BABY’S AGE AT DEATH AND CAUSE (DISEASE) OF DEATH

A baby who comes into the world has less chance to live one week than an old man of 90, and less chance to live a year than one of 80.—Bergeron.

The most dangerous time of life is early infancy; even old age seldom has greater risk. Death strikes most often in infancy. The Johnstown babies died during their first year of life at the rate of 134 per 1,000 born alive, and they paid their heaviest toll in their very earliest days. If the total of 196 deaths had been distributed evenly throughout the 12 months, 8.3 per cent. of the babies would have died each month and 25 per cent. during each quarter. But instead of that 37.8 per cent. died in the first month; 9.2 per cent. in the second, and 8.2 per cent. in the third, or over 55 per cent. in the first quarter.

Table 17.—Number and Per Cent Distribution of Deaths of Babies, by Age at Death.


AGE AT DEATH.	DEATHS OF BABIES OF ALL MOTHERS.
AGE AT DEATH.	Number.	Per cent. distribution.
Total deaths in first year	196	100.0
First quarter	108	55.1
First month	74	37.8
First week	45	23.0
Less than 1 day and 1 day	30	15.3
2 days	4	2.0
3 to 6 days	11	5.6

Second week	14	7.1
Third week	7	3.6
Fourth week	8	4.1

Second month	18	9.2
Third month	16	8.2

Second quarter	42	21.4
Third quarter	31	15.8
Fourth quarter	15	7.7

The large number of deaths in the first few hours or days of life indicates that many babies are born with some handicap and that in many instances the mother has been subjected to some condition which resulted in the birth of a child incapable of withstanding the ordinary strain of life. Of the 45 babies who died in Johnstown less than a week after birth, 38 died of prematurity, congenital debility or malformations, or injuries received at birth. In one other case the cause of death was given as “bowel trouble” and in six other cases it was not clearly defined. In addition to the 45 babies just referred to as having died in their first week, 12 died later either from prematurity or from congenital defects.

Of the deaths from causes arising after birth, 52 were attributed by the attending physicians to diarrhoea and enteritis, 50 to respiratory diseases; and 44 to some other or to some ill-defined cause.

Table 18.—Distribution of Deaths During First Year and Infant Mortality Rate, According to Cause of Death and Nativity of Mother.

CAUSE OF DEATH.	DEATHS DURING FIRST YEAR OF BABIES OF—
	All mothers.		Native mothers.		Foreign mothers.
	Number.	Infant mortality rate.	Number.	Infant mortality rate.	Number.	Infant mortality rate.
All causes	196	134.0	85	104.3	111	171.3
Diarrhea and enteritis	52	35.5	17	20.9	35	54.0
Respiratory diseases	50	34.2	19	23.3	31	47.8
Premature births	24	16.4	11	13.5	13	20.1
Congenital debility or malformation	19	12.9	5	6.1	14	21.6
Injuries at birth	7	4.8	6	7.4	1	1.5
Other causes or not reported	44	30.1	27	33.1	17	26.2

The latest census report on mortality statistics characterizes diarrhoea and enteritis as the “most important preventable cause of infant mortality” in the United States, and numerically at least it proves to be the most important cause of infant death in Johnstown.

Holt [^[23]] says that one of the most striking facts about diarrheal diseases in infants is their prevalence during the summer season. In Johnstown the infant diarrheal deaths were least prevalent in the first quarter of the year, next in the second, next prevalent in the fourth, and most prevalent in the third or summer quarter.

[23]. The Diseases of Infancy and Childhood, by L. Emmett Holt. p. 345. New York, 1912.

Table 19.—Distribution of Deaths, According to Cause of Death and Quarter of Calendar Year in which Death Occurred.

CAUSE OF DEATH.	All deaths.	QUARTER OF CALENDAR YEAR IN WHICH DEATH OCCURRED.
CAUSE OF DEATH.	All deaths.	First.	Second.	Third.	Fourth.
All causes	196	54	29	74	39
Diarrhea and enteritis	52	3	5	32	12
Respiratory diseases	50	24	8	7	11
Premature births	24	7	5	9	3
Congenital debility or malformation	19	5	2	8	4
Injuries at birth	7	5	1		1
Other causes or not reported	44	10	8	18	8

Our figures are too small to admit of broad generalizations or a very full discussion of infant deaths according to the period of the year.

This excess of infant deaths from diarrhea in the summer months has been established by statistics in many countries, and the cause of such an excess has been the subject of much discussion, but as yet there is no general agreement. Liefmann and Lindemann [^[24]] conclude, however, that in this field of controversy there are certain facts which are at present well established, these being the dependence of the high summer mortality on methods of feeding, on hot weather, and on the living and social condition of the parents. The last factor mentioned by these authors, including as it does housing conditions, economic status, and degree of intelligence, is becoming more and more the subject of study and investigation. It has been shown that the distinctly harmful effect of hot weather on the infant is increased when the housing conditions are bad; in overcrowded homes with bad ventilation the indoor temperature may be many degrees higher than the outdoor temperature. The ignorance and carelessness of mothers has also been shown to increase the bad effect of hot weather. With hygienic care, including cool baths, much fresh air, and careful feeding, many infants are able to pass through extremely hot weather without diarrheal disturbances.

[24]. Liefmann, H., and Lindemann, H., Die Lokalization der Sauglingsterblichkeit und ihre Beziehungen zur Wohnungsfrage. Med. Klinik 1912, pp. 8, 1074.

Respiratory diseases were reported as a cause of death with almost as great frequency as diarrheal diseases. As shown by Table [19], these deaths occurred principally in the colder months of the first and fourth quarters of the calendar year.

FEEDING

Food is recognized as of such importance in relation to infant mortality that studies of this subject frequently resolve themselves into studies of feeding only. Invariably these demonstrate the truth of the statement of Dr. G. F. McCleary [^[25]] that “in human milk we have a unique and wonderful food for which the ingenuity of man may toil in vain to find a satisfactory substitute.” Many mothers, however, still fail to appreciate the risk their young babies face in being given any except the natural infant food, and consequently babies are in large numbers wholly or partly weaned from the breast in the earliest months of their lives.

[25]. Infantile Mortality and Infants’ Milk Depots. London.

Breast feeding is far more general, comparatively, among the poorer mothers than among the well to do, as shown by the following summary which gives the number and per cent. of babies of mothers with husbands earning varying incomes, who had been completely weaned from the breast when they were 3, 6, or 9 months of age, respectively. For each of the periods indicated the percentage completely weaned from the breast is much greater in the groups where earnings are highest.

Table 20.—Distribution of Babies Alive at 3, 6, and 9 Months of Age by Type of Feeding at Each of Said Ages, According to Annual Earnings of Father and Nativity of Mother.

ANNUAL EARNINGS OF FATHER AND NATIVITY OF MOTHER.	BABIES LIVING AT AGE OF—
	3 months.			6 months.			9 months.
	Total.	Completely weaned from breast.		Total.	Completely weaned from breast.		Total.	Completely weaned from breast.
	Total.	Number.	Per cent.	Total.	Number.	Per cent.	Total.	Number.	Per cent.
Total	1,355	193	14.2	1,313	250	19.0	1,282	358	27.5
Under $624	341	22	6.5	322	32	9.9	309	57	18.4
$625 to $899	358	48	13.4	351	63	17.9	342	85	24.9
$900 and over [^[26]]	629	114	18.1	616	146	23.7	608	201	33.1
Not reported [^[27]]	27	9	33.3	24	9	37.5	23	10	43.3

Mother native	765	155	20.3	747	195	26.1	735	251	34.1
Under $624	69	10	14.5	66	13	19.7	65	18	27.7
$625 to $899	180	36	20.0	177	46	26.0	173	55	31.8
$900 and over[^[26]]	491	100	20.4	482	127	26.3	476	168	35.3
Not reported[^[27]]	25	9	36.0	22	9	40.9	21	10	47.6

Mother foreign	590	38	6.4	566	55	9.7	547	102	18.6
Under $624	272	12	4.4	256	19	7.4	244	39	16.0
$625 to $899	178	12	6.7	174	17	9.8	169	30	17.8
$900 and over[^[26]]	138	14	10.1	134	19	14.2	132	33	25.0
Not reported[^[27]]	2			2			2

[26]. Includes those reported as earning “ample.” “Ample,” as used in this report has a somewhat technical meaning; when information concerning the father’s earnings was not available and the family showed no evidences of poverty, the word “ample” was used. When, however, the family was clearly in a state of abject poverty, it was included in the group “Under $521.”

[27]. Unmarried mothers’ babies also included.

Breast feeding, wholly or in part, is continued for a longer period by foreign than by native mothers, as indicated in the preceding table, showing that 20.3, 26.1, and 34.1 per cent. of the native mothers’ babies as compared with 6.4, 9.7, and 18.6 per cent. of the foreign mothers’ babies had been weaned from the breast at the age of 3, 6, and 9 months, respectively.

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.

SEX OF BABY AND NATIVITY OF MOTHER.	All births.	Live births.	STILLBIRTHS.		DEATHS DURING FIRST YEAR.
SEX OF BABY AND NATIVITY OF MOTHER.	All births.	Live births.	Total.	Rate per 1,000 births.	Total.	Infant mortality rate.
BABIES OF NATIVE MOTHERS.

Total number	860	815	45	52.3	85	104.3
Male:
Number	433	406	27	62.4	46	113.3
Per cent.	50.3	49.8	60.0		54.1
Female:
Number	427	409	18	42.2	39	95.4
Per cent.	49.7	50.2	40.0		45.9

BABIES OF FOREIGN MOTHERS.

Total number	691	648	43	62.2	111	171.3
Male:
Number	380	355	25	65.8	59	166.2
Per cent.	55.0	54.8	58.1		53.2
Female:
Number	311	293	18	57.9	52	177.5
Per cent.	45.0	45.2	41.9		46.8