13 to 18 months,
inclusive; and 11 at 19 to 24 months (in 1 case the age of weaning
was not known).
It was customary, however, among the majority of mothers, in
addition to the breast milk, to feed their babies indiscriminately, in
accordance with a popular supposition that a taste of everything the
mother eats will protect him from colic. Seven white babies and 19
negro babies were given food in addition to breast milk from their
1Per cent of all issues resulting in stillbirth, or miscarriage in cities and towns so far studied by the
Children’s Bureau have been as follows:
City or town.
Johnstown, P a .........................
Manchester, N. H ........... .
Waterbury,' Conn.....................
New Bedford, Mass.................

births. ^ riages.


City or town.

Akron, Ohio.............................



* Feeding records covering the first year of the baby’s life were obtained for the mother’s last child under
5 years, a total of 78 records for whitebabies and 86 for negro babies.
Federal Reserve Bank of St. Louis



first month of life. By the beginning of the fourth month 23 white
and 45 negro babies were being fed. One mother fed her baby at 2
months because he was “ hearty and wanted to eat.” Another gave
her babies a taste of almost everything she ate, especially in the
spring, to prevent their having colic with every new vegetable. A
negro mother, who reported that her baby hadiiad nothing but the
breast for the first seven months, upon reconsidering “ reckoned he
had had watermelon and the other children might: have given him
peaches and apples.” Some few were fed “ chewed rations” until
the teeth arrived, i. e., the father or mother chewed the baby’s food
before giving it to him. “ Sugar tits ” of moistened bread, sugar, and a
little butter, lard, or fat meat, tied in an old thin cloth, are common
pacifiers. Fat meat is sometimes given as a purgative and, among
the negroes, is a common substitute for oil. I t is customary to give
catnip tea until the mother’s milk has come, often continuing the tea
during the first few weeks.

1 T O 15 Y E A R S O F A G E .

General health.

The so-called “ children’s diseases”—measles, mumps, whooping
cough, and chicken pox—have been widespread in this locality. Of
other diseases, the most commonly reported were dysentery and
stomach disorders of various sorts, pneumonia, malaria, “ sore eyes,”
hookworm, tonsilitis, “ worms,” smallpox, and typhoid fever. Some
half a dozen children among those visited have been considered by
their families to be mentally defective.
It was shown a few years ago that the county was heavily infected
with hookworm disease. During a campaign against hookworm,
carried on in the county in 1911 by the Rockefeller Sanitary Com­
mission (now the International Health Board of the Rockefeller
Foundation) in cooperation with the State board of health, 3,301 per­
sons were examined, of whom 1,839, or 55.7 per cent, were pronounced
to be infected with hookworm. The campaign was apparently con­
fined to the examination and treatment of individuals and did not
include the erection of sanitary privies throughout the county which
has been the important feature of the more recent hookworm cam­
paigns in other counties of the State,
The International Health Board, in its report for 1915, describes
the effect upon the population of a prevalence of hookworm disease:
In no country is the death rate ascribed directly to hookworm disease particularly
high; this disease is never spectacular, like yellow fever or plague or pernicious malaria.
It is the greater menace because it works subtly. Acute diseases sometimes tend to
strengthen the race by killing off the weak; but hookworm disease working so insid­
iously as frequently to escape the attention even of its victim s tends to weaken the
race by sapping its vitality. Persons harboring this infection are more susceptible to
Federal Reserve Bank of St. Louis



such diseases as malaria, typhoid fever, pneumonia, and tuberculosis, which prey
upon lowered vitality. But even more important than this indirect Contribution to
the death roll are the cumulative results—physical, intellectual, economic, and
moral—which are handed down from generation to generation through long periods
of tim e.1

Within recent years the county has been covered by a typhoid
campaign also, during which free vaccination for typhoid was avail­
able for all persons of the county, through the cooperation of the
State board of health with local authorities. In the course of the
Children’s Bureau survey an interesting story was told of the dis­
astrous results that had followed the failure of one family to avail
themselves of vaccination. The mother wanted them all to drive
over to the schoolhouse and have it done, but the father thought it
was not worth while ; he had heard it made one sick and did not wish
to risk losing time from work. In the midst of “ cotton-picking
time” the 15-year-old boy developed a bad case of typhoid; for
weeks the mother and oldest brother had to give their entire atten­
tion to nursin’g the sick boy. This case of typhoid cost the family
$50 for help hired to replace these three cotton pickers of the family
and, in addition, a doctor’s bill of $50.
Mortality of children from 1 to 15 years of age.

In the 127 white families visited there had been 17 deaths of chil­
dren 1 to 5 years of age. According to the mothers’ statements, 6
had occurred from intestinal disorders ; 2 from meningitis ; 2 from
chills and fever; 1 each from pneumonia, measles, Bright’s disease,
“ spinal disease,” “ stomachitis,” and membranous croup; and in 1
case the cause was unknown. Between the ages of 6 and 15 only
1 death had occurred, and in this case the cause was not known.
Among the 129 negro families 25 children had died between the
ages of 1 and 5 years—7 of intestinal disorders; 4 of respiratory
diseases; 4 had been burned to death; 1 drowned; 1 strangled; 2 had
died of typhoid; 1 each of scarlet fever, sunstroke, thresh, eczema,
and congenital defects; and in one case the cause of death was
unknown. There had been 5 deaths of negro children between the
ages of 6 and 16—2 of tuberculosis, 1 of “ worms,” 1 had been shot,
and 1 burned to death.
A striking proportion of deaths from accident was reported among
the negro children—7 out of 25 deaths between the ages of 1 and 5
years and 2 out of 5 between 6 and 16.
Home remedies.

Distance from doctors and drug stores has usually resulted in the
extensive use of home remedies and patent medicines. Many families
keep a supply of drugs on hand, such as salts, camphor, oil, calomel,
turpentine, paregoric, asafetida, and quinine.
1 The Rockefeller Foundation, International H ealth Commission, Second Annual Report, 1915, pp.
11. 12.
Federal Reserve Bank of St. Louis



A thriving business is conducted by a firm which maintains con­
tinuously an agent and a two-horse load of patent medicines in this
section. Croup and cough "cures/’ liniments, soothing and teeth­
ing sirups, remedies for women’s diseases and for constipation are
part of his stock and have a wide sale among his patrons. The
remedies are usually put up in dollar packages with wrappers which
make extravagant claims for their virtues.
The State board of health recommended to the legislature of 1917
the passage of a State law regulating the conditions of sales of trade­
mark remedies as follows: (1) "The elimination of secrecy, requiring
that the remedy publish its formula on the package,” and (2) "a
sufficient tax on the various brands of secret remedies on the market
of this State to enable the State government to encourage and answer
inquiries from the people regarding the action of any drug or combi­
nation of drugs.” 1 Although the "secret remedies” law failed of
passage, two important acts of the 1917 legislature concerning patent
remedies provide (1) that the package or label of any drug product
shall not contain any statement regarding the curative or therapeutic
effect of such article which is not true2 (in harmony with the Federal
food and drugs act and copied by most of the States in their laws),
and (2) that the sale is forbidden and the advertising unlawful of any
proprietary medicine purporting to cure certain diseases, for which
no cure has been found 3—a law in harmony with advanced legislation
upon this subject.
Negro mothers, in addition to a liberal patronage of patent medi­
cines, also rely to a large extent upon homemade "teas” of native
herbs, which they gather from early spring to late autumn. The
majority of babies are given catnip tea from birth. For colds,
favorite remedies are teas of pine tops, boneset, horehound, or penny­
royal. Purge grass is thought infallible for constipation. For diar­
rhea, the dollar weed is given, also sweet-gum leaves, queen’s delight,
or red raspberry tips; for "female troubles,” red shank, slippery elm,
burdock, and single or double tansy are in favor.

Most of the families visited have gardens, though many, because
the poor soil requires much fertilizer and labor, feel that they can not
spare the expense or the time for a garden of'any considerable size.
The average family raises beans, tomatoes, field corn, sweet potatoes,
Irish potatoes, cabbage, collards, turnips, okra, and field peas. The
garden insures the family sufficient vegetables during the summer
months, but for a good part of the year the diet is much more limited.
i Sixteenth Biennial Report of the North Carolina State Board of Health, 1915-1916, p. 58.
*Acts of 1907, ch. 368, as amended by Acts of 1917, ch. 19.
* Acts of 1917. ch. 27-
Federal Reserve Bank of St. Louis

r u r a l c h il d r e n .


Few families conserve any variety of vegetables, usually depending
upon sweet and Irish potatoes, collards, and turnips for winter use.
Although apples, peaches, plums, and cherries are scarce, black­
berries, huckleberries, and scuppernong grapes are fine and plentiful.
The more thrifty and enterprising housewives can, dry, and other­
wise preserve fruit for winter use. The migratory life of the tenant
family, however, offers small incentive to provide for the morrow.
Little stock is kept in this section, and a number of families arc
without milk and butter. The county makes but 3 pounds of butter
to each person per year.1 Poultry also is considerably below the usual
quota in rural districts, and eggs are scarce. Few families keep sheep,
though all have hogs, pork being almost the sole dependence for meat.
Corn is a staple article of diet, whether as “ roasting ears,” hominy
grits, or ground into meal. Molasses, homemade from sorghum cane,
is widely used for “ sweetening” during the winter season.
The preparation of food, from the point of view of the needs of
growing children, leaves much to be desired. This, of course, is not
true of the more prosperous and intelligent families, but the children
of the small tenant are given much of pork, fried food, and half-cooked
starch in the form of hominy and of corn and wheat bread. This
heavy diet of partly cooked starches, with an excess of fat and a
deficiency of fruits and green vegetables (except in the summer),
together with the custom of indulging children in the most unde­
sirable habits of eating whenever and whatever they please, is doubt­
less a factor in the indigestion, which, according to the mothers, is
one of their chief difficulties with the children. In many homes the
child is allowed to go to the “ safe” for leftovers whenever he can
think of nothing else to do, with the result that he never knows the
wholesome urge of a good healthy appetite, and his stomach knows
no rest.
The rural mother has been at a great disadvantage; because of her
remoteness and infrequent intercourse with her neighbors, she has
had no standard of comparison by which to measure her methods and
achievements. Now, however, the old order is rapidly changing, and
every year brings her into closer touch with better and more modern
methods of home economics and household management. The
women of this township now have at their disposal the services of a
county home demonstration agent, and are within a reasonable dis­
tance of community fairs, county fairs, and farmers' institutes,
where lectures, demonstrations, and exhibits have been arranged for
their benefit.
i Thirteenth. Census of the United States, 1910, Vol. VII, Agriculture.
Federal Reserve Bank of St. Louis



E D U C A T IO N .

School law.

According to the school law, as amended in 1917, a North Carolina
child must be in school between the ages of 8 and 14,1for four months
of the school term each year. The 14-year age limit is a recent pro­
vision—a part of the important educational program enacted by the
last session of the legislature and effective beginning September 1,
1917.2 At the time of the inquiry, school attendance was compulsory
only for children of 8, 9, 10, and 11 years. The law makes an excep­
tion in cases where the child is so physically or mentally handicapped
as to make attendance impracticable; also where he lives
miles or
more from the schoolhouse; or where, because of extreme poverty, his
services are necessary to his parents, or they are unable to provide him
with suitable clothing or necessary books.3 Since even under the
terms of the new law, the child is assured of only 24 months schooling
in preparation for his life work, the law is still obviously inadequate
in its scope. Moreover, in this rural section at least, the “ extreme
poverty” exemption clause is liberally interpreted; and children are
frequently kept at home to help on the farm during the busy seasons.
School term and attendance.

At the time of this inquiry, the school term in the neighborhoods
visited covered five months, November to March, inclusive, with the
exception of the largest school, which was in session six months (made
possible by special local taxation). Not only is the term short, but
attendance is irregular, the yearly average varying from 50 to 85 per
cent of the total enrollment. Fewer children attend in November
(cotton picking season) than at any other time during the term. In
March, also, many of the older boys are kept at home to help with the
spring plowing..
The majority of homes visited are within a reasonable distance of
the school. Thirteen white and 27 negro families, however, with
children of school age have no school nearer than
miles, and, ac­
cording to the school law, no child living that distance or farther is
required to attend school.3
Although the majority of the children start to school at 6 years,
over one-fourth had not been sent until they were 7 years or older,
usually because the family lived at a distance from the school or the
child was not as strong as the others. Occasionally a 5-year-old was
sent along with the older children, not to have any share in the
school work but “ just to be going,” as the mother said. Nineteen
of the 257 white children of school age, and about the same propor1 In Mitchell County school attendance between the ages oi 8 and 15, and in Polk County between the
ages of 7 and 15.
2 Acts of 1913, ch. 173, sec. 1, as amended by Acts of 1917, ch. 208.
* Acts of 1913. ch. 173. sec. 2.
Federal Reserve Bank of St. Louis



tion of negro children, had never attended school at all. One mother
explained that her 9-year-old boy would have 3%miles to travel to
school—7 miles the round trip—the winters are hard and he has so
many colds that she has not sent him.
I t was gratifying to find so many of the older children of 15 to 20
years still in school, at least for the two or three winter months,
ambitious to supplement in this way their inadequate schooling as
young children. A child is usually well grown before he leaves
school finally and as a rule has some good reason for leaving—he is
needed on the farm or in the house, or he marries or goes off to work.
A few were “ tired of school,” one did not like the teacher, one was
“ slow at books and ashamed to go,” and one had left to join the
Army. Poverty also is a frequent factor in poor attendance, par­
ticularly among the negro families. A negro mother lamented that
her children could have gone more this year if they had had good
The short school term, together with irregular attendance, make it
difficult for the child to progress rapidly in school. Ability to read
and write is a minimum to be expected from him as a result of his
contact with school; many, however, fail to achieve even this claim
to education. In the families visited, approximately 1 white child
out of 10, 1 negro child out of 3, between the ages of 10 and 20 years,
had not yet learned to read and write.
Attitude of parents toward education.

As a rule the parents were interested in their children’s school
progress, though few ever visited the school or consulted the teacher.
A proud mother told of her 10-year-old prize speller, who had missed
only one word all last winter and not one the year before. One
mother, who complained that the teacher let the children loiter and
fight on the way home, was asked if she ever visited the school to
talk things over with the teacher and admitted that she had never
seen any one of their teachers. Although one out of six of the white
mothers and one out of three of the negro mothers visited were
themselves illiterate, the attitude often attributed to illiterate par­
ents, that “ what was good enough for us is good enough for our
children,” was not encountered in this community. On the con­
trary, it is often a consciousness of their own defective education
that stimulates the parents to see to it that their children have better
opportunities. A negro woman, who had attended school only four
weeks in her whole life, explained that for that reason she is “ push­
ing” the children—she wants them to get some “ learning.”
School facilities.

The township provides five schools for white children and four
nesro schools.
Federal Reserve Bank of St. Louis



W h i t e S c h o o l s . —The largest white school is a well-equipped,
three-teacher school, with a course of study through the tenth grade;
another is a two-room, two-teacher school. These two school dis­
tricts have voted the special school tax (30 cents on the hundred
dollars valuation of property and 90 cents on the poll tax), which is
placed to the credit of the school district voting it. This amount
may be used for various purposes, such as lengthening the school
term, increasing the teacher’s Salary, building a new school, or
getting an additional teacher. The three other white schools are oldfashioned, one-room, one-teacher schools, with a total enrollment of
less than 30 children to the school. The township seems to offer an
excellent opportunity for a consolidation of rural schools, in accord­
ance with the newer standards for rural educational facilities.
County schools are supported almost entirely by county taxes,
with the exception of limited grants from the meager State school
fund and a special district school tax if agreed upon by a majority
vote of the qualified voters of the district. The Progressive Farmer 1
urges the necessity for increased school funds:
The first thing and biggest thing we are going to say in this issue of The Progressive
Farmer is this—that our folks in North Carolina, South Carolina, Virginia, and Georgia

ought to absolutely double their school taxes during the coming year.








It is no use to say we can’t afford it. With cotton at 20 to 25 cents a pound and
tobacco and peanuts selling at corresponding figures, it is folly to say that we can’t
do more for our schools than we did when cotton was 6 to 10 cents and other crop
prices in keeping with these. And we ought to be ashamed of ourselves if we don’t
do more. The tinje has come when any man ought to be ashamed when he leaves
home if he can’t say he lives in a local tax school district—and one in which the tax
is adequate.







Look at the facts. The North Atlantic States spend $50.55 per year on schools per
child; the South Atlantic States $18.91-—not 40 per cent as much. The North Central
States spend $44.15 per child; the South Central States $19.01—not half as much.
North Dakota, a rural State, is spending $64 a year per child; wild Idaho $55, and
even Mormon Utah $52, while Virginia spends $19, North Carolina only $12, South
Carolina only $11, and Georgia $13. Nor can we say we are doing as well in propor­
tion to wealth, for while North Dakota spends on schools 44 cents a year for each $100
of her wealth, Idaho 49, and Utah 51, Virginia and North Carolina spend only 28 cents
a year per $100 of wealth, South Carolina 27 cents, and Georgia 29.
The Carolinas, Virginia, and Georgia therefore might double the amount they
are spending for schools and even then not spend as much as some other States are

The rural-school teacher of this section is poorly paid; five of the
eight teachers of the township are paid from $45 to $75 per month,
the other three only $40 per month for the five-month term—a
meager yearly salary of $200! The average salary for the eight
teachers of the township ($286) is, however, somewhat above the
1 The Progressive Farmer. Saturday, June 30,1917.
Federal Reserve Bank of St. Louis


r u r a l c h il d r e n .

low State average of $243 for teachers in the public schools, but isscarcely more than half the average ($525) for the United States.1
Buildings and equipment.—All the school buildings are frame; three
are in good repair, painted, and attractive, while two are unpainted
and uninviting.
Each schoolhouse stands in a grove of-trees, in most instances
young oaks, but no attempt has been made in any case to beautify
the grounds with shrubbery or flowers. All have plenty of play space,
and the largest school is provided with a basket-ball court.
The larger schools are plastered and wainscoted, the one-teacher
schools merely ceiled. All are heated by unjacketed wood stoves.
The two larger schools are provided with cloakrooms; in the oneroom schools the children hang their wraps on nails or hooks on the
walls of the classroom. All the schools have new desks and chairs
of graduated size, each accommodating two children, except at one
school, which has individual seats. Blackboard space is inadequatein one school only 12 feet—partly black cardboard and partly pine
boards painted black. Aside from desks, chairs, and blackboards,
little else in the way of equipment is furnished by the school authori­
ties, and anything further must be added by the teacher or by inter­
ested school patrons. Two schools have pianos, only one has a
dictionary, and three have no maps—which, as may be imagined,
greatly hampers the teaching of geography. The children provide
their own schoolbooks, paper, and pencils. An interested teacher
of a one-teacher school had herself supplied her own primary, history,
and geography “ helps,” desk copies of all textbooks used, material
for county commencement exhibits, drawing paper, crayons, pencils
when the children ran short, and had induced the local “ community
club” to contribute copy books.
School libraries at each of the schools are a source of enjoyment
to the children during the school term.
Sanitation.—Drinking water is obtained from drilled wells on the
school premises, except for one school, which used a near-by spring.
There is usually a gourd or cup at the pump, but the teachers are
making an effort to have at least each family of children bring a cup,
which is a step toward the individual drinking cup.
Toilet facilities are inexcusably poor. Two schools have no toilet
whatever, two have a toilet for girls only, while the largest has one
for boys and one for girls.
School activities—A t some of the schools the children are eager
and interested members of school clubs. An Audubon society is
responsible for an enthusiasm for birds among small boys of that
neighborhood; 12 bird houses were made by the boys of this school
last year, exhibited at the county fair, and afterwards set up on the

Compiled from Report of Commissioner of Education for year ending June 30,1916, Vol.U , p. 30.
Federal Reserve Bank of St. Louis



home farms. One mother whose boy has learned to know the birds
and their notes confessed that it has made her notice the birds, too.
A canning club, pig club, and corn club have headquarters at the
schools and a remote one-teacher school has a “ Robert E. Lee Soci­
ety” which meets every Friday afternoon for debates or literary
programs and has been found an excellent means of getting parents
to visit the school. All the schools were well represented at the
county commencement held in March at the county seat; a oneteacher school of this township was the winner of several prizes-—
for the best all around one-teacher school exhibit, for the best seventhgrade penmanship, for the best composition on the necessity for the
protection of birds, and for the best beaten biscuit.
The township schools have not been used to any great extent for
community purposes. Farmers’ institutes are held yearly at the
largest school, and the winter before the survey a “ moonlight” school
was also held there. Two other schoolhouses are used for meetings of
the local community clubs, and at another a union Sunday school has
its services on Sunday afternoons; occasionally political meetings also
are held at the schools. For the most part the people have not yet
accustomed themselves to the idea of a school as a social and com­
munity center, and the schoolhouse commonly stands idle and unused
for over half the year.
N e g r o S c h o o l s — The four negro schools of the township, like
the average rural schools for negroes in the South, are poor.
The negro child of the township goes to school in a one-room,
unpainted schoolhouse, and sits with several children in a row on a
long homemade bench with no back except a rail and no place to hold
his books and papers except on his lap. He “ does his sums” on a
homemade blackboard of three boards nailed together and painted
black, and recites his lessons to a teacher (colored) who for five
months draws a salary of $25 per month. His school term lasts 100
days, of which he misses no. small share to help his father with the
In two of the negro schools the course does not extend beyond the
fourth grade; one has six grades, and the largest negro school of the
township is of a better type, with classes up to the seventh grade
and a teacher who draws a salary of $30 per month. At the negro
county commencement this school was the winner of four prizes_more than any other.negro school of the county.
Enrollment in the four negro schools varies from 44 to 96. All
the teachers are overburdened by the number of pupils. I t is plain
one teacher’s time divided among 96 children in seven grades can
give each child only the merest smattering.
Federal Reserve Bank of St. Louis



All the negro schools have undertaken industrial work of some
description. The girls learn darning, buttonhole making, hemming,
and embroidery. Lacking sewing machines at the school, the chil­
dren cut, baste, and fit the garments there and take them home to
sew. One teacher has attempted a weekly cooking demonstration
at homes in the neighborhood. The boys make baskets and mats of
corn shucks, mats of raveled tow sacks (in which cotton seed and
fertilizer come), chair seats of splints, and maps which they color
with crayons.
Two negro schools are using water from good drilled wells on the
schoolhouse grounds, and another carries water from a drilled well at
the nearest farm, 300 yards distant. One, however, still draws
water from a dug well on the school premises—a shallow well only
12 feet below the surface, obviously subject to pollution by seepage,
and also open and unprotected from dust and dirt. None of the
four negro schools is provided with toilet facilities of any description.
H ig h S c h o o l s . —Besides the district schools the county publicschool system provides at the county seat a good, well-equipped high
school for white children and a normal school for colored. The col­
ored “ normal” is both boarding and day school and has a dormitory
where, for a small sum, girls from the country round about may live
during the school term, furnishing their own supplies and doing their
own cooking and housework.
F a r m - l i f e S c h o o l s .—There has been some discussion of a “ farmlife” school for this count}7. This type of school, offering a course of
study better adapted to rural conditions than the standardized
school of the three R ’s, has proved its worth in other parts of the
State and would be a distinct asset to this county.
The purpose of the farm-life school is to give to the boys and girls
such preparation as the county public high schools give, and in addi­
tion to that to give the boys training in agricultural pursuits arid
farm life, and to prepare the girls for home making and home
The course of study in a farm-life school (the State now has 21
such schools) includes such rural subjects as the following: Botany,
agriculture, field crops, vegetable gardening, fruit culture, farm ani­
mals, feeding live stock, dairying, poultry raising, soils and fertilizer,
rural economics, and farm equipment.
M o o n l ig h t S c h o o l s .—This neighborhood has had a share in the
State’s campaign against illiteracy, holding a “ moonlight school” at
the largest school of the township. The “moonlight school,” which
originated in Kentucky and has been found effective there and in
other States, is a night school for adult illiterates, conducted for
short periods, usually at the public school by volunteer teachers,
preferably on moonlight nights for the greater convenience of the
Federal Reserve Bank of St. Louis



country people. The State department of public instruction is hoping
by this means to reduce materially the illiteracy of white adults.
North Carolina had in 1910 a higher rate of illiteracy (14 per cent of
the male adult native white population) 1 than any other State.
C H IL D R E N ’S F A R M A N D O T H E R W O R K .2

The effect of farm work on the development of the child is a prac­
tically unexplored field. It has probably been too 'often assumed,
however, that a child’s work on the farm is limited to morning and
evening chores—all light work, with no tax on strength or endurance,
and requiring only two or three hours a day. In this study the
attempt was made to discover for this one rural township of the
South the various farm occupations—both field work and chores—
performed by children, the health hazards involved in each, ages anil
sex of the children, their working hours and their wages where the
farm work is away from home.
A white family, living on a farm of 110 acres, with 30 acres in cul­
tivation, consists of father, mother, and six children—two boys of
15 and 13, a girl of 10, boy of 8, girl of 6, and a 3-year-old baby.
The two older boys plow, help set out the garden, hoe corn, strip
fodder, gather corn, and chop and pick cotton; these boys also help
take care of the stock and feed the hogs. The 10-year-old girl and
8-year-old boy drop corn and peas, hoe com, chop and pick cotton,
and pick peas; the little girl also helps her mother with the house­
work, and the boy takes the cow to the pasture and back and carries
wood and water. The 6-year-old girl feeds the chickens, brings in
stove wood, and helps irregularly with the cotton picking.

Every farm child has a variety of chores to perform around the
house and at the bam —the boys feed the mule, “ tote” water, feed
the chickens and hogs, chop wood and bring it in, “ carry” the cow
back, and forth to the pasture, and weed the garden; the girls, besides
their share of the housework, help with milking, churning, canning,
and preserving. All these various odd jobs have been considered
chores, as distinguished from regular field work with the crops.
Field work.

It was found that two-thirds of the white children and three-fourths
of the negro children from 5 to 15 years old, in addition to chores and
odd jobs, helped in the fields, cultivating and harvesting the crops.
Children of all ages were at work in the fields; 51 were children under
8 (22 white and 29 negro); 120, of whom 47 were white and 73 negro
children, were under 10 years.
1 Thirteenth Census of the United States, 1910, Vol. I, Population, p. 1258.
2 The discussion of children’s farm and other work is limited in this inquiry to children from 5 to 15 years
inclusive, living at home at the time nf the agent’s visit, i. e., 219 white and 270 negro children, of whom
144 white children (88 boys and 56 girls) and 204 negro children (103 boys and 101 girls) worked in the fields.

63721°—18---- 4
Federal Reserve Bank of St. Louis



Cotton is the leading crop, and in the cotton field a large propor­
tion of the labor is performed by children of various ages, from the
well-grown boy of 15 to the toddler of 5 or 6, who work along with
the rest of the family in cotton-picking time.
• '
Plowing, planting the cotton crop, and putting out fertilizer is
usually considered a man’s work, though sometimes done by the
older boys. Thirty-eight white boys 9 to 15 years old and 53 negro
children from 7 to 15 (51 boys and 2 girls) had helped with the plowing,
using a one-horse plow. Cotton is planted with a “ cotton planter/’
drawn by one mule. The boy’s work consists in driving the mule
and keeping to the top of the ridge—light work, for the soil has been
plowed before. Some judgment and experience is required to manage
the animal, keep him in a straight line, and hold the planter to the
top of the ridge. Fertilizer is sometimes scattered by hand, but
usually put out with a distributor drawn by one mule—light work
that can be done by any boy who can plow.
The next process in the cotton crop is “ chopping” the cotton, i. e.,
thinning it and weeding out the grass between the plants with a hoe
(the grass between the rows is plowed under). On the first round
the plants are “ chopped out,” leaving two stalks; on the second
round only single plants are left, 12 to 15 inches apart. Numbers of
children, of both sexes and all ages from 5 to 15 years, help with the
chopping; for it requires little strength and no particular skill,
except on the first round when there is danger of injuring the young
plants. It is, however, very fatiguing in the hot sun of midsummer;
and, because of the monotony of keeping the same position, the
shoulders and arms ache from the muscular exertion, and the hands
become cramped from holding the hoe. The chances are that any
considerable amount 6f this sort of work is too severe for a young
child. One hundred and two white children and 147 negro children
had chopped cotton during the summer of the inquiry.
Cotton picking is the work of the entire family. One mother,
when she puts “ one at it,” puts “ them all at it.”" One hundred and
forty-one white children and 204 negro children, of both sexes and
all ages from 5 to 15 years, picked cotton. Many families take all
the children to the field, even, as has been Said, depositing the baby
in a box under the trees at the end of the row. The cotton picker
walks up and down between the rows, stooping over to pick the
cotton and tossing it into a sack worn over the shoulder; when filled,
the sack is emptied into a sheet spread out on the ground at the end
of the row. Although cotton picking is light work requiring little
strength, it has its bad features when the age of the children in the
cotton fields is considered. There is exposure to sun and heat in the
early part of the season; fatigue, due to long hours, monotony, and
the stooping posture; and no small muscular strain from carrying
Federal Reserve Bank of St. Louis



the cotton—as much as 10, 15, or 20 pounds accumulates in the sack
before it is emptied into the sheet. The pickers are also under
some nervous strain, often racing one another to see who can pick
the most in a day. Where they are working out for some one else,
the pay is at piece rates—50 cents for every 100 pounds picked—
which encourages speeding up.
Corn is usually planted with a planter drawn by one mule; in this
case only the older boys who are “ plow hands” would be called
upon to help. Sometimes the old-fashioned method of “ dropping”
by hand is followed, and this is pften done by the younger children.
Hoeing corn is about the same process as “ chopping” cotton and is
done by children of the same ages.
Pulling or “ stripping” fodder is considered harder work than hoe­
ing corn and cotton, or picking cotton. Twenty-four white children
and 52 negro children—boys and girls from 6 to 15 years of age—
pulled fodder. The blades of the fodder are stripped from the corn­
stalks, tied in bunches to the stalks, and left to dry. I t is doubtful
whether any child who is not fairly well-grown should have this sort
of work to do, since reaching the highest blades necessitates consid­
erable muscular strain.
In the tobacco crop, as with cotton, children can he used at almost
every step of the process. The plants are set out by hand, at intervals
of about 18 inches. This is done by both boys and girls and is com­
paratively light work. The stooping posture would be trying if kept
up for any length of time, but in two or three days a large crop can
be set out.
A child of 8 or 9 can “ top” tobacco; i. e., pinch off the small top
leaves; he needs only to know how to count in order that he may
leave the same number of leaves on all the plants. A week or so
later the new sprouts are broken off; this is called “ sprouting” or
“ priming.” Young children go from plant to plant also, picking off
the bugs.
Children can also “strip” tobacco, though some judgment is
required for this; the large lower leaves are stripped from the plant,
and care must be taken to gather only perfect leaves and to avoid
breaking or crushing them. The next step is tying the leaves
together in bunches of five or six, ready for curing—simple work and
done by young children. Only the older boys and grown men can
attend to the curing, which is a tedious process requiring judgment
and experience.
Children under 16 have a share in various minor farm activities
also, helping with the crops of peas, beans, and sweet potatoes, help­
ing in the garden, and picking fruit and berries.
Federal Reserve Bank of St. Louis



Working hours.

The hours of children regularly at work in the field vary, not only
in the different families but also according to the season of the year.
In spring and summer many work from “sun to sun” ; others start
to the field in the morning when the dew has dried, and work until
about an hour before sunset. No work is done in the heat of the day;
i. e., from 11 to 1 or from 12 to 2, unless the family is ‘/pushed”
with the crop.
In cotton-picking time the working day is from 7 or earlier until
sundown with almost no time off for dinner; many families take their
dinners to the field and eat as they go up and down the rows. 1‘Some
mornings the sun is an hour high and some it’s not up yet before we’re
in the field,” said one mother. One negro mother rouses her family
at 4 o’clock; she was “ raised that way” ; her father and mother
always ate”their breakfast by candle light.
W ages when at work away from home.

Although most of the children work only on their own home farm,
a number work out for the neighbors also a few odd days when their
labor can be spared from their own crop. Chopping cotton is paid
for by the day, girls between 12 and 15 making 40 cents a day and
boys 50 cents. A 10-year-old boy was getting 40 cents and a boy
of 8 years, 20 cents. Picking cotton is paid at piece rates—-50 cents
per 100 pouiids—which encourages speeding up and accounts for a
vast pride in the amount each child can pick. Children between
12 and 15 years of age pick from 125 to 200 pounds a day.
For the children to help with the crop is such a customary pro­
cedure that it is accepted as a matter of course. From instincts of
thrift and industry, most parents wish their children to learn to work.
It is by no means always a question of poverty, for children of
well-to-do farmers are to be found in the field as well as those of poor
tenants. A reasonable amount of farm work can hardly bo-injurious
to the health of a sturdy, well-grown child, and early training in habits
of industry will be of value to him later in life, yet there can be no
doubt that interruption of the child’s schooling in order to have him
help with the crop seriously handicaps him. This can not be justified
even in cases of poverty. Moreover, very young children should not
be called upon to perform regular daily field labor with its accompani­
ment of long hours, exposure to the heat of the sun, monotony, and

Recreation, community interests, and the social aspects of country
life are rather more developed in this township than in the average
rural community where wholesome means of relaxation and diversion
are too often lacking.
Federal Reserve Bank of St. Louis



White families.

During the winter, social intercourse is largely confined to churchgoing, an occasional school entertainment, and now and then a visit
to town on Saturday afternoons. In August, after the cotton is
“made” (bolls formed and further cultivation impossible), there is
leisure, before cotton picking, for visiting, entertaining, ice-cream
suppers, picnics, and swimming parties at the picturesque mill ponds.
A community club picnic has been the means of bringing together
two or three neighborhoods every August. Speakers are invited,
and an exhibit of home products is arranged, with prizes offered for
the best bread, preserves, cake, flowers, and other home products.
After a picnic dinner, athletic contests and a canning club demonstra­
tion occupy the afternoon.
Three church denominations are represented in the township,
each with preaching services once a month. Two have Sunday school
also every Sunday afternoon. Church rivalry—occasionally a source
of discord in a small community—is remarkably lacking in this town­
ship, where the whole neighborhood attends services, ice-cream sup­
pers, and ‘ protracted meetings” at all three churches indiscrim­
School entertainments of various sorts are given now and then
such as Christmas celebrations, box suppers, “ concerts,” Easter-egg
hunts, pound parties, ice-cream suppers, lectures on birds, and an
occasional evening with a professional short-story teller. Sometimes
admission is charged and the proceeds used to buy extra furnishing
or equipment for the school. Thirty dollars, raised by the largest
school last year, provided shades and curtains and basket-ball
equipment, and paid the expenses of the school’s share in “ county
commencement.” A one-teacher school gave an interesting “ meas­
uring party” to which every person who came brought “ a penny a
foot and a penny for each inch over” of his height, and a prize was
given to the tallest person present.
Athletic sports,'unfortunately, arouse little interest. The town­
ship is without a single baseball team or tennis court. “ Old Hun­
dred’’—something like baseball, but played with a soft ball—is
popular among the school children at recess. One school has or­
ganized a basket-ball team for boys and one for girls. Swimming in
the mill ponds or river is a favorite diversion with the boys, and the
older boys and men occasionally fish and hunt for birds, squirrels,
rabbits, and foxes. During shad season “ fish fries” are popular
with the young people.
Among the adults clubs and lodges are numerous, including
Masons, Odd Fellows, Woodmen, two “ community clubs,” and
various church Societies. Farmers’ institutes, held every year at
the largest schoolhouse, are well attended by both men ami women
Federal Reserve Bank of St. Louis



As an up-to-date farmer explained, “ you can always get some new
ideas; it got me in the notion of sowing clover.” A farmers’ union
was organized a few years ago, but finally failed.
The community clubs (women’s organizations under the leadership
of the county home demonstration agent) are especially interesting
and successful and are proving a definite force for progress in their
neighborhoods. The programs at their monthly meetings embrace
a variety of topics of interest to rural women, such as bread making,
canning vegetables in the home, poultry raising, flower and vegetable
gardening, and exterminating flies and mosquitoes.
A girl’s “ canning club,” under the direction of the county home
demonstration agent, has had two successful seasons. The girls
plant and cultivate a garden of a tenth of an acre and can the prod­
ucts for home and market. Their demonstration of tomato canning
is a popular feature of the annual canning club picnic.
A boys’ corn club, discontinued the year of the inquiry, had made
a good record the previous summer. A 15-year-old prize winner
raised 101 bushels the first year and 106 the second, to the acre,
which was three times his father’s record of 30 to 35 bushels. The.
boy deep-plowed the soil and used more fertilizer, but his yield was
out of all proportion to the additional expense. Another corn-club
boy deposits in the bank the proceeds from his acre of corn. His
father has him keep books and sell the corn himself, to teach him
the business side of farming.
In three-fourths of the white homes of the township some sort of
publication is taken regularly. A number of families are getting
weekly rural editions of the county papers; several subscribe for
semiweekly or triweekly Atlanta papers; and a number of farm
papers are taken. Of magazines, however, there is surprising dearth;
the so-called “ woman’s magazine” which so many women are finding
helpful, with its pages on household management and the care of
children, is seldom found in this section. Literary magazines, also,'
are rare.
Although the man of the house usually makes at least a monthly
trip to town and in the fall of the year goes in almost every week,
hauling cotton, going to town seems to be an arduous undertaking
for his wife. She accomplishes it only about half a dozen times a
year, when shopping is necessary or when the children clamor to be
taken in for the county fair or county commencement. Often ten­
ant families, lacking a conveyance, find the trip out of the question.
Migration from country to town is rare in this community. As the
boys and girls grow up and marry, practically all settle in the same
neighborhood where they were reared. A real contentment with
country life is the rule; nearly every family expressed the firm
conviction that “ the country is the best place to raise children,” some
Federal Reserve Bank of St. Louis



on moral grounds dreading the contaminating influence of town life
and some on the grounds of health. One mother wished for better
schools for the children, like the town schools, but thought the
country the place to rear children, for, as she said, “ there’s more
fresh air, and they can play about and are not ^as apt to catch con­
tagious diseases as in town.” A mother, reared in a mill town,
objects to the long hours, hot sun,’ and loneliness of the farm. “ In
the mill town you weren’t lonely, you could get up with somebody
and talk and have a good time,” she said. Another, however, was
glad to get her little family away from the mill into the country,
because it was easier to keep them from bad influences.
Negro families.

The negro is by nature gregarious and revels in social gatherings.
Church is the most common meeting place and never lacks a good
attendance. “ The most we go,” said one mother, “ is to church, and
that is so often that’s all we can do.” One takes her “ little crowd”
and goes to preaching, prayer meeting, and Sunday school not at
one church but three—Failing Run, Brown Chapel, and Grays Creek
all having her loyal support.
The negro school is often the scene of festivities; concerts are
popular, with speaking, singing, and dialogues. A small one-teacher
school has been provided with window curtains, a. curtain to go across
the “ stage,” and a large hanging lamp—all bought with the proceeds
from an ice-cream supper given by the teacher.
There had also occurred recently a “ farmers’ dinner,”a dime party,
“ pan cake tosses,” an Easter barbecue, and a Fourth of July enter­
tainment given by the Masons and the Eastern Star. Here and
there a mother of a stricter turn of mind voiced her disapproval of
anything of the sort, and merely allows her “ children to go to church,
or to a funeral, or to a sickness, or something like that, and straight
home again.” More than one negro mother prided herself upon her
severity with her children. “ I don’t let mine stroll about to learn
more devilment,” one explained. Negro boys were only slightly
interested in athletic sports, swimming, fishing, hunting for birds,
squirrels, and rabbits; some few played baseball. One negro family
rejoices in a cheap little graphophone which the mother had seen
advertised in the papers as a good way to keep the boys home at night.
Clubs and “ societies” have a fascination for the negro; most of
them are organizations paying a benefit in case of sickness or death.
“ Society” dues, ranging from 10 to 50 cents a month, are a heavy
drain on the poverty-stricken negro family, though payment is kept
up even at a real sacrifice, spurred by the dread of sickness or of
death and pauper burial. Usually a disproportionately larger
amount has to be paid into the organization funds than is ever re
Federal Reserve Bank of St. Louis



covered by benefits. Moreover, it is a rule of the orders that no
benefit can be claimed if there has been any lapse in payment.
Trips to town are rare, for the negro family is usually without a
mule and has to “ chance i t ” with the neighbors or sometimes on the
landlord’s farm wagon.
Two-thirds of the negro homes are without a newspaper or magazine
of any sort, though one mother explained that they sometimes see a
paper in the neighborhood, and she thinks “ it makes your mind feel
better” to read the paper. Another family brought out three mail­
order catalogues which constituted the family reading matter for
the year.
Among the negro families the consensus of opinion seems to be
that “ for a regular stay place, country is the best”—a sentiment
almost universally expressed but with interesting variations: “ I ’d
rather live in my smokehouse than stay in town” ; the country
“ becomes poor folks better” ; in the country “ you’re not all scroughed
Some strongly disapprove of town with its “ racket and foolish­
ness” and are convinced that it is well for children to be reared far
from such contaminating influences. “ Country children always have
to work; town children just play and learn badness.” Another
mother thinks her children are better off in the country where it is
more open and the children have room for play.
One knows the country is healthier; there are more odors in town;
when she goes in on Saturdays she comes home with a sick headache
every time. “ There’s more pure fresh air in the country,” said one,
“ and folks in town have to eat canned goods. The country’s free
and easy; you can raise anything you need.” I]ood and fuel are a
consideration with the negro family. One said: “ The country is
best for me, where I can get my living better, and when I get cold I
can get me a piece of wood and make me a fire and when I get ready
to go somewhere I can go without stepping in somebody’s door.”
Another, woman likes the country where she can get her own wood
and light, and raise her own “ something to eat.”
On the other hand, some would rather live in town. “ We have to
work so hard for something to eat out here we don’t want it when we
get it,” was the verdict of one. Another has a first cousin in town and best, for “ everything is handy and you can run out and
get what you want.” Two negro women wanted to move to town
because of hard work on the farm; “ it’s a heap harder with the sun
burning your back u p ” than work in town. A woman who had
come from town where it was "“ right good and lively” complained
that “ here you hardly see anyone pass only about twice a month.”
Another thinks, however, “ there’s no call to get lonesome in the
country; there’s always plenty of work to do.”
Federal Reserve Bank of St. Louis



It is only recently that public attention has been directed to the
recreation and social life of rural communities. Certain nation-wide
developments, such as the movement for “ the school as social center,”
indicate a marked interest at present in this phase of rural life. An
act of the last session of the legislature of,this State “ to impove the
social and educational conditions in rural communities”1 is in accord
with present-day efforts for more widespread, opportunities for whole­
some means of entertainment and diversion in rural sections of the
1See p. 109.
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis

P L A T E X V I.— M O U N T A IN C O U N T R Y O F T H E S O U T H E R N A P P A L A C H IA N S .

P L A T E X V I I — F A L L S O F T H E T U C K A S E E G E E (“S U N N IN G T U R T L E ”).
Federal Reserve Bank of St. Louis

P L A T E X V I I I — A M O U N T A IN G R IS T M IL L .

P L A T E X I X — A H I L L S I D E C O R N F IE L D .
Federal Reserve Bank of St. Louis

P L A T E XX .— G R IN D I N G S O R G H U M C A N E F O R M O L A S S E S .

Federal Reserve Bank of St. Louis

P L A T E X X II. — A L O G C A B IN IN T H E M O U N T A IN S ,

P L A T E X X III. — A M O R E C O M F O R T A B L E M O U N T A IN F A R M H O U S E .
Federal Reserve Bank of St. Louis

P L A T E X X IV .— A M O U N T A IN W A S H

P L A C E.

P L A T E X X V .— A T T H E S P R IN G .
Federal Reserve Bank of St. Louis

P L A T E X X V I I — P L O W IN G F O R W IN T E R W H E A T ,
Federal Reserve Bank of St. Louis

P L A T E X X V III. — O N T H E W A Y T O S C H O O L , C A R R Y IN G C O R N T O T H E M IL L .

P L A T E X X IX .

Federal Reserve Bank of St. Louis

P L A T E X X X — S T U R D Y C H IL D R E N O F A M O U N T A IN S C H O O L .

P L A T E X X X I.— A S C H O O L “ N I N E " W IT H H O M E M A D E B A L L A N D BAT.
Federal Reserve Bank of St. Louis

PART m .

After consulting with various authorities, and after visiting several
counties in the western and mountainous sections of the State, a
county was chosen for the survey which is thought to be representa­
tive of the highland region from topographical, industrial, and eco­
nomic points of view. It was decided to make the house-to-house
study in three distinctly rural townships with a combined population
equal to that of the township chosen in the cotton country. The
selected areas, while not representative of the most prosperous farm­
ing districts of the mountains, are not, on the other hand, an extreme
of isolation, but are thought to be fairly typical, embodying many
customs and characteristics of the mountain section. From the fact
that in the mountain townships chosen, as well as in the lowland
county township, all families having children under 16—and not
selected families—were visited, we may infer that this is a fair cross
section of the rural child population of the mountain country. The
survey, covered 231 families and included 697 children under 16.

The selected townships are at the nearest point 4 miles and at the
farthest point 25 miles from the county seat, which is their nearest
town. It is a rough and rugged country with mountains ranging
from 3,500 to 6,000 feet closing in the district on all sides except along
the main highway. The broad, rich valley at the county seat be­
comes more narrow as the roads wind through the mountains and
along the noisy streams. Beautiful natural scenery, blue-misted
peaks, laurel-bordered streams, and charming waterfalls are charac­
teristic of the mountain country. The bracing and invigorating cli­
mate has become famous for its healthfulness and in near-by counties
has attracted large numbers of tourists. The summer is short and a
rigorous winter closes in early, contributing doubtless to the hardiness
of the people. The records of the Weather Bureau over a period of 6
years show a mean temperature of 39° in December to 73° in July and
August; a minimum of - 9 ° and a maximum of 96°.
Except for the main highways, the county roads are rough, pre­
cipitous, and, in winter, almost impassable. The result is that the
mountain family is economically handicapped by the difficulties of 59
Federal Reserve Bank of St. Louis




crop disposal and is also cut off from social life within the neighbor­
hood, and from the stimulating intercourse with other communities
which makes for progress!
EvenNthe main highways are impassable to automobiles for any.
distance from the county seat except during the summer months;
other roads can not be traveled by automobiles at any season of the
year* many, as they ascend into the hills, becoming trails which none
but a sure-footed horse or pedestrain would attempt. Occasionally
the road ends abruptly at a swift mountain stream, and only a good
guesser can tell whether to ford up stream or down to find its contin­
uation. Often the road follows the creek and is subject to fierce storms
and freshets which wash out the road, leaving gaps, ruts, and bowl­
ders to impede travel.
There is no railway communication, the townships lying 4 to 25
miles distant from the railroad, but scant telephone service (none
whatever in one of the townships), and only a “ star route” delivery
of mail along the main road between post offices.
A large and varied stand of timber is giving way before the logging
camps and sawmills, which are gradually pushing into the more dis­
tant mountains. Dilapidated flumes down the mountain sides m ark
the passing of this industry, or rather the exhaustion of the supply..
However, the leading industry of the section is still the conversion of
timber into various products, and “ nowhere else in the tempeiate
zone,” according to Kephart, “ is there such a variety of merchant­
able timber as in western Carolina and the Tennessee front oi the
Unaka system.” 1 Quantities of bark and wood of chestnut-oak and
other oaks, hemlock, pine, etc., are sold to the tanneries at the
county seat. “ Pins”—strips of wood used by the telegraph and
telephone companies to hold insulators to the poles are also sold
in quantities.
Unlimited water power is found in this section, utilized mainly for
running sawmills and the many small gristmills along the mountain
streams, where a certain proportion of the grain ground is charged
as toll. Grinding by water power in the primitive but picturesque
mountain mill is a slow process; a favorite story is told of a bird that
flew into the bin for food but starved while waiting for the trickling
stream of meal.
Small mica mines are scattered through the mountains; they are
owned and worked by families or groups of interested men and fur­
nish an occupation for odd times. The output is bought by agents
who travel through the country representing electrical, automobile,
and stove manufactories.
i Kephart, Horace: Our Southern Highlanders, p. 54.
Federal Reserve Bank of St. Louis



The mountain region is said to be a “ natural apple-growing sec­
tion” ; also designed by nature for grass growing, cattle raising, dairy,
farming, and cheese and butter making.1
Farming, on account of the topography of the land, is fraught with
many difficulties. Bad roads and distance from market also consti­
tute real obstacles, with the result that, while nearly every man con­
siders himself a farmer, his farming is on a small scale, his object
being to raise sufficient food for his family rather than to produce a
crop for market.
The early-settlers of the mountain country were Scotch-Irish who,,
after a sojourn in western Pennsylvania, reached the southern high­
lands by migrating sou thward through the mountains. These Sco tchIrish along with some Irish and some Pennsylvania Dutch, as Kephart points out in Our Southern Highlanders, “ formed the vanguard
westward into Kentucky, Tennessee, Missouri, and so onward until
there was no longer a West to conquer. Some of their descendants
remained behind in the fastnesses of the Alleghenies, the Blue* Ridge,
and the Unakas and became, in turn, the progenitors of that race
which by an absurd pleonasm, is now commonly known as the
‘mountain whites/ but properly Southern Highlanders.” 2
The townships chosen for the inquiry.are populated wholly bv
native white Americans, usually of Scotch-Irish descent. This
county, like the lowland county, is considerably more thickly settled
than the average rural area of the United States. The population
density per square mile is 26.3 as compared with 16.6 for the rural
area of the entire United States.3

Mountain homes are scattered along the valleys of the streams and
.follow the “ coves” or depressions in the hillside worn by the,swift
creeks in their courses down the mountain.
Farm acreage.

Little farming is done except on the “ bottom land” along the
rivers, where the soil is fertile and yields a rich harvest of grain or
potatoes, without being fertilized. The mountain sides are culti­
vated with difficulty; each family has a garden, a hillside of corn,
usually also winter wheat, a small plot of tobacco for home use, sor­
ghum for sirup, and ordinarily keeps bees. The average so-called
farmer, cultivating only 6 or 7 acres of corn and still less of wheat,
usually raises enough foodstuffs to supply his own family, but has no
1 University of North Carolina Record, No. 140, p. 29.
* Kephart, Horace: Our Southern Highlanders, pp. 151,152.
* Thirteenth Census of the United States, 1910, Vol. I, Population, p. 55.
Federal Reserve Bank of St. Louis



crops to offer for sale. His farm occupies from 50 to 100 acres, only
from 10 to 25 acres of which is improved land.
Farming methods in the mountains are primitive. Stolid oxen
are commonly the beasts of burden, not only because their cost is
less than that of horses or mules but also because they need not be
stabled and their strength and endurance particularly adapt them to
the mountain country.
Land tenure.

Although a few families of “ renters’7 were found, home and farm
ownership are the rule, and farm tenancy is relatively small as com­
pared with the cotton country. When a young couple marry they
usually move into a little house on the old home place, “ make a crop77
of their own, and live there rent free until the land is divided at the
father’s death, and the portion on which they are living finally
becomes theirs. Five-sixths of the families in the three townships
either owned their own farms or lived with the grandparents on
their land. The neighborhoods visited included a few families of
“ renters,” usually on the most remote and undesirable farms, often
on the mountain tops with no road other than a sledge trail of mud.
Some renters’ families make their crop on two-thirds shares, fur­
nishing the stock and two-thirds of the fertilizer and getting two-thirds of the crop; others “ get what they make” in return for various
improvements or services performed, such as clearing the land, build­
ing the new house, tending stock, etc.
Family income.

Farming in the mountain country does not produce a living, and
the mountain family must derive its small income from a variety of
sources. After the crop is laid by, the farmer and his boys turn
their attention to the timberlands, where they peel bark, make pins,
and cut acid wood and cord wood to be hauled to “ the railroad” and
sold for cash. Bark (used for tanning hides at the county-seat fac- #
tory) is peeled from black, white, and chestnut oaks and from hem­
lock; and at the time of the survey was sold by the cord at $11 for
the chestnut oak, $8 and $9 for black and white, and $9 for hemlock.
Often the farmer hires it hauled to town, paying half what the load
brings. Pins for telegraph and telephone poles sell for $4 per 1,000—■
extremely poor pay when one considers that it takes a man and a
boy two days to make that many pins and two days more to haul
them to town. If the farmer hires them hauled, it costs him $2,
one-half the price of the load. Acid wood brings $5 a load and tele­
graph poles $3 apiece. Mica mining adds to the family income in
some cases. The mines are small excavations in the hillsides, often
manned only by the father and the boys of one family, sometimes
with four or five neighbors hired to help at $1.25 per day. Many of
Federal Reserve Bank of St. Louis



the men and grown sons go off on what is locally called “ public
works” during the winter, i. e., at the sawmill, kaolin mine, or lumber
camp, where wages at the time of the survey were from $1.50 to $2
a day. A few days’ farm labor—helping the neighbors after their
own crop is made—adds a few dollars more to the credit of the family.
Farm work is paid at the rate of $1 per day for men, 50 cents for
women, and 35 cents for children.
A typical family of father, mother, and five children had 15 acres of
land in corn; they raised none for sale, in fact had to buy corn for
their own use before the season was over. In the course of 12 months
they had sold a steer in the “ settlement” for $20 and had traded at
the country store about $15 worth of chickens and eggs, in addition
to 3 bushels of beans at $3 per bushel and 3 bushels of dried fruit at
5 cents a pound; the “ men folks” had peeled 5 cords of bark which
they hired hauled to town at a profit of $25 and had made and
taken to town. 6 loads of “ pins-” at $4 a load. The father of the
family “ went off to public works” for two months in the autumn as
a hand at the sawmill, earning $1.50 per day—a total family cash in­
come from all sources of $167, which must support a family of
seven, covering every expenditure, for a 12-month period.
..Essen with no expenditure for rent or fuel, and very little for food,
the meager cash income of the average mountain family is insufficient
for its support in any reasonable degree of comfort. Among the.
families visited, 3 out of 5 had a net cash income of less than $200;
4 out of 5 lived on less than $300; and 9 out of 10 on less than $500.
Farm expenditures.

Although the farm income is low, farm expenses are also low;
commercial fertilizer is rarely used for corn and not to any extent
for wheat, the average family buying only 4 or 5 sacks at $2 a sank
for winter wheat. Hired help is negligible, an occasional day’s work
is “ swapped,” and sometimes during the busy season the neighbors
help for a few days at a time at $1 per day.
M ethods of purchasing.

The average mountain family scorns debt and prides itself on
paying cash for everything bought. The long-time accounts, credit
systems, crop liens, etc., so common in the cotton country, are non­
existent in these neighborhoods. Except for such provisions as soda,
snuff, coffee, sugar, soap, and kerosene, usually purchased at the
country store, it is customary to send to town for food, clothing, and
other supplies to be purchased for cash with the proceeds from the
sale of a load of bark or pins. Mail-order purchasing is practically
unknown. When something is needed between trips to town, the
woman of the house trades a chicken or two at the country store.
Eggs, dried fruit, butter, etc., are also disposed of in this way.
Federal Reserve Bank of St. Louis



Disposal of crops and other produce.

Most of the small amount of farmproduce sold is disposed of in the
“ settlement,” i. e., among the neighbors. Corn, potatoes, wheat,
sirup, stock, hogs, and sheep are usually marketed in this way.
Meats, butter, apples, beans, and cabbages are often hauled to town;
sometimes corn and potatoes also. Marketing produce in the rough
mountain country is a difficult problem. In some neighborhoods
visited the haul to market is from 15 to 25 miles over rough roads—
at least an all-day trip and often requiring a day each way! Some
few farmers haul their produce to the mill towns of South Carolina—■
a four to six day trip in “ prairie schooners,” camping out by the
roadside at night.


The average mountain home is picturesque rather than comforta­
ble. With his own hands the early settler built for his family a oneroom cabin of rough-hewn logs with a deep-sloping shingled roof;
no windows, no porches, a door at each side, and a fireplace of rough
field stone chinked with mud. So substantial were these early
homes that many are still occupied, still attractive, the weathered perfect harmony with the surrounding hills. The log cabin,
however, is no longer built; it has been largely supplanted by two
other types of homes—the rough shack of undressed upright boards,
and the more comfortable modern clapboarded cottage of at least
four rooms, with porches, often an upper story, and usually ceiled.
Sometimes the old and new exist side by side, with a clapboarded
wing, porches, and windows added to the original log cabin.
The interior of a mountain Gabin is often unusually interesting;
its walls and rafters darkened from the smoke of the open fire in the
rough-stone fireplace; stubby little split-bottomed chairs drawn up
before the fire; deep feather beds spread with gay patchwork quilts;
clean flour sacks of dried beans and apples stowed away in every
corner; and festoons of red pepper, strips of pumpkin, and drying
herbs hanging from the rafters. A spinning wheel often occupies
the place of honor on the front porch, and hanks of snowy wool
hang from the rafters waiting to be knit into wool socks for winter
wear. On the hillside back of the house one finds a colony of bee­
hives locally known as “ bee gums,” commonly of black gum logs
hollowed out and capped with a square piece of board.
In a typical log house of one room, shed, kitchen, and loft—a
quarter of a mile up a steep mountain trail from the nearest neigh­
bor—a father and mother are rearing their six children. Asters and
cosmos, towering head high, almost obscured the house from view; a
little creek dashes past, 50 feet below. Trays of apples and beans
were drying in the sun. Inside, the -house was not ceiled and the
Federal Reserve Bank of St. Louis



mother had papered the walls with newspapers which, she said,
“ turned the wind” and kept them warmer and more comfortable,
though not so warm as a “ tight” (sheathed or plastered) house
A little two-room cottage, almost hidden from the road by a dense
intervening wilderness of laurel and rhododendron, is the home of a
family of father and mother and five children; the house, of upright
boards, ceiled inside, was immaculately clean and in perfect order
at 8 o’clock in the morning. Snowy hand-woven counterpanes
covered the three homemade beds. The open fireplace held an iron
pot of beans cooking for dinner. The porch was piled high with
wool drying in the sun, and the yard was clean and bright with
An occasional painted two-story farm dwelling shelters the mem­
bers of a family who have prospered at farming and on “ public
works” until they are the owners of a considerable tract of land and
are leaders of the settlement in which they five. Comfortable house
furnishings, two fireplaces, porches—front and back—a capacious
barn, good spring house, and well-built privy all testify to a prosper­
ity above the average.
The common type of mountain home, however, is lacking in certain
essentials of a comfortable dwelling place, the most frequent defects
being insufficient space, which necessitates overcrowding; insuffi­
cient fight, due to the small number and size of windows; and the
difficulty of heating when the house is a loosely constructed log
cabin or unceiled cottage.
A majority of mountain homes in the townships visited were small
in spite of the abundance of timber in the vicinity; over one-third
are one- or two-room houses; less than one-fifth have more than
four rooms. Limited house space coupled with families above the
average in size (in over half the homes visited there were six or more
persons in the family) results in overcrowding within the house,
often quite as serious as in the congested sections of cities. In onefourth of the homes there were five or more persons to each sleeping
room; 38 families of two to nine persons were housed in one-room
cabins, cooking, eating, and sleeping in one small room.
At one home a grandmother, a great-grandmother, and three boys—
8,15, and 21—all sleep in one room. A family of father, mother, and
10 children were living in a cabin of two rooms and loft. At another
home the father, 19-year-old son, and two young daughters slept,
lived, and ate in one room, cooking in the fireplace.
Keeping the house warm in winter is a difficult problem with most
families. Many houses are unceiled, with cracks between the logs
or undressed boards. Even with these cracks chinked up with mud
Federal Reserve Bank of St. Louis



is far from comfortable.
W a t e r S u p p l y .—Almost every mountain family draws its drink­
ing water from a clear sparkling spring, which is counted as one of
the family’s choicest possessions. “I t’s good water,” said one
mother, “ everybody says it’s the best water in this country.” .An­
other woman, who had just returned from a visit to her daughter in
town, “ could hardly drink the town water.” She would “ drink and
drink and then wasn’t satisfied.”
That there is a real danger lurking in the use of spring water in a
locality where insanitary conditions prevail is as yet unrecognized.
Many springs are below the house and in a position to receive the
house drainage. Lack of privies greatly increases the danger of con­
taminated water.
Of the 10 wells in the neighborhoods visited, only 3 are of the
drilled type—usually considered the safest form of water supply for
rural households. One family has had a well drilled through, solid
rock from top to bottom; the top is cemented, and the well is pro­
vided with a good pump. At one home, an open well had been in
use until three years ago when, after a case of typhoid fever at the
next house, the county physician condemned the well and had the
family sink a new one, which is closed in with a tight board platform
and has an iron pump.
Another family uses “branch” water through the winter; the
spring is so far away that carrying water such a distance in rough
weather would be a great hardship. In this case, though there is no
house above the family on the “branch,” there is no reason to believe
the branch water would be free from pollution, for the settlement is
not remote, and there is considerable passing back and forth over the
P r i v i e s . —Sanitation falls far short of present-day standards for
rural communities. Privies are extremely rare, only 1 family in 10
having a toilet of any description. It is not uncommon to find a
considerable prejudice against them, many families disliking, as do
some families of the cotton country, the idea of filth accumulated
in one place. *Where a toilet is present at all it is usually for reasons
of privacy; i. e., where the house fronts a frequently traveled road,
with no woodland in the immediate vicinity. The intimate relation
between good sanitation and good health is little-understood. The
few privies in the neighborhood—25 among the 231 families visited—
are almost invariably built far out over the ‘‘branch, ” the contents
washing down the swiftly moving stream. The State board of health
is constantly emphasizing the importance of improved rural sanita­
tion and pointing out the direct connection between lack of privies
Federal Reserve Bank of St. Louis



and the transmission of such diseases as typhoid, hookworm, and the
diarrheal diseases.
D i s p o s a l o f R e f u s e . —Garbage is commonly fed to the hogs;
other refuse is either burned or thrown, with small idea of a sanitary
disposal, into a hollow down the hill, into the branch, raked away
from the house, or thrown into the woods.
Manure accumulates in the stable to be used as a fertilizer twice a
year, for spring com and winter wheat. No attempt is made to treat
it in such a way as to guard against flies. It is quite common, how­
ever, for the bam to be located at some distance from the house, often
100 or 200 yards away, or “on the other side of the hill.” Where
this is the case, the fly nuisance is less objectionable, but by no means
F l i e s . —Flies are numerous because of the primitive, insanitary
conditions prevailing; mosquitoes, however, are rarely if ever seen.
No one of the homes visited was adequately screened; some few have
screen doors or screens at doors and kitchen windows, but it is only
in rare cases that any attempt at screening has been made.
M A T E R N IT Y C A R E .1

During the inquiry 160 mothers, who had given birth to a child—
live or stillborn—within five years previous to the agent’s visit, were
interviewed with especial reference to their maternity care at their
last confinement.
Large families are common in the mountains; the women marry
early and bear children at frequent intervals. Slightly over twothirds of the mothers had married at 20 years or younger and nearlv
half at 18 years or younger. Of 103 women visited, who had been
married 10 years or more, 90 (87 per cent) had had 6 or more issues.
Facilities for m edical, hospital, and nursing care.

Facilities for the care and treatment of sickness are strikinglv
lacking in this county. Only five physicians 3—four at the county
seat and one in a village where a normal school is located—over­
burdened almost to the breaking point, are the dependence for
medical service of a population of 13,718.® This is an average of
2,744 persons to a physician, which is over four times as many as the
average (691) for the United States.4 The concentration of physi­
cians at the coimty seat is to be expected, for social and financial
reasons; but, because of rough roads, at times almost impassable, and
an absence of telephone communication, also because of the prohibi­
tive expense of a day’s trip from physician to patient, the greater
1 See discussion of general need for m aternity care as given for the lowland coimty, p. 26.
American Medical Directory of 1916, pp. 1153, 1163.
«Estim ated for 1916 by the U. S. Bureau of the Census.
* American Medical Association Bulletin, Jan. 15,1917, p. 99 .
Federal Reserve Bank of St. Louis



part of the county is practically cut off from medical service. There
is no physician resident in either of the three townships of the survey,
and the families live from 3 to 25 miles from the nearest doctor.
The county has no hospital, the nearest being located at the county
seat of the adjacent county, reached once a day by mail stage across
the roughest of mountain roads. No trained nurses are resident in
the county, and patients are entirely dependent upon the wellmeaning but untrained services of neighbors and relatives.
M aternal deaths.

The maternal mortality of the county indicates a need for con­
sideration of the problems of prenatal and obstetrical care. During
1916 there were three deaths in the county from causes connected
with childbirth,1 a rate of 21.9 per 100,000 population.3 ‘ Here, as in
the lowland county, it is impossible to determine whether this rate
is sporadic or usual, since mortality statistics for the State and its
counties are not available earlier than 1916, when the State was ad­
mitted to the area of death registration; also, a rate is often mis­
leading when the area is small and a small number of deaths are
considered. However, it is significant that this rate is higher than
the rate (17.3) among the white population of the lowland county,
approximately the same as the rate (21.1) for the white population
of the State as a whole, and distinctly higher than the average for
the death registration area of the United States in 1915 (15.2).3
Prenatal care.

Prenatal care of mothers in the mountain country, as in rural
sections of the lowlands,4 is practically nonexistent; even mothers
living within 6 or 8 miles of a physician rarely consulting him during
their pregnancy, content usually with notifying him of the expected
confinement. Even this precaution is often omitted and valuable
time is lost hunting a substitute when the family physician is away
on a call. No one of the 160 mothers visited can be said to have
had the supervision which has been described as constituting “ ade­
quate” prenatal care.5 Of the 160 mothers, 124, or more than
three-fourths, had had no advice or supervision whatever during
their pregnancy, and no prenatal care of any sort; only 7 had seen a
physician previous to confinement; and only 1 had had urinalysis.
Twenty-eight mothers had been visited by the midwife before con­
finement-visits, however, usually social rather than professional
in character and not involving a physical examination of the mother.
1Information furnished by the bureau of vital statistics of the State board ot health.
2Based on the U. S. Census’s estimated population of 13,718 for the county in 1916.
3See Mortality Statistics, 1915, p. 59. U. S. Bureau of the Census, Washington, 1917. Sum of the rates
there given for “ puerperal fever” and “ other puerperal affections-?
* See p. 29.
‘ See p. 30.
Federal Reserve Bank of St. Louis



Attendant at birth.

Because of the inaccessibility of physicians,1 the midwife has
necessarily been employed to a large extent for obstetrical work.
The more prosperous and intelligent families called a physician to
attend the mother in confinement; 68 of the 160 mothers had been
attended by a physician at their last confinement; the others, with
the exception of 2 where a relative assisted and 1 where there was no
attendant whatever, depended upon neighborhood midwives. In 5
cases at the last confinement and many times in previous confinements
the doctor had been late, not arriving until after the birth of the child.
Several families who had intended to employ a physician failed alto­
gether in their efforts to reach him.
This inability to secure adequate medical attention at childbirth
had often resulted disastrously. A mother in a remote little cabin far
up on a mountain trail was very miserable during pregnancy. Twice
a week for the last two months her husband went down the moun­
tain to the nearest store and telephoned to the doctor in an effort to
keep him informed as to her condition. When labor came on, how­
ever, it was impossible to get the doctor, and the mother suffered all
night before he arrived and delivered her. One of her twins died at
The doctor was sent for one night to attend a woman in confine­
ment, but the country was “ all frozen u p ” and he said that he could
not make the 8-mile trip until the next day. A midwife was called in;
the mother’s health has been poor ever since this confinement.
A mother whose baby died at birth is confident the child would
have lived if they could have got the doctor there in time.
One woman had twins several hours apart; the doctor was late
and the mother thinks that without the assistance of a midwife she
and the second baby would have died. After this experience she
engaged both doctor and midwife for each confinement. The doctor
was late also when her last child was born.
Another family tried all night to get a doctor, but the baby strangled
before he reached them, though it was born alive.
At one home a midwife was engaged, but when summoned had gone
to a “ union meeting” at the church and failed to arrive until three
hours after the baby Was born.
A mother who has lost two of her five children in stillbirth does not
know the cause; the babies were both alive when labor began, but
the mother always has had a long tedious labor. She never has had
a doctor.
A mother of nine children, too isolated in her home at the end of the
trail for a doctor to reach her without excessive delay, has never had
a doctor in attendance at confinement. On two occasions a midwife
iSee p. 67.
Federal Reserve Bank of St. Louis



was engaged, but tbe mother’s experience has led her to feel slight '
confidence in midwifery, and she now prefers to manage for herself,
with the aid of her husband and what information she can get from
the woman’s page of their farm paper. When her first child was
born, the midwife came four days before; this made extra cooking
for the mother who, in additon, had to carry wood and water. When
it was found to be a case of breech presentation, the midwife did not
know what to do, and became so excited that she had to be sent away
because she was disturbing the mother.
M i d w i v e s .—All the 11 midwives liv ng n the district studied
were interviewed, also 2 from an adjoining township who are some­
times engaged by women of this section. Eleven are white and 2
negro, ranging in age from 39 to 65 years. Five can read and write
and 2 state that they can read but not write; only 3, according to
their reports, are licensed by the State board of health. The
experience of these 13 women in midwifery had extended over periods
of from 5 to 25 years.
Charges ranged from $2 to $5, $3 being the common price. Serv­
ices rendered included delivery and from one to three postpartum
visits if within walking distance. If desired, they stayed from two
to seven days, assisting in the work of the household after the mother
and baby had been made comfortable. In this case, an extra charge^
of *$2 per week was made.
None of the midwives report any supervision of pregnancy, physical
examination of the mother, or urinalysis. With the exception of one
who recommends that her patients use sulphur freely to regulate the
bowels, no prenatal advice of any sort is given.
In preparation for their cases two midwives use carbolic or antisep­
tic (bichlorid) tablets; four merely wash their hands. One midwife
owns a bag and carries carbolic acid, antiseptic tablets, and spirits of
ammonia. Three attempt no preparation of the patient. Ten prepare
the bed if they arrive in time. All use old quilts, though four have
clean linen before and after confinement, if possible. Quinine, blackpepper tea, red-raspberry, lady-slipper, and other teas are commonly
given to hasten confinement. Other remedies are sweet apple bark,
cinnamon, garden sage, black gum, star root, hemp, and bead wood.
From one to three examinations of the mother are usually made
during labor; three midwives make no examination, one because she
believes in letting nature take its course. Another makes no exam­
ination so long as the patient seems to be doing well. One makes an
immediate examination, for she wishes to be honest with the patient
and with herself, and if the child is not “ properly placed” wishes the
doctor called at once.
Nine have never called a doctor, though a few would do so if the
patient were not doing well—that is, if there were a prolonged labor
(24 hours or more), a “ preternatural present,” rigors, or nervousness.
Federal Reserve Bank of St. Louis



Postnatal care.

Usually the doctor makes no return visit, to the mother after the
birth of the child; of the 68 mothers attended by physicians only 9
had had any medical supervision after childbirth. The distance from
the physician, the almost prohibitive cost of his visits, and the lack
of recognition by the mothers of the importance of after care áre gen­
erally the deterrent factors.
The midwife, if living any considerable distance away, stays some­
times several hours, occasionally for two or three days; where she
is a near neighbor it is customary for her to “ drop in” every dav or
so in passing. Of the 89 mothers attended by midwives, in 7 cases
the midwife had remained in the home; in 40 she had made one or
more postnatal visits. Even the mothers attended by midwives,
however, in many cases were left entirely to their own resources after
the child's birth.
Nursing care in confinement.

Trained nursing in confinement is wholly lacking. No one of the
mothers visited had had the benefit of either a trained or “ practical”
nurse during confinement; 11 had been nursed by the attending mid­
wives. Of the 160 mothers, 148 were dependent upon untrained
nursing—that is, members of the household, relatives, neighbors, or
R est before and after confinement.

Though not under the strain of helping make a crop for market as
in the eastern county, much of the burden of providing for the fam­
ily falls upon the mother, who often feels that she can not spare the
time either for sufficient rest before or a reasonable convalescence
afterwards.4s a rule, however, during this period, other members of the family
take over the heavier part of the mother’s work—washing, milking,
and field work; for the last three months of pregnancy, at least, the
average mother stops helping with the field work. Thirty-five of the
one hundred and sixty mothers, about one-fifth, had continued their
field work beyond three months before confinement, this depending
largely upon the season of the year in which confinements occurred.
Certain, weeks of summer and autumn are the busy seasons with the
crop, when all possible help is needed in the field.
In this section the mother’s period of rest in bed after confine­
ment is usually limited to from 7 to 10 days. About one-third of the
mothers visited were in bed two weeks or more, though in a few ex­
ceptional cases they were up and about their work in three or four
days. A strong wholesome-looking mother of seven children told
the agent that everybody wonders that she does not break down and
get old; she thinks it is because she is careful to rest sufficiently after
Federal Reserve Bank of St. Louis



her children are horn. She works up to the last minute, for she feels
stronger when carrying her children than after confinement; after­
wards, however, she rests for a month, which she thinks is “ every
woman’s entitlement.”
M other’s work.

The work of the mountain mother is burdensome and she bears
more than her share of responsibilities of the household. Her house­
work includes washing, ironing, cooking, cleaning, sewing, and often
spinning and knitting for the family. Handicapped by lack of mod­
em conveniences, her task involves undue hardship. In most of the
homes cooking is done on a small wood stove, with none of the mod­
ern conveniences; often the only implements are iron kettles, pots,
and ovens which may be used interchangeably on the stove or in the
fireplace; the latter is still preferred by many for baking corn bread
and sweet potatoes. A scant allowance of fuel is provided from
meal to meal. During a rainy spell, or when the father is away or
sick, or the children off at school, the mother may be left without
fuel, though wood grows at her very door.
Carrying water, a toilsome journey up and down hill several times a
day, usually falls to the lot of mother and children. No one of the
families visited had water in the house or on the porch, and only 1
out of 5 within 50 feet of the house. Twenty families carried water
over 500 feet and 8 families were from an eighth to a quarter of a
mile distant from their springs.
The wash place, consisting of tubs on a bench and a great iron wash
pot in which the clothes are boiled, is usually close by the spring.
Much straining and lifting and undue fatigue are involved in this out­
door laundry. Sometimes even a washboard is a luxury, substituted
by a paddle with which the clothes are pounded clean on a bench or a
smooth cut stump.
Much of the family bedding is homemade, the work of the women
and girls in their leisure hours, after the crops are laid by or in the
evening by the fireside. Besides the time-honored “ log cabin” pat­
tern, their collections of patch-work quilts include such quaint and
intricate designs as “ Tree of Life,” “ Orange Peel,” and “ Lady of
the White House.” Many a mountain home has its spinning wheel
still in use and occasionally one finds an old-fashioned hand loom.
Some homes display a collection of coverlids and blankets, handmade
at every step of the process. The wool was grown on the home farm;
sheared from the sheep; washed, carded,-and spun by the women
and girls of the family; dyed, sometimes with homemade madder,
indigo and walnut dyes; and woven on the loom into coverlids and
blankets. Even the designs are often original or variations of old
favorites, like the “ Whig Rose,” “ Federal City,” and “ High Creek’s
Delight by Day and'Night.”
Federal Reserve Bank of St. Louis



The other duties of the mother are largely seasonal. From De­
cember to August the children are home from school and she has their
help. Together they make the garden; help plant the com and peas
for winter; gather them when ripe; pull fodder and dig potatoes; feed
the stock; and perform the usual farm chores of milking, churning,
and carrying water. In many homes the mother may be found doing
chores which are usually considered a man’s work, unduly prolonging
her working hours and exposing herself to more stress and strain than
is compatible with her own health or that of the children she is
I t is uncommon for help to be hired in the home, except occasion­
ally for a few days during confinements. Moreover, with the excep­
tion of sewing machines, household conveniences are totally lacking.
Hard-working women complained that the men have planters, drill­
ers, spreaders, and all kinds of “ newfangled help,” but that nothing
had been done to make women’s work easier.
Practically all the mothers visited, besides their housework and
chores, had helped in the fields more or less—hoeing com, pulling
fodder, and so forth. Of 212 mothers, 188, almost nine-tenths, had
worked in the field before marriage; 167 since childhood; and 166, or
three-fourths of the mothers visited, had helped in the field after
A woman’s field work in the mountain country is not so extensive
or fatiguing as in the lowlands where the cotton crop requires the
constant labor of the entire family many hours a day during a long
summer and autumn. In the mountains, little farming is done, the
average family raising no appreciable farm produce for sale. The
woman helps plant and hoe the com and in the autumn helps harvest
the crops—stripping fodder, carrying it to the barn, making sirup
from sorghum cane, picking beans, gathering apples, and digging
potatoes. Her field work is not arduous in itself, but only because
it is undertaken in addition to her already numerous duties—caring
for the children, housework, sewing, canning, and chores.
IN F A N T C A R E .

Infant mortality.

These townships of the mountain country have a considerably
higher—that is, less favorable—infant mortality rate than any of
the rural sections so far studied by the Children’s Bureau. Of 1,107
children bom alive, whose birth occurred at least one year before the
family was visited, 89 had failed to survive their first year, an infant
mortality rate of 80.4 or a loss of one child in 12. This rate (80.4) is
almost twice as high as among the white children of the lowland
county (48), and considerably higher than the infant mortality rate
in the county studied in Kansas, computed on this same basis, which
Federal Reserve Bank of St. Louis


r u r a l c h il d r e n .

was 55 per 1,000 live-bom children. K ephart1 mentions the high
infant mortality among the mountain children:
Mountain women marry young, many of them at 14, 15, and nearly all before they
are 20. Large families are the rule; 7 to 10 children being considered normal and 15 is
not an uncommon number; but the infant mortality is high.

The infant mortality rate shows a considerable variation with the
age of the mother, being least favorable where the mother is under
20 and most favorable between the ages of 25 and 29.2
A g e a t D e a t h a n d M o t h e r ’s S t a t e m e n t o f C a u s e o f D e a t h .—

A proportionately greater loss of infant life occurred within the first
two weeks than at any other time within the year, as repeatedly
shown in previous studies of infant mortality. Of the 89 infant
deaths, 38, nearly half, had occurred within the first two weeks;
7 were deaths of babies 2 weeks, but less than a month old; 17 were
1 month, but less than 3; 8 were between 3 and 6 months; and 19
were 6 months, but less than 1 year. The proportion of infant
deaths occurring in the last hah of the year is considerably higher
than is common and may be attributed about equally to feeding
disorders and to disturbances of the respiratory tract.
Prematurity was the most important cause of infant loss in these
communities. * Of the children that failed to survive their first year,
one in four (22 out of 89) had been prematurely born. “ Bold hives”
is a term encountered throughout the mountains, used loosely to
designate infant ills of various sorts, particularly gastro-intestinal
disturbances and croup. Seventeen babies, according to the state­
ment of the mothers, had died of the “ bold hives.” Ten infant deaths
from gastro-intestinal causes and 14 from respiratory causes were
reported, besides those which may have been included in the blanket
term “ bold hives.” There were 2 deaths from measles and 2 from
whooping cough. Eight were due to the following causes: 1,
“ scrofula” ; 1, “ eczema” ; 1 was “ found dead in the morning” ; 1
was ‘1always sickly ” ; 1 “ took fits ” ; 1 was 11malformed ” ; 1 “ died
all at once” ; and 1 was “ drowned.” In 14 cases the cause of death
was not reported.
1 Kephart, Horace: Our Southern Highlanders, pp. 258, 259.
2 The rates are as follows:

Age of mother.

All ages.................................................................................. .........................................
Under 20...................................................................................................................... ; ...............
(40 and over not shown because such a small number of births occurred at this age.)
Federal Reserve Bank of St. Louis





S t i l l b i r t h s a n d M i s c a r r i a g e s .—The proportion of children still­
born (2.3 per cent) is slightly less than in the lowland county for either
white (3.9 per cent) or negro (3.5 per cent) mothers. A somewhat
larger percentage of pregnancies had, however, terminated in mis­
carriages, 5.5 per cent, as contrasted with 3.6 per cent for white
mothers and 5.4 per cent for negro mothers in the lowland county.

Infant feeding.

Feeding records, covering the history of the baby's feedings during
the first year of life, were obtained for the last child under 5 years and
included 160 children.
As in many rural districts, infant feeding follows traditional
methods. Distance from the physician is so great that his super­
vision of feeding is out of the question, and books and magazines
with articles on infant care £re extremely rare. The result is that
the mother relies wholly upon the advice of relatives and neighbors
and her own experience.
Breast feeding is universal. Every one of the 157 babies for whom
records were secured had had some breast feeding from birth up to the
ninth month. Weaning is commonly left to the inclination of the
baby itself; of the 67 babies weaned by the time of the agent's visit,
only 10 were weaned before reaching their first birthday. Commonly
they were 13 to 18 months old (33), while 17 were 19 months to 2
years, and 4 were over 2 years at the time of weaning.
In addition to the breast milk the average baby is given from an
early age a taste of everything the mother eats. As a rule hunger is
the only recognized cause for crying, and the mother's indulgence
knows no bounds when it comes to feeding her baby. That the child's
stomach is overloaded by indiscriminate and unwise feeding is due
not at all to indifference but to her determination that he shall not go
Catnip, ground ivy, or red alder teas are commonly given in the
early months—almost universally for the first three days. Usually
after three or four months the child is “ fed" tastes of solid food.
One mother fed her children after three weeks. “ When I went to
the table they went with me," she said. Another had fed her last
baby catnip tea, coffee, and sweetened milk during the first three
days, then sugar and milk to the second month, and after that
everything she ate. Her babies “ mighty near live on sugar till
they are big enough to eat." Often it is the children who “ spoil"
the baby and begin his irregular habits of eating.
Many, of course, are more careful with the baby's diet. “ It doesn’t
do them much good if you keep burning them up with strong meat
and vegetables," had been the experience of one mother. Another
had fed her first and second child from birth, but is convinced that
she made a mistake, and therefore gave the third and fourth noth­
ing but the breast.
Federal Reserve Bank of St. Louis



P H Y S IC A L C O N D IT IO N O F C H IL D R E N F R O M 1 T O 15 Y E A R S O F AG E.

General health.
Without a physical examination it is, of course, impossible to
make any but the most general statements as to the health of the
children visited. The most common illnesses, according to the moth­
ers, are associated with the gastro-intestinal tract—colic, diarrhea,
dysentery, and cholera infantum being reported in many cases.
Next in frequency came the complications of the respiratory tract,
locally designated as “ phthisicy ” conditions, which were found in
numerous households. The child would “ choke up” with cold,
and be “ wheezy,” and so forth. “ Pneumonia fever” and pleurisy
were terms loosely used, but were recognized as being illnesses of
serious import.
Contagious diseases, especially measles and whooping cough,
were common in spite of the remoteness of the homes. With no
public health protection, at the time of the inquiry, in the forms of
quarantine, placarding, reporting, and no medical inspection of
schools, the children were continually at the mercy of such diseases.
Diphtheria and typhoid have also been fairly common. A number
of cases suggestive of meningitis were reported and six known cases
of infantile paralysis were found (occurring previous to 1916), be­
sides others which it was impossibe to verify. Unlike the lowland
county, malaria is rare in this region.
Hookworm or “ dew poison” is common, almost universal, among
the barefoot children of the mountains. A hookworm campaign was
conducted in the county in 1913 by the Rockefeller Sanitary Com­
mission, now the International Health Board of the Rockefeller Foun­
dation. During the campaign 1,202 persons were examined, of
whom 774 or 64.4 per cent were found to be infected. This cam­
paign, like that in the lowland county, was confined to the examina­
tion and treatment of individuals and did not include the erection of
privies throughout the county, which has been the important feature
of the more recent campaigns. The efficacy of hookworm treatment
is now recognized in this county, but only continued educative work
along sanitary fines and a widespread provision of sanitary privies
can make such a campaign effectual. When even the schools are
not equipped with privies of any description, the public can not
be expected to take very seriously the menace of soil pollution.
An interesting disease peculiar to this mountain region and to
parts of New Mexico and Tennessee is the milk sickness, or “ milk
sick,” as it is persistently called. This affects all ages alike and is
often urged as a reason for substituting other foods for milk for
young children. It is said that one or two men of the county claim
to be specialists in the disease, which is, however, almost invariably
Federal Reserve Bank of St. Louis



fatal; and not only tlie public but also the skilled and experienced
medical profession of this vicinity have a wholesome dread of “ milk
sick. ’ The disease is thought locally to have occurred only where
the cow has been pasturing in certain shady coves of rich vegetation
and usually in the spring of the year. It is said that as these coves
are cleared of their dense vegetation milk sickness disappears.
According to Rosenau,1milk sickness—
was once very prevalent throughout the central part of the United States, and was
one of the dangers our pioneering forefathers had to contend with. In somelocalities
the disease was so prevalent and fatal that whole communities migrated from the
milk-sick sections to parts where the disease did not occur.
We are told b y Col. Henry Watterson that Nancy Hanks, the mother of Abraham
Lincoln, died from this disease in 1818 after an illness of a week. In the words of
Col. Watterson, “ the dreaded m ilk sickness stalked abroad sm iting equally human
beings and cattle.” * * * It is an acute, nonfebrile disease due to the in ­
gestion of m ilk or the flesh of animals suffering from a disease known as “ trembles.”
The affection is characterized by great depression, persistent vomiting, obstinate
constipation, and a high mortality * * * there is no known cure or preven­
tion except the elimination of the disease in cattle, which fortunately is rapidly
taking place.

Neglect of the teeth, eyes, and ears is particularly noticeable in
these communities and affords common cause of distress and disa­
bility. The average child is in serious need of dental attention;
several cases of “ sore eyes” and of trachoma were found; running
or “ healing ” ears was a common occurrence, a number of children
having defective hearing due to lack of suitable attention.
Mortality and mother’s statem ent of causes of death.

Forty-six deaths of children from 1 to 5 years of age had occurred,
of which the largest number, according to the mother’s testimony’
were due to respiratory diseases—4 of pneumonia, 3 of croup, 1 of
diphtheria, 4 of whooping cough, and 1 of “ lung trouble.” Seven
children were said to have died of meningitis, 4 of flux, 2 of cholera
infantum, 2 of typhoid, and 2 had been burned to death. According
to the mother’s testimony, in other cases death had resulted from
scrofula, bold hives, spinal disease, paralysis, drowning, stomach
trouble, diarrhea, “ rising” of head and throat, scarlet fever, fever,
inflammation of stomach and spine, teething, and 1 “ because it was
a blue baby.” Ten children had died between the ages of 6 and 16
years, of meningitis (2), diphtheria, pneumonia, Bright’s disease,
worms, typhoid, scarlet fever, 1 from drowning, and 1 of whose
death the mother could not give the cause.
M edical care.

The rural child of the mountains, just as was the case with the
rural child of the lowland county, instead of being immune from the
ills of the city child, is subject to the same diseases and, in addition,
is seriously handicapped by the lack of available medical service.
‘ Rosenau, M. J.: The Milk Question, pp. 129,130. Houghton-Mifflin Co., Boston and New York, 1912.
Federal Reserve Bank of St. Louis


r u r a l c h il d r e n .

The area studied was from 4 to 25 miles from a licensed physician.
The nearest substitutes were two men supposed to be specialists in
the treatment of “ milk sickness,” an Indian doctor living somewhere
in the mountains who was said to be an expert in “ summer com­
plaint” and skin eruptions, and medical students or traveling prac­
titioners who sometimes pass through the country. The five licensed
practitioners of medicine resident in the county,1 even working to
the limit of physical endurance, find it quite impossible to reach the
whole countryside. It is unavoidable that the children should suffer
from this lack of medical or public-health supervision.
One home is 20 miles distant from the nearest doctor—a day and
a half’s journey unless one travels by night. Once, 10 years ago, the
family sent for the doctor, but he was unable to get a horse, so failed to
arrive. The mother in this home is exceptional. She has 11
fine, robust children, all of whom are living, and has amassed a
fund of common-sense methods which she applies in rearing her
family single-handed, as she must, being completely cut off from
medical advice.
This mother “ begins with their diet” ; she sees to it that they have
plenty of fruit, vegetables, milk, and eggs the year round. The baby’s
milk has her particular attention; she is careful to keep it perfectly
clean and has a big box over the spring where the milk can be kept
cool and good. She has the children bathe regularly, change thenclothes often, and sleep in fresh air summer and winter. She says1‘the
boys are in the river most all summer.” When the children appear
ill she sends them to bed without supper—only a drink of water,
keeps something hot at their feet, gives them salts, and takes care
that they are clean “ inside and out.” Due to the mother’s skilled
nursing, the whole family weathered even smallpox without a doctor.
Home rem edies.

The mountains are full of fragrant herbs noted for their medicinal
qualities. Every home, however small, has its stock of herbs, gath­
ered by the housewife each in its proper season and stage of develop­
ment. The most commonly used were catnip, pennyroyal, and
ground ivy for colds and grippe and “ to break out the hives” ; boneset for coughs and fever; fife everlasting, lady slipper, and red rasp­
berry for colds or fever, stomach trouble, or headache, and to “ quiet
the nerves and make a body rest” ; red alder for hives; goldenseal
for colic, stomach trouble, sore throat, fever, and as a tonic; par­
tridge vine (also known as wallink, pheasant berry, one berry, and
mouse-ears) to break out the hives; black-snake root for cramps, colic,
colds, and fever; camomile for stomach trouble; ginseng for polio,
stomach trouble, hives, sore throat or mouth; and gulver root for the
‘ Seep. 57.
Federal Reserve Bank of St. Louis



liver. “ All sorts of teas” was one mother’s explanation of her habits
of doctoring. On the other hand, with some families teas are not in
favor; one mother “ hardly ever uses teas any more” ; and another
“ never could see that teas and such do much good.”
Homemade salves, poultices, and liniments are numerous. For
sores a salve of heart leaves* carpenter leaves, or balm of gilead,
rosin, and fresh butter stewed down; for rheumatism a liniment of
kerosene, turpentine, camphor, and apple vinegar in equal parts,
with salt; for coughs, a sirup of catnip, horehound, Indian turnip,
and honey; and for cuts, bruises, and sores “ tincture of lobelia,”
made by chopping the whole plant and making a strong extract,
then adding whisky and straining.
In addition to teas, oil, salts, turpentine, paregoric, sulphur for
sores, a patent “ pneumonia cure,” and various forms of cordials
and “ drops” (soothing sirups) are popular. Patent medicines are
not patronized to any great extent.
D iet.

With the excellent climate and soil of this section a variety of
diet is possible. The average family raises in small quantities cab­
bage, potatoes, beans, beets, onions, tomatoes, corn, sweet potatoes,
and pumpkins; occasionally peppers, kershaws (a species of squash),
cucumbers, parsnips* and turnips. Fruits are limited to apples,
which are raised in abundance, wild grapes, and occasionally peaches.
Cereals, milk, and eggs are more common than in the lowland county!
and besides the pork—the main dependence of the families in the
lowland county—there are also poultry, beef, and mutton.
From spring to autumn may be seen the systematic preparation
for winter. Aside from the storing of grain, potatoes, and apples,
each yard has its stretchers of drying peas, beans, sliced sweet
potatoes, and apples; poles strung with great orange rings of pump­
kins, bunches of tawny tobacco and fragrant herbs. Porches are
hung with festoons of peppers, onions, and leather breeches (beans
strung in the pod). When dried, these stores are neatly packed in
“ pokes” (flour sacks) and stored for winter.
Much fruit is canned—apples, berries, peaches, etc.—in boiling
water without sugar. Jars are packed with wild grapes and filled
with boiling sirup; jam, jelly, fruit butter, and pickles of all kinds
are made. Apples are “ bleached” in great quantities—a process
which keeps them white, moist, and juicy like fresh apples, but
requires no sugar nor cooking. The apples are peeled, sliced7 and
turned into a covered barrel or cask with a perforated bottom through
which fumes of sulphur are allowed to percolate. The receptacle is
kept covered by only a heavy cloth, and apples are added from time
to time, and subjected to the same process. Kegs of kraut are made
Federal Reserve Bank of St. Louis



and gallons of beets and beans similarly packed. In fact, if all
housewives showed the same thrift, economy, and ingenuity char­
acteristic of the mountain woman, this country would produce
enough food and to spare.
The mothers are earnest and hard working in their efforts to do
their best for their children, but they lack an understanding of the
needs of the growing child. This was shown in the unsystematic,
promiscuous feeding, in the preparation of underdone starches, in
excess of fats, and in a too hearty diet. Three heavy meals a day
are served and food ad libitum between times—potatoes, beans, peas,
meat, and big doughy biscuits, or partially cooked corn bread.
This county has no home demonstration agent, no farmers’ insti­
tutes with their sessions for women—in fact no organized means for
an exchange of stimulating ideas and improved methods of house­
hold management.
E D U C A T IO N .

In spite of the compulsory-attendance law, the mountain child
in the townships visited is not getting his just educational rights.
He attends school during the five months’ term in a hit-or-miss
fashion for a few years, then stops altogether, at an early age, usually
under 16 years, before he has acquired even the first essentials of an
education. “ They have it here now so the children have to go to
school,” said one mother approvingly of the school law. Another,
however, thinks the State has no right to compel children to go to
school and then fail to provide good roads and transportation; her
children are obliged to cross a deep and very swift creek; the uncer­
tain foot bridge is often out of place; and the children often come
home wet to the waist after fording the stream.
School term and attendance.

The school term, at the time of the inquiry, covered from four to
five months, usually beginning the first of August and extending
to the middle of December. The midwinter school term, customary
in most parts of the country, is impossible in this section because of
the rough weather, bad roads, and distance of the children from the
school; in the spring the children are needed at home to help with
the planting.
For one reason or another schooling is continually interrupted, the
most common causes being farm work—particularly “ fodder pull­
ing” in the fall of the year—and bad weather. In one family the
children missed two months out of the five-months’ term; they have
to “ stop out and help a lo t” and besides “ when it gets too cold and
rough they can’t travel this mountain.” Such irregular schooling
discourages even the most ambitious. For example, a 16-year-old
boy who has gone a while every year but has had to stop to gather
Federal Reserve Bank of St. Louis



fodder, plow, sow wheat, etc., is so “ disheartened” at faffing behind
his classes that he threatens not to go any more.
A number of homes have no school within a reasonable distance;
one-third of the families visited are 2 miles or more from the school;
in 39 families children of school age are not compelled to attend at
all, since there is no school within 2^ miles of their home, which is the
greatest distance they can be compelled by law to travel. Ar> un­
usually bright, alert 11-year-old boy has only 11 months schooling
to his credit; he wants to be in school, but the family lives on a remote
mountain top and the 6-mile round trip to the school would be too
much for him. The mother of a 9-year-old “ teaches him at home, f
He s so young and it s so far to walk, and school is confining on a
young one,” she says. At the home of a family of “ renters” living
3^ miles from the schoolhouse, the father is distressed because his
three children aged 10, 12, and 14—are having no schooling; it is
impossible for them to go such a distance, especially since they have
to travel a steep trail straight up the mountain. He has been hoping
for a school nearer in order that the children may attend regularly.
“ There wouldn’t be any day so cold but that we could wrap them up
and send them, then,” said he. The children’s mother t.hinlra “ ft
looks like a renter’s children ought to have a chance as well as any­
body s.
One of the schools attended by the children visited is badly
located on the summit of one of the highest mountains in the whole
system. A strong, robust adult would find the long climb up the
mountainside a trying ordeal. For little children it is almost im­
possible, and irregular attendance is the result.
Although the majority of children begin school at 6 years of age,
over one-fourth are not sent until they are 7 or older because of the
distance they would have to travel and the rough weather to which
they would be exposed. As a rule a child has stopped school before
he is 16.
The short school term and irregular attendance are probably re­
sponsible for the slow progress made by many of the children. It
was surprising to find that over one-third of the children 10 to 20
years old in the three townships visited were unable to read and
Attitude of parents toward education.

At a number of homes, instead of making school a serious business
there seemed to be a tendency on the part of parents to humor the
children m their whims. Three children—aged 6, 8, and 10—who
did not like the teacher, were allowed to stay home whenever they
pleased. Another teacher is severe with the children and the father
is afraid to make his boys attend against their will “ for fear some­
thing wifi go wrong.” One mother “ never sends hers until they want
63721°—18--- 6
Federal Reserve Bank of St. Louis



to go; children never study to do good until they take the notion/’ ,
she said. Another thinks if you send them at 6 they “ get a disgust
at school and want to quit.’’ In one family the oldest child, aged 14, f
is sickly; “ he couldn’t go and we kept home the other one (13 years)
to humor him,” said the mother.
Many parents, however, in spite of the hard struggle to make a bare
living on the mountain hillsides, with “ fighting blood” aroused are
trying to give their children every possible opportunity for school­
ing. A mother who herself had to work from early childhood has
always sent all her children to school with a grim determination
to give them a “ grand education” ; she cheerfully shoulders the farm
work, pulling fodder, cutting tops, etc., in the field all day that the
children may be kept in school. In another mountain home there
hangs a framed certificate showing that a 9-year-old girl, the youngest
in the family of 10, was neither absent nor tardy during the entire
school term last year. A girl of 14, another “ youngest child,” has
gone to seven “ schools” (school terms) and has never missed a day
or been late. One mother, herself illiterate, “ wants her children to
be well-educated so they can read the Bible.’ ’
A large family in a poverty-stricken little home at the foot of a
high mountain, many miles from the nearest town, has had all kinds
of bad luck, and if it had not been for the mother’s ambition for
them the children could not have had a chance. Once when there
was an unusually good teacher at the subscription school, and the
family could not afford to send the children, the mother went to the
teacher and asked him if he would accept the heaviest pair of wool
blankets she could weave instead of tuition. He agreed. She later
made the same arrangement with one or two other teachers. When
the time came to send the two oldest girls to the town school, the
mother and the oldest boy took a cane mill over the mountains,
making sirup on shares, wherever people raised cane. They sold sirup
and made enough to start the girls, borrowing the rest with the under­
standing that the girls would pay it all back the first year they taught.
At the town school the girls made gratifyingly high records in scholar­
ship. The mother is a splendid type of woman, desperately anxious
that the children shall “ learn and get ahead.’’
It is customary in'this county for the teacher to take the school
census before the term begins, a plan which gives her, often a stranger
in the neighborhood, an excellent opportunity to visit and get ac­
quainted with the children’s parents. During the term, however,
little visiting is done; occasionally the teacher goes home with one
of the chiklren for the night and occasionally a mother or father
visits the school to explain why their children must stay at home and
help with the crops. Nothing like the parent-teachers’ associations
of the cities has ever been organized and there seems to be little coop
Federal Reserve Bank of St. Louis




eration between the parents and teachers in planning together for
the best welfare of the children.
Need for medical inspection of schools.

Several children are missing school because of physical defects,
some of which might easily be corrected; with medical inspection of
school children and the “ follow-up” visits of a public health nurse,
much of this absence could be avoided. A 9-year-old boy has been
in school for two years, but could not learn anything, so his father
took him out last year at Christmas; his eyes were bad and every­
thing blurred when he tried to read. No efforts have been made to
have his eyes examined and he will probably be out of school indefi­
nitely. A 12-year-old crippled child will have but little schooling,
though a special shoe might remedy the difficulty. The school is
only an eighth of a mile away, but the road is rough and slippery,
crossing a creek by a foot log, through a boggy meadow, and up a
steep rocky hill.
School facilities.

Seven district schools are available for children of the three town­
ships visited; only two of the seven are one-teacher schools. In one
school the children can advance as far as the eighth grade; in three, to
the seventh; and in the others no higher than the sixth. The schools
have not adapted themselves to farm life; none is equipped for
domestic science; none is emphasizing improved methods of farming.
Teachers' salaries are low; of the 13 teachers in three townships,
8 were paid at the rate of $40 per month, a total of $200 for the five
months' term; 5 received only $30 a month, or $150 for the entire
school year.
The schools are well built, ceiled, painted, and in good repair. It
was interesting to learn, however, that in order to build the two newest
schoolhouses, no school was held for a two-year period in these two
school districts, this being the only way funds could be diverted for
that purpose.
School equipment is meager and antiquated. Only three of the
seven schools have desks and chairs of graduated size, each accom­
modating two children. The other four manage as best they can
with long, old-fashioned, homemade benches, which are uncomfort­
able, can not be adjusted to the size of the individual child, and afford
no desk space. Books, papers, etc., must be held on the lap, which
makes it particularly difficult for the children to learn to write.
Blackboard space is insufficient, and two of the schools have neither a
map nor a globe. Schoolbooks are another of the teacher's problems,
the law requiring them to be furnished by the parents, who are often
unable, sometimes unwilling, to provide a complete set. In a remote
one-teacher school only two boys were supplied with the full collection
Federal Reserve Bank of St. Louis



of books used in their classes. At another school, the teacher reports^
they scarcely average two books to a class.
All the schools are heated by unjacketed wood stoves. The older
boys keep the stove supplied with wood, chopping it during school
hours; the boys work in relays for a week at a time, losing most of
the morning lessons during their “ turns.”
Only two of the seven schools have libraries, in spite of the ease
with which one can be secured. The State school law provides for
the establishment of permanent school libraries at rural schools, on
condition that the local district raises $10; $10 is then added by the
county and $10 by the State, and the fund of $30 used to purchase
books from a list approved by the State superintendent. The State
library commission at Raleigh also has available for loan a traveling
library which costs the borrowers only the freight both ways.

Sanitary conveniences are lacking. One only of the seven schools
is provided with a privy for the girls. The other schools have no
toilets whatever—a particularly dangerous condition in a country
where the spring, so easily polluted, is the common source of drinking
water. All the schools obtain their drinking water from springs. A
State bulletin Presses the importance of privies at the public school
as follows:
In a few sections of our State it is a regrettable fact that at some schoolhouses no
provision whatever is made for the proper care or disposal of this excrement. Near-by
woods and undergrowth form the only means of privacy. As a matter of fact, it is
really more essential that a school be provided with at least two good privies than that
it have deskB or even a stove. There is absolutely no argument in favor of not having
good privies. The absence of such sanitary precaution jeopardizes the lives and health
of the teacher, children, and community. Many typhoid fever outbreaks are spread
directly by this means.

The school and the community.

The mountain schools are not availing themselves of their oppor­
tunity to build up a community spirit and a well-knit community
life in their districts. The school building is all too rarely used for
purposes other than the school session. Where the church has no
building of its own, the schoolhouse is used for church services; also
for an occasional political meeting. Two schools have special Friday
afternoon programs with recitations or a spelling match; in another
there is a fairly well-organized literary society, which meets once a
week. The fact that this is attended by the whole neighborhood
emphasizes the need of social diversion. One teacher had. once
arranged a Thanksgiving celebration; another had an entertainment
in October; and usually “ school closing” is observed by some sort
of special program. Aside from these few efforts, the schools con­
tribute nothing to the social life of the neighborhood.
' Flans for Public Schoolhouses and School Grounds, pp. 69, 70. Issued from the office of the State
superintendent of public instruction, 1914.
Federal Reserve Bank of St. Louis


N O R T H C A R O L IN A .



Field work.

The mountain child, as well as the child of the cotton country, does
his liberal share of the field work, besides his regular chores at the
house and bam. Over nine-tenths of the children visited, 8 to 15
years old, and 11 younger than 8 years, worked in the fields along
with their parents, helping to sow and harvest the crops; a number
also helped in the timberland after the crops were laid by.
In a typical mountain family, the two boys of 11 and 14 help with
the plowing and the planting of com, dropping and covering the corn
by hand, also helping to plant beans and potatoes. Through the
summer they hoe com, and in the autumn pull fodder, gather corn,
pick beans, gather apples, dig potatoes, and help make sirup. Their
two little sisters of 8 and 9 hoe com irregularly through the summer
and in the autumn pick beans, gather fruit, and help their mother
dry the apples and beans for the winter. The children attend to
most of the chores also—the boys cut the wood, see that the fires
are kept up, and feed the stock; the little girls assist in the home
work and help bring in wood and water.
Plowing in preparation for the crops, usually with a one-horse
plow, is the work of the men and the older boys. Eighty boys from
9 to 15 years old were “ regular plow hands.”
Com is usually dropped by hand; planters are rarely used, partly
because of the expense and partly because they are less satisfactory
on the steep hillsides. A father of eight children was asked why he
had not bought a com planter. “ I already have eight,” said he.
Forty-two children, boys and girls, “ dropped” com.
Hoeing com requires the services of the entire family. Practically
all the children who did field work of any kind (234 out of 240), hoed
corri:—children of all ages from 5 to 15 and both boys and girls.
Fatigue and some muscular soreness result from the constant striking
with the hoe and from maintaining the same slightly stooping pos­
ture, grasping the hoe handle in the same position. As a rule, how­
ever, in the mountain country the corn field is a mere “ patch” and
the labor involved is spasmodic, a few days at a time or a few hours
a day, unless the family is hard pressed with work after wet weather.
In a family of 10 children, the 15-year-old “ dropped and the others
covered corn; and all who were large enough hoed com.” These
children work from 8 in the morning until “ just time to go after the
Many children miss school for two or three weeks during the fall
of the year to help with fodder pulling.1 Two hundred children, 132
boys and 68 girls, pulled fodder; 33 were young children 6 to 10
years old, 82 were children under 12 years.
1 For description oi fodder pulling, see p. 51.
Federal Reserve Bank of St. Louis


R U R A L C H IL D R E N '.

Children also help bring in the fodder. If it has been tied to the
stalks to dry, the stalks are cut by hand, loaded into a wagon or
sled, hauled to the bam, and stored away. This can be done only
by the men and older boys. Where the fodder has been stacked in
loose bundles, even a young child can shoulder and “ tote a bundle
or two of fodder” to the bam. The fodder is not heavy but rough
to handle; it cuts and chafes the skin. Some farmers cut and shock
the com. When this method is followed, only the older children
help. The stalks of com and fodder are gathered, stacked length­
wise about a single stalk, and bound around with a blade of fodder—
an operation involving some muscular strain and requiring strength,
height, and arm reach, since the com is tall and the stack large
Men and older boys also gather the com and haul it in. The ears
are broken from the stalk, tossed into a wagon or sled, and hauled
to the bam. One hundred and four of the older children helped
gather com.
Wheat—a winter crop in this section—is commonly sown broad­
cast, usually by a full-grown man, sometimes by the older boys, who
must be skilled and experienced in order to get the seed scattered
evenly. Wheat is sown in the autumn and harvested the next
summer. Cradling is the work of a grown man; the boys and girls
help in raking, binding, gathering, shocking, and hauling the wheat.
“ Grass,” or hay, is cut by the men and older boys; mowing
machines are occasionally used on “ bottom land,” but the oldfashioned scythe is necessary on the hillsides. Strength and mus­
cular force are required to swing the heavy blade. In making hay,
men and older boys rake the hay from the ground, toss it onto a
wagon or sled, and haul it to a comer of the field, where it is forked
off and built into one or more stacks, according to the size of 'the
crop. A boy doing this kind of work must have strength enough to
toss the hay onto the stack, and strength and height enough to handle
the fork.
Tobacco curing, in the mountains, far from being the elaborate
process found in eastern North Carolina, consists simply in hanging
the leaves out somewhere in the open air to dry, under a shed or on
the porch. When the leaves have been stripped from the stalk,
they are tied in bunches and suspended from a pole to dry, then done
up into twists by the children.
Making simp from sorghum cane utilizes the labor of every mem­
ber of the family. Eighty-seven children helped with the simp
making. The older boys help cut the cane and carry it over their
shoulders to the cane mill or load it on a sledge drawn by a steer,
and bring it down the hill. At the mill a child of 12 can feed the
cane between the revolving cylinders, which crush the cane and
Federal Reserve Bank of St. Louis



extract the Juice. A younger child often drives the horse, mule, or
steer which furnishes the power to run the mill. After the juice has
been extracted from the cane, it is strained once or twice through
cloth—“ a flour poke”—into a long deep vat, in which it boils for
from two to three hours. Women and older girls do the straining.
While it boils, the thick scum which continually rises must be kept
skimmed off, always the work of the older people; toward the end
one of the grown women of the family must be on hand to judge
when the proper consistency has been reached; after the sirup is
taken from the fire it is strained once more; here again the older
children help.
The mountain child also has a variety of chores about the house
and bam. The boys cut wood and bring it in, carry water to the
house, take water and dinners to the men in the field, drive the
cows, feed the stock, carry slops, run errands, and “ go to mill”
with com, while the girls help with the cooking and sewing; clean­
ing, milking, and churning; drying beans; drying, bleaching, and
canning fmit; and taking care of the chickens.
The boys’ share in getting in the wood lies in cutting it into lengths
with an ax or crosscut saw. Only a few days’ supply is made ready
at a time, and wood is cut all through midwinter in all kindp of
weather. It is hard, fatiguing work, and involves the danger of
injury with the saw or ax. Various odd jobs fall to the lot of the
older boys, such as clearing ground, cutting briers, chopping weeds,
and building fences; that is, simple rail fences, the common type in
the mountain country.
If a child is undeveloped, he is spared the usual chores and occa­
sional field work of the average country p-hfld.

After the crops are laid by, the older boys help their father in the
timberland, supplementing the scant family income by hauling to
town a few loads of bark or pins. In the spring when the sap rises
is the time for stripping the bark. After the tree has been cut down,
a steel wedge is slipped between the bark and trunk, forcing the bark
off in strips—the work of a grown man, sometimes done by a boy of
15 or 16 if large and well grown. The boy’s share of the work
usually is to pile the bark out of the way as it is stripped, for drying.
In late summer the boys help load it on the sled or wagon. Boys alsoassist in guiding the sled, drawn by a steer, down the mountain to the
wagon road; the bark is then ready to be loaded on the wagon and
hauled to town. Working with the bark requires considerable
strength and muscular force, and fatigue and muscular soreness
result from such heavy work. Thirty-six boys from 8 to 15 years
and two girls had helped peel bark and pile it out of the way.
Federal Reserve Bank of St. Louis


R U R A L C H IL D R E N .

Pins formerly were made of locust and brought a good price but,
owing to the scarcity of that wood, the industry is no longer profitable
and is reserved for odd times. Oak is now used. The tree, after
being felled, is sawed with a crosscut saw into 14 to 16 inch lengths;
a boy 10 years old can take one end of the saw, his father taking the
other. Twenty-five boys and two girls, from 10 to 15 years of age,
helped make pins. The actual making of the pins requires two
persons, one with an ax and wedge, the other with a maul—home­
made of tough, fine-grained hickory. The first worker dents the
timber with his ax, then inserts the wedge and holds it in place, while
the second deals the wedge a blow with the heavy maul, splitting the
timber. The boy usually holds the wedge while the-older man
wields the maul; occasionally they change about to “ spell” each
other. As a rule, only a rather well-grown boy over 12 would help
make pins, since he must have bodily strength and muscular power
sufficient to handle the heavy maul and crosscut saw.
Usually only older boys are sent to town with a load of bark or pins,
though two boys—11 and 13—have been making the 12-mile trip
alone for three years, driving a double team of horses, mules, or
steers. It is usually an all-day trip; the roads are bad, with deep
mud holes, bowlders, etc., and are so narrow that considerable maneu­
vering is necessary in order to pass another team. The boy must
have strength, muscular power, and size enough to hold back a double
team down the steep hills; also alertness, for the main roads to town
are traveled by cars as well as teams. The trip involves fatigue and
muscular and nervous strain. Bark is driven to the acid factory at
the county seat and unloaded by the driver; the factory buyer weighs
it and pays by the cord, standard prices, according to whether it is
chestnut oak, white oak, black oak, or hemlock. Pins are hauled
to the railroad and sell as a rule for $4 per 1,000.
Working hours.

Working hours on the mountain farm are irregular. So little land
is cultivated that farm work is not continuous; on some days a few
hours during the day, on others nothing but chores. During the
busy seasons all hands put in a full day’s work in the field; but these
seasons are concentrated into a few weeks—during spring and
autumn plowing, in the summer after wet weather, and at harvest
time. Although each family has its own custom, usually a workday
begins about 6 in the spring and summer, 7 or 8 in the autumn, and
ends at sundown, with an hour off for dinner. Some families prefer
to “ lie late” in the morning to avoid the heavy dew, and then work
until dark instead. The children of one family work from “ dawn to
dark” when not in school; they are up before “dawn, do the chores,
feed stock, gather fruit, carry slops, do the milking, then go to the
Federal Reserve Bank of St. Louis

N O R T H C A R O L IN A .


Wages when at work away from home.
As a rule, the children doing farm work, work only on the home
farm, helping their own family. A few of the older children, usually
over 12, also work out for wages, often for relatives, a day or two at a
tune and not more than two or three weeks during the season, when
work on their own crop permits. Some instances were found of
younger children working out. A 10-year-old boy hoed com about
10 days last summer, making 50 cents a day for a 10-hour day. A
boy of 11 hoed com for his uncle during the past two summers, five
or six days each summer, at 25 cents for the regulation 10-hour day.
Two boys of 8 and 10 hoed com and helped with the fodder at 25
cents per day. A boy of 11 plowed, hoed, helped with the hay, com,
and simp for a few days at 40 cents a day.

Social life in the mountains is extremely limited, in most neigh­
borhoods resolving itself into attendance' at “ preaching” once a
month, Sunday school “ rally,” and county fair once a year, and
visiting among the neighbors in the immediate vicinity.
Even church is often inaccessible and out of the question in rough
weather. A mother of a poor tenant family high up on a mountain
top laments that her children never get to Sunday school or “ preach­
ing” ^ on Sunday she reads the Bible to them and has the blessing,
and “ that’s the best I can do,” she said. Another mother takes her
children to church once a month and to Sunday school occasionally.
They have no way to go, however, unless they walk and it is “ much
too worrisome a trip with children.” A family, out of reach of
church in any direction, explained that they used to have preaching
over across the mountain, but not enough people went, so the preacher
refused to come any more.
Where the children can get to Sunday school their enjoyment of it
is intense. A little 10-year-old girl has kept all her Sunday school
cards from last year and this, and has them pasted on a piece of
cardboard and tacked up on the wall. The annual Sunday school
“ rally” is one of the few community gatherings to which all the
families take their children and their dinners, and spend Saturday
and Sunday at the church, singing and visiting and listening to the
‘circuit rider.” Elaborate preparations are made; hogs and beef
are butchered, chickens killed, all the best jellies and preserves are
brought out, and bread and cake baked in abundance for the picnic
dinner spread beneath the trees.
The schools, as has been said, are used very little for social pur­
poses. One school until last autumn had never had an entertainment
as far back as anyone could remember, another had planned for one
last year, but it rained. At a more enterprising school, however
Federal Reserve Bank of St. Louis


r u r a l c h i l d r e n -.

was found an interesting and flourishing literary society, so successful
that it is filling the schoolhouse at its Friday night meetings. At
one of the meetings, after several recitations by the younger children,
six of the older boys debated cleverly on “ Resolved, That Washington
deserves more credit for defending America than Columbus for
discovering it.”
Lack of organization, of community interests, and of “ teamwork”
have long been characteristic of the mountain people. Aside from
the few men who maintain membership and a lukewarm interest in
the Masons, Odd Fellows, or “ Juniors,” there are no clubs of any
sort in the neighborhoods visited. In less than one-tenth of the
families was there any member of the family belonging to a social
Books are seldom bought and, as a rule, only from traveling agents;
a very miscellaneous collection of reading matter is secured in this
way. Newspapers and magazines are rarely found in mountain
homes. Over half the families visited take no periodical of any sort.
The county paper is subscribed to most frequently : about one-fourth
of the familios were taking farm papers. Only 9 of the 231 families
visited had subscribed to any of the woman’s magazines.
One father would take a newspaper, but can not spare the time to
make the 11-mile round trip to the post office across the mountains^—
almost a day’s journey. A magazine, particularly if illustrated, is
treasured highly. A 14-year-old boy is “ so fond of reading that
when he has a book or paper he won’t go to bed until he has read it.”
The smaller children, as well as the older ones, are in need of means
for recreation. The play spirit is conspicuously absent. Toys are
uncommon; the few dolls of the neighborhood are too highly prized
for common use as playthings. A little crippled girl has two Christ­
mas dolls, still in the boxes in which they came two or three years
ago, tacked up against the wall.
The isolation of the mountain people, particularly the women and
children, their lack of intercourse with their neighbors, with the
townspeople, and with the outside world can not fail to impress the
visitor. Bad roads and lack of conveyances, together with scarcity
of telephones and absence of mail service close at hand, are largely
responsible for cutting off the family from outside communication.
The rural free delivery has not yet penetrated to the neighborhoods
visited. They have instead the “ star route” system by which the
mail carrier travels only the main roads between post offices. Fami­
lies living at a distance from the post office find it difficult to make
the journey for their mail with any regularity. One family, at the
end of a steep mountain trail, visited September 5, had not been to
the post office for mail since July.
Federal Reserve Bank of St. Louis

N O R T H C A R O L IN A .


Trips to town are infrequent. Town shopping for the whole fam­
ily is largely intrusted to the “ men folks,” and their many natural
blunders in selections of feminine apparel are accepted with stoical
fortitude. “ There’s no call for me to go to town,” said one woman.
In a probably typical family the father goes to town every week or
two, the mother once or twice a year, and the older children about as
often as the mother, though they “ are like their father and would go
every week if they had a chance.”
Often it is the difficulty of taking young children that keeps the
family so closely at home. A mother, who has not been to town for
three years, “ likes to go, but with such a crowd of children (seven)
she can’t figure how to take them all along.” A mother at the end of
a lonely trail has never been to town in her life; she has not been to
the country store—5 miles away—since her oldest girl (now 15) was
a baby, but “ aims to go next spring if she lives and nothing happens,
and do her own trading again.” A mother who leads a lonely life,
with her husband off on “ public works” and the children at school!
has never been to a fair or a show in her life and never gets away
from home at all except to her nearest neighbors, a quarter of a mile
down the mountain. A bad trail, merely a sledge road straight up
the mountain, leads to their cabin, the last of that cove; it is rarely
that anyone comes along that way. Another has never seen a rail­
way train in her life; she went to the county seat once with her hus­
band 15 years ago, the day after she was married—but the train
was late, and it was so cold that they could not wait and had to come
back to the mountains without seeing it. Her husband gets to town
two or three times a year. None of the children has ever gone
except the oldest, who went last year to “ show the doctor her ton­
Few families have a conveyance of any sort; aside from three sur­
reys in the neighborhoods visited, travel must be performed in a farm
wagon or, more commonly, afoot. Sometimes the wagon, loaded
with pins or bark, drawn by a pair of oxen, is accompanied to town
by various members of the family who, though walking, can easily
keep pace with the slow-moving oxen. One 'family that seldom leaves
the neighborhood had “ planned on going-” to the county fair thisyear, but could not get room in the neighbor’s wagon and owned no
Few of the families visited expressed any desire to move to town.
A mother of 13 children was proud of the fact that “ not one of my
children wants to go to town to live.” Of one man strongly averse
to town it was said “ the quickest he can get away is too long for him.” ,
Some of the mountain families visited had lived elsewhere and
returned to the mountains. A family consisting of father, mother,
and four children are all glad to get back from the mill village!
Federal Reserve Bank of St. Louis



The mother thought she could not endure spending her life there
where she had to put each child to work as soon as possible. She
had been so sorry for the country people who had sold out before
going to the mill and had no home to come back to. Another fam­
ily had tried the mills for three years but were glad to get back to
the mountains, “ where there is freedom and enough to eat and bum .”
In another family the children all liked the mill town better than
the mountains, and the family would have stayed there, but con­
tracted measles; one boy died, and the grandfather was ill for four
or five months. Another mother has no use for a cotton mill, “ you
bum up in there with no air; the children never got to sit down from
the time they went in in the morning till they came out at night,
11 hours.”
On the other hand, the hardships of the mountains have so im­
pressed themselves upon the lives of the people that some are anxious
to leave for the sake of the children, if not for themselves. A
mother in a lonely cabin on the mountain top does not like the
mountains, but “ a poor man can’t buy a river farm.” She “ wants
to move down lower because of schooling and preaching.”
Another woman on one of the best farms in the country, who was
herself reared in town, wishes to move back to town next year that
the children may be near good schools and get to church and Sunday
school and have the doctor at hand. Also, she misses the fresh meat
and the good things one can buy in town. One mother complains
that “ a body has to work mighty hard to five and hardly can live in
this country.” Another “ would rather live in a smoother place than
in this steep country, but not in a city; it’s too binding in” ; she
wants to “ make her own beans and roasting ears.”
One family is divided among itself; the father has no use for towns,
the mother would not five there unless she could have her garden and
chickens; she “ would rather five on a farm if she had a real farm,
but gets tired of these mountains where you can’t raise anything.”
The two oldest girls are not satisfied with the old cabin on the creek
and want to move to town, and the boys, too, “ want to go where they
can see more.”
Rural communities such as have been described in this mountain
county, where isolation and a lack of community spirit are charac­
teristic, are especially in need of such plans as the State superin­
tendent of public instruction and the executive secretary of the
State bureau of community service are developing in connection
with a recent act of the legislature to provide for the incorporation
of' rural communities.1
Federal Reserve Bank of St. Louis


Hie findings of these surveys of child care in a typical lowland
or cotton-raising county and in a typical mountain county of North
Carolina are significant not only for the counties studied, but also
for rural areas in many of the southern States.
The population of the areas studied is uniformly native-born
American of native parentage—in the lowland county about evenly
divided between the whites and negroes, and in the mountains ex­
clusively white. In the lowland county, farming is pursued largely
under a system of tenancy, two-fifths of the white and' three-fourths
of the negro farmers visited being tenants. Farm acreage is small;
about half the white and over four-fifths of the negro farms visited
are “ one-horse” farms; that is, worked with one horse or mule, and
with only approximtaely 25 acres in cultivation. Cotton is the
“ money crop” and is an expensive crop to produce. The small
tenant operates his farm under the heavy handicap of the crop
hen system.
In the mountain county, farming, on account of the topography of
the land, is attended with difficulties. Although nearly every man
considers himself a farmer, he farms on a small scale, with the
object of raising sufficient food for his family rather than producing
a crop for market. The average farm occupies some 50 to 100
acres with only 10 to 25 acres of improved land. The scant income
derived from farming must be supplemented by the sale of timber
products at the county seat, by mica mining, and by “ public works”
at the sawmill, kaolin mine, or lumber camp. Although there were
a few families of “ renters,” tenancy is not nearly so common as in
the cotton country, and the majority of families own their homes
and the land on which they five.
The children’s home environment in the lowland county families
visited varies widely according to the economic circumstances of the
family, the children of the landowners having more comfortable as
as well as more healthful surroundings than the tenant’s children.
Lack of sufficient house room at many tenant homes is perhaps the
most serious housing defect, resulting in overcrowding, particularly
of sleeping quarters. Sanitation is a serious problem; more than
half the homes of white families and four-fifths of the negro homes
Federal Reserve Bank of St. Louis



have no privy of any kind; at a number of homes, drinking water is
obtained from a dug well—obviously an unsafe source of supply,
particularly in a district where soil pollution is widespread.
The typical mountain home is picturesque rather than comfort­
able. Certain housing defects are common; notably lack of suffi­
cient house space, which results in overcrowding, especially of the
sleeping rooms; insufficient light, many of the older cabins having
no windows other than heavy wooden shutters, which, when closed,
leave the room quite dark; and the difficulty of heating loosely con­
structed cabins and rough board houses during the severe winter
weather. Sanitation is primitive. Nine families in 10 have no
toilet of any description. The spring, the common water supply,
is dangerously subject to pollution because of the absence of privies.
Both counties have a strikingly high maternal death rate from
causes pertaining to childbirth—in the lowland county, 41.5, and
in the mountain county, 21.9 per 100,000 population, as compared
with the rate, 15.2, for the entire area of death registration.1 In
the lowland county, though the rate for white women, 17.3, is some­
what higher than the rate for the death registration area, the high
total death rate is due to an alarmingly high rate, 93.9, among
negro women.
An urgent need for provision for maternity care was one of the
most important findings of the survey; facilities for guarding the
health and life of the mother at childbirth are totally inadequate in
the rural communities visited. In the lowland county, though twothirds of the white mothers were attended in childbirth by a phy­
sician, one-third of the white mothers and over nine-tenths of the
negro mothers had employed a negro midwife. A physician was
often out of the question for various reasons such as cost, distance,
scarcity of telephones, and bad roads during part of the year. I t
was evident from the testimony of the mothers that the midwife was
a precarious dependence when complications had arisen. Ample
facilities for hospital care are available at the county seat, from 4 to
14 miles distant, where two hospitals are located. This county has
also made an excellent beginning in public-health nursing, with a
nurse for white and one for negro women; their time, however, is
so largely occupied at the county seat and in the surrounding mill
villages that they are unable to render any appreciable amount of
nursing service in the rural districts of the county. Few of the
mothers visited had had any prenatal advice or attention. Nursing
care at confinement, except in a few families who had engaged a mid­
wife as nurse in addition to the doctor, consisted of the untrained
services of relatives and neighbors; none of the mothers had engaged
‘ Mortality Statistics, 1915, p. 59. U. S. Bureau of the Census, Washington, 1917. Sum of the rate»
there given for “puerperal fever” and “other puerperal affections.”
Federal Reserve Bank of St. Louis



a trained nurse, and only two a “ practical” nurse. The majority
of the mothers also failed to receive adequate supervision «luring
their convalescence after childbirth.
In the mountain county no physician is resident in any of the three
townships of the survey, and the families live from 4 to 25 miles from
the nearest doctor. There is no hospital within the county, the
nearest being located at the county seat of the adjacent county,
reached once a day by mail stage across the roughest of mountain
roads. There are no trained nurses in the county, and patients are
dependent upon the well-meaning but untrained services of relatives
and neighbors. Trained nursing in confinement was wholly lacking.
No one of the mothers visited had had the services of either a trained
or “ practical” nurse during confinement; some few had been nursed
by attending midwives; the others, by relatives, neighbors, or
friends. Prenatal care is practically nonexistent; more than threefourths of the mothers visited had had no advice or supervision
whatever during their pregnancy. Over half the mothers were
attended in confinement by a neighborhood midwife. Inability
to secure medical attention at childbirth had sometimes resulted
disastrously, according to the testimony of the mothers. Postnatal
visits are rarely made by the physician, but where a midwife lives
close by, which is often the case, it is customary for her to “ drop in ”
every day or so in passing.
The Children’s Bureau, in a publication on Maternal Mortality,1
suggests that the following plan is essential in order to secure ade­
quate medical and nursing care for mothers and babies in a rural
1. A rural nursing service, centering at the county seat, with nurses especially
equipped to discern the danger signs of pregnancy. The establishment of such a serv­
ice would undoubtedly be the most economical first step in creating the network of
agencies which will assure proper care for both normal and abnormal cases. In the
rural counties in the United States which already have established nurses, the growth
of this work will be watched with the greatest interest.
2. An accessible, county center for maternal and infant welfare at which mothers
may obtain simple information as to the proper care of themselves during pregnancy
as well as of their babies.
3. A county maternity hospital, or beds in a general hospital, for the proper care
of abnormal cases and for the care of normal cases when it is convenient for the women
to leave their homes for confinement. Such a hospital necessarily would be accessible
to all parts of the county.
4. Skilled attendance at confinement obtainable b y each woman in the county.

In the lowland county, the most immediate need in respect to
maternal care seems to be for the employment of a rural nurse for
the white and one for the negro women of the rural sections of the
1 Meigs, Dr. Grace L.: Maternal Mortality from all Conditions Connected with Childbirth in the United
States and Certain Other Countries, p. 27. U. S. Children’s Bureau Publication No. 19. Washington, 1917.
Federal Reserve Bank of St. Louis



county, which are now out of reach of the public-health nurses at the
county seat. Prenatal care and assistance at confinement, also
postnatal supervision and advice as to the care of the young baby,
would be important phases of the work of the rural nurse. In the
mountain county, a cottage hospital at the county seat would prove of
value to the mothers within a radius of a few miles; while roads con­
tinue to be as poor as at present, however, any facilities at the county
seat will be inaccessible to the greater part of the county’s rural
population. There is an obvious and immediate need for rural
nurses, to visit the mothers in their own homes. This county at
present, unlike the lowland county, has no public-health nurse. The
ways in which a nurse could be of help to mothers in this district
have been indicated.
Although even one public-health nurse in a county can accomplish
much along educational lines as to the proper maternity and infant
care and the care of the school child, on account of the territory to
be covered, one nurse alone obviously can not meet all the needs of
the rural mother and child. The ideal which has been attained in a
few counties is the division of the county into smaller districts with
a county nursing service and community nurses; in a small district
the nurse can do bedside nursing and nursing at the time of confine­
ment, as well as more general educational work. Methods of initia­
ting a rural nursing service on the county plan are described in a
recent publication of the Children’s Bureau 1 as follows:
In certain counties the work was established at first through private subscriptions;
enough money was raised in this way to support a nurse for a period of 6 to 12 months;
after the value of the work had been demonstrated the county authorities appropri­
ated m oney to continue it. This was in recognition of the fact that public-health
nursing is not a charity but is a measure for health protection to w hich all the people
of the comm unity have a right. In one county in a Middle Western State a federation
of women was formed w hich included all the organizations of women in the c o u n t y women’s clubs, ladies’ aid societies, and parent-teacher associations, as well as small
neighborhood groups of rural women. Largely through the efforts of this federation
a tax was levied b y referendum vote and a large sum of m oney provided for health
work. Two nurses are now em ployed b y this county.
In many counties the nursing service has been established through the employment
of a nurse for the rural schools, and this method has proved very successful. In other
counties the nurse has begun her work as a tuberculosis nurse; in others as an assistant
to the county health officer. Whatever the beginning of the work, the nurse soon
finds that the assistance w hich she can g ive to mothers in the care of them selves and
of their babies is one of its most important developm ents.
In planning a rural nursing service two things are essential:
1. E very effort should be made to get the right nurse. The nurse employed
should have had training in public-health or visiting nursing such as is giv en now in
many training courses, and should also have practical experience. Nurses who have
had hospital training only are not fitted to carry out public-health nursing successfully.
2. Ample provision must be made for transportation through th e county.i Moore, Elizabeth: Maternity and Infant Care in a R ural County in Kansas, pp. 49,50.
Bureau Publication No. 26. Washington, 1917.
Federal Reserve Bank of St. Louis

U. S. Children’s



The communities visited in the lowland county have a low rate of
infant mortality—48 per 1,000 live-bom white children, a loss of 1
child in 20, and 64 per 1,000 live-bom negro children, a loss of 1 child
in 16. The considerably higher death rate among negro infants, as
well as the previously mentioned higher maternal death rate among
negro mothers, indicates a need for further efforts directed toward
prenatal, maternal, and infant care for the negro population. The
mountain townships visited have a considerably higher—that is,
less favorable—rate of infant mortality than either of the rural sec­
tions so far studied by the Children’s Bureau. Of 1,107 children
bom alive at least one year before the agent’s visit, 89 had failed to
survive their first year—an infant mortality rate of 80.4, a loss of
1 child in. 13 as compared with a rate of 55 in a Kansas county
studied by the bureau,1 and 48 in the lowland county of this survey.
Even in the mountain county, however, the rate of; infant mortality
is low as compared with the rate in cities and towns.
In the mountain county, prematurity was the most important
cause of infant loss. One child in four that failed to survive its first
year had been prematurely born. Moreover, nearly half the infant
deaths had occurred within the first two weeks. This is additional
evidence of the urgency of prenatal care for the mother, additional
evidence also of the need for a rural nurse who as one of her duties
would advise the mother as to prenatal and infant care.
I t is significant that the comparatively low rate of infant mor­
tality of the rural communities visited, in both the lowland and the
mountain county, is coincident with universal breast feeding of
infants. In the lowland county, all the 78 white babies for whom
feeding histories were secured had been nursed during the first five
months; of the 86 negro babies, all were breast fed during their first
two months; in the mountain county, every one of the 115 babies
for whom feeding histories were secured had been nursed from birth
up to at least the ninth month of age. In both counties nursing is
usually continued well into the second year. In addition to breast
feeding, however, the babies are often indulged from an early age
in tastes of family diet.
The interest shown by the mothers in having their children ex­
amined at the children’s health conferences held by the Children’s
Bureau in the lowland county, suggests the desirability of a periodic
examination of infants with opportunities for informal advice to the
mothers as to infant care. Such examinations might be held by
physicians, with a public-health nurse in attendance, at accessible
centers scattered through the rural sections of the county. The
nurse might also establish her headquarters at these centers where
1 Maternity and Infant Care in a Rural County in Kansas, p. 41.

Federal Reserve Bank of St. Louis



she could be available for consultation with mothers who need her
advice and from which centers she would visit homes and schools of
that district.
The rural child is subject to the common diseases of the city child
and is handicapped by the lack of medical care in sickness. In the
absence of a physician within a reasonable distance, and of a county
nursing service, the mother is thrust upon her own resources in case
of sickness, and must rely largely upon home remedies. In the low­
land county, patent remedies, especially croup and cough “ cures,”
liniments, soothing and teething sirups, remedies for women’s diseases,
and for constipation have a widespread sale. A recent “ secret
remedies” bill recommended to the State legislature of 1917, by the
State board of health, failed of passage. In the mountain families,
and in some of the white and most of the negro families of the lowland
county, “ doctoring” with native herbs is customary. A periodic
physical examination of the school children, as proposed by the State
board of health, should be an important step in the checking of disease.
Family diet from the point of view of the growing child leaves much
to be desired ; it is probable that the heavy diet of the average family,
with an excess of fat and partly cooked starch, and a deficiency of
fruit and vegetables except during the summer months, together with
the custom of indulging children in promiscuous habits of eating, is a
factor in the indigestion which according tp the mothers is one of
their chief difficulties. Diet is more varied in the mountain than in
the lowland county, but is still scarcely adapted to the needs of thè
There is a very obvious need in these rural communities for in­
creased attention to educational opportunities for the children.
Under the terms of thè school law, attendance is compulsory for
children between 8 and 14 years for only four months of the school
term, but even this is practically unenforced. The school term is
short—commonly five months for white and four months for negro
schools—and this, together with irregular, spasmodic attendance
makes progress difficult. The rough roads, bad weather, and need
for help with the farm work are responsible for the irregular attend­
ance. Between the ages of 10 and 20, approximately 1 white child
out of 10 and 1 negro out of 3, in the lowland county, had not learned
even to read and write; in the mountain families,, this rate was ap­
proximately 1 out of 3.
In the lowland county communities, two of the white school dis­
tricts have voted the special school tax and have well-built, wellequipped schoolhouses. Three of the white schools, however, and
all the negro schools are one-room, one-teacher schools. School san­
itation is notably deficient. Only one of the five white schools has
one toilet for boys and one for girls; two have one for the girls only,
Federal Reserve Bank of St. Louis



while two of the white schools and all four negro schools have no
toilet facilities whatever. In the mountain townships visited, most
of the seven school districts have new buildings, painted and in good
repair; school equipment, however, is meager and antiquated. San­
itary conveniences are lacking. Only one of the seven schools is
provided with a privy for the girls, and the other schools have no
toilets whatever, a particularly dangerous condition since the spring
is the source of drinking water.
The children of the family performed a considerable share of the
farm labor on their home farms, working in the fields along with
their parents, helping to sow and harvest the crops, a number in the
mountains also helping in the timberland after the crops were laid
by. In the lowland-county communities, two-thirds of the white
children and three-fourths of the negro children 5 to 15 years old,
in addition to doing a variety of chores, helped in the fields, culti­
vating and harvesting the crops, particularly chopping and picking
cotton and hoeing corn. In the mountain country, farm work is
irregular, since little farming is done, and usually the busy seasons
with all hands putting in a full day's work are coricentrated into a
few weeks.
Although early training in habits of industry is desirable, and
though a reasonable amount of farm work would scarcely injure a
healthy child of sufficient size and strength, children’s work on the
farm, such as is described in this report, has certain objectionable
features, the most serious of which are the undue strain upon the
strength of the child, the interruption of his schooling, and, in the
lowland county, the ill effects upon his health of prolonged exposure
to the heat of the sun.
In the lowland-county township, opportunities for recreation and
social intercourse are more numerous than in many rural commu­
nities. School entertainments are given occasionally, and other
means of social diversion are popular, such as picnics, ice-cream sup­
pers, swimming parties, individual entertaining and visiting, and
Saturday trips to town. Clubs and lodges of various sorts are found.
Three-fourths of the white families subscribe regularly for some* sort
of publication, usually weekly rural editions of the county papers.
Migration from country to town is rare, and the average family is
satisfied with country life.
Negro families also have ample means of social intercourse. Church
is their common meeting place and frequent services are held. The
schools occasionally arrange an entertainment to raise money for
some needed article of equipment. Clubs and societies are common
among the adult negroes, and are usually organizations which pay a
benefit in case of sickness. Trips to town are infrequent, due to a
lack of mules and conveyances. The negro family also is genuinely
content with country fife.
Federal Reserve Bank of St. Louis



In the mountains facilities for recreation are extremely limited
and badly needed. Social intercourse consists largely of attending
“ preaching” once a month, county fair once a year, and an occasional
visit to the neighbors in the immediate vicinity. There is a marked
lack of community interests and of social Organizations of any sort.
Books, newspapers, or magazines are seldom found in mountain
homes. Few families have a conveyance of any sort, hence trips to
town are rare, especially for the women and children. Here, as in
the lowland county, few families expressed a desire to move to town.
Some, however, were eager to leave for the children’s sake—to be
more convenient to school, church, and doctor.

Federal Reserve Bank of St. Louis






Through an exceptionally effective, progressive-minded State
board of health, alive to the needs of the rural population, which
constitutes a large portion of the inhabitants of the State, much is
being accomplished along the lines of public health and sanitation.

With an original annual appropriation of $100 in 1877, the State
board of health soon made itself a necessary factor in the welfare of
the State. In 1909 the services of a full-time health officer were
secured. Since then public health work has developed into a wellorganized department with an executive office, State laboratory of
hygiene, State sanatorium and bureau of tuberculosis, and bureau
of engineering and education, vital statistics, rural sanitation, soil
pollution, and accounting. In 1916 the State ranked twentieth in
per capita expenditure for public-health work, $0,026, the expendi­
tures of the other States ranging from $0.0073 in Tennessee to
$0.1521 in Florida, according to compilations by Dr. Charles V.
Chapin, for the American Medical Association.1

The ‘‘model law” for birth registration went into effect in North
Carolina July 1 , 1913. Its enforcement has been particularly diffi­
cult in this State because of the rural character of the population,
and also because of the large proportion of births attended by mid­
wives. In June, 1916, registration of deaths was considered com­
plete enough to warrant the inclusion of North Carolina in the death
registration area of the Bureau of the Census. Recently (December,
1917), the inclusion of the State in the census area of birth registra­
tion marks the culmination of the effective efforts of the State board
of health toward improved statistics.
As a test of birth registration in the areas covered by the survey,
all births which had occurred in 1915 (found by house-to-house
visits during the course of the inquiry) were checked back to the
i Sixteenth Biennial Report of the N orth Carolina State Board of Health, 1915-1916, p. 17.

Federal Reserve Bank of St. Louis



c h il d r e n .

records at the county seat. Of the 61 births occurring in that year
in the township of the lowland county, 48, or 79 per cent, had been
registered. In one of the mountain townships, none of the 21 births
occurring in 1915 was registered; the registrar appointed for the
township had refused to serve and the office was allowed to remain
vacant during the entire year. Another mountain township had
registered 21 out of 23 births, and the third, a small, remote town­
ship 20 miles from the county seat, had registered every one of its
13 births.

To interest the general public in hygiene and sanitation, the board
of health has in constant use a portable motion-picture outfit suit­
able for work in rural districts, a series of illustrated stock lectures,
traveling exhibits, and an extensive press service. The motionpicture health films reach, among others, a large class of people who
read very little, and these films present to them in simple form the
principles of sanitation and disease prevention. The picture show
makes the rounds of rural schools in an automobile, which carries an
extra engine to run the lights and furnish power for the pictures.
A “ Charlie Chaplin” movie lends variety to the health films and a
victrola furnishes music during the changing of reels.
Outfits of lectures on health subjects, illustrated by a set of lantern
slides with a stereopticon lantern, are furnished free of charge to
Y. M. C. A. workers, teachers, preachers, and others interested in
public health. The traveling exhibit presents the more important
health problems by means of charts and models, usually accom­
panied by a demonstrator. The press service sends out to news­
papers of the State a daily article of from 200 to 300 words, pub­
lishes a monthly bulletin, and issues special pamphlets.
H O O K W O R M , T Y P H O ID , A N D

P E L L A G R A C A M P A IG N S .

In a five-year campaign ending May, 1915, the Rockefeller Sani­
tary Commission, now the International Health Commission, exam­
ined 267,999 citizens of the State for hookworm infection, and treated
95,618 infected citizens, also improving 1,796 privies.1
The State bureau of rural sanitation has reached 21 counties with
its typhoid vaccinations and given three complete vaccinations to
100,000 people, vaccinating an average of 4,761 persons in each
county—from 16 to 20 per cent of the population of the counties.2
A pellagra campaign in one county has been fruitful of lasting
results, convincing the public of the value of a more varied dietary.
1 Sixteenth Biennial Report of the North Carolina State Board of Health, 1915-1916, p. 61.
2 Sixteenth Biennial Report of the N orth Carolina State Board of Health, 1915-1916, p. 45.
Federal Reserve Bank of St. Louis




This work, which has for its object the control of diseases spread
through pollution of the soil, is a recent development and so far
has been conducted in only one county. The method followed, as
described in the annual report of the State board of health is “ to
visit each and every home in the county and demonstrate to the
people the ways in which this class of diseases is spread and to
interest them in providing sanitary privies as a preventive measure.
Also, an important part of the campaign is to examine and give
treatments for hookworm disease and vaccinations to prevent typhoid
fever.” 1


One of the most interesting features of the State board of health
program has been the development through the cooperation of the
State board of health and the State University of a home postgradu­
ate course in children’s diseases for the doctors of the State. The
fundamental principle consists in bringing the teacher to the class
instead of sending the class to the teacher. The plan was initiated
in 1916 in two counties. Two experts were obtained to bring a sixweeks’ course to 80 rural physicians, the expense of from $2,000 to
$2,500 being shared by them. The amount which each physician
paid was about $30, whereas, had he gone to any of the large hospital
centers for such a course the expense would have amounted to from
$300 to $400, including travel, lodging, and the loss of income during
absence. The course consisted of a lecture and clinic one day a
week in each of six towns of the counties selected. Physicians were
allowed to bring their own patients for consultation, and so urgent
was the demand for the clinics that they will doubtless be repeated
another year, the subject to be chosen by the subscribing physicians.2
P U B L IC -H E A L T H N U R S I N G .

The State sanatorium and bureau of tuberculosis of the State board
of health has been instrumental in securing a director of publichealth nursing for the State, in cooperation with the Metropolitan
Life Insurance Co., which pays one-half her salary and expenses.
The Metropolitan company has also cooperated in local nursing activi­
ties, awarding five scholarships in public-health nursing in the Uni­
versity of Cincinnati. In 1916 a three-days’ conference of the 35
public-health nurses of the State was held at the State sanatorium;
one result of this conference was a great stimulation throughout the
State of interest in public-health nursing. By February, 1918, there
were in North Carolina 65 public-health nurses 3 (more, it is reported,
1 Sixteenth Biennial Report of the North Carolina State Board of Health, 1915-1916, p. 46.
2 Sixteenth Biennial Report of the N orth Carolina State Board of Health, 1915-1916, p. 28.
3 The University of N orth Carolina News Letter, Vol. IV , No. 13, Feb. 20, 1918.
Federal Reserve Bank of St. Louis



than in any other southern State). They were supported by public^
funds, mill companies, women’s clubs, philanthropic groups, churches,
and lodges, aided by the Metropolitan Life Insurance Co. The de­
mand for public-health nurses is greater than the supply. To meet
this demand, the State board of health, in cooperation with the
University of North Carolina, is planning a training school for
public-health nurses.


A reeent act to prevent blindness in infancy,1 passed by the State
legislature of 1917, requires the registration of mid wives with the
State board of health “ in order that the prophylactic solution and
necessary instructions may be furnished them.” A penalty of from
$10 to $50 is prescribed for midwives failing to register. Although
this is an important step in the right direction, as yet no provision
has been made for an examination or supervision of midwives.


IN F A N C Y .

An act of the legislature of 19172 makes it “ unlawful for any
physician or midwife practicing midwifery in the State of North
Carolina to neglect or otherwise fail to instill or have instilled, im­
mediately upon its birth, in the eyes of the new-born babe two drops
of a solution prescribed or furnished by the North Carolina State
Board of Health.”

The reporting of infectious diseases to the State board of health
was made compulsory by an act of the legislature of 1917,3 which
also provides means for control and supervision of such diseases.
By the terms of this act, it is the “ duty of every physician to notify
the county quarantine officer of the name and address, including
the name of the school district, of any person living or residing,
permanently or temporarily, in the county about whom such physi­
cian is consulted professionally and whom he has reason to suspect
of being afflicted with whooping cough, measles, diphtheria, scarlet
fever, smallpox, infantile paralysis, typhoid fever, typhus fever,
Asiatic cholera, bubonic plague, yellow fever, or other diseases
declared by the North Carolina State Board of Health to be infectious
and contagious, within 24 hours after obtaining reasonable evidence
for believing that such person is suffering from one of the aforesaid
diseases.” In cases where the patient is unattended by a physician,
the duty of notifying the quarantine officer falls upon the parent,
guardian, or householder in the order named. I t is the duty of the
lActs of 1917. ch. 257. sec. 8.
Federal Reserve Bank of St. Louis

2 Acts

of 1917. ch. 257. sec. 3.

s Acts of 1917. ch. 263. sec. 7.



county quarantine officer to report cases of the above-mentioned
diseases to the State board of health within 24 hours after the disease
has been reported to him. The State board of health is empowered
to make such rules and regulations as may be necessary for the
supervision and control of these diseases. Persons willfully violating
the law or the rules and regulations adopted by the board of health
are guilty of a misdemeanor and subject to fine or imprisonment.

O F S C H O O L C H IL D R E N .

Considerable attention is now being directed to the care of the
rural school child. Many localities have developed a complete pro­
gram for supervision of the child’s health and physical development
during his years of schooling, with medical inspection of the children
periodically, and a school nurse who visits in the homes and sees to
it that the child receives the treatment which has been recommended.
I t has been proved that school medical inspection needs a school
nurse to make it effective.
In this State the board of health has developed a “ unit of school
inspection” which so far has been carried on in six counties. The
bureau of rural sanitation in the first 19 months of its existence
inspected 206 schools, examined 15,751 children, found 7,390—
almost half—to be physically defective in some respect and has
been instrumental in having 10 per cent treated.1 The value of this
plan lies chiefly in arousing local interest through demonstration; it
does not meet the need for permanent periodic examination of the
children or for a permanent school nurse. Recently a unique com­
pulsory State-wide plan has been devised by the board of health
and enacted into law by the legislature2 for the physical examination
of school children at a minimum of expense. The teachers them­
selves will make the examinations according to a manual of instruc­
tions prepared by the State board of health and State superintendent
of public instruction with the assistance of the United States Public
Health Service. A record of each examination will be made on
cards provided by the State board of health and transmitted to a
physician in each county designated by the State board of health,
who will notify the parent or guardian of any child with serious
physical defects as defined by the State board of health to bring the
child before him for a thorough physical examination.
According to the law it is compulsory for a parent so notified to
bring his child before the physician. The physician will be compen­
sated by the county commissioners for the examinations. Parents
are then notified of any defect discovered and advised as to the
treatment which the child should receive. Arrangements will be
i Sixteenth Biennial Report of the North Carolina State Board of Health, 1915-1916, pp. 45, 46.
* Acts of 1917. ch. 244.
Federal Reserve Bank of St. Louis



made by the State board of health and State superintendent of public
instruction with physicians and dentists of the county to treat school
patients at a reduced cost, 20 per cent of which may be paid by the
State board of health, provided the county commissioners will pay
20 per cent. This leaves only 60 per cent of the cost to be borne by
the parents, besides securing for them a reduced rate for their chil­
dren’s treatment. The law provides that every school child shall be
examined at least once every three years, and that the work shall
be so planned by the State board of health and State superintendent
of pub he instruction as to cover the entire State once in every three
“ C O U N T Y U N I T S .”

Much of the work of the State board of health is carried on by State
board of health agents in each county under the “ county u n it”
system, by which the State and county share the expense of educa­
tional health work. Under, this system school inspection “ units”
have been conducted, and typhoid, hookworm, pellagra, etc., have
been dealt with.
Recently the State board of health, in cooperation with the Inter­
national Health Board of the Rockefeller Foundation, has contracted
with 10 counties of the Statò for a three-year program of health work
in those counties. The program agreed upon is to consist, in each
county, of units devoted to soil pollution, quarantine and disin­
fection, school inspection, life extension, and infant hygiene all under
the direction of a full-time health officer, and at an average yearly
cost to the county of between $3,000 and $4,500. Definite contracts
have been agreed upon and signed by the State board of health and
representatives of the cooperating counties.
Public-health activities have reached a high degree of development
in this State and are carefully and efficiently organized under the
State board of health. The next step might well be the organization
of a division of child hygiene; no doubt this important feature of the
health program will be developed shortly by this State just as it has
become an important part of the State boards of health in New York,
Kansas, New Jersey, Ohio, and Montana. Such a bureau correlates
the various health problems of childhood, such as the reduction of
infant mortality, prenatal and infant care, medical inspection of
schools, health of children in State institutions, and activities of
children’s conferences and clinics.

Under the joint leadership of the State and Federal Departments
of Agriculture, according to the terms of the Smith-Lever Act,1
various organizations throughout the State are stimulating an interest
in higher standards of farming and farm life.
i 38 U. S. S tat. L
Federal Reserve Bank of St. Louis

P t. I, p. 372 (act of May 8. 1914).





Ninety-six counties of the State, including the lowland county at
the time of this survey and the mountain county recently, have a
county agent who by demonstration and other methods interests the
farmers of his county along the lines of improved methods of agri­
culture, farm management, marketing, purchase of supplies, and so
Home demonstration agents to interest farm women in modern
household economics are present in 58 counties, including the lowland
county of the survey.

G IR L S ’ C L U B S .

Clubs, open to boys and girls between the ages of 10 and 18, are
proving an effective means of reaching the rural community through
the child. These clubs are supervised by State agents, assisted by
county agents, usually cooperating with school officials and rural
Boys’ com clubs were the first organization of this type. The
com-club boys raise an acre of com, usually on their fathers’ farms,
and prizes are offered for the most successful corn-club member—based on the largest production at the lowest cost, with the best
exhibit of 10 ears and the best essay on the year’s work.
Boys’ pig clubs are arousing interest in pork production, and are
teaching the boys profitable methods of feeding, the value of the best
breeds, and the home production of meat for the family.
Boys’ and girls’ poultry clubs are demonstrating poultry raising,
handling, and marketing, the value of uniform product of high class
for cooperative marketing, better care of poultry and eggs, and the
increased revenue derived from better breeding and management.
Girls’ canning-club work has developed into one of the most impor­
tant features of the State relations service. The girls plant and culti­
vate a garden of a tenth of an acre, and can the products for home and
market. Prizes are awarded on the basis of the quality and quantity
of the canned product, the profit shown by cost accounting, and a
written account of how the crop was made.
F A R M E R S ’ I N S T IT U T E S .

Farmers’ institutes with lectures and demonstrations by experts,
for both farmers and farm women, had been held in many counties
during 1916, including the lowland county of this study.
This lowland county has been well organized for rural progress,
with its county agent and home demonstration agent; its well-estab­
lished corn, pig, poultry, and canning clubs for the boys and girls; a
flourishing and stimulating county fair with an infant-welfare sec­
tion; and, for some years past, sessions of the farmers’ institutes.
Federal Reserve Bank of St. Louis



The mountain county, on the other hand, at the time of the survey
showed a total lack of community organization of agricultural activi­
ties—no county agent, no demonstration agent, no boys’ and girls’
clubs, no farmers’ institutes throughout the county. The county
fair is the only stimulus to improved farming and farm life, and even at
the county fair the exhibit of farm products is meager and almost over­
shadowed by the cheap commercial amusements offered. The recent
employment of a county agent is an important beginning toward an
improved agricultural program for the county.


Ample facilities for extending credits to the farmer, thus combating
the u crop-lien” and high-interest evils, have been organized and a
variety of systems, State and Federal, devised by which the farmer
can borrow money for land purchase or improvement.
The Federal farm loan act,1which affords an opportunity to secure
long-time credit (from 5 to 40 years) at a rate of interest not to exceed
6 per cent, should not only help the farmer to secure capital, but,
because the money will be borrowed through a local farm-loan asso­
ciation, should also stimulate cooperative enterprise.
The McRae rural credits bill,2 passed by the 1915 legislature, pro­
vides for the organization of credit unions for short-time credit under
the supervision of the State board of agriculture. Loans by the
credit unions under this law can be made to members for the purpose
of raising crops only and are loaned upon the name of the farmer.
The rate of interest is limited to 6 per cent. In the autumn of 1917
there were 14 rural credit unions in the State—more, it is said, than
in any other State.
C O U N T Y F A IR S .

The majority of the counties of the State, including the two coun­
ties visited, held county fairs in 1916. The county fair has won an
assured place for itself in the activities for rural progress, affording
as it does an opportunity for the farmer to compare his results with
the best achievements of the county, and with the produce of his
neighbors who face the same problems and surmount the same ob­
stacles that he must reckon with. Farm women also benefit by ex­
hibits of household products—jellies, jams, preserved fruits and vege­
tables, cakes, bread, needlework, and knitting.
In this State, as elsewhere, the county fair has also been found an
excellent opportunity for presenting to the mothers the newer ideals
in child care and giving them the advantage of expert advice as to the
physical development of their children. A number of counties have
1 Farm Loan Act, act of July 17,1916. 39 U. S. S tat. L., p. 360.
2 Acts of 1916, ch. 115.
Federal Reserve Bank of St. Louis



Introduced baby conferences of various types as a feature of the fair
with a growing tendency to abolish, or at least to minimize, the com1 petitive element, which was a prominent feature of the earlier baby
contests. The babies are weighed and measured by competent
physicians who point out defects to the mothers and give them con­
structive suggestions for improving the child’s general health. Free
literature on infant care is frequently distributed. Baby “ shows”
of various sorts were held in connection with county fairs in a number
of counties, including the lowland county of this survey, which has
had one for three years. The mountain county would, no doubt,
also find the mothers interested in the introduction of such a feature.

The activities of the State bureau of community service have been
of especial significance to the rural districts of the State. Under
the leadership of this bureau, a number of rural neighborhoods have
been organized into “ Community Service Leagues,” with committees
on education, farm progress, cooperative marketing, health organiza­
tion and social life, and an executive committee which in consulta­
tion with the State bureau determines upon the line of work for each
year and the special problems upon which attention is to be con­
Two important acts of the 1917 session of the legislature gave a
decided impetus to the movement for community organization.
An article in the Community Center for September, 1917, comments
on one of these acts as follows*
B y this act [an “ act to provide for the incorporation of rural com m unities,” 1917,
ch. 128], the people of each rural neighborhood—a common school district or uniting
group of districts—* * * may secure the powers and advantages of incorporation
usually reserved for cities and villages—the right to enact ordinances [through a legallyprovided-for comm unity assembly] and assure common contribution to pay for com­
m unity improvements through the levyin g of taxes; th ey may nominate for the
Governor’s appointment a comm unity judge or magistrate; and * * * may,
through their duly chosen execu tive committee of “ directors,” take any and all
necessary steps looking to a system o f" * * * cooperative comm unity marketing.
A committee appointed b y a conference which was called by Governor B ickett to
prepare a statem ent concerning the purpose of this law concludes its report with
these words:
“ It w ill make the school and the schoolhouse the center and rallying point for all
activities, agencies, and plans for the improvement of community life and the advance­
ment of comm unity progress and prosperity.
“ It is applied democracy, and in accordance w ith the traditions and genius of our
race. * * *
. “ In short, it makes progress legal and binding when favored by a majority of the
community instead of its being probably only an ineffectual, effervescent masssentim ent.”
Federal Reserve Bank of St. Louis



Through an “ act to improve the social and educational conditions
of rural communities” 1 it is the duty of the State superintendent of
public instruction “ to provide for a series of rural entertainments,
varying in number and cost and consisting of moving pictures
selected for their entertaining and educational value, which enter­
tainments may be given in the rural schoolhouses of the State as
herein provided.”

An interesting organization of the State university—the North
Carolina Club—is composed of university students and faculty mem­
bers, “ bent on accurate, intimate acquaintance with the Mother
State.” The society has entered upon its third year of study of
economic and social problems in North Carolina, “ her resources,
advantages, opportunities, and achievements; the production and
retention of wealth and the conversion of wealth into welfare and
well-being; market and-credits; organization and cooperative enter­
prise; schools and colleges, churches and Sunday schools; public
health and sanitation; problems of urban and rural life; * * *.” 2
Affiliated with the North Carolina Club are various county clubs of
students, exploring the economic and social problems of their home
counties. Nearly 70 “ home-county” studies have been made by
these clubs and prepared for publication in the home papers. In
some instances the county officials are preparing to issue these
county studies in pamphlet form for textbook use by students in
the high schools, by teachers in the county institutes, and so forth.
The subjects covered in the study of each county are as follows:
(1) The Historical Background, (2) Timber Resources, (3) Mineral Resources, (4)
Water-Power Resources, (5) Industries and Opportunities, (6) Facts About the Folks,
(7) Facts About Wealth and Taxation, (8) Facts About the Schools, (9) Facts About
Farm Conditions, (10) Facts About Farm Practices, (11) Facts About Food and Feed
Production, (12) The Local Market Problem, (13) Where the County Leads, (14)
Where the County Lags, and (15) The Way Out.2

Such a searching study of the home State must prove of great
value in the development of a trained and intelligent leadership
which is one of the most essential factors in the progress of any State.

Up to September 1, 1917, when the Federal child labor law went
into effect, the employment of children was regulated only by the
State law, which is meager and ineffective. The State labor law
permits the employment of children 12 years of age or over in manu1 Acts of 1917, ch. 186.
2 University of N orth Carolina Record, No. 140, pp. 7, 8.
2 The Federal child laoor law was in effect at the time of the study, h ut it has since been declared uncon­
stitutional by a decision of the Supreme Court of the U nited States (June 3,1918).
Federal Reserve Bank of St. Louis



facturing establishments, providing that no child between the ages
of 12 and 13 shall be employed except in an apprenticeship capac1 ity, and then only after having attended school 4 months in the
preceding 12 months.1 The State law also prohibits night work in
any mill, factory, or manufacturing establishment—that is, between
the hours of 9 p. m. and 6 a. m.—for children under 16 years of age.2
By the passage of the Federal child labor act,3 in effect September
1, 1917, the age at which children are permitted to work in manu­
facturing establishments, mills, factories, workshops, or canneries
shipping in interstate or foreign commerce is fixed at 14 years, with
the added provision that no child under 16 shall work more than 8
hours a day, 6 days a week, or between 7 p. m. and 6 a. m., in such
Prohibition of employment in agricultural pursuits is not specified
in either the State or Federal law.

The school law of North Carolina makes definite provision for its
enforcement; under the general supervision of the State superintend-,
ent of public instruction it charges the county board of education
with the appointment of attendance officers, one to each township,4
and provides that the county board, together with the county super­
intendent, may make rules governing school attendance.5 Yet, as a
matter of fact, in the counties of the survey at least, the law is very
poorly enforced, due largely no doubt to a discouraging indifference
on the part of the public, and to the lack of a system of special tru­
ancy officers. According to the census figures, North Carolina’s rank
in school attendance, as compared with the other States, is thirtythird.8 In view of the fact that on account of the Federal child
labor law-7many children under 14 are released from the mills, a rigid
enforcement of the compulsory-attendance law would seem particu­
larly desirable.




The State juvenile court law 8 embodies the modern conception of
the delinquent child as a ward of the State in need of guidance rather
than as an offender to whom punishment should be meted. The
1 Pells Revisal of 1908, Supplem ent 1913, ch. 45 a , sec. 1981 b.
P. R ., 1908, Supp. 1913, ch. 45 A, sec. 1981 ee (2).
s 39 U. S. S tat. L., p. 675 (act of Sept. 1,1916).
* P. R ., 1908, Supp. 1913, secs. 4092a (5) to 4092a (6), as amended by 1917, ch. 208, sec. 2.
s P. R ., 1908, Supp. 1913, sec. 4092a (11), as amended by 1917, ch. 208, sec. 1.
e Thirteenth Census of the United States, 1910. Vol. I, pp. 1118-1127.
- i The Federal child labor law was in effect at the tim e of the study, b ut it has since .been declared un­
constitutional by a decision of the Supreme Court of the United States (June 3,1918).
8 Acts of 1915. ch. 222.
Federal Reserve Bank of St. Louis



modern principle of probation is an important feature of the l a w permitting the court to suspend sentence and place the child on pro­
bation for a specified period. The court has jurisdiction over adults
contributing to the child’s delinquency, juvenile offenders are tried
before the county courts, and the-law directs the court to hold
separate trials for children as far as practicable. No child 14 years
of age or under can be committed by the courts to any jail or prison
inclosure where the child will be the companion of older and more
hardened criminals, except where the charge is for a capital or other
felony, or where the child is a known incorrigible or habitual offender;
the child may be placed in a detention home or in the temporary
custody of a responsible person pending the disposal of his case by
the court.
Although most of the essentials of good juvenile court legislation
are included in the law, it is lacking in certain respects: Separate
sessions of the court for the trial of juvenile offenders are not oblig­
atory; children 14 years or younger, if known as “ incorrigible” or
“ habitual offenders,” may be confined in jail or prison, where they
are subject to the contaminating influences of adult offenders; and
the probation system, except in a few of the larger cities which main­
tain paid probation officers, is dependent upon volunteer service.
The Stonewall Jackson Training School near Concord provides
institutional restrictions and training for a limited number of delin­
quent boys—97 were enrolled at the time of this study—but, accord­
ing to the annual report for 1916 of the board of public charities, it is
handicapped by insufficient equipment and needs to be materially
The 1917 legislature has provided for the issuing of bonds to erect
an institution for delinquent girls,1 which has been a most vital and
urgent need. At the time of the study, throughout the State, no
separate institution was available for this class of offenders. When
the judge of a North Carolina court pronounces a girl, however
young, guilty of a crime, he has no alternative but to place her in
the State penitentiary. In 1916 alone there were received at the
State prison, with no provisions at that time for a separation of
young from older prisoners, 48 children under 20, 8 from 10 to 15,
and 40 from 15 to 20 years of age.2 Recent legislation3 for the pur­
pose of regulating the “treatment, handling, and work of prisoners”
provides that “ the races shall be kept separate, and youthful con­
victs from old and hardened criminals in sleeping quarters.”
1 Acts of 1917, chs. 265,265.
2 Annual Report of the Board of Public Charities of N orth Carolina, 1916, p. 30.
2 Acts of 1917. ch. 286. sec. 24.
Federal Reserve Bank of St. Louis



C H IL D R E N .1

A State school for the feeble-minded, the Caswell Training School
^ at Kinston, affords facilities for institutional care and industrial
training for 200 children, and had an enrollment of 181 on November
30, 1916.2 Fifteen children, reported feeble-minded, were inmates
of county almshouses 3—obviously unsuitable institutions for their
care, since they are unequipped for the special treatment and training
necessary for the mentally defective. No suitable State provision
has been made for feeble-minded negro children, who are committed
to the county almshouses.
Seventeen children under 16—both boys and girls—were patients
at the epileptic colony of the State hospital for the insane at Raleigh.4
The North Carolina school for the white deaf, located at Morganton, had a capacity of 300 and an enrollment of 281.5 State schools
for the blind—white and negro—at Raleigh had an enrollment of 286
white boys and girls and 69 negroes.6 The negro school also has the
care of 105 deaf negro children.
Along with a plea for an industrial school for delinquent girls and for
an increase in the capacity of the Jackson Training School for Boys,
the board of public charities in its report for 1913 mentions the need
for a hospital for crippled children also—a hospital school where 1‘the
children are taught during the months when under treatment. * * *
Many States have opened such institutions, and the wonderful cures
have demonstrated that they are eminently worth while.” 7 The first
step toward an orthopedic hospital was taken by the legislature of
1917,8 which appropriated $20,000 for this purpose, provided the
amount can be duplicated from sources other than the State. A com­
mittee appointed by the governor has selected a site at Gastonia and
is empowered to proceed when the necessary funds shall have been


C H IL D R E N .

The State orphanage for white children at Oxford has an enroll­
ment vof 375, and the orphanage for colored children, also at Oxford,
155.9 Several private orphanges scattered throughout the State are
caring for 1,690 children; also a children’s home society at Greens­
boro, the only child-placing society in the State, has under its superi The figures given in this section are as of Nov. 30,1916.
a Annual Report of the Board of Public Charities of N orth Carolina, 1916, p. 22.
* Ibid., p. 74.
4 Ibid., p. 19.
* Ibid., p. 26.
* Ibid., pp. 24, 25.
7 Ibid., p. 7.
s Acts of 1917, ch. 199.
9 Annual Report of the Board of Public Charities of N orth Carolina, 1916, pp. 31,33.

63721°---- 18------ 8
Federal Reserve Bank of St. Louis



vision 442 children who have been placed in private homes.1 A num­
ber of dependent children, 37 in 1916, were cared for temporarily in
the county homes or “ almshouses” 2 designed for adults, totally un­
fitted, according to modern standards, for the special problems of
child care. The board of public charities urges the county commis­
sioners to provide otherwise for the children as soon as possible.


P U B L IC W E L F A R E .

Since March, 1917, a new “ State Board of Charities and Public
Welfare,” taking the place of the old “ Board of Public Charities,”
has been given the duty to “ study and promote the welfare of the
dependent and delinquent child and to provide either directly or
through a bureau of the board for the placing and supervision of de­
pendent, delinquent, and defective children,” and to “ inspect and
make report on private orphanages^ institutions, and persons receiv­
ing or placing children.” 3 This board hopes eventually to organize
county boards of public welfare throughout the State, with a locally
paid county commissioner of public welfare in every county.
1 Annual Report of the Board of Public Charities of N orth Carolina, 1916, p. 38.
* Ibid., p. 74.
* Acts of 1917. ch. 170.
Federal Reserve Bank of St. Louis

[Page l .|


S. No. ' B .C . No.

[Page 2.1
D .C .N o.

1 2








BABY—1. M. F . 2. L. I. 3. L. B., S. B. 4. A t one year:
Alive, Dead. 5. Date of b ir th ........... 6. Date of d e a th ...........
7. Feeding:


23. Mother’s oc­ Industries E x­ Ages.

8 9 10 11 12

(a) Breast only...........
(b) Breast and other..
FA T H E R —24.

E .O .


a. Specify (b) and (c).................................................................
MOTHER—8. Marriage ages............ duration............. years.
25. Illness.

9. Pregnancies.

death 26. Physical history of children.

10. Before conf.: Saw pby’n, mwf., how often— Ur. exam,


19. Usual du­ Ceased. Re­

ib) Cleaning.
(c) W ashing..
(d) Iro n in g ...
(e) Bulk family sewing.

Usual duties.





Distance from phy’n .............
From telephone.....................
Distance from school...........
Education of living children

Reason for leav­

(i) Garden.......
(j) F a rm .........



c8 J q



Y.N. Y.N.
Y.N. Y.N.

Federal Reserve Bank of St. Louis

Read and


27. Home remedies.

Can read


how often__
After: No. visits__ 12. Drops in baby’s eyes......................
Cord, how dressed..... ..................................................................
Instruction in inf. care................................................................
Nursing care in conf.: (a) K in d .................................................
(b) D u ratio n ............ 16. How long in bed .......................
Usual help w ith housework........................................... .......v. . E x tra help in confinement.........................................................

Ages at school.

Period. Cause of death

1Total m onths’
[ Grade com­
! Can read and

Moth­ Child’s A t’d’t
er’s present

N a tiv e

No. Sex.


[¡Page 3.]
These col­
umns are
reser v e d
for office


Children’s farm work—by seasons.


Children’s other work.



E xtent


Ages Hours Wages

HOME—35. No. acres— No. im proved— 36. Rental $__ per___Own, free (value $ ...
per — ) Worked on shares: Y . N. % ....................................................
37. Mortgage $ . . . . R ate of in t___ 38. Crops and stock..................! . . . ! ! ! ” .................
39. E quipm ent...................................... -............................
40. Persons: Fam ily— Others__ T otal___ Specify o th e rs.!!!!!!!!..........................................
41. No. roo m s....N o . used for sleeping....... Baby sleep alone: Y. N. w ith ........adults___
children 42. House screened Y. N .............................................................................
43. Water: dg. w .,d r. w .,cist.,sprg. Distance from house, siope, up, down from house; up,
down from privy.'. Casing..................................................................................................._'
44. Toilet: none, privy, specify....... ' Slope, up, down from house. Condition.......................
45. How often cleaned.. . . . Disposal.......................................................................
‘46. Garbage: B um , bury, fed stock....... 47. R ubbish...................! !! !!!!!!!!!!!!!!!!!!!!!!!
48. Manure.
Sketch of premises.
49. General description of house and


0 25


'j 'F t
Symbols: D=dwelling. P = p riv y . W =well.
Sp=spring. St.=stable. H p= hogpen.

[Page 4.]
Home economics: [Diet and clothing; income—(cash and other); indebtedness, other than mortgage;
store credits and methods of purchasing; expenditures for stock and farm equipm ent; for hired help;
method of crop disposal; distance from m arket, etc.]


Social life, recreation, use of leisure tim e, etc.:
Distance from nearest town.
R .F .D . Y .N .
Publications taken.
TGive for each member of family: Membership in farm or civic association, club, lodge, grange, etc.; a t­
tendance at Farm ers’ Institutes; frequency of visits to town, participation in social events, etc.; also atti­
tude toward farm life, desire to go to mill town or city, etc.]


Federal Reserve Bank of St. Louis


Date of visit.



bureau .

1. Name and a d d re ss.............. ........................... ....................... 2. Col., w h ite ........................
3. No. births attended in 1915......... No. w ith M. D ............ 4. P atients wh., col., b o t h .........................
Services during confinement : 5. How is patient p rep ared ....................................................................
6. How does midwife prepare herself.....................................................................................................
7. Antiseptics u s e d ............................................................................................................................
No. exams, usually made during labor — 9. 2d and 3d stages of labor, how treated ..............................
Treatm ent of c o r d ................................................ of infected c o r d ..................................................................
No. cases infected c o rd ............................................ ; of umbilical h e rn ia .......................................................
Treatment of baby’s eyes........................................ 13. No. cases of infected e y e s................................
Remains how long after b i r t h ............................ No. calls after . . . . Patient discharged w h e n ...........
W hat exafn. m ade previous to discharge........................., ....................................... .............................
15. W hat advice given on infant c a r e .......................................................... *.............................................
_ 16. W hat services performed other than obstetrical: Nursing, Y. N. Housework, Y. N.
A bnormal cases: 17. No. treated in 1915 . . . . No. lacerations__ No. repaired by mwf............. .
Other abnormal cases: Specify...............................................................................................................
18. Use of in stru m en ts.................................................. ; of anaesthetics.......................................................
19. Bag: E quipm ent and co n dition......................................................................................................
20. Under what circumstances does mwf. call phy n ..............................................................................
Names of phyns. c a lle d .........................................................................................................................
21. No. s tillb irth s......... No. infant d e a th s ......... C auses..................................................................
22. Mothers’ deaths: No............ Causes................................................ .....................................................
N o. cases of childbed fe v e r.......................................... .......................................................................
Services during pregnancy : 23. Sees patient how often, and in w hat mos...........................................
24. Does mwf. as a rule m ake phys. exam.: Y. N. Specify no. and k i n d .......................................................
Urine exam.: Y. N. and in what mos......................................................... .................................
25. Prenatal care: Advice given m o th ers......................................................... ......... ..................w _


T raining of midwife : 26. W h e re .............. 27. Name school or ph y n .......... v. . 28. Diploma: Y. N.
Mos. a tte n d e d ......... 30. Lectures per w e e k ......... 31. No. births attended during train in g ..............
Genl. ed u catio n....................... .......................................................................... Can read and write: Y. N.
Yrs. practiced: T o ta l......... ; in township s tu d ie d .................... 34. Usual charge for conf. $..................
Does she register births: Y. N. How long a f te r .................................................| ....................
License No...................
Condition of house
....... .................................... ; of person .......................................... ;
Approximate a g e ......................
E n ter notes and rem ark s...................................................... .............

Federal Reserve Bank of St. Louis

C h il d r e n ’s B u r e a u .
W a s h in g t o n .


Name of school.................... ...................
Graded or ungraded................................
Teachers, num ber.......................... .......
Enrollm ent, to ta l....................................

2. W hite or negro......... , .......................... 3. T e rm ..................
5. Highest class............................................................................ .
7. Salary................................................- ...................‘......................
B o y s .......................................................... G irls...................... .






School building:
M aterial....................................... 13. Finished, outside ............ in s id e .............. 14. No. ro o m s..........
Blinds or shutters a t w indow s.............................. 16. Method of heating ................................................
Provison for coats, e t c ............................................. 18. General condition...............- ...............................
E q u ip m e n t..................... ..................................... | ........................... ...................................- ............- .............
Num ber of toilets, for b o y s..................girls ..................... 21. Distance a p a r t .........................................
Drinking water, Dg. W., Dr. W ., S p ................... 23. Drinking cup, individual, com m on ..................
Any attem pt to beautify grounds w ith flowers, shrubbery, or tre e s ...........................................................
Playground, Yes, No.
School activities:
L ib ra ry .......................................... .....................
27. School clubs (Audubon Soc., e tc .) .....................
A th letics..................... .................................................................................. — .................................................
Industrial w o rk ............................................................................................ .......................................................
County commencement, No. atte n d in g ................ 31. E xhibits and prizes............................................ .

32. School entertainm ents . ......................................................................................................................................
The school and the community:
33. Community gatherings held a t the school, meetings of Community Club, Farm ers’ Institutes, etc.

34. Money raised privately or by school entertainm ents last year and how used..............
35. No. of visits to p a re n ts............................................
Federal Reserve Bank of St. Louis

36. No. parents who visit school