SUMMARY AND CONCLUSIONS.

New Bedford is a manufacturing city whose chief industry is cotton textiles. A large proportion of the population of the city was foreign born, especially Portuguese and French Canadian; a large proportion of women worked in the mills. Wages in New Bedford were low.

INFANT MORTALITY RATE.

The study of infant mortality in New Bedford included a total of 2,662 births. The infant mortality rate for the 2,587 live births was 130.3, a very high rate when compared with the rate of 100 for the birth registration area in 1915. The mortality rate in precincts 1, 2, 3, 13, and 17,1 constituting the so-called "unfavorable" area, was 156.6 as contrasted with the figure of 94.6 for the rest of the city. In the precincts mentioned were most of the colonies of foreign nationalities, including a very large proportion of the French Canadians, Portuguese, and Poles-groups in which the infant mortality rates were high.

NATIONALITY.

Almost three-fourths of the mothers of the study were foreign born. The mortality rate for infants of foreign-born mothers was 138.9 as contrasted with 108.4 for infants of native mothers. The largest nationality group represented was the Portuguese white, who contributed one-fourth of the births in the selected group, and who had the highest mortality rate in the city, 200.9. The FrenchCanadian group was next in size; it had an infant mortality rate of 115.5. The Poles had a rate of 119.8, and the English, 100.9.

A large proportion of the foreign-born mothers, and particularly of the Portuguese, were illiterate, or unable to speak English, or both. The mortality rate for infants of illiterate mothers was 188, as contrasted with 107.1 for babies whose mothers could read and write. Among infants born to mothers of non-English-speaking nationalities, the mortality rate for the group whose mothers were able to speak English was 97.4 as contrasted with the rate of 180.4 for those whose mothers were unable to speak English. Mothers of 584 infants could neither read, write, nor speak English. The rate for this group was 203.

Gastric and intestinal of infants in this study.

CAUSE OF DEATH.

diseases caused 37.1 per cent of all deaths Compared with other cities studied by the bureau, the mortality rate from gastric and intestinal diseases was nearly four times as high in New Bedford as in Brockton and nearly six

times as high as in Saginaw; in both the textile towns, Manchester and New Bedford, the rate from gastric and intestinal diseases was high, in Manchester even higher than in New Bedford.

The rate from these causes was over three times as high for infants of Portuguese-white mothers as for infants of native mothers.

The mortality from respiratory diseases was higher in New Bedford than in any other city studied by the bureau, although only slightly higher than for Johnstown and Manchester. Practically all the excessive mortality from respiratory and gastric and intestinal diseases was due to the heavy mortality among infants of Portuguesewhite mothers.

The rate for deaths from causes peculiar to early infancy was lower in New Bedford than in any city previously studied by the bureau.

ATTENDANT AT BIRTH.

Seventy-three per cent of the births of the study were attended by physicians and 23 per cent by midwives. Among the foreign born 30 per cent of the births were attended by midwives. The Portuguese white had the largest proportion of confinements thus attended.

FEEDING.

The average mortality among artificially fed infants was approximately four and one-half times the rate among infants breast fed. A great difference was shown in the rates for artificially fed infants of native and of foreign-born mothers, the rate for the latter being nearly one and one-half times as high as the rate for the former.

FATHER'S EARNINGS.

Fathers of 41 per cent of the babies in this study worked in the cotton mills during the greater part of the year following the babies' births. Three-fourths of the infants were born in families where the father earned less than $850 a year.

In the group of infants whose fathers earned less than $450 a year, comprising over one-fifth of all the births, the infant mortality rate was 201.9. With one exception the rate decreased as the fathers' earnings increased, to the low rate of 59.9 for infants whose fathers earned $1,250 or over. In the lowest earnings group 1 live-born baby in every 5 died before reaching its first birthday; in the highest earnings group only 1 in 17 died.

GAINFUL EMPLOYMENT OF MOTHER.

Forty-seven per cent of the births were to mothers gainfully employed during the year preceding the baby's birth and 41 per cent

earnings of the father, the higher was the proportion of mothers gainfully employed. Very few of the births were to mothers gainfully employed where the father earned over $850. Gainful employment away from home during the year following the birth of the infant usually involved early artificial feeding.

The mortality rate for infants of mothers who were gainfully employed prior to the birth was 154.5, as contrasted with a rate of 108.8 for infants of mothers not employed.

The mortality among infants of mothers who were gainfully employed away from home during the lifetime of the infants was approximately one and one-half times the average mortality.

CIVIC AGENCIES.

The Instructive Nurses Association carried on the infant-welfare work during the summer months from the milk stations, but at the time of the study these nurses were able to care for but a small proportion of the infants in the city. Experience has shown that infantwelfare centers are the most effective means of giving practical instruction to the mothers in the right methods of caring for their babies and medical advice and trained-nursing care for the babies who are in especial need of them. In addition, facilities for public-health nursing should be sufficient to assure prenatal and postnatal care and instruction to those mothers who would otherwise be neglected, and these special services to mothers as well as to babies should be accessible to all.

During the years following this study, by means of printed pamphlets, advertisements, the lecture hall, and the motion-picture theater the city health department has done valuable work in disseminating knowledge of simple health precautions against the spread of disease. Such methods, applied to the problems of infant welfare, have been found effective.

CONTRAST BETWEEN NEW BEDFORD AND BROCKTON.

Conditions in New Bedford are particularly striking in contrast to those in Brockton, the only other Massachusetts city studied. In the selected groups, New Bedford had the higher rate, 130.3, as compared to 96.7 in Brockton. Perhaps the most striking difference between the two cities, in so far as the explanation of the difference in the infant mortality rate is concerned, is in the nationality composition. New Bedford has a large proportion of Portuguese, with the excessively high infant mortality rate of 200.9; Brockton had no large single group with so high a rate, and indeed, the largest group, composed of Lithuanians and Poles, had an infant mortality

and high mortality rate, were omitted from New Bedford, the rate would have been only 103.7, or much more nearly like that of Brockton.

A second point of contrast is found in the much larger proportion of the births in New Bedford that occurred in the lower economic groups. Three-eighths of the births occurred in families in which the father earned less than $550; in Brockton only one-eighth of the births were in such families. Twenty-five per cent of the births in New Bedford were in families whose fathers earned $850 or over; in Brockton 45 per cent earned over this amount. Evidently, since the infant mortality rate falls as the father's earnings increase, the infants in Brockton had a much better chance of survival than those in New Bedford.

A third point of difference lies in the proportion of mothers gainfully employed away from home. In Brockton mothers of less than 4 per cent of the infants were so employed during the year following the baby's birth; while in New Bedford mothers of 22 per cent were so employed. During the year preceding the birth, 12 per cent of the mothers were gainfully employed away from home in Brockton as contrasted with 33 per cent for New Bedford.

The difference in the rates for the two cities is the more remarkable, since in type of feeding given to the babies New Bedford shows a larger proportion exclusively breast fed in each month of life.

These are the principal points of difference: New Bedford had lower standards of living, a larger proportion of mothers gainfully employed, a more difficult problem of assimilation of foreign elements. These differences reflect themselves in the excessively high mortality from gastric and intestinal diseases (nearly four times that of Brockton) and from respiratory diseases (over twice the Brockton rate). Deaths from these causes are easily preventable; with proper care and feeding most of them would not occur. Relatively, New Bedford has a much larger and more difficult problem than Brockton in reducing its infant mortality rate.

earnings of the father, the higher was the proportion of mothers gainfully employed. Very few of the births were to mothers gainfully employed where the father earned over $850. Gainful employment away from home during the year following the birth of the infant usually involved early artificial feeding.

The mortality rate for infants of mothers who were gainfully employed prior to the birth was 154.5, as contrasted with a rate of 108.8 for infants of mothers not employed.

The mortality among infants of mothers who were gainfully employed away from home during the lifetime of the infants was approximately one and one-half times the average mortality.

CIVIC AGENCIES.

The Instructive Nurses Association carried on the infant-welfare work during the summer months from the milk stations, but at the time of the study these nurses were able to care for but a small proportion of the infants in the city. Experience has shown that infantwelfare centers are the most effective means of giving practical instruction to the mothers in the right methods of caring for their babies and medical advice and trained-nursing care for the babies who are in especial need of them. In addition, facilities for public-health nursing should be sufficient to assure prenatal and postnatal care and instruction to those mothers who would otherwise be neglected, and these special services to mothers as well as to babies should be accessible to all.

During the years following this study, by means of printed pamphlets, advertisements, the lecture hall, and the motion-picture theater the city health department has done valuable work in disseminating knowledge of simple health precautions against the spread of disease. Such methods, applied to the problems of infant welfare, have been found effective.

CONTRAST BETWEEN NEW BEDFORD AND BROCKTON.

Conditions in New Bedford are particularly striking in contrast to those in Brockton, the only other Massachusetts city studied. In the selected groups, New Bedford had the higher rate, 130.3, as compared to 96.7 in Brockton. Perhaps the most striking difference between the two cities, in so far as the explanation of the difference in the infant mortality rate is concerned, is in the nationality composition. New Bedford has a large proportion of Portuguese, with the excessively high infant mortality rate of 200.9; Brockton had no large single group with so high a rate, and indeed, the largest group, composed of Lithuanians and Poles, had an infant mortality