Visit ebooknice.

com to download the full version and

explore more ebooks or textbooks

(Ebook) Digital Image Processing and Analysis :

Human and Computer Vision Applications with
CVIPtools, Second Edition by Umbaugh, Scott E ISBN
9781439802069, 1439802068
_____ Click the link below to download _____
https://ebooknice.com/product/digital-image-processing-and-
analysis-human-and-computer-vision-applications-with-
cviptools-second-edition-5144784

Explore and download more ebooks or textbooks at ebooknice.com

Here are some recommended products that we believe you will be
interested in. You can click the link to download.

(Ebook) Computer Vision and Image Analysis; Digital Image Processing

and Analysis by Scott E Umbaugh

https://ebooknice.com/product/computer-vision-and-image-analysis-
digital-image-processing-and-analysis-55456502

(Ebook) Digital Image Enhancement, Restoration and Compression:

Digital Image Processing and Analysis (for True Epub) by Scott E
Umbaugh

https://ebooknice.com/product/digital-image-enhancement-restoration-
and-compression-digital-image-processing-and-analysis-for-true-
epub-55795470

(Ebook) Biota Grow 2C gather 2C cook by Loucas, Jason; Viles, James

ISBN 9781459699816, 9781743365571, 9781925268492, 1459699815,
1743365578, 1925268497

https://ebooknice.com/product/biota-grow-2c-gather-2c-cook-6661374

(Ebook) SAT II Success MATH 1C and 2C 2002 (Peterson's SAT II Success)

by Peterson's ISBN 9780768906677, 0768906679

https://ebooknice.com/product/sat-ii-success-
math-1c-and-2c-2002-peterson-s-sat-ii-success-1722018
(Ebook) Matematik 5000+ Kurs 2c Lärobok by Lena Alfredsson, Hans
Heikne, Sanna Bodemyr ISBN 9789127456600, 9127456609

https://ebooknice.com/product/matematik-5000-kurs-2c-larobok-23848312

(Ebook) Cambridge IGCSE and O Level History Workbook 2C - Depth Study:

the United States, 1919-41 2nd Edition by Benjamin Harrison ISBN
9781398375147, 9781398375048, 1398375144, 1398375047

https://ebooknice.com/product/cambridge-igcse-and-o-level-history-
workbook-2c-depth-study-the-united-states-1919-41-2nd-edition-53538044

(Ebook) Master SAT II Math 1c and 2c 4th ed (Arco Master the SAT
Subject Test: Math Levels 1 & 2) by Arco ISBN 9780768923049,
0768923042

https://ebooknice.com/product/master-sat-ii-math-1c-and-2c-4th-ed-
arco-master-the-sat-subject-test-math-levels-1-2-2326094

(Ebook) Computer Vision for Microscopy Image Analysis (Computer Vision

and Pattern Recognition) by Mei Chen Ph.D (editor) ISBN 9780128149720,
0128149728

https://ebooknice.com/product/computer-vision-for-microscopy-image-
analysis-computer-vision-and-pattern-recognition-34708838

(Ebook) Computer Vision and Action Recognition: A Guide for Image

Processing and Computer Vision Community for Action Understanding by
Md. Atiqur Rahman Ahad ISBN 9789491216190, 9491216198

https://ebooknice.com/product/computer-vision-and-action-recognition-
a-guide-for-image-processing-and-computer-vision-community-for-action-
understanding-2395062
DIGITAL IMAGE
PROCESSING
AND ANALYSIS
Human and Computer Vision
Applications with CVIPtools
SECOND EDITION

SCOTT E UMBAUGH

Boca Raton London New York

CRC Press is an imprint of the

Taylor & Francis Group, an informa business
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2010 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Version Date: 20131004

International Standard Book Number-13: 978-1-4398-0206-9 (eBook - PDF)

This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to
publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials
or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material repro-
duced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any
copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint.

Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any
form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming,
and recording, or in any information storage or retrieval system, without written permission from the publishers.

For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copy-
right.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400.
CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been
granted a photocopy license by the CCC, a separate system of payment has been arranged.

Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identifica-
tion and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com

and the CRC Press Web site at

http://www.crcpress.com
 To my wife Jeanie

Our children Angi, Kayla, Michael, Robin, and David

Our grandchildren Tyler, Connor, and Ava

And to the memory of Patricia Umbaugh and Soumya Tummala

© 2011 by Taylor & Francis Group, LLC

Contents

Preface..............................................................................................................................................xv
Acknowledgments....................................................................................................................... xix
Author............................................................................................................................................ xxi

Section I Introduction to Digital Image Processing and Analysis

1. Digital Image Processing and Analysis..............................................................................3

1.1 Overview.........................................................................................................................3
1.2 Image Analysis and Computer Vision........................................................................5
1.3 Image Processing and Human Vision.........................................................................8
1.4 Key Points...................................................................................................................... 12
Exercises................................................................................................................................... 13
References................................................................................................................................ 13
Further Reading...................................................................................................................... 14

2. Computer Imaging Systems................................................................................................ 15

2.1 Imaging Systems Overview....................................................................................... 15
2.2 Image Formation and Sensing................................................................................... 20
2.2.1 Visible Light Imaging..................................................................................... 21
2.2.2 Imaging outside the Visible Range of the EM Spectrum.......................... 28
2.2.3 Acoustic Imaging............................................................................................30
2.2.4 Electron Imaging............................................................................................ 32
2.2.5 Laser Imaging.................................................................................................. 33
2.2.6 Computer-Generated Images........................................................................34
2.3 CVIPtools Software.....................................................................................................34
2.3.1 Main Window.................................................................................................. 37
2.3.2 Image Viewer................................................................................................... 39
2.3.3 Analysis Window........................................................................................... 39
2.3.4 Enhancement Window...................................................................................42
2.3.5 Restoration Window.......................................................................................42
2.3.6 Compression Window....................................................................................43
2.3.7 Utilities Window.............................................................................................44
2.3.8 Help Window.................................................................................................. 46
2.3.9 Development Tools......................................................................................... 46
2.4 Image Representation.................................................................................................. 50
2.4.1 Binary Images.................................................................................................. 50
2.4.2 Gray-Scale Images........................................................................................... 51
2.4.3 Color Images.................................................................................................... 52
2.4.4 Multispectral Images...................................................................................... 61
2.4.5 Digital Image File Formats............................................................................ 62
2.5 Key Points......................................................................................................................65

© 2011 by Taylor & Francis Group, LLC v

vi Contents

Exercises................................................................................................................................... 68
Problems........................................................................................................................ 68
Programming Exercises............................................................................................... 70
Supplementary Exercises....................................................................................................... 70
Supplementary Problems............................................................................................ 70
Supplementary Programming Exercises.................................................................. 71
References................................................................................................................................ 72
Further Reading...................................................................................................................... 73

Section II Digital Image Analysis and Computer Vision

3. Introduction to Digital Image Analysis............................................................................77

3.1 Introduction..................................................................................................................77
3.1.1 Overview..........................................................................................................77
3.1.2 System Model.................................................................................................. 78
3.2 Preprocessing............................................................................................................... 79
3.2.1 Region of Interest Image Geometry............................................................. 79
3.2.2 Arithmetic and Logic Operations................................................................85
3.2.3 Spatial Filters................................................................................................... 91
3.2.4 Image Quantization........................................................................................ 95
3.3 Binary Image Analysis.............................................................................................. 104
3.3.1 Basic Image Thresholding........................................................................... 105
3.3.2 Connectivity and Labeling.......................................................................... 109
3.3.3 Basic Binary Object Features....................................................................... 111
3.3.4 Binary Object Classification........................................................................ 115
3.4 Key Points.................................................................................................................... 125
Exercises................................................................................................................................. 129
Problems...................................................................................................................... 129
Programming Exercises............................................................................................. 132
Supplementary Exercises..................................................................................................... 134
Supplementary Problems.......................................................................................... 134
Supplementary Programming Exercises................................................................ 135
References.............................................................................................................................. 137
Further Reading.................................................................................................................... 138

4. Segmentation and Edge/Line Detection......................................................................... 139

4.1 Introduction and Overview...................................................................................... 139
4.2 Edge/Line Detection................................................................................................. 140
4.2.1 Gradient Operators....................................................................................... 144
4.2.2 Compass Masks............................................................................................. 147
4.2.3 Advanced Edge Detectors........................................................................... 148
4.2.4 Edges in Color Images.................................................................................. 159
4.2.5 Edge Detector Performance......................................................................... 164
4.2.6 Hough Transform......................................................................................... 176
4.2.6.1 CVIPtools Parameters for the Hough Transform..................... 185
4.2.7 Corner Detection........................................................................................... 185

© 2011 by Taylor & Francis Group, LLC

Contents vii

4.3 Segmentation.............................................................................................................. 188

4.3.1 Region Growing and Shrinking................................................................. 190
4.3.2 Clustering Techniques................................................................................. 195
4.3.3 Boundary Detection..................................................................................... 203
4.3.4 Combined Segmentation Approaches....................................................... 210
4.3.5 Morphological Filtering............................................................................... 211
4.4 Key Points.................................................................................................................... 236
Exercises................................................................................................................................. 245
Problems...................................................................................................................... 245
Programming Exercises............................................................................................. 250
Supplementary Exercises..................................................................................................... 251
Supplementary Problems.......................................................................................... 251
Supplementary Programming Exercises................................................................254
References.............................................................................................................................. 255
Further Reading.................................................................................................................... 256

5. Discrete Transforms............................................................................................................ 259

5.1 Introduction and Overview...................................................................................... 259
5.2 Fourier Transform...................................................................................................... 265
5.2.1 One-Dimensional Discrete Fourier Transform........................................ 268
5.2.2 Two-Dimensional Discrete Fourier Transform........................................ 271
5.2.3 Fourier Transform Properties..................................................................... 274
5.2.3.1 Linearity......................................................................................... 274
5.2.3.2 Convolution.................................................................................... 274
5.2.3.3 Translation...................................................................................... 275
5.2.3.4 Modulation..................................................................................... 275
5.2.3.5 Rotation........................................................................................... 275
5.2.3.6 Periodicity...................................................................................... 276
5.2.3.7 Sampling and Aliasing................................................................. 277
5.2.4 Displaying the Discrete Fourier Spectrum............................................... 279
5.3 Discrete Cosine Transform....................................................................................... 282
5.4 Discrete Walsh–Hadamard Transform................................................................... 287
5.5 Discrete Haar Transform.......................................................................................... 292
5.6 Principal Components Transform........................................................................... 292
5.7 Filtering....................................................................................................................... 295
5.7.1 Lowpass Filters............................................................................................. 296
5.7.2 Highpass Filters............................................................................................ 299
5.7.3 Bandpass and Bandreject Filters................................................................. 301
5.8 Discrete Wavelet Transform..................................................................................... 302
5.9 Key Points.................................................................................................................... 315
Exercises................................................................................................................................. 322
Problems...................................................................................................................... 322
Programming Exercises............................................................................................. 329
Supplementary Exercises..................................................................................................... 330
Supplementary Problems.......................................................................................... 330
Supplementary Programming Exercises................................................................ 332
References.............................................................................................................................. 333
Further Reading.................................................................................................................... 333

© 2011 by Taylor & Francis Group, LLC

viii Contents

6. Feature Analysis and Pattern Classification.................................................................. 335

6.1 Introduction and Overview...................................................................................... 335
6.2 Feature Extraction...................................................................................................... 336
6.2.1 Shape Features.............................................................................................. 337
6.2.2 Histogram Features...................................................................................... 341
6.2.3 Color Features............................................................................................... 347
6.2.4 Spectral Features........................................................................................... 347
6.2.5 Texture Features............................................................................................ 349
6.2.6 Feature Extraction with CVIPtools............................................................354
6.3 Feature Analysis......................................................................................................... 357
6.3.1 Feature Vectors and Feature Spaces........................................................... 357
6.3.2 Distance and Similarity Measures............................................................. 359
6.3.3 Data Preprocessing.......................................................................................364
6.4 Pattern Classification................................................................................................. 368
6.4.1 Algorithm Development: Training and Testing Methods...................... 368
6.4.2 Classification Algorithms and Methods.................................................... 370
6.4.3 Cost/Risk Functions and Success Measures............................................. 373
6.4.4 Pattern Classification with CVIPtools........................................................ 376
6.5 Key Points.................................................................................................................... 378
Exercises................................................................................................................................. 387
Problems...................................................................................................................... 387
Programming Exercises............................................................................................. 391
Supplementary Exercises..................................................................................................... 395
Supplementary Problems.......................................................................................... 395
Supplementary Programming Exercises................................................................ 397
References.............................................................................................................................. 398
Further Reading.................................................................................................................... 399

Section III Digital Image Processing and Human Vision

7. Digital Image Processing and Visual Perception......................................................... 403

7.1 Introduction and Overview...................................................................................... 403
7.2 Human Visual Perception......................................................................................... 403
7.2.1 Human Visual System..................................................................................404
7.2.2 Spatial Frequency Resolution...................................................................... 410
7.2.3 Brightness Adaptation................................................................................. 415
7.2.4 Temporal Resolution..................................................................................... 419
7.2.5 Perception and Illusion................................................................................ 421
7.3 Image Fidelity Criteria.............................................................................................. 421
7.3.1 Objective Fidelity Measures........................................................................423
7.3.2 Subjective Fidelity Measures.......................................................................425
7.4 Key Points.................................................................................................................... 432
Exercises................................................................................................................................. 436
Problems...................................................................................................................... 436
Programming Exercises............................................................................................. 439
Supplementary Exercises..................................................................................................... 439
Supplementary Problems ........................................................................................ 439
Supplementary Programming Exercises................................................................440

© 2011 by Taylor & Francis Group, LLC

Contents ix

References.............................................................................................................................. 441
Further Reading....................................................................................................................442

8. Image Enhancement............................................................................................................443
8.1 Introduction and Overview......................................................................................443
8.2 Gray-Scale Modification............................................................................................445
8.2.1 Mapping Equations......................................................................................445
8.2.2 Histogram Modification.............................................................................. 456
8.2.3 Adaptive Contrast Enhancement............................................................... 468
8.2.4 Color................................................................................................................ 476
8.3 Image Sharpening . ................................................................................................... 489
8.3.1 Highpass Filtering........................................................................................ 490
8.3.2 High Frequency Emphasis.......................................................................... 490
8.3.3 Directional Difference Filters...................................................................... 493
8.3.4 Homomorphic Filtering............................................................................... 494
8.3.5 Unsharp Masking......................................................................................... 497
8.3.6 Edge Detector–Based Sharpening Algorithms........................................ 499
8.4 Image Smoothing....................................................................................................... 503
8.4.1 Frequency Domain Lowpass Filtering...................................................... 503
8.4.2 Convolution Mask Lowpass Filtering........................................................ 503
8.4.3 Nonlinear Filtering.......................................................................................505
8.5 Key Points.................................................................................................................... 514
Exercises................................................................................................................................. 521
Problems...................................................................................................................... 521
Programming Exercises............................................................................................. 527
Supplementary Exercises..................................................................................................... 529
Supplementary Problems.......................................................................................... 529
Supplementary Programming Exercises................................................................ 530
References.............................................................................................................................. 531
Further Reading.................................................................................................................... 532

9. Image Restoration and Reconstruction........................................................................... 535

9.1 Introduction and Overview...................................................................................... 535
9.1.1 System Model................................................................................................ 535
9.2 Noise Models.............................................................................................................. 537
9.2.1 Noise Histograms......................................................................................... 537
9.2.2 Periodic Noise................................................................................................542
9.2.3 Estimation of Noise......................................................................................543
9.3 Noise Removal Using Spatial Filters.......................................................................545
9.3.1 Order Filters...................................................................................................548
9.3.2 Mean Filters................................................................................................... 553
9.3.3 Adaptive Filters............................................................................................. 558
9.4 Degradation Function............................................................................................... 569
9.4.1 Spatial Domain: Point Spread Function.................................................... 569
9.4.2 Frequency Domain: Modulation/Optical
Transfer Function..................................................................................... 573
9.4.3 Estimation of the Degradation Function................................................... 576

© 2011 by Taylor & Francis Group, LLC

x Contents

9.5 Frequency Domain Filters........................................................................................ 577

9.5.1 Inverse Filter.................................................................................................. 578
9.5.2 Wiener Filter.................................................................................................. 582
9.5.3 Constrained Least Squares Filter................................................................ 583
9.5.4 Geometric Mean Filters................................................................................ 586
9.5.5 Adaptive Filtering......................................................................................... 587
9.5.6 Bandpass, Bandreject, and Notch Filters................................................... 588
9.5.7 Practical Considerations.............................................................................. 591
9.6 Geometric Transforms............................................................................................... 594
9.6.1 Spatial Transforms........................................................................................ 595
9.6.2 Gray-Level Interpolation.............................................................................. 597
9.6.3 Geometric Restoration Procedure.............................................................. 599
9.6.4 Geometric Restoration with CVIPtools..................................................... 601
9.7 Image Reconstruction................................................................................................ 603
9.7.1 Reconstruction Using Backprojections......................................................604
9.7.2 Radon Transform..........................................................................................608
9.7.3 Fourier-Slice Theorem and Direct Fourier Reconstruction.................... 610
9.8 Key Points.................................................................................................................... 611
Exercises................................................................................................................................. 624
Problems...................................................................................................................... 624
Programming Exercises............................................................................................. 629
Supplementary Exercises..................................................................................................... 631
Supplementary Problems.......................................................................................... 631
Supplementary Programming Exercises................................................................633
References..............................................................................................................................633
Further Reading.................................................................................................................... 635

10. Image Compression............................................................................................................. 637

10.1 Introduction and Overview...................................................................................... 637
10.1.1 Compression System Model...................................................................... 641
10.2 Lossless Compression Methods...............................................................................645
10.2.1 Huffman Coding......................................................................................... 649
10.2.2 Run-Length Coding.................................................................................... 651
10.2.3 Lempel–Ziv–Welch Coding....................................................................... 655
10.2.4 Arithmetic Coding...................................................................................... 656
10.3 Lossy Compression Methods................................................................................... 657
10.3.1 Gray-Level Run-Length Coding............................................................... 659
10.3.2 Block Truncation Coding........................................................................... 660
10.3.3 Vector Quantization................................................................................... 666
10.3.4 Differential Predictive Coding................................................................. 670
10.3.5 Model-Based and Fractal Compression................................................... 678
10.3.6 Transform Coding...................................................................................... 681
10.3.7 Hybrid and Wavelet Methods................................................................... 688
10.4 Key Points.................................................................................................................... 696
Exercises................................................................................................................................. 702
Problems...................................................................................................................... 702
Programming Exercises............................................................................................. 707

© 2011 by Taylor & Francis Group, LLC

Contents xi

Supplementary Exercises..................................................................................................... 708

Supplementary Problems.......................................................................................... 708
Supplementary Programming Exercises................................................................ 709
References.............................................................................................................................. 710
Further Reading.................................................................................................................... 711

Section IV Programming and Application Development with

CVIPtools
11. CVIPlab................................................................................................................................. 715
11.1 Introduction to CVIPlab............................................................................................ 715
11.2 Toolkits, Toolboxes, and Application Libraries...................................................... 721
11.3 Compiling and Linking CVIPlab............................................................................ 722
11.3.1 How to Build the CVIPlab Project with Microsoft’s
Visual C++• 2008......................................................................................... 722
11.3.2 Mechanics of Adding a Function with Microsoft’s
Visual C++• 2008......................................................................................... 724
11.3.3 Using CVIPlab in the Programming Exercises with Microsoft’s
Visual C++• 2008......................................................................................... 728
11.3.4 Using Microsoft’s Visual C++• 2010......................................................... 731
11.4 Image Data and File Structures............................................................................... 734
11.5 CVIP Projects.............................................................................................................. 739
11.5.1 Digital Image Analysis and Computer Vision Projects......................... 739
11.5.2 Digital Image Processing and Human Vision Projects......................... 741

12. Application Development.................................................................................................. 743

12.1 Introduction and Overview...................................................................................... 743
12.2 CVIP Algorithm Test and Analysis Tool................................................................ 744
12.2.1 Overview and Capabilities........................................................................ 744
12.2.2 How to Use CVIP-ATAT............................................................................. 744
12.2.2.1 Running CVIP-ATAT................................................................ 744
12.2.2.2 Creating a New Project............................................................. 744
12.2.2.3 Inserting Images........................................................................ 745
12.2.2.4 Inputting an Algorithm............................................................ 747
12.2.2.5 Performing an Algorithm Test Run........................................ 751
12.2.2.6 Comparing Images.................................................................... 751
12.2.3 Application Development Example with Fundus Images.................... 754
12.2.3.1 Introduction and Overview..................................................... 754
12.2.3.2 New Algorithm.......................................................................... 755
12.2.3.3 Conclusion.................................................................................. 760
12.3 CVIP Feature Extraction and Pattern Classification Tool.................................... 761
12.3.1 Overview and Capabilities........................................................................ 761
12.3.2 How to Use CVIP-FEPC............................................................................. 761
12.3.2.1 Running CVIP-FEPC................................................................ 761
12.3.2.2 Creating a New Project ........................................................... 761
12.3.2.3 Entering Classes in CVIP-FEPC.............................................. 763
12.3.2.4 Adding Images and Associated Classes................................ 763

© 2011 by Taylor & Francis Group, LLC

xii Contents

12.3.2.5 Applying Feature Extraction and Pattern Classification..... 764

12.3.2.6 Running the Test....................................................................... 766
12.3.2.7 Result File................................................................................... 766
12.3.3 Application Development Example with Veterinary
Thermographic Images.............................................................................. 770
12.3.3.1 Introduction and Overview..................................................... 770
12.3.3.2 Experiments............................................................................... 770
12.3.3.3 Results . ...................................................................................... 775
12.3.3.4 Conclusion.................................................................................. 775
12.4 Skin Lesion Classification Using Relative Color Features................................... 775
12.4.1 Introduction and Project Overview......................................................... 775
12.4.2 Materials and Methods.............................................................................. 776
12.4.2.1 Image Database......................................................................... 776
12.4.2.2 Creation of Relative Color Images.......................................... 776
12.4.2.3 Segmentation and Morphological Filtering..........................777
12.4.2.4 Feature Extraction ....................................................................777
12.4.2.5 Lesion and Object Feature Spaces ......................................... 779
12.4.2.6 Establishing Statistical Models............................................... 779
12.4.3 Experiments and Data Analysis............................................................... 780
12.4.3.1 Lesion Feature Space................................................................. 781
12.4.3.2 Object Feature Space................................................................. 783
12.4.4 Conclusions.................................................................................................. 785
12.5 Automatic Segmentation of Blood Vessels in Retinal Images............................. 786
12.5.1 Introduction and Overview...................................................................... 786
12.5.2 Materials and Methods.............................................................................. 787
12.5.3 Results.......................................................................................................... 792
12.5.4 Postprocessing with Hough Transform and Edge Linking.................. 794
12.5.5 Conclusion................................................................................................... 794
12.6 Classification of Land Types from Satellite Images Using Quadratic
Discriminant Analysis and Multilayer Perceptrons............................................. 795
12.6.1 Introduction and Overview...................................................................... 795
12.6.2 Data Reduction and Feature Extraction................................. 797
12.6.3 Object Classification................................................................................... 799
12.6.4 Results..........................................................................................................800
12.6.5 Conclusion................................................................................................... 801
12.6.6 Acknowledgments......................................................................................803
12.7 Watershed-Based Approach to Skin Lesion Border Segmentation.....................803
12.7.1 Introduction.................................................................................................803
12.7.2 Materials and Methods .............................................................................803
12.7.3 Experiments, Results, and Conclusions...................................................809
12.8 Faint Line Defect Detection in Microdisplay (CCD) Elements............................ 811
12.8.1 Introduction and Project Overview......................................................... 811
12.8.2 Design Methodology.................................................................................. 811
12.8.3 Line Detection Algorithm.......................................................................... 812
12.8.3.1 Preprocessing............................................................................. 812
12.8.3.2 Edge Detection........................................................................... 814
12.8.3.3 Analysis of the Hough Space................................................... 816
12.8.4 Results and Discussion.............................................................................. 819
12.8.5 Summary and Conclusion......................................................................... 820
© 2011 by Taylor & Francis Group, LLC
Contents xiii

12.9 Melanoma and Seborrheic Keratosis Differentiation Using Texture

Features....................................................................................................................... 820
12.9.1 Introduction and Overview ..................................................................... 820
12.9.2 Materials and Methods.............................................................................. 821
12.9.3 Texture Analysis Experiments.................................................................. 823
12.9.4 Results and Discussion..............................................................................830
12.9.5 Conclusion...................................................................................................830
12.9.6 Acknowledgments...................................................................................... 831
12.10 Compression of Color Skin Tumor Images with Vector Quantization ............. 831
12.10.1 Introduction and Project Overview......................................................... 831
12.10.2 Materials and Methods.............................................................................. 832
12.10.2.1 Compression Schemes ............................................................ 832
12.10.2.2 Subjective Evaluation of the Images...................................... 833
12.10.3 Compression Schemes................................................................................834
12.10.3.1 Preprocessing and Transforms...............................................834
12.10.3.2 Vector Quantization................................................................. 836
12.10.3.3 Postprocessing . ........................................................................840
12.10.4 Results and Analysis.................................................................................. 841
12.10.4.1 Results and Analyses for the Schemes with
Compression Ratio 4:1.............................................................. 841
12.10.4.2 Results and Analyses for the Schemes with
Compression Ratio 8:1..............................................................842
12.10.4.3 Results and Analyses for the Schemes with
Compression Ratio 14:1............................................................843
12.10.4.4 Results and Analyses for the Schemes with
Compression Ratio 20:1............................................................845
12.10.4.5 Comprehensive Analysis of the Four
Compression Ratios.................................................................. 847
12.10.5 Conclusions and Future Work.................................................................. 849
12.10.6 Acknowledgments...................................................................................... 851
References.............................................................................................................................. 852

13. CVIPtools C® Function Libraries..................................................................................... 855

13.1 Introduction and Overview.................................................................................... 855
13.2 Arithmetic and Logic Library: ArithLogic.lib...................................................... 855
Arithlogic Library Function Prototypes................................................................ 855
13.3 Band Image Library: Band.lib ............................................................................... 856
13.4 Color Image Library: Color.lib................................................................................ 856
Color Library Function Prototypes........................................................................ 857
13.5 Compression Library: Compression.lib................................................................ 857
Compression Library Function Prototypes.......................................................... 858
13.6 Conversion Library: Conversion.lib....................................................................... 861
Conversion Library Function Prototypes............................................................. 861
13.7 Display Library: Display.lib.................................................................................... 863
13.8 Feature Extraction Library: Feature.lib.................................................................864
Feature Library Function Prototypes.....................................................................864
13.9 Geometry Library: Geometry.lib............................................................................ 867
Geometry Library Function Prototypes................................................................ 867

© 2011 by Taylor & Francis Group, LLC

xiv Contents

13.10 Histogram Library: Histogram.lib......................................................................... 870

Histogram Library Function Prototypes............................................................... 870
13.11 Image Library: Image.lib......................................................................................... 871
13.12 Data Mapping Library: Mapping.lib..................................................................... 872
13.13 Morphological Library: Morphological.lib........................................................... 873
Morphological Library Function Prototypes........................................................ 873
13.14 Noise Library: Noise.lib........................................................................................... 875
Noise Library Function Prototypes........................................................................ 875
13.15 Segmentation Library: Segmentation.lib.............................................................. 876
Segmentation Library Function Prototypes.......................................................... 876
13.16 Spatial Filter Library: SpatialFilter.lib .................................................................. 878
Spatial Filter Library Function Prototypes........................................................... 878
13.17 Transform Library: Transform.lib..........................................................................884
Transform Library Function Prototypes................................................................884
13.18 Transform Filter Library: TransformFilter.lib....................................................... 885
Transform Filter Library Function Prototypes..................................................... 885

Section V Appendices
Appendix A: CVIPtools CD..................................................................................................... 891
Appendix B: Installing and Updating CVIPtools .............................................................. 893
Appendix C: CVIPtools Software Organization................................................................. 895
Appendix D: CVIPtools C® Functions.................................................................................... 897
D.1 Toolkit Libraries............................................................................................ 897
D.2 Toolbox Libraries.......................................................................................... 902
Appendix E: Common Object Module (COM) Functions: cviptools.dll......................... 911
Appendix F: CVIP Resources................................................................................................... 923

Index.............................................................................................................................................. 927

© 2011 by Taylor & Francis Group, LLC

Preface

Digital image processing and analysis is a field that continues to experience rapid growth,
with applications ranging from areas such as space exploration to the entertainment indus-
try. The diversity of applications is one of the driving forces that make it such an exciting
field to be involved in for the twenty-first century. Digital image processing, also referred to
as computer imaging, can be defined as the acquisition and processing of visual informa-
tion by computer. This book presents a unique approach to the practice of digital image
processing, and will be of interest to those who want to learn about and use computer
imaging techniques.
Digital image processing can be divided into two primary application areas, human
vision and computer vision, with image analysis tying these two together. Although the
book focuses on image processing and analysis, the image analysis part provides the
reader with the tools necessary for developing computer vision applications such as those
discussed in Chapter 12. The automatic identification of land types in satellites images,
robotic control of a Mars rover, and the automatic classification of abnormalities in medical
images are examples of computer vision applications. Human vision applications involve
manipulation of image data for viewing by people. Examples include the development of
better compression algorithms, special effects imaging for motion pictures, and the resto-
ration of satellite images distorted by atmospheric disturbance.

Why Write a New Edition of This Book?

The first topic is: Why a new title? The change is primarily due to definitions used in
current practice. The previous title Computer Imaging tends now to refer to PhotoShop®-
type applications and document imaging only. Digital Image Processing and Analysis is more
comprehensive, explanatory, and up-to-date. The subtitle, Human and Computer Vision
Applications with CVIPtools, reinforces the applications-oriented nature of the book and
fact that CVIPtools is integrated more throughout this edition.
As before, this edition of the book takes an engineering approach to digital image pro-
cessing and brings image processing and image analysis into a unified framework that pro-
vides a useful paradigm for both human and computer vision applications. Additionally,
the theoretical foundation is presented as needed in order to fully understand the mate-
rial. Although theoretical-based textbooks are available, they do not really take what I con-
sider an engineering approach. I still feel that there is a need for an application-oriented
book that brings image processing and analysis together in a unified framework, and this
book fills that gap.
For the new edition of the book I wanted to use color throughout and add more materials on
the processing of color images. Happily, the publisher agreed. I also reorganized, updated,
expanded, and added more materials that make it more useful as an ­applications-oriented
textbook. I added supplementary exercises, a new chapter on applications, and developed
two new major tools that allow for batch processing, the analysis of imaging algorithms,
and the overall research and development of imaging applications.

© 2011 by Taylor & Francis Group, LLC xv

xvi Preface

The creation of the two new software tools, the Computer Vision and Image Processing
Algorithm Test and Analysis Tool (CVIP-ATAT) and the CVIP Feature Extraction and
Pattern Classification Tool (CVIP-FEPC), realizes a much more powerful development
environment. The new Windows® version of CVIPtools, which has been integrated even
more throughout the book, in conjunction with the two new development tools, creates a
valuable environment for learning about imaging as well as providing a set of reusable
tools for applications development.

Who Will Use This Book?

The book is intended for use by the academic community in teaching and research, as well
as working professionals performing research and development in the commercial sectors.
This includes all areas of digital image processing and analysis, both human and computer
vision applications. It will be useful to academics and practicing engineers, consultants, and
programmers, as well as those in the graphics fields, medical imaging professionals, multi-
media specialists, and others. The book can be used for self-study and is of interest to anyone
involved with developing imaging applications, whether they are engineers, geographers,
biologists, oceanographers, or astronomers. At the university it can be used as a textbook in
standard digital image processing and/or computer vision senior-level or graduate courses,
or may be used at any level in an applications-oriented course. One essential component
that is missing from standard theoretical textbooks is a conceptual presentation of the
material, which is fundamental for gaining a solid understanding of these complex topics.
Additionally, this book provides the theory necessary to understand the foundations of digi-
tal image processing, as well as that which is needed for new algorithm development.
The prerequisites for the book are an interest in the field, a basic background in computers,
and a basic math background provided in an undergraduate science or engineering pro-
gram. Knowledge of the C®, C++®, or C#® programming language will be necessary for those
intending to develop algorithms at the programming level. Some background in signal and
system theory is required for those intending to gain a deep understanding of the sections on
transforms and compression. However, the book is written so that those without this back-
ground can learn to use the tools and achieve a conceptual understanding of the material.

Approach
To help motivate the reader I have taken an approach that presents topics as needed. This
approach starts by presenting a global model to help gain an understanding of the over-
all process, followed by a breakdown and explanation of each individual topic. Instead
of presenting techniques or mathematical tools when they fit into a nice, neat theoretical
framework, topics are presented as they become necessary for understanding the practi-
cal imaging model under study. This approach provides the reader with the motivation to
learn about and use the tools and topics, because they see an immediate need for them. For
example, the mathematical process of convolution is introduced when it is needed for an
image zoom algorithm, and morphological operations are introduced when the filtering
© 2011 by Taylor & Francis Group, LLC
Preface xvii

operations are needed after image segmentation. This approach also makes the book more
useful as a reference, or for those who may not work through the book sequentially, but
will reference a specific section as the need arises.

Organization of the Book

The book is divided into five major sections. The first section of the book, Introduction
to Digital Image Processing and Analysis, contains all of the basic concepts and defini-
tions necessary to understand digital image processing. The second section, Digital Image
Analysis and Computer Vision, describes image analysis and provides the tools, concepts,
and models required to analyze digital images and develop computer vision applications.
Section III, Digital Image Processing and Human Vision, discusses topics and application
areas for the processing of images for human consumption, so it starts with a chapter on
visual perception. Each chapter includes numerous references and examples for the mate-
rial presented. The material is presented in a conceptual and application-oriented manner,
so that the reader will immediately understand how each topic fits into the overall frame-
work of imaging applications development.
The programming and applications development part of the book, Section IV, Program­
ming and Application Development with CVIPtools, provides all the necessary informa-
tion required to use the CVIPtools environment for algorithm development. This section
also includes information to assist with the implementation of the programming exercises
included with each chapter. It also includes a chapter on using the new development tools
and examples of applications that have been developed in the past few years. The last sec-
tion, Appendices, contains reference material for use with CVIPtools, as well as other useful
computer imaging–related information.

Using the Book in Your Courses

The book is intended for use in both digital image processing and computer vision courses.
Both types of courses will use the introductory chapters in the first section. After the intro-
duction, computer vision courses will concentrate on Section II, where the introductory
chapter presents a model of image analysis and concludes with the development of a pat-
tern classification algorithm for geometric objects in images. This model provides a foun-
dation for all the tools that are developed and discussed throughout the second section.
Digital image processing courses will focus on the third section, which contains an intro-
ductory chapter on human visual perception, followed by chapters on image enhance-
ment, restoration, and compression. Most image processing courses will also want to cover
Chapter 5 on image transforms. Both computer vision and image processing courses can
use the programming parts of the book, depending on the instructor’s teaching structure.
I encourage all who use the book to explore the programming exercises as they provide a
valuable learning tool for computer imaging. There are also many tutorial exercises using
CVIPtools included with each chapter, which provide hands-on experience and allow the
user to gain insight into the various algorithms and parameters. Use the following table to
outline your course.
© 2011 by Taylor & Francis Group, LLC
xviii Preface

Senior Level/Graduate Required Additional/Optional Reference

Courses Chapters Chapters/Sections Chapters
Image Analysis 1, 2, 3, 4, 5.1, 5.2, 5.7, 6, 11 5.3, 5.4, 5.5, 5.6, 5.8, 12 13, Appendices
Computer Vision
Machine Vision
Digital Image Processing 1, 2, 3.1, 3.2, 5.1, 5.2, 5.7, 5.3, 5.4, 5.5, 5.6, 11, 12 13, Appendices
Digital Picture Processing 5.8, 7, 8, 9, 10
Image Processing

After the CVIPtools environment is installed from the CD, an image database will be in
the default images directory, which contains the images used in the book. The CVIPtools
Website, www.ee.siue.edu/CVIPtools, is a resource that has useful imaging examples,
information and links to other imaging Web sites of interest. Additionally, a Solutions
Manual with Instructor’s CD containing PowerPoint lecture slides is available from the
publisher to those adopting the book in their courses.

CVIPtools Software Development Environment

The software development environment includes an extensive set of standard C® libraries,
a skeleton program for using the C libraries called CVIPlab, a dynamically linked library
(cviptools.dll) based on the common object module (COM) interface, a GUI-based program
for the exploration of computer imaging called CVIPtools, and the two new algorithm
development and batch processing tools CVIP-ATAT and CVIP-FEPC. The CVIPlab pro-
gram and all the standard libraries are ANSI-C compatible. The new version of CVIPtools
has been developed exclusively for the Windows® operating system, but various UNIX
versions are available at the Web site (www.ee.siue.edu/CVIPtools). The CVIPtools soft-
ware, the libraries, the CVIPlab program, CVIP-ATAT, CVIP-FEPC, images used in the
textbook, and associated documentation are included on the CD.
The CVIPtools software has been used in projects funded by the National Institutes of
Health, the U.S. Department of Defense, and numerous corporations in the commercial sec-
tor. CVIPtools has been used in the medical, aerospace, printing, and manufacturing fields
in applications such as the development of a helicopter simulation, automated classification
of lumber, skin tumor evaluation and analysis, embedded image processing for print tech-
nology, the automatic classification of defects in microdisplay chips, and the analysis of
veterinary thermographic images for disease evaluation. Since it is a university-sponsored
project, it is continually being upgraded and expanded, and updates are available via the
Internet (see Appendix B). This software allows the reader to learn about imaging topics in
an interactive and exploratory manner, and to develop their own programming expertise
with the CVIPlab program and the associated laboratory exercises. With the CVIPlab pro-
gram they can link any of the already defined CVIPtools functions, ranging from general
purpose input/output and matrix functions to more advanced ­transform functions and
complex imaging algorithms; some of these functions are state-of-the-art algorithms since
CVIPtools is continually being improved at the Computer Vision and Image Processing
Laboratory at Southern Illinois University Edwardsville (SIUE).

© 2011 by Taylor & Francis Group, LLC

Acknowledgments

I thank Southern Illinois University Edwardsville, specifically the School of Engineering

and the Electrical and Computer Engineering Department, for their support in this
endeavor. I also thank all the students who have taken my imaging courses and provided
valuable feedback regarding the learning and teaching of digital image processing and
analysis.
The initial version of the CVIPtools software was developed primarily by myself and a
few graduate students: Gregory Hance, Arve Kjoelen, Kun Luo, Mark Zuke, and Yansheng
Wei; without their hard work and dedication the foundation that was built upon for this
new version would not be solid. The next major Windows® version of CVIPtools was devel-
oped primarily by myself and Iris Cheng, Xiaohe Chen, Dejun Zhang, and Huashi Ding.
Additional students who contributed were Husain Kagalwalla and Sushma Gouravaram.
The current version of CVIPtools was initially developed by Patrick Solt and Evan Bian.
The work was completed by Patrick Solt as the project manager, with Jhansi Akkineni,
Mouinika Mamidi, Pelin Guvenc, Serkan Kefel, and Hari Krishna Akkineni providing
programming support. Jhansi Akkineni served as project coordinator and helped Patrick
with management duties.
Patrick Solt deserves special credit for helping to coordinate and manage the CVIPtools
for Windows project. He dedicated a major amount of his time to the development of the
CVIPtools software, and helped us greatly in project organization and in solving many
problems. Overall, Patrick’s contributions to this project have been substantial, and his
extra efforts deserve special recognition. Jhansi Akkineni’s efforts also deserve special
recognition. Her dedication to the project and the help she provided to others working on
the project were substantial. Iris Cheng, who was the primary contributor on the original
Windows version of CVIPtools, also deserves special recognition for her continued sup-
port as a consultant on the project.
The Computer Vision and Image Processing Algorithm Test and Analysis Tool, CVIP-
ATAT, underwent many changes before its release with this book. The initial development
was provided by Sid Smith and Jeremy Wood. Geer Shaung and Evan Bian provided sub-
stantial new developments for this tool, which helped to make it more practical for its use
with CVIPtools. Further development was required to get it into its current form, which
was completed, tested, and utilized in projects by Pelin Guvenc. The Computer Vision
and Image Processing Feature Extraction and Pattern Classification Tool, CVIP-FEPC, was
created and developed by Patrick Solt, further developed by Jesse Phelps, and partially
funded by the Long Island Veterinary Specialists.
In small but important parts of CVIPtools public domain software was used, and
kudos to those who provided it: Jef Pokanzer’s pbmplus, Sam Leffler’s TIFF library, Paul
Heckbert’s Graphics Gems, the Independent JPEG Group’s software, Yuval Fisher’s fractal
code, and the Texas Agricultural Experiment Station’s code for texture features.
I’d like to thank those who contributed photographs and images: Mark Zuke, Mike
Wilson, Tony Berke, George Dean, Sara Sawyer, Sue Eder, Jeff Zuke, Bill White, the National
Oceanic and Atmospheric Administration, NASA, and MIT. H. Kipsang Choge deserves
credit for helping out with the figures, especially for Chapters 2 and 5, and I thank him
for this work. Thanks also to David, Robin, Michael, Jeanie, Jeff, Mom, Greg, Glicer, Gaby,

© 2011 by Taylor & Francis Group, LLC xix

Random documents with unrelated
content Scribd suggests to you:
The omission of these babies meant the exclusion of a number of mothers in a group that was too
important racially to be omitted from an investigation embracing all races and classes. Accordingly a list
of babies christened in the Serbian Church and born in the year 1911 was secured and an attempt
made to locate them. In addition an agent called at each house in the principal Serbian quarter to
inquire concerning births in 1911. A number of unregistered babies of Serbian mothers were thus found
and included in the investigation.
The agents were sometimes approached by mothers of babies born in 1911 who resented being omitted
from the investigation simply for the reason that their babies’ births had not been registered. The
agents were therefore instructed to interview mothers thus accidentally encountered and to include
their babies in the investigation. But no additional baptismal records were copied nor was a house-to-
house canvass made of the city; in fact, no further means were resorted to to locate unregistered
babies for the purpose of including them in the investigation.
There were 1,763 certificates copied at Harrisburg, and 1,383 of the babies named in them were
reached by the agents. In addition, 168 babies for whom there were no birth certificates, but who were
located in the ways just noted, were included, making a total of 1,551 completed schedules secured.
Of the 380 not included in the investigation there were 149 who could not be located at all; 220 others
had moved out of reach—that is, into another city or State; 6 of the mothers had died; 3 could not be
found at home after several calls, and 2 refused to be interviewed.
From the following summary of data recorded on the certificates of the 380 unlocated babies just
referred to it appears that the infant mortality rate (134.3) among them is almost the same as that
(134) shown in Table 1 for babies included in the investigation. In reality, however, it is perhaps a little
higher, as some of these babies no doubt died outside of Johnstown and their deaths were recorded
elsewhere.

SEX OF BABY. ATTENDANT AT BIRTH.

NATIONALITY Total Live Still-
OF MOTHER. births. births. births.
Male. Female. Physician. Midwife. Unknown

Total 380 350 30 227 153 158 180 33

Native 134 118 16 76 58 122 5 7
Foreign 246 232 14 151 95 36 184 26
Slovak, Polish,
43 41 2 27 16 4 37 2
etc
Croatian and
13 11 2 10 3 7 6
Servian
Magyar 1 1 1 1
German 8 8 6 2 2 5 1
Italian 41 39 2 26 15 3 36 2
Syrian and Greek 7 6 1 3 4 3 4
British 7 7 3 4 5 2
Austrian (not
otherwise 123 116 7 73 50 19 89 15
specified)
Not reported 3 3 2 1 3
 RELATION OF INFANT MORTALITY TO ENVIRONMENT
NEIGHBORHOOD INCIDENCE
The rate of infant mortality is regarded as a most reliable test of the sanitary condition of a district. (Sir
Arthur Newsholme, Elements of Vital Statistics, p. 120. London, 1899.)
Johnstown is a hilly, somewhat Y-shaped area of about 5 square miles which spreads itself out into long,
narrow, irregularly shaped strips, detached by rivers and runs and steep hills. In some places it is not
over a quarter of a mile wide, but its extreme length is about 4 miles. The city is composed of 21 wards
and is an aggregation of what were formerly separate unrelated boroughs or towns. The names of
these different sections, together with the numerical designations of the wards included in or
comprising them, are shown in the following table. This table gives for each section not only the total
population according to the Federal census of 1910, but also the number of live-born babies included in
the investigation and the number and proportion of deaths among such babies during their first year.

Table 1.—Distribution of Population, Live Births and Deaths During First Year, and Infant
Mortality Rate According to Section of Johnstown, for all Children Included in this Investigation.

Deaths
during
Total first Infant
Population,
SECTION OF CITY AND WARD. live-born year of mortality
1910.[12]
babies. babies rate.
born in
1911
The whole city 55,482 1,463 196 134.6
Down-town section (wards 1, 2, 3, 4) 5,944 80 4 52.0
Kernville (wards 5, 6) 6,070 104 6 57.7
Homerstown (ward 7) 4,476 109 17 156.0
Roxbury (ward 8) 2,862 85 19 117.6
Conemaugh Borough (wards 9, 10) 5,282 136 16 117.6
Woodvale (ward 11) 3,945 107 20 271.0
Prospect (ward 12) 1,893 55 11 200.9
Peelorville (ward 13) 1,443 13 4 ([13])
Minersville (ward 14) 2,403 72 9 125.0
Cambria City (wards 15, 16) 8,706 310 55 177.4
Moxham (ward 17) 5,735 157 14 39.2
Morrellville (wards 18, 19, 20) 5,757 194 15 32.5
[13]
Coopersdale (ward 21) 968 36 8 ( )

12. Federal census of 1910.

13. Total live births less than 50; base therefore considered too small to use in computing an infant
mortality rate.
To learn where the babies die is perhaps the first step in solving the infant mortality problem. The
modern health officer recognizes this and generally has in his office a wall map upon which are
indicated sections, wards, city blocks, and sometimes even houses. As infant deaths are reported, pins
are stuck in the map in the proper places, a density of pins on any part of the map indicating, of course,
where deaths are most numerous, although the percentage of infant deaths may not be the highest.
The highest infant mortality rate, 271, is found in the eleventh ward, known as Woodvale, although this
is neither the most populous ward nor the one having the largest number of births. The infant mortality
rate here, however, is double the rate for the city as a whole and more than five times as great as it is
for the most favorable ward.
This is where the poorest, most lowly persons of the community live—families of men employed to do
the unskilled work in the steel mills and the mines. They are for the most part foreigners, 78 per cent.
of the mothers interviewed in this ward being foreign born.
Through Woodvale runs the main line of the Pennsylvania Railroad. To the north of the tracks rises a
steep hill, toward the top of which is Woodvale Avenue, the principal street north of the railroad. (See
plate A.) Sewer connection is possible for the houses along this avenue, as a sewer main has recently
been installed, but the people have not in all cases gone to the expense of having the connection made,
and in other cases where they have done so sometimes only the sinks are connected with the sewer
and the yard privy is retained.
On the streets above Woodvale Avenue dwellings are more scattered and the appearance is more rural.
A few of the families still have to depend upon more or less distant springs for their water, although city
water is quite generally available throughout Woodvale.
The streets near the bottom of the hill, as Plum Street, for example, are so much below the level of the
sewer mains that they can not be properly drained into the sewer. Private drain pipes from houses are
buried a few feet below the surface and protrude from the sides of the hills, dripping with house
drainage which flows slowly into ditches and forms slimy pools. (See Plates B and C.)
None of the streets on the north side of the railroad track are paved; sidewalks and gutters are lacking.
In cold weather the streets are icy and slippery and even dangerous on account of the grade. In warm
weather they are frequently slippery and slimy with mud.
Maple Avenue is the principal street of that part of Woodvale lying to the south of the railroad tracks,
and it is the only properly paved and graded street in Woodvale. The streets on this side of the tracks,
however, are not in as bad a condition as those to the north, nor are the drainage and general sewerage
conditions as offensive as north of the tracks, but many of the streets are nevertheless muddy and
filthy. (See Plate D.)
Prospect ranks next to Woodvale in infant mortality, having a rate of 200. This section, lying along a
steep hill and above one of the big plants of the steel company, has not a single properly graded,
drained, and paved street. The sewers are of the open-ditch type, and the natural slope of the land
toward the river is depended upon for carrying off the surface water that does not seep into the soil.
The closets are generally in the yard and are either dry privies or they are situated over cesspools.
Some of the people who live on the lower part of the slope have wells sunk directly in the course of the
drainage from above. (See Plate E.)
Cambria City, which is composed of the two most populous wards of Johnstown, has the third highest
infant mortality rate, 177.4. It has a large foreign element, as is evidenced by the fact that 90.6 per
cent. of the mothers interviewed were foreign born. It is situated along the river, between the hills of
Minersville and Morrellville, and somewhat to the north of Prospect. The sewage from other residential
sections and from the steel mills above them empties into the river at this point. In warm, dry seasons
the river is low, flows slowly, and forms foul-smelling pools.
Sewer connection is possible for most of the houses in Cambria City, although all are not connected.
Some, on the streets bordering the river, have private drain pipes that empty out into the stream.
Others have their kitchen sinks connected with the sewer but still retain yard privies, which, of course,
are not sewer connected.
There is considerable crowding of houses on lots, rear houses being commonly built on lots intended for
but one house. Density of population and house congestion are greater here than elsewhere in the city.
The streets of Cambria City are somewhat better graded and more generally paved than those of
Woodvale, but muddy streets and unpaved sidewalks nevertheless exist here. Broad Street, however,
which is the business thoroughfare and runs through the center of the section, is the widest and best
constructed street in Johnstown. Bradley Alley, on the other hand, running the length of Cambria City
and parallel to Broad Street, is the most conspicuous example in the city of a narrow lane or alley used
as a residence street. A number of small dwellings, generally housing more than one family, have their
frontage on this alley, which is 19 feet 10 inches in width and without sidewalks. It is unpaved and in
bad condition, generally being either muddy or dusty and littered with bottles, cans, and other trash.
(See Plates F. and G.)
Homerstown has an infant mortality rate of 156, ranking fourth among the several sections of
Johnstown in this respect. It has a fairly prosperous and somewhat suburban appearance, but its
comparatively high infant mortality rate can perhaps be partly accounted for by the bad street
conditions and the fact that refuse of all sorts is dumped into the shallow river at this point.
Minersville is a district where a high rate would be expected from prevailing conditions. The rate is 125,
or less than the average for the city but more than double that for the most favorable sections. This
ward is built on a hill and so located that the rising clouds of grit-laden smoke from the steel mills
envelop it much of the time. Only one street in this section is well paved, and this is seldom clean.
Houses on some of the streets near the top of the hill are not sewer connected, and streams of waste
water trickle down the hill and give rise to unpleasant odors. (See Plates H and I.)
Conemaugh Borough, with an infant mortality rate of 117.6, ranks sixth in this respect among the
sections into which Johnstown has been divided. It comprises wards 9 and 10 and begins at the edge of
the down-town section and spreads upward over the hills to the southwest. Some of the houses on
streets near the top of the hill are not sewer connected, and streams of water constantly trickle down
the numerous alleys and streets that descend the hill. (See Plate J.) This section makes a very
unfavorable first impression because of the open drainage and of the many dirty, badly paved streets.
(See Plate K.) Unlike some of the other wards, it has a rather evenly distributed population and is
without the vast uninhabited areas and acutely congested spots found in some other sections. On the
whole there is little crowding on the lots and there are many good-sized yards. One-third of the
population is foreign born. Of these the Italians are the most numerous. Despite certain ugly spots this
section has not the unwholesome atmosphere that characterizes Woodvale and to a lesser extent
Prospect, Cambria City, and Minersville.
The infant mortality rate of 117.6 per thousand in Roxbury is the same as that of Conemaugh Borough.
For reasons not plainly apparent the rate here is higher than in Moxham, Morrellville, Kernville, or the
down-town section, although it appears to be as favorably conditioned as these sections are from a
social, economic, and sanitary standpoint. Here, as in all these sections, however, are many conditions
not conducive to health. For example, parts of Franklin Street are in bad repair. The roadway is full of
ruts and holes; the street, which is seldom sprinkled, is dusty in dry weather and muddy in wet weather,
and in front of good houses along one section of this street runs an open ditch that receives house
drainage.
Moxham has the eighth highest infant mortality rate, it being 89.2. Conditions here are generally rather
favorable, although there is some complaint that at “high water” the sewage received by one of the
runs in this section backs into some of the houses and then the sinks and water-closets overflow. Some
of the homes here, near the city limits, are not supplied with city water but are still dependent upon
wells and springs.
One of the three wards constituting Morrellville (ward 18) has a rural appearance; there is little house
crowding on lots, big yards are common, and the streets are not paved. It is, however, marred by an
offensive open-ditch sewer. Ward 19 of Morrellville has a more finished, less rural appearance. One of its
objectionable features is that house drainage and the bloody waste of slaughterhouses are emptied into
a shallow stream that flows through it. Ward 20 adjoins ward 19, and although it spreads out into a
suburb it appears for the most part to be a comfortable and busy little village. Strayer’s Run winds
about here and receives sewage. The fact that it is without a guardrail in some places and that the
railing is inadequate in others makes it a source of danger, and according to common report such
accidents as children falling into the stream have occurred. The infant mortality rate for Morrellville is
82.5.
Kernville, a section with a considerable proportion of prosperous people, has a very favorable infant
mortality rate, it being 57.7. Parts of this section, however, are on a hill stretching upward from Stony
Creek, which is both unsightly and offensive in warm weather and when the water is low.
The down-town section, i.e., wards 1, 2, 3, and 4, where are to be found many of the best conditioned
houses, the homes of many of the well-to-do people, has the lowest infant mortality rate in the city, it
being but 50.
No infant mortality rate is presented in the tables for Coopersdale or for Peelorville. In the first-named
section only 36 live-born infants were considered, and 8 of them died in their first year. But this high
rate need not be considered as especially significant, as the base number is small for such a
computation. Coopersdale, however, is a suburban-appearing community in which one would expect the
infant mortality rate to be low.
Peelorville is that part of the thirteenth ward which adjoins Prospect. A number of company houses are
located here in which sanitary conditions are fairly good. The ward seems to have good drainage and no
sewage nuisances. It is a community of wage earners and not of prosperous homes. Only 18 babies are
included in the report for this district, one of whom died. With such a small base the infant mortality
rate is not significant. (See Plate L.)
 SANITARY CONDITIONS—SEWERAGE, PAVEMENTS, GARBAGE
COLLECTIONS
The general inadequacy of the sewerage system which has been indicated for the city as a whole is due
in part to the fact that the city is largely an aggregation of sections, formerly independent of Johnstown
itself, which have been annexed at different periods. Some of these boroughs had sewer systems more
or less developed when they were taken into Johnstown; others had none. Not only the sewerage of
Johnstown but that of outlying boroughs pollutes the two shallow rivers, the Conemaugh and the Stony
Creek, that flow through Johnstown. These are burdened with more waste than they can properly carry
away, and the deposits which are left on the rocks in various sections of both rivers create nuisances
that are the subject of much complaint, especially during the warm summer months. (See Plates M, N,
O, and P.) At various times agitation has been started to improve the rivers which, as they flow through
Johnstown, are, at the low-water stage, little better than swamps of reeking slime from the waste
matter emptied into them from the hundreds of sewers along their banks. The pipes through which
waste matter is emptied into the streams go only to the river edge, leaving their mouths uncovered and
making the river beds at times pools of slowly flowing filth. These unsightly, malodorous conditions
could be remedied if pipes were extended out into the middle of the streams, where the water is
deeper.
With the exception of sprinkling a few wagon loads of lime along the banks of the streams each year,
the city has done nothing to abate the nuisances arising from the use of these rivers as sewers or to
restrain the coal and steel companies from allowing the drainage from mines and mills to enter the
streams.
The engineer’s records show that Johnstown had in 1911 a total of 41.1 miles of sewers and 36 sewer
outlets, and 82 miles of streets, 52.7 miles being paved. The alleys in Johnstown are generally
inhabited. They are narrow and without sidewalks. Their length is 52.88 miles and 47.35 miles are
unpaved. The combined length of streets and alleys is 134.88 miles. A comparison of this combined
length of streets and alleys with the 41.1 miles of sewers having 36 outlets shows the inadequacy of the
sewer system.
Not only is there an absence of paving, but the roadways are in very bad condition. A protest by “A
Citizen” in the Democrat of June 26, 1913, says that there are nine months in the year when it would be
impossible for the proposed fire-department automobile engines to attend a fire in the seventh, eighth,
eleventh, seventeenth, eighteenth, nineteenth, twentieth, and twenty-first wards owing to the condition
of the streets.
The scavenger system is also very defective. Citizens are required to pay for the removal of their ashes,
trash, and garbage. Garbage collections are not made by the municipality, but by private contractors,
and any sort of receptacle, covered or uncovered, can or box, is pressed into service by householders. It
is by no means uncommon to find streets and alleys littered with ashes, garbage, bottles, tin cans, beer
cases, and small kegs. Dirty streets are by no means exceptional in Johnstown, even though the State
of Pennsylvania has a law (act of Apr. 20, 1905) which provides for the punishment of any person who
litters paved streets. It reads, in part, as follows (sec. 7 of Pamphlet Laws, 227):
“From and after the passage of this act, it shall be unlawful, and is hereby forbidden, for any person or
persons to throw waste paper, sweepings, ashes, household waste, nails, or rubbish of any kind into any
street in any city, borough, or township in this Commonwealth, or to interfere with, scatter, or disturb
the contents of any receptacle or receptacles containing ashes, garbage, household waste, or rubbish
which shall be placed upon any of said paved streets or sidewalks for the collection of the contents
thereof.
“Any person or persons who shall violate any of the provisions of this act shall, upon conviction thereof
before any magistrate, be sentenced to pay the cost of prosecution and to forfeit and pay a fine not
exceeding $10 for each offense, and in default of the payment thereof shall be committed and
imprisoned in the county jail of the proper county for a period not exceeding ten days.”
In a report on infant mortality to the registrar general of Ontario, 1910, Dr. Helen MacMurchy says:
“Improve the water supply, the sewerage system, and the system of disposing of refuse; introduce
better pavements, such as asphalt, and at once there is a decline in infantile mortality.” All these are
sanitary features in need of great improvement in Johnstown, and unquestionably a lowered infant
mortality rate would reward any efforts for their betterment.
 HOUSING
In Johnstown the so-called “double” house predominates, usually frame. The double house is in reality
two semidetached houses built upon a single lot. Rows of three or more houses of two, three, or four
rooms each are common, and they are known locally as three-family, or six-family houses, as the case
may be. Sometimes these are “rear houses,” that is, they are built behind other houses that face the
street, on the same lots and in fact are approached by way of a narrow alley running alongside the
house that has its frontage directly on the street. For this type of house water-closets or privies are
often in rows in the yard or court that is used in common by all families. (See Plates Q and R.) In some
places they are too few in number to permit each family to have the exclusive use of one.
Johnstown has three or four comparatively high-grade apartment houses, and in several office buildings
rooms are rented to families for housekeeping. These are generally taken by native families.
In one of these office buildings the two lower floors are used for business purposes and the two upper
floors are given over entirely to tenement purposes. From 40 to 50 families live here, many of whom
have but one room. To serve the 20 or 25 families on each floor there is one bath and toilet room for
men and another for women. Adjoining the toilet rooms is a small room containing garbage cans and
trash receptacles for the use of the tenants.
The sanitary conditions in some of the best tenements or apartments, however, are not up to the
standards of other cities, and in those occupied by the poorer people conditions are much worse than
are usually permitted to exist in cities having large tenement houses in great numbers, where a
tenement-house problem is recognized as such and active efforts are made by the municipality to
improve conditions.
An absolute measure of the importance of each single housing defect in a high mortality rate can not be
secured from this study. But it is not without interest to note that in homes where water is piped into
the house the infant mortality rate was 117.6 per thousand, as compared with a rate of 197.9 in homes
where the water had to be carried in from outdoors. Or that in the homes of 496 live-born babies where
bathtubs were found the infant mortality rate was 72.6, while it was more than double, or 164.8, where
there were no bathtubs. Desirable as a bathtub and bodily cleanliness may be, this does not prove that
the lives of the babies were saved by the presence of the tub or the assumed cleanliness of the persons
having them. In a city of Johnstown’s low housing standards, the tub is an index of a good home, a
suitable house from a sanitary standpoint, a fairly comfortable income, and all the favorable conditions
that go with such an income.
The same trend of a high infant mortality rate in connection with other housing defects is noted in the
next table.

Table 3.—Distribution of Live Births and of Deaths During First Year, and Infant Mortality Rate,
According to Housing Conditions.

Deaths during First Year

HOUSING CONDITIONS Live births Number Infant mortality rate

Total 1,463 196 134.0

Dry homes 808 99 122.5
Moderately dry homes 336 47 139.9
Damp homes 319 50 156.7
Bath 496 36 72.6
No bath 965 159 164.8
[14]
Not reported 2 1 ( )
Water supply in house 1,173 138 117.6
Water supply outside 288 57 197.9
Not reported 2 1 ([14])
City water available 1,333 176 132.0
City water not available 128 19 148.4
Not reported 2 1 ([14])
Yard clean 801 80 99.9
Yard not clean 632 107 169.3
No yard 28 8 ([14])
Not reported 2 1 ([14])
Water-closet 739 80 108.3
Yard privy 722 115 159.3
Not reported 2 1 ([14])

14. Total live births less than 50; base therefore considered too small to use in computing an infant
mortality rate.
The following summary may be of interest in indicating some relation between infant mortality and
cleanliness or uncleanliness combined with dryness or dampness of homes:

Table 4.—Distribution of Live Births and of Deaths During First Year, and Infant Mortality,
According to Cleanliness and Dryness of Home.

Deaths during First Year

TYPE OF HOME Live births Number Infant mortality rate

All types 1,463 196 134.0

Clean 943 107 113.5
Moderately clean 354 58 163.8
Dirty 166 31 186.7
Dry 807 99 122.7
Damp 656 97 147.9
Clean:
Dry 581 61 105.0
Damp 362 46 127.1
Moderately clean:
Dry 158 27 170.9
Damp 196 31 158.2
Dirty:
Dry 68 11 161.8
Damp 98 20 204.1
Dirt is doubtless unhealthful, but the amount of ill health or the number of infant deaths caused by a
home being dirty can hardly be measured, when, as is usually the case, the dirt is accompanied by so
many other bad conditions arising from poverty. For example, a home in close proximity to railroad
tracks or mills whose stacks send forth clouds of soot, smoke, and ashes is generally the poorly built
home of those who have neither time nor means to secure and retain cleanliness under such difficulties.
Overcrowding in homes is another factor the relative importance of which can not be exactly
determined, because of its close connection with other ills. But the degree of overcrowding is greatest
in the small cheaper houses, those of one, two, three, or four rooms. The average number of persons
per room in the homes of all live-born babies for whom the data were secured was found to be 1.38.
Homes of four rooms were more numerous than those of any other size and they housed an average of
1.58 persons per room. The number of babies in homes of various sizes with the number of persons per
room for homes of each size was as follows:

Table 5.—Number of Babies Living in Homes of Each Specified Size, and Average Number of Persons
Per Room in Homes of Each Size.

Size of home Live-born babies Persons per room

All homes 1,463

1 room 33 4.42
2 rooms 165 2.27
3 rooms 147 1.83
4 rooms 526 1.58
5 rooms 222 1.22
6 rooms 233 1.07
7 rooms 38 .96
8 rooms 43 0.83
9 rooms 22 .93
10 rooms 4 .88
11 rooms 4 .64
12 rooms 1 .75
13 rooms 1 .69
14 rooms 2 .43
Not reported 22
In homes of one, two, three, or four rooms or where the number of occupants ranged from 4.42 to 1.58
persons per room the infant mortality rate was 155, as compared with a rate of but 101.8 in larger
homes, where the number ranged from 1.22 to 0.43 persons per room.
The 1910 census returns show that the greatest overcrowding was in ward 15, where the average
number of persons per dwelling was 9.9. Wards 16, 11, and 14 came next with rates of 8.3, 7.7, and 7.2
respectively. The infant mortality rate for these four wards is 190.2, which is over one-third more than
the rate for the whole city.
The mortality rate among infants who slept in a room with no other person than their parents was much
lower than among those who slept in a room with more than two persons. The babies that slept in
separate beds also had a much lower infant mortality rate than those who did not sleep alone, as shown
in the next table. (Table omitted.)
In presenting statistics on sleeping and ventilation, only the babies who lived at least one month have
been considered, for the reason that so many deaths during the first month of life were due to prenatal
causes.
The incidence shown in the foregoing table is significant, even though it can by no means be deduced
therefrom that the health of a large proportion of babies was so impaired by sleeping with older and
more or less unhealthy persons that death resulted. But irregular night feeding and overfeeding are
undoubtedly harmful, and the mother is tempted to subject the baby to this when it sleeps with her and
disturbs her rest.
Of the 1,389 babies who lived at least one month, 600, or 43.2 per cent., lived in homes where the
baby slept in a room with not more than two other persons. The fact that the baby slept in a room with
no more persons than its parents generally argues that the family’s means permitted them to have one
or more additional rooms for other members of the family, but in other cases, of course, merely that
there were no other persons in the family.
Almost every home visited had means for good ventilation of the baby’s room at night, yet but 604, or
43.5 per cent., of the 1,389 babies who lived at least a month slept at night in well-ventilated rooms—
that is, in rooms where, according to the mother’s statement, a window was open all night. Some
mothers opened windows when the weather was neither cold nor damp; or opened them in a hall or
room adjoining that where the baby slept; others emphatically stated that at night the windows were
“always shut tight.” The babies subjected to differences of ventilation show corresponding variations in
infant mortality rates.
A high death rate in badly ventilated homes can not be charged wholly to bad air. The mother who did
not, or could not, provide proper ventilation was generally the mother without the means or the
knowledge necessary to enable her to care for her baby properly in other respects, and yet the marked
differences suggest that ventilation is itself a very important ally of the baby in its first year of struggle
for existence.
In many rooms that were poorly ventilated, windows were not opened for the reason that the room was
not properly heated and the houses themselves were flimsy and drafty. The problem in such houses is
to keep warm. If the windows were frequently or constantly opened, the houses would be too cold to
live in. In some localities the outside air is so laden with soot, ashes, dirt, and smoke that every effort is
made to keep it out of the house.
The foreigners, who generally have the most miserable homes, are not dirty people who select bad
living conditions through innate poor judgment, low standards, and lack of taste. The squalid homes
which housed the natives and later the Germans and the Irish until the present type of immigrants
came to do the more poorly paid work were the only homes available within the purchasing power of
their low wages. The new immigrants demanded practically nothing and the owners did practically
nothing in the matter of improving these homes, which naturally became more and more squalid as
time went on. An excessive infant mortality rate and insanitary homes in unhealthful sections were
found to be coexistent.
 NATIONALITY

GENERAL NATIVITY

The investigation embraced 860 babies of native mothers (of whom 6 were negroes) and 691 babies of
foreign mothers, making a total of 1,551. The infant mortality rate for the entire group was 134 per
1,000 live births; for the babies of native mothers 104.3, and for those of foreign mothers 171.3. The
stillbirth rate for native mothers having children in 1911 was less than that for foreign mothers, being
52.3, as compared with 62.2 per 1,000 total births.
The line between the natives and foreigners is very sharply drawn in Johnstown. The native population
as a rule knows scarcely anything about the foreigners, except what appears in the newspapers about
misdemeanors committed in foreign sections. The report of the Immigration Commission[15] comments
“on the attitude of the police department toward foreigners ... with regard to Sunday desecration,” and
states that “the Croatians are accustomed to spend Sunday in singing, drinking, and noisy
demonstrations. The police have been instructed to show no leniency on account of ignorance of the
municipal regulations, and, without any attempt at explaining the laws, they arrest the offenders in
large numbers.” Again, it states: “They are arrested more often for crimes that make them a nuisance to
the native population than for mere infractions of the law.... Few arrests are made for immorality among
foreigners.” “Sabbath desecration” is the crime foreigners are most frequently charged with.

15. United States Immigration Commission Reports, Volume VIII., “Immigrants in Industries: Part 2,
Iron and Steel Manufacturing in the East,” p. 387. Reference is to Johnstown and is a very true
picture of various immigrant institutions and of the comparative progress and assimilation of
different races there. Although the immigration report was made five years before our
investigation, conditions remain practically the same.
Foreigners are employed largely in the less skilled occupations of the steel mills, which operate 24 hours
a day, seven days a week. At the time the investigation was made some of the men in the steel mills
worked for a period of two weeks on a night shift of 14 hours, then two weeks on a day shift of 10
hours, and back again to the night shift of 14 hours for another two weeks, and so on. When shifts
were changed, one group of men was required to work throughout a period of 24 hours instead of for
the usual 10 or 14 hour period and another group had 24 hours off duty. Some departments of the steel
mills, however, shut down on Sundays, and in some departments for certain occupations an eight-hour
day prevails, but these more favorable conditions do not prevail among the majority of the unskilled
foreign workers whose homes were visited.
The foreigners who work on a 24-hour shift in a mill on one Sunday frequently “desecrate” their
alternate free Sabbath by “singing, drinking, and noisy demonstrations,” in spite of the known danger of
arrest for “crimes that make them a nuisance to the native population” or for “Sabbath desecration,”
laws concerning which are strictly enforced in Johnstown; for example, children are not permitted to
play in public playgrounds on Sunday and mercantile establishments are required to be closed on that
day. Also, it is “unlawful for any person or persons to deliver ice cream, or to sell or deliver milk from
wagon or by person carrying same, within the city on the Sabbath day, commonly called Sunday, after
12 o’clock m.” The ordinance from which the foregoing sentence was quoted became a law on January
25, 1914.

SERBO-CROATIAN

The foreign group having the highest infant mortality rate is the Serbo-Croatian[16] where infant deaths
numbered 263.9 per 1,000 live births.
 16. A distinct and homogenous race, from a linguistic point of view, among Slavic peoples. They are
divided into the groups “Croatian” and “Servian,” on political and religious grounds, the former
being Roman Catholics and the latter Greek Orthodox. Their spoken language is the same but they
can not read each other’s publications, for the Croatians use the Roman alphabet, or sometimes
the strange old Slavic letters, while the Servians use the Russian characters fostered by the Greek
Church.
Three Krainers have also, for convenience, been included in this group. Krainers are Slovenians
from the Austro-Hungarian Province of Carniola and are designated “close cousins of the Croatians
but with a different though nearly related language” by Emily Greene Balch in her book entitled
“Our Slavic Fellow Citizens.”
The men of the Serbo-Croatian group are fine looking and powerful and are employed in the heavy
unskilled work of the steel mills and the mines. They greatly outnumber the women of their race in
Johnstown, and a man with a wife frequently becomes a “boarding boss”; that is, he fills his rooms with
beds and rents out sleeping space to his fellow countrymen at from $2.50 to $3 a month each. The
same bed and bedding is sometimes in service both night and day to accommodate men on the night
and the day shifts of the steel mills.
The wife, without extra charge, makes up the beds, does the washing and ironing, and buys and
prepares the food for all the lodgers. Usually she gets everything on credit and the lodgers pay their
respective shares biweekly. These conditions exist to some extent among other foreigners, but are not
as prevalent among other nationalities in Johnstown as among the Serbo-Croatians.
In a workingman’s family, it is sometimes said, the woman’s work-day is two hours longer than the
man’s. But if this statement is correct in general, the augmentation stated is insufficient in these
abnormal homes where the women are required to have many meals and dinner buckets ready at
irregular hours to accommodate men working on different shifts.
The Serbo-Croatian women who, more than any of the others, do all this work are big, handsome, and
graceful, proud and reckless of their strength. During the progress of the investigation, in the winter
months, they were frequently seen walking about the yards and courts, in bare feet, on the snow and
ice-covered ground, hanging up clothes or carrying water into the house from a yard hydrant.
Whether it harmed them to expend their force and vigor as they did could not be determined in
individual cases, but their babies are the ones who died off with the greatest rapidity, their infant
mortality rate being 263.9, as compared with the rates of 171.3 for all the foreign; 104.3 for the
natives; and 134 for the entire group as shown in Table 18. Excluding babies of Serbo-Croatian mothers,
the infant mortality rate for babies of foreign mothers is but 159.7.

ITALIAN

The Italian mothers visited in Johnstown bore 75 children in 1911, 4 being stillborn. The infant mortality
rate among the live born was 183.1, the highest of any racial group excepting the Serbo-Croatian,
where it was 263.9.
The Italians have been in Johnstown somewhat longer than the Serbo-Croatians and they seem to have
a little firmer grip on the community life there. Their homes are a shade better, a trifle cleaner, and
somewhat less crowded than those of the Serbo-Croatians, although their hygienic standards seem little
if any higher and they rank no better in literacy. The women do not perform the arduous duties that are
the lot of so many of the Serbo-Croatian women; they have not the robust physique of the latter and
the men are not found in those branches of the steel industry which require the extraordinary strength
possessed by the Serbo-Croatians. The occupations of the Italian fathers were found to be more
diversified than those of the Serbo-Croatians, some being fruit, grocery, or cheese merchants;
steamship agents; bricklayers, carpenters, or workers at other skilled and semiskilled trades.
 SLOVAK, POLISH, ETC.

The infant mortality rate in the group designated “Slovak, Polish, etc.” is 177.1. In this group are
included all the Slavic races represented in the investigation excepting the Serbo-Croatian. The babies of
Slovak[17] mothers were found to be most numerous, there being 276 of them. There were 108 babies
of Polish,[18] 2 of Bohemian,[19] and 7 of Ruthenian[20] mothers. In addition, one baby of a Scandinavian
(Danish) mother was included, not because Scandinavians bear the least racial resemblance to the
Slavic races, but because the few Scandinavians in Johnstown happened to be on about the same
economic footing as the “Slovak, Polish, etc.”

17. Slovaks occupy practically all except the Ruthenian territory of northern Hungary; also found in
great numbers in southeast Moravia. They are the Moravians conquered by Hungary. In physical
type no dividing line can be drawn between Slovaks and Moravians. It is often claimed that Slovak
is a Bohemian dialect.

18. The west Slavic race native to the former Kingdom of Poland. For the most part they adhere to the
Roman rather than the Greek Orthodox Catholic Church.

19. The westernmost division or dialect of the Czech and the principal people or language of Bohemia.
Czech is the westernmost race or linguistic division of the Slavic (except Wendish, in Germany),
the race or people residing mainly in Bohemia and Moravia.

20. Also known as Little Russians; live principally in southern Russia; also share Galicia with the Poles
but greatly surpassed by Poles in number. In language and physical type resemble Slovaks.
Generally Greek Orthodox, but a few are Greek Catholics of the Roman Catholic Church, whose
priests marry, and are separated from other Roman Catholics by marked religious differences.
The rate for this group is lower than that for either the Serbo-Croatians or the Italians, but it is
nevertheless very high and one exceeded by only a few European countries, as shown by the table on
page 12.
Some of the “Slovaks, Poles, etc.,” live in the same squalid sections as the Serbo-Croatians, and in the
same type of inferior houses, but on the whole they have been in Johnstown longer, are more
prosperous, and are therefore beginning to move from Cambria City and Woodvale, where formerly
practically all lived, into more desirable sections. Those who have been in this country longest and
intend to stay here are buying homes with large yards in the less crowded sections and are raising
vegetables and flowers. Others, however, still remain in poor neighborhoods and sometimes buy houses
there for from $300 to $600 each, built close together on rented ground.
Lodgers are by no means uncommon among the people in this group, but usually their homes are
cleaner, less crowded, and possessed of more comforts than those of the Serbo-Croatians and Italians.

OTHER NATIONALITIES

The British[21] infant mortality rate in Johnstown is 129 and the German 127.7. The British and Germans
in Johnstown are more prosperous than the Slavic, Magyar, Jewish, Italian, Syrian, and Greek peoples,
and regard the others as “foreigners.” It was strange to hear a man, one who could 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.

21. English, Irish, Scotch, and Welsh included in the term British.
In the Magyar 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.
(Omitted.)
 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.
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.
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 that
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.
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 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[22]

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.

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

DEATHS DURING
STILLBIRTHS.
FIRST YEAR.
LITERACY OF FOREIGN Total Live
Infant
MOTHERS. births. births. Per
Number. Number. mortality
cent.
rate.
Foreign mothers 691 648 43 6.2 111 171.3
Literate 445 419 26 5.8 62 148.0
Illiterate 246 229 17 6.9 49 214.0

ABILITY TO SPEAK ENGLISH

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.

DEATHS DURING
STILLBIRTHS.
FIRST YEAR.
Total Live
ABILITY TO SPEAK ENGLISH. Infant
births. births. Per
Number. Number. mortality
cent.
rate.
Foreign mothers 691 648 43 6.2 111 171.3
Speak English 263 247 16 6.1 36 145.7
Can not speak English 428 401 27 6.3 75 187.0

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.
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.

DEATHS DURING
STILLBIRTHS.
FIRST YEAR.
Total Live
AGE OF MOTHER. Infant
births. births.
Number. Per cent. Number. mortality
rate.
All mothers 1,551 1,463 88 5.7 196 134.0
Under 20 105 95 10 9.5 13 136.8
20 to 24 476 454 22 4.6 55 121.1
25 to 29 410 391 19 4.6 56 143.2
30 to 39 480 449 31 6.5 61 135.9
40 and over 80 74 6 7.5 11 148.6
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 also Table
XII, based upon the entire reproduction histories of the mothers included in this study. As all the
children borne by these mothers are included, the base numbers in the latter table are larger and the
figures therefore somewhat more significant.
 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.

DEATHS OF BABIES OF ALL MOTHERS.

AGE AT DEATH. Per cent.
Number.
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.

DEATHS DURING FIRST YEAR OF BABIES OF—

All mothers. Native mothers. Foreign mothers.
CAUSE OF DEATH. Infant Infant Infant
Number. mortality Number. mortality Number. mortality
rate. rate. 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
19 12.9 5 6.1 14 21.6
malformation
Injuries at birth 7 4.8 6 7.4 1 1.5
Other causes or not
44 30.1 27 33.1 17 26.2
reported
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.

QUARTER OF CALENDAR YEAR IN

All
CAUSE OF DEATH. WHICH DEATH OCCURRED.
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.

BABIES LIVING AT AGE OF—

ANNUAL
3 months. 6 months. 9 months.
EARNINGS
Completely Completely Completely
OF FATHER
weaned from weaned from weaned from
AND
Total. breast. Total. breast. Total. breast.
NATIVITY
OF MOTHER. Per Per Per
Number. Number. Number.
cent. cent. 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
629 114 18.1 616 146 23.7 608 201 33.1
over[26]
Not
27 9 33.3 24 9 37.5 23 10 43.3
reported[27]

Mother
765 155 20.3 747 195 26.1 735 251 34.1
native
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
491 100 20.4 482 127 26.3 476 168 35.3
over[26]
Not reported[27] 25 9 36.0 22 9 40.9 21 10 47.6

Mother
590 38 6.4 566 55 9.7 547 102 18.6
foreign
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
138 14 10.1 134 19 14.2 132 33 25.0
over[26]
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.

DEATHS DURING
STILLBIRTHS.
FIRST YEAR.
SEX OF BABY AND NATIVITY All Live Rate
Infant
OF MOTHER. births. births. per
Total. Total. mortality
1,000
rate.
births.
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
 MOTHER’S HOUSEHOLD DUTIES, CESSATION AND RESUMPTION OF
The extent to which the native and foreign mothers in Johnstown relinquished a part of their household
duties as the time for their confinement approached is shown below:

Table 26.—Distribution of Births According to Time of the Mother’s Relinquishment of Part of

Household Duties Before Confinement, by Nativity of Mother.

To To
TIME OF RELINQUISHMENT OF PART OF HOUSEHOLD All
native foreign
DUTIES BEFORE CONFINEMENT. births.
mothers. mothers.
All mothers 1,551 860 691
No household duties relinquished to day of confinement 1,350 695 655
Part of duties relinquished:
Less than 7 days before confinement 3 1 2
7 to 13 days before confinement 7 5 2
2 weeks to 1 month before confinement 16 12 4
1 month or more before confinement 174 146 28
Had no household duties 1 1
Among the 174 babies of mothers who relinquished part of their household duties a month before
confinement, the infant mortality rate was 112.5, as compared with 136.7 for those of other mothers.

Table 27.—Distribution of Births and of Deaths During First Year, and Infant Mortality Rate,
According to Time of Relinquishment of Part of Household Duties of Mother Before Confinement.

Deaths
Infant
TIME OF RELINQUISHMENT OF PART OF All Live during
mortality
HOUSEHOLD DUTIES BEFORE CONFINEMENT. births. births. first
rate.
year.
All mothers 1,551 1,463 196 134.0
No cessation or less than 1 month 1,376 1,302 178 136.7
1 month or more 171 160 18 112.5
No housework 1 1
To what extent the relinquishment of household duties at a given time directly affected the health of the
child can not be definitely shown. A relation may exist, but on the other hand the difference in the
mortality rate may be due to the fact that the mothers could afford to give consideration to their
condition and escape some of their heaviest tasks as their pregnancy approached its end, and were
members of families who were thoughtful of them and relieved them of these tasks or employed extra
household assistance at such times.
Another indication of intelligence and of comfortable surroundings is the care given a mother in the
early days of her baby’s life, particularly if she is a nursing mother. The duration of her rest period
before the resumption of part of her household duties is one measure of this. The foreign mothers, with
less education, more numerous and arduous tasks, less opportunity for leisure, and smaller incomes,
begin to resume their housework sooner than the native mothers with young babies.
 Table 28.—Distribution of Live Births and of Deaths During First Year, and Infant Mortality Rate,
According to Time of Mother Resuming Part of Household Duties After Confinement, by Nativity of
Mother.

DEATHS DURING
LIVE BIRTHS TO—
TIME OF RESUMING PART OF FIRST YEAR.
HOUSEHOLD DUTIES AFTER Infant
All Native Foreign
CONFINEMENT. Total. mortality
mothers. mothers. mothers.
rate.
Total 1,463 815 648 196 134.0
8 days or less 467 44 423 79 169.2
9 to 13 days 560 446 114 70 125.0
14 days or more 427 318 109 41 96.0
Mother died or not reported 9 7 2 6 ([28])

28. Total number of live births less than 50; base therefore considered too small to use in computing
an infant mortality rate.
The fact that a mother takes up her housework in the early days of her baby’s life does not necessarily
increase the danger of its death. In some cases, however, mothers stated that the quantity of their
breast milk was noticeably impaired when they got up and resumed their work too soon. Naturally this
would affect the baby’s nutrition. In other cases a mother’s cares and duties may be so absorbing that
she can not give the baby full attention. Whatever the exact explanation, attention should be called to
the greater frequency of infant deaths when the mother resumed household duties very soon after
childbirth.
A statement of the time of the mother’s resumption of household duties in full, like that giving the time
of resumption in part, shows that the native mothers have the longer period of rest.

Table 29.—Distribution of Live Births and of Deaths During First Year, and Infant Mortality Rate,
According to Time of Mother Resuming all Household Duties After Confinement, by Nativity of
Mother.

DEATHS DURING
LIVE BIRTHS TO—
TIME OF RESUMING ALL FIRST YEAR.
HOUSEHOLD DUTIES AFTER Infant
All Native Foreign
CONFINEMENT. Total. mortality
mothers. mothers. mothers.
rate.
Total 1,463 815 648 196 134.0
8 days or less 219 13 206 37 168.9
9 to 13 days 182 132 50 30 164.8
14 days or more 1,053 663 390 123 116.8
Mother died or not reported 9 7 2 6 ([29])

29. Total live births less than 50; base therefore considered too small to use in computing an infant
mortality rate.
The infant mortality rates for all mothers in the group just referred to, according to the time of resuming
housework in full after childbirth, show fewer infant deaths proportionately when the mother has had a
longer rest; that is, a rest of two weeks or more.
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebooknice.com