Miscellanea 
195 
Next i^roceeding to allow for two faetorw wo find 
fD>\!i = "-^'-i, /D^'ci^'^i, /i)'V = '35, 
the latter result whow.s that general deatln-ate and illiteracy are about equally influential on the 
relation of employment of women to infantile mortality. Finally I corrected for all three factoi's 
and found : 
or GO of the crude correlation r,7, = -68 is due to women being most employed in towns where 
the general deathrate is high, where illiterates arc frequent and the ]3opulation is largely ft)reign- 
born. How much further the relati<.>nship would be reduced, could we equalise other features of 
these Massachusetts cities, it is not possible to predict. The examination of the individuals in 
one city appears to me to be the <inly satisfactory method of disentangling the numei'ous lactors 
which influence infant mortality. AVo commend, however, the study of the iirst jmrt of this 
Report, as it deals very clearly with the difficulties which arise, and will counteract the tendency, 
which is prevalent, to assert causation whenever association is obser\'ed. The author lays stress 
on avoiding such logical confusions. 
Part II of the Report deals with infant mortality and its relation to the employment of 
mothers in Fall River, Massachusetts. In 1908 the attempt was made to visit the homos of 
each of the mothers of the 859 infants who died during the year and to ascertain details con- 
cej-ning her occupation, etc. In 279 eases the family could n(jt be traced. In 266 cases prior to 
the birth of the cliild the mother was at work outside the home while in 314 cases the mother's 
work was limited to household duties or other work carried on entirely at home. Thus only the 
cases of deaths are dealt with and the causes of death are compared in the two groiips of cases 
(1) when the mother was at work outside the home prior to the birth of the child a.nd (2) when 
the mothei''s work was carried on entirely in the home. 
I hold that this method will never prove as satisfactory as that empli)yed in districts in 
England ; in England certain districts are chosen and every baby witliin that area is visited 
and the deathrate per number born in one group can be compared with another and the 
circumstances surrounding those babies who survive and those who die in the tirst year of life 
in a given district can be analysed. 
I do not think that the fact that a rather higher percentage of all deaths from gastritis etc. in 
Fall River occur when the mother works away from home and a rather higher percentage from 
congenital debility at birth when the mother does not work away from home will help us much 
in discovering the influence of the employment of the mother on infant mortality, nor do I think 
it will throw much light on the question of stillbirths with which the Report also deals. It is 
found that there are no more stillbirths proportional to all deaths when the mother is industrially 
employed, but it seems to me that this tells us nothing about tVie number of stillbirths pro- 
portional to all births. The real question is whether mothers employed away from home in 
factory or workshoi), whose otlier circumstances are the same, lose more children in the first year 
of life or have more children stillborn tlian the mothers who are only employed in their homes 
and I do not think a comparison of causes of death will lead us much further, and I think it may 
lead to difficulties. 
When dealing with the mother's work after childbirth in relation to the causes of infant 
mortality it is pointed out that the smaller percentage of deaths from congenital disease among 
the children of mothers who returned to work after childbirth was owing to the fact that most 
of the children dying from this group of causes died in the earlj' weeks of life before the mother 
returned to work. ¥ov this same reason the number of deaths from gastritis etc. of children 
whose mothers returned to work is exaggerated, for we are missing out a whole series of illnesses 
