TEE WASTE OF LIFE 193 



Besides the forms of work already mentioned, this association lays 

 stress upon the importance of better teaching of obstetrics in our medical 

 schools, upon the extension of maternity hospitals, out-patient obstet- 

 rical services, visiting obstetrical nurses, and either the thorough educa- 

 tion or gradual abolition of midwives, also pre-natal instruction of ex- 

 pectant mothers. Many mothers lose their health or their lives, and 

 more babies perish or become permanently crippled or blind, as a result 

 of improper management during child-birth. 



Why Poverty is Fundamental 



The first field study of the Children's Bureau has just been published 

 (1915), and inaugurates a proposed series of studies in infant mortality, 

 to be made in typical American communities. It was undertaken by 

 means of personal interviews with the mothers of all the babies born in 

 the city of Johnstown, Pa., during one calendar year, 1,551 in all, of 

 whom 196 died, or 134 per 1,000 births. The estimated rate throughout 

 the United States is 124 per 1,000 (U. S. Census Report, 1911), which 

 may be compared with a rate of about 261 in Eussia, 105 in England, 

 75 in Australia, and 51 in New Zealand. 



Owing to the method of enquiry, and to the absence of a physician 

 upon the staff of the bureau, only family, social, industrial and civic 

 factors were considered in Johnstown, omitting all reference to two 

 important causes of infant mortality — alcoholism and venereal disease. 

 Emphasis is placed upon the economic factor, and it plainly appears 

 from a study of the tables presented, that, whatever the immediate 

 cause of death, the underlying cause in a large majority of cases was 

 that mother of all evils, poverty. 



A study of environment shows that the death rate was 271 per 

 1,000 babies in the poorest sections of the city, or more than five times 

 that in the best residential sections. It was 171 for foreign mothers 

 as against 104 for native mothers. It was 214 for illiterate foreign 

 mothers, or 66 per 1,000 greater than for foreign mothers who could 

 read. The duration of the mother's rest period before and after con- 

 finement was found to affect the result, as was also the employment of a 

 midwife instead of a physician. But most of these points depend di- 

 rectly upon the fundamental question of income. The father's earn- 

 ings were discovered to be the one factor of greatest importance. 

 Babies whose fathers earned ten dollars a week or less died at the rate 

 of 256 per 1,000, while those whose fathers earned $25 or more a week 

 died at the rate of 86 per 1,000. The foreigners, especially the recent 

 arrivals, were generally those who lived in the poorest and most unsani- 

 tary quarters, whose women were ignorant and overworked, forced to 

 carry water, to keep lodgers, or to work for wages, and all these mis- 

 fortunes were commonly due to the lack of a proper living wage for 

 the men. 



