to indicate that definite efforts have been put forth to check the infant deaths from this disease.

Of the 34 deaths of Montclair babies 9 were from prematurity or congenital debility. As a large proportion of these deaths is usually ascribed to prenatal causes, it would seem that in Montclair further care of the mothers is needed during their period of pregnancy.

In Montclair some few prospective mothers are reached during their pregnancy by the women's clinic which since 1904 has been held twice a week at the Mountainside Hospital. Obstetrical cases coming to the hospital for advice have been referred to this clinic. The number of mothers who have the advantage of clinical advice, however, is small, and it would seem either that the existence of the clinic should be more widely advertised or that the prenatal work should be reorganized to include regular visits of a nurse to the prospective mother in her own home.

Syphilis has long been recognized as a factor among the causes of fetal deaths and deaths of early infancy. Venereal diseases were made reportable in Montclair in March, 1913. During the remainder of that year 14 cases of syphilis and 4 of gonorrhea were reported. A recent ordinance of the board of health (Dec. 8, 1914) provides that treatment of persons found to be affected with venereal disease shall be compulsory.

There were 7 deaths from respiratory diseases, of which 6 occurred in February and 1 in March. Three babies died of malnutrition and . 1 from each of the following causes: Asphyxia neonatorum, diphtheria, peritonitis, and acute nephritis.

SEX.

It is generally found that infant mortality is higher among males than among females. The mortality rate of male infants in Montclair was found to be 88.2 and of female infants 80.8.

ILLEGITIMACY.

Only 7 of the 402 babies included in this investigation, or 1.7 per cent, were born out of wedlock. Four of the 7 were in the fourth ward, 2 in the first ward, and 1 in the second. One was of native white parentage, 2 of Polish, 1 of Italian, 1 of Swedish, and 2 of negro. Four of the 7 died-3 of enterocolitis and 1 of inanition.

ATTENDANT AT BIRTH.

It is perhaps of some interest to know to what extent mothers are attended at birth by midwives. Montclair has a considerable group of midwife cases, mostly among the Italian mothers. There are two possible explanations for this condition-one, the national custom among the Italians; the other, the lower fee demanded by the midwife, who in addition will render certain little household

services. Seventy-four of the 402 births included in this study were attended by midwives; of this number 65 were births to foreign-born white mothers. Only 5 native white mothers and 4 negro mothers were attended by midwives.

The midwives of New Jersey are licensed by the State board of medical examiners after an examination before the board and are required to register at the office of the county clerk. The law provides that they shall always secure the services of a reputable physician upon the appearance of any abnormal symptoms in either mother or child. Whenever a midwife files a birth certificate with the Montclair Board of Health the nurse calls on the following day at the address given to verify the information on the certificate. In this way she can determine incidentally whether the mother and child received proper attention at the hands of the midwife. A recent amendment of the sanitary code of Montclair provides that a midwife when called to a case shall report immediately to the board of health the name and address of the patient. This provision will enable the board of health nurse to be present at the delivery when it is considered advisable and will be a means of further supervision of midwives.

ECONOMIC STATUS OF THE FAMILY.

It is obvious that even the care given the baby by its mother often must be offset by the evils resulting from an income insufficient for the family's needs, since a low income frequently must involve undesirable housing accommodations, an overworked mother, insufficient nourishment for mother and child, and lack of competent medical advice. Sir Arthur Newsholme has found in his English studies that "infant mortality is higher among the poor than among the well to do, although natural feeding of infants is probably more general among the former." Table 7 shows that in Montclair the infant mortality rate was approximately two and one-half times as high among families where the income was less than $12 a week as among families where the income was $23 a week or more.

1

Table 7.—Births, deaths under 1 year, and infant mortality rate, according to total family income.

1 Report on Infant and Child Mortality, by the medical officer of the local government board, 1909-10. London, 1910.

2 Exclusive of illegitimate births.

The following table shows that of the 95 babies living in families where the income was less than $625 only 5 were babies of native white mothers, 66 were babies of foreign-born white mothers, and 24 babies of negro mothers. Of the 128 babies in the group with an income of $1,200 and over, 100, or 78.1 per cent, were babies of native white mothers.

TABLE 8.-Number of births, according to total family income and nativity and color of

The father's occupation gives some indication of the economic and social position of the family and the standard of living which they must undertake to maintain.

TABLE 9.—Births, deaths under 1 year, and infant mortality rate, according to occupation of father and nativity and color of mother.

1 Exclusive of illegitimate births.

2 Total number of live births less than 40; base therefore considered too small for use in computing an infant mortality rate.

The group of babies whose fathers were professional or business men shows the extremely low infant mortality rate of 41.7. In the "skilled trades" group the rate has risen to 74.4, while among babies whose fathers are engaged in semiskilled trades, unskilled trades, and domestic service the rate is 101.4-more than double the rate for the first group. It will be seen that unskilled workers form a large group among the foreigners and Negroes, while few professional or business men are found in these population groups.

MOTHERS.

Occupation. The mother's occupation bears a very close relation to the welfare of the baby. If the mother's employment during pregnancy involves the strain of long hours and hard work, the result is that she is less fit to bear the child or care for it after its birth. Her employment outside the home after the birth of the child means that the baby during her absence must depend for its care upon a relative, neighbor, or paid attendant; it means also the cessation of breast feeding. Table 10 shows that only 45 Montclair mothers were engaged in any occupation other than that of housekeeping for their own families. Of the 45 mothers who were gainfully employed, about three-fourths (34) were engaged in domestic or personal service, including the mothers who were living out in service, those who went out by the day, those who did laundry work either in their own homes or elsewhere, and those who kept lodgers. One mother was employed in a jam factory and 10 were helping either regularly or occasionally in their husbands' stores. A comparison of the infant deaths among babies of working and of nonworking mothers shows that a much larger proportion of babies of working mothers failed to survive their first year; there were 10 deaths among the 45 babies of working mothers as contrasted with 24 deaths among the 357 babies of nonworking mothers.

TABLE 10.—Births and deaths under 1 year, according to occupation, nativity, and color of

mother.

Literacy. Comparisons are shown in the following table between the infant mortality of babies of literate and of illiterate mothers, and of babies of mothers who can speak English and of those who must depend on a foreign language. Only babies of foreign-born white mothers have been included in these computations. The presence in the community of comparatively large groups of illiterate mothers and of mothers who can not speak English increases the problem presented to the agencies interested in infant-welfare work, for the illiterate mothers are generally less careful in following instructions than the more intelligent mothers, while the mothers who do not

speak English must explain their difficulties through an interpreter. The rate of infant mortality in Montclair is found to be relatively high among babies of illiterate mothers and of mothers who can not speak English.

TABLE 11.—Births, deaths under 1 year, and infant mortality rate, according to the mother's literacy and ability to speak English, for all babies of foreign-born white mothers.

Authorities agree that the breast milk of the mother is the best possible food for the baby, particularly during the early months of its life. It is significant that of the 23 babies who died within the first year but after the first week only 5 were exclusively breast fed at the time of their death, 6 were partly breast fed, and 12 were artificially fed.

Table 12 shows the type of feeding prevailing among Montclair babies at different ages. "Breast fed" as used in this report means that the baby was nursed and had no artificial food whatever; "partly breast fed" means that the baby was nursed but was being given artificial food as well; "artificially fed" means that the baby had been completely weaned.

TABLE 12.—Number and per cent of babies receiving specified type of feeding at 3, 6, and 9 months, respectively, according to nativity and color of mother.