ANALYSIS OF INFANT MORTALITY, MONTCLAIR, 1912. Although the group of babies found in a city the size of Montclair is necessarily small, and there are manifest limitations to an analysis of the information concerning the 402 births and 34 infant deaths included in the Montclair inquiry, it is interesting to find that the data collected in this study agree in general with the findings of the more comprehensive inquiries into infant mortality which have been made in this and foreign countries.

INFANT MORTALITY RATE.

The results of the study in Montclair show that of the 402 babies included in the investigation 34 died before they were 1 year old, giving an infant mortality rate for this selected group of 1912 babies of 84.6 per 1,000 live births. This rate is slightly less than the rate (89) for the same year computed according to the usual method 1 and published in the board of health report for that year. The average rate for the five years from 1909 to 1913, computed according to the usual method, was 84.8, which was but slightly lower than the rate (89) for 1912. In 1913 the rate dropped to 64.

Because of this country's inadequate system of birth registration it is impossible to show the infant mortality of any one city as compared with that of other cities throughout the United States. The following table, however, shows the infant mortality rates for 1912 in cities of approximately the size of Montclair (i. e., 20,000 to 30,000 population) within the so-called area of birth registration: 2

Live births, deaths under 1 year, and infant mortality rate in 1912 for cities and towns of 20,000 to 30,000 population (1910) within the area of birth registration.

1 For explanation of usual method of computing infant mortality rate, see page 8.

3 From State report.

Gloucester..

Medford..

Waltham...

Brookline..

2 Comprising the New England States, Pennsylvania, and Michigan, New York City, and Washing

ton, D. C.

476

551

634 418

142.9

133.1

113.8

171.5

177

113. 1

109.2

99.8

86.8

55

Live births, deaths under 1 year, and infant mortality rate in 1912 for cities and towns of 20,000 to 30,000 population (1910) within the area of birth registration—Continued.

1 Figures for Rhode Island and Pennsylvania by correspondence, as State reports not yet available.

The census report on mortality statistics for 1911 gives the estimated infant mortality rate for the birth registration area of the United States for 1910 as 124. This estimated rate may be compared with the rates for foreign countries in the following table, in which the 1912 figures have been given wherever possible, and in all other cases the year indicated is the latest year for which statistics are available.

Deaths of infants under 1 year of age per 1,000 live births in foreign countries for the latest year for which statistics are available.1

1 Compiled from statistics contained in the Seventy-fifth Annual Report of the Registrar General of Births, Deaths, and Marriages in England and Wales, 1912.

ENVIRONMENT.

Neighborhood incidence. The fourth ward is the most congested section of Montclair, and in it is found most of the negro and foreign population of the town, the Italian being the predominating nationality. Moreover in 1912, according to the report of the board of health, the tenement-house population of ward 4 was 1,476, or 27.3 per cent of the population of the ward, and 268 children under 5 years of age, or 38.4 per cent of the children of that age in the ward, were living in tenements. In this ward were located 80 of the 113 tenement houses of Montclair.1

The other wards, except for a few scattered groups of shabbylooking cottages, are almost uniformly attractive residential sections with well-kept shaded streets, comfortable one-family dwellings, and plenty of open space. The finest residences are to be found on the mountain in the section extending across the upper portions of the second, third, and fifth wards. The business district of Montclair is almost exclusively confined to Bloomfield Avenue, which is the main street of the town.

The variation in the infant mortality rate in different sections of the town is shown in the following table:

TABLE 1.-Population, births, deaths under 1 year, and infant mortaltity rate, by wards.

1 Annual Report of the Board of Health of the Town of Montclair, N. J., p. 21. 1912.

The highest rate as well as the greatest number of infant deaths was found in the fourth ward, which also had the highest birth rate. In 1912 almost twice as many babies died in the fourth ward as in all the other wards combined. The rate for this ward (130.4) was more than one and one-half times as high as the rate (84.6) for the town as a whole.

In 1913, however, the infant mortality rate for the fourth ward was lower than the rate for the second and third wards, while in 1914 its rate was lower than the average for the entire town. This gratifying decrease in the infant death rate of the most congested section of the town should probably be ascribed largely to the development of the baby clinic,2 with the "follow-up" visits of the nurse to the mothers in their homes and to the careful supervision by the board of health of the housing and sanitation of this section.

Table 2 shows the distribution of births and of deaths of infants under 1 year of native white, foreign white, and negro mothers in the various wards. By far the greatest number of births to foreign and negro mothers occurred in the fourth ward.

TABLE 2.-Births and deaths under 1 year, according to nativity and color of mother, by

wards.

Housing. Generally speaking, the housing in Montclair is good. The most common type of house is the two story and attic frame cottage for one family, with a yard of good size. The town's housing problem resolves itself for the most part into that of improving conditions in the fourth ward, where one finds the greatest congestion and overcrowding, where one notices the greatest number of houses of unkempt appearance and in bad repair, and where one occasionally finds basement tenements and constantly sees dirty yards.

The fourth ward in 1912 filed with the board of health more complaints against nuisances than any other ward. There were 26 complaints about plumbing from this ward, or 56 per cent of the plumbing complaints for the entire town.

According to the definition of a "tenement house" which appears in the State tenement-house act1 there were in the town, December 31, 1912, 133 tenement houses, 20 of which would be ordinarily classed as apartment houses. The Annual Report of the Board of Health for 1912 gives the following interesting statistics as to certain living conditions of the tenement-house population:

The entire tenement-house population averages 1.26 persons per room, or 5 persons to every four rooms; the colored population averages 1.01 persons per room, the Italian 1.67, and the other white population 0.86. Over half of the tenement-house populalation lives in three-room tenements, with an average of 1.4 persons per room. There are 95 families in two-room tenements and 3 in one-room tenements. All of the tenement houses are provided with sewer connection for water-closets and sinks.

1 A tenement house is any house or building or portion thereof which is rented, leased, let, or hired out to be occupied or is occupied as the home or residence of three families or more living independently of each other and doing their cooking upon the premises, or by more than two families upon any floor so living and cooking but having a common right in the halls, stairways, yards, water-closets, or privies, or some of them.

As will be shown in the discussion of sewage disposal, Montclair is well sewered. In 1912 there remained in the town 76 privies on unsewered streets and 26 privies on streets in which there were sewers. It should be said, however, that the board of health has passed an ordinance providing that all privy vaults which for lack of a public sewer in the street can not be abolished must be made water-tight and provided with a fly-tight superstructure and self-closing covers. Although it is recognized that it would be impossible to determine the relative importance of any particular housing defect in its relation to infant mortality, nevertheless a classification of babies visited according to the type of home in which they were found may be of interest. Babies who died during the first week have been excluded from the following summary because it was felt that in a considerable number of these cases prenatal influences must have been largely responsible for their deaths. Nor have illegitimate babies been included, since their home conditions were abnormal. The figures are too small to be conclusive, but they show a tendency toward an increase of infant deaths where poor housing conditions were found.

Although in Montclair was found a large group of babies whose parents owned their homes and an additional group whose parents paid over $30 a month rent, over one-third of the babies lived in homes where the rental was less than $15 a month.

It will be seen that 23 of the babies visited lived in homes where the toilet was a yard privy and 129 in homes in which was no bathtub. A large number of homes were reported as dirty or only moderately clean, and a still larger number of yards were reported as dirty.

The means for ventilation of the baby's room was in most cases good. The actual ventilation, however, which is shown in the summary, depended on the custom of the mother or attendant.

TABLE 3.-Babies surviving at least one week and deaths under 1 year of age, according to specified housing conditions.