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TABLE 22.-DISTRIBUTION OF BABIES ALIVE AT END OF EACH MONTH, FROM SECOND TO TENTH, INCLUSIVE, ETC.-Continued.

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The next table differentiates between babies of native and foreign mothers, giving the statistics by three-month periods instead of by single months.

TABLE 23.-DISTRIBUTION OF BABIES ALIVE AT THE END OF 3, 6, AND 9 MONTHS, RESPECTIVELY, ACCORDING TO TYPE OF FEEDING, NUMBER OF DEATHS DURING FIRST YEAR, AND RATE PER 1,000 ALIVE IN EACH GROUP, BY NATIVITY OF MOTHER.

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These statistics show that the manner of feeding is one of the most important considerations in the life and health of a baby. But a comparison of the number of deaths among babies whose fathers earn specified sums (Table 31) shows that the influence of poverty reaches even the breast-fed baby. When the fathers' earnings are small a larger proportion of babies die despite breast feeding.

SEX.

The Johnstown investigation comprehended 1,551 births in the year 1911, male births numbering 813 and female 738, the proportion being as 1,101.6 male to 1,000 female births; or, stated inversely, 907.7 female to 1,000 male births. Newsholme1 says that "male infants always suffer from a higher infant mortality rate than female infants," and in Johnstown we find this true for the group as a whole, the rates being as shown in the next table:

TABLE 24.-DISTRIBUTION OF LIVE BIRTHS AND STILLBIRTHS AND OF DEATHS DURING FIRST YEAR, AND INFANT MORTALITY RATE, ACCORDING TO SEX OF BABY.

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Among foreign mothers male births were considerably in excess of female births; among native mothers the reverse was true. The more favorable mortality rate for female infants does not prevail among the children of foreign mothers, as can be seen in the next table, which shows an infant mortality rate of 177.5 for girls as compared with one of 166.2 for boys.

Thirty-ninth Annual Report of the Local Government Board. London, 1910.

TABLE 25.-DISTRIBUTION OF ALL BIRTHS, LIVE BIRTHS, AND STILLBirths and of DEATHS DURING FIRST YEAR, AND INFANT MORTALITY RATE, ACCORDING TO SEX OF BABY AND NATIVITY OF MOTHER.

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The extent to which the native and foreign mothers in Johnstown relinquished a part of their household duties as the time for their confinement approached is shown below:

TABLE 26.-DISTRIBUTION OF BIRTHS ACCORDING TO TIME OF THE MOTHER'S RELINQUISHMENT OF PART OF HOUSEHOLD DUTIES BEFORE CONFINEMENT, BY NATIVITY OF MOTHER.

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Among the 174 babies of mothers who relinquished part of their household duties a month before confinement, the infant mortality rate was 112.5, as compared with 136.7 for those of other mothers. TABLE 27.-DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, AND INFANT MORTALITY RATE, ACCORDING TO TIME OF RELINQUISHMENT OF PART OF HOUSEHOLD DUTIES OF MOTHER BEFORE CONFINEMENT.

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To what extent the relinquishment of household duties at a given time directly affected the health of the child can not be definitely shown. A relation may exist, but on the other hand the difference in the mortality rate may be due to the fact that the mothers could afford to give consideration to their condition and escape some of their heaviest tasks as their pregnancy approached its end, and were members of families who were thoughtful of them and relieved them of these tasks or employed extra household assistance at such times. Another indication of intelligence and of comfortable surroundings is the care given a mother in the early days of her baby's life, particularly if she is a nursing mother. The duration of her rest period before the resumption of part of her household duties is one measure of this. The foreign mothers, with less education, more numerous and arduous tasks, less opportunity for leisure, and smaller incomes, begin to resume their housework sooner than the native mothers with young babies.

TABLE 28.-DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR, AND INFANT MORTALITY RATE, ACCORDING TO TIME OF MOTHER RESUMING PART OF HOUSEHOLD DUTIES AFTER CONFINEMENT, BY NATIVITY OF MOTHER.

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1 Total number of live births less than 50; base therefore considered too small to use in computing an infant mortality rate.

The fact that a mother takes up her housework in the early days of her baby's life does not necessarily increase the danger of its death. In some cases, however, mothers stated that the quantity of their breast milk was noticeably impaired when they got up and resumed their work too soon. Naturally this would affect the baby's nutrition. In other cases a mother's cares and duties may be so absorbing that she can not give the baby full attention. Whatever the exact

explanation, attention should be called to the greater frequency of infant deaths when the mother resumed household duties very soon after childbirth.

A statement of the time of the mother's resumption of household duties in full, like that giving the time of resumption in part, shows that the native mothers have the longer period of rest.

TABLE 29.-DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR, AND INFANT MORTALITY RATE, ACCORDING TO TIME OF MOTHER RESUMING ALL HOUSEHOLD DUTIES AFTER CONFINEMENT, BY NATIVITY OF MOTHER.

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1 Total live births less than 50; base therefore considered too small to use in computing an infant mortality rate.

The infant mortality rates for all mothers in the group just referred to, according to the time of resuming housework in full after childbirth, show fewer infant deaths proportionately when the mother has had a longer rest; that is, a rest of two weeks or more.

ECONOMIC FACTORS.

EARNINGS OF FATHER.

A grouping of babies according to the income of the father shows the greatest incidence of infant deaths where wages are lowest, and the smallest incidence where they are highest, indicating clearly the relation between low wages and ill health and infant deaths.

1

For all live babies born in wedlock the infant mortality rate is 130.7. It rises to 255.7 when the father earns less than $521 a year or less than $10 a week, and falls to 84 when he earns $1,200 or more or if his earnings are "ample." The variation in the infant mortality rate from one earnings group to another is not perfectly regular and consistent, but if any two or more consecutive groups are combined an invariable lowering of the infant mortality rate from one such combined group to that next higher results.

1 "Ample" as used in this report has a somewhat arbitrary meaning. When information concerning the father's earnings was not available and the family showed no evidences of actual poverty, the word "ample" was used. If no information concerning earnings was available when, on the other hand, the family was clearly in a state of abject poverty, then the income was tabulated as "Under $521."

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