to hear a man, one who could hardly speak English, say, "We are not foreigners; we are Germans." The British and Germans occupy the same relative position economically that they occupy in the infant mortality scale with relation to other races.

1

In the Magyar 1 group, of 38 babies born alive 4 died in their first year, making an infant mortality rate of 105.3, which is almost as low as that for babies of native mothers. The Magyars are little if any better off than the other "foreigners" among whom they live, but they possess somewhat higher standards of living. They live in poor neighborhoods and have inferior houses, but their homes are cleaner and they themselves somewhat more alert, personally cleaner, and less illiterate than the other foreigners.

There were but 10 babies of Hebrew mothers and 12 of Syrian and Greek mothers; among these there were no deaths. These groups are too small numerically to be significant in a comparative race study of infant mortality.

STILLBIRTHS.

In all there were but 88 stillbirths included in the investigation. They were more numerous proportionately among the Germans than among the mothers of any of the other nationalities. No single nationality group, however, has a very large representation, and hence a comparison of the rate for one with that for another nationality is not as significant as the difference in rate between native and foreign mothers. Although a special study of the causes of stillbirths was not made in connection with a study of deaths of infants during their first year of life, nevertheless the incidence of these births among the different nationality groups is believed to be of some interest, and therefore shown in the next table.

TABLE 9.-DISTRIBUTION OF BIRTHS AND OF STILLBIRTHS, AND RATE OF STILLBIRTHS PER 1,000 BIRTHS, ACCORDING TO NATIONALITY OF MOTHER.

The race of Finno-Tatar origin that invaded Hungary about the ninth century and is now dominar there; commonly called Hungarians.

ATTENDANT AT BIRTH.

The native mother usually had a physician at childbirth; the foreign-born, a midwife. The more prosperous of the foreign mothers, however, departed from their traditions or customs and had physicians, while the American-born mothers, when very poor, resorted to midwives. The midwives usually charged $5, and sometimes only $3; they waited for payment or accepted it in installments, and they performed many little household services that no physician would think of rendering.

TABLE 10.-Number and Per Cent of BIRTHS ACCORDING TO ATTendant at BIRTH AND NATIVITY OF MOTHER.

Two-thirds of those having no attendant were Serbo-Croatians. It was a Polish woman, however, who gave the following account of the birth of her last child:

At 5 o'clock Monday evening went to sister's to return washboard, having just finished day's washing. Baby born while there; sister too young to assist in any way; woman not accustomed to midwife anyway, so she cut cord herself; washed baby at sister's house; walked home, cooked supper for boarders, and was in bed by 8 o'clock. Got up and ironed next day and day following; it tired her, so she then stayed in bed two days. She milked cows and sold milk day after baby's birth, but being tired hired some one to do it later in week.

This woman keeps cows, chickens, and lodgers; also earns money doing laundry and char work. Husband deserts her at times; he makes $1.70 a day. A 15-year-old son makes $1.10 a day in coal mine. Mother thin and wiry; looks tired and worn. Frequent fights in home.

The infant mortality rate was lower for babies delivered by physicians than for those delivered by midwives or for those at whose birth no properly qualified attendant was present. This is not necessarily an indication of the quality of the care at birth, although in some cases the inefficiency of the midwife may have directly or indirectly caused deaths, just as in some instances a physician's inefficiency may have caused them. The midwife, however, is resorted to by the poor, and in their homes are found other conditions that create a high infant mortality rate.

TABLE 11.-DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, AND INFANT MORTALITY RATE, ACCORDING TO ATTENDANT AT BIRTH AND NATIVITY OF MOTHER.

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

Frequently the Serbo-Croatian women dispense altogether with any assistance at childbirth; sometimes not even the husband or a neighbor assists. Over 30 per cent of the births among the women of this race took place without a qualified attendant. More than one-half of those delivered by midwives, less than one-fifteenth of those delivered by physicians, and about one-fifth of those delivered without a qualified attendant had babies who died in their first year of life, as shown in the next tabulation:

TABLE 12.-DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, ACCORDING TO ATTENDANT at Birth, for Babies of Serbo-Croatian MOTHERS,

Fifteen of the 19 Serbo-Croatian women whose babies died under 1 year of age kept lodgers.

In Johnstown the midwife is resorted to principally by the poor. Recent laws that the State is now trying to enforce require that the standard for the practice of midwifery be raised. If this can be done midwives might become definitely helpful persons in the community. One or two of the intelligent graduate midwives in Johnstown have 61112°-15- -3

been an educational force among the foreign mothers for some years past. On the other hand there were others who were so dirty and so ignorant that they were a menace to the public health.

MOTHERS.

LITERACY.1

There are differences in the infant mortality rate between the babies of literate and the babies of illiterate mothers; between those with mothers who can speak English and those with mothers who can not; and between babies of the mothers who have been in this country for a considerable period and those of the newer arrivals. Comparisons of this nature are confined to the foreign mothers, as only three cases of illiteracy were found among native mothers, and the other comparisons would not, of course, be applicable in any case to native mothers.

The next table shows that the infant mortality rate among the children of illiterate foreign mothers was 214, or 66 per thousand greater than the rate among literate foreign mothers.

Table 13.-Distribution of Births and of DEATHS DURING FIRST YEAR, INFANT MORTALITY RATE, AND NUMBER AND PER CENT OF STILLBIRTHS, ACCORDING TO LITERACY OF FOREIGN MOTHERS.

The next table shows that babies whose mothers can not speak English were characterized by a more unfavorable infant mortality rate than other babies.

TABLE 14.-DISTRIBUTION OF BIRTHS and oF DEATHS DURING FIRST YEAR, INFANT MORTALITY RATE, AND NUMBER AND PER CENT OF STILLBIRTHS, ACCORDING TO ABILITY OF FOREIGN MOTHER TO SPEAK ENGLISH.

By literacy is meant ability to read and write in any language and not simply in English.

YEARS IN THE UNITED STATES.

In addition to a consideration of the babies according to their mothers' ability to speak English, it is of interest to note the infant mortality rates among babies whose mothers have been in this country for different periods of time.

TABLE 15.-DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, and INFANT MORTALITY RATE, ACCORDING TO LENGTH OF RESIDENCE OF FOREIGN MOTHER IN THE UNITED STATES.

The high infant mortality rate for the children of newer immigrants, illiterates, and those who can not speak English is perhaps affected by the fact that they are at the same time generally of the poorest families and are housed in the most insanitary and unhealthful part of the city.

AGE.

The age of the mother is frequently believed to be a factor in the health of the child. The highest infant mortality rate was found to be that for the group of babies with mothers over 40 years of age, and the lowest for babies of mothers from 20 to 24 years of age.

TABLE 16.-DISTRIBUTION OF Births and oF DEATHS DURING FIRST YEAR, INFANT MORTALITY RAte, and Number and Per CENT OF STILLBIRTHS, ACCORDING TO AGE OF MOTHER.

The youngest mothers have a higher stillbirth rate than other mothers, and the oldest group of mothers has the next highest rate. In this connection not only the foregoing table is of interest, but