DIARRHEA AND DYSENTERY. Whilst diarrhea is a symptom of very many diseases, there is reason for believing that certain forms, occurring in infants as well as adults, towards the middle or close of a hot, dry summer, are caused by the consumption of tainted food, milk, impure water, etc., superinduced by putrefactive bacteria, and that the serious forms of summer complaints are due to specific germs. From what we know of the nature and cause of dysentery we are led to consider it an infectious disease, which is spread very much like typhoid fever. The tropical form of dysentery is caused by an ameboid organism, while the type most prevalent in this country is due to a bacillus. In our present state of knowledge we may conclude that the virus of dysentery, whether of the bacillary or amebic type, proceeds from the intestinal discharges of a previous case, and the most usual mode of transmission of the germs is through the water supply. This is the opinion of Virchow, based upon personal experience in Egypt, and Uffelmann has frequently observed that persons using boiled water during a dysentery epidemic remained exempt, and that the simple closing of a suspicious well often checked the spread of the disease. It is also perfectly conceivable that the germs may be spread through soils strongly polluted and infected with excrementitious matter, and with particles of dust gain access to milk, fruit, fresh vegetables, etc., which are eaten raw.. The agency of flies in carrying the germs from infected sources to the food supply cannot be ignored. Temperature also plays an important role in the development of the disease. At all events, statistics show that in temperate climates the disease assumes epidemic proportions in July, August and September, and declines with the approach of cold weather; it goes hand in hand, therefore, with a maximum temperature of the air and soil. It is also a clinical fact that badly nourished individuals, and those suffering from indigestion or intestinal catarrhs, are especially liable to be attacked. Prophylaxis: In the attempt to prevent epidemic extensions of these diseases the water supply should be looked after, and every source of contamination of wells, springs ard public reservoirs must be avoided, and suspicious supplies closed. The public should be enlightened as to the nature of these diseases, and especially of the necessity for prompt disinfection of stools. It should also be informed that indigestion, the result of indiscretion in eating and drinking and chilling of the body, increase the susceptibility; that it is desirable during the prevalence of these diseases to use only boiled water and milk, and to avoid the consumption of raw vegetables and fruit, unless they have been thoroughly washed with water previously boiled. INFANTILE MORTALITY. According to Oesterlein's statistics it is safe to assert that the average death rate during the first year of life is 188 out of 1,000 infants born. According to the census of 1900 the infantile mortality per 1,000 births in the so-called Registration States was as follows: It will be seen that the rate of Vermont and Michigan is less than one half that of the District of Columbia. The rates in foreign countries likewise vary considerably. In France the average rate from 1874 to 1893 was 167; in 1903 it had fallen to 137, practically the same as that of New Jersey. According to Harrington* our highest rate about equals Russia, and it is not much greater than that of Austria. Rhode Island makes a better showing than Germany and Italy. The German rates for the five years 1901-1905 were as follows: 216, 184, 202, 204, 204. The Italian rates are 170. Maine stands with England and Wales, and better than Belgium and the Netherlands. The rates for England and Wales are 150; Belgium 156; The Netherlands 147. The rate of Vermont is lower than Scotland (126), Denmark (127), Finland (134), or Switzerland (144). Michigan is also lower than Scotland (126). The following countries have lower rates: New South Wales, 108; Victoria, 105; Ireland, 105; South Australia, 102; Queensland, 101; Sweden, 98; Norway, 90; New Zealand, 79. These are mean rates for rural and urban districts. In towns and cities the mortality is always higher, amounting to 33.6 per cent, as compared with the rural mortality of 27.8 per cent. The District of Columbia in 1900 had the unenviable reputation of leading the list of the Registration States in Infant Mortality, but the rate of Washington as a city compares favorably with other cities. The census of 1900 gives a list of 106 cities and towns with infantile *Harrington, Infantile Mortality, “Am. Jour. Med. Sc.," December, 1906. death rates in excess of 175. In 9 cases the rate exceeded 300; in 38 it was between 200 and 280, and in 49 it was between 175 and 200. The following is a partial list of these cities: The following is a list of 24 German cities with excessive infantile death rates: In 1904, in the 323 German cities and towns having populations exceeding 15,000 the rate was 202. In the 12 months ended June 30, 1906, the rate in 32 German cities with a population of over 100,000 the rate was 198. (Harrington.) From the foregoing figures it appears that in many cities, out of every 1,000 children born alive, over one-third perish before the completion of the first year; but fortunately for the perpetuation of the human race the average infant mortality all over the world is only about one sixth of those born. Of the twelve months during the first year of life the first month furnishes the highest mortality. Of the 1,233 infantile deaths reported in this city in 1906, 222 were due to premature birth; 40 to congenital debility; 28 to malformations, and 9 to difficult labor. The first month is followed by the second, third and fourth months, probably also because of diminished vital resistance. The tenth, eleventh and twelfth months are also dangerous months, as this is at the usual period of weaning with its attending danger from digestive diseases incident to artificial feeding. We have already referred to diarrheal diseases as the principal cause of infantile mortality. A mortality of 40 per cent from diarrheal diseases, and 2.5 per 1,000 from tubercular diseases of the abdominal lympathics and glands can not fail to claim our attention, and certainly points, with more than mere suspicion, to the fact that the morbific agent in these cases is introduced into the body with the food, especially unwholesome and infectious cow's milk. Nor is it improbable that the 21 per cent who die from affections of the respiratory organs are largely the victims of ignorance as regards temperature and clothing and other environments of the child. The infant mortality is everywhere influenced by extremes of heat and cold, but the hot months, like July, August and September, are the most dangerous on account of the disastrous attacks of diarrheal diseases. The fatal influence of heat is graphically shown in the accompanying chart. (See next page.) The deaths from diarrheal diseases ranged according to months, from 5 in January to 108 in July, and 58 in August, after which there is a rapid decline. The same abrupt changes are noted in the large statistical material of German cities in 1905, dealing with 128,035 deaths under one year, the deaths from diarrheal diseases ranging from 1,192 in January to 15,863 in August. High infantile mortality rates have always been considered the opprobrium of the healing art. Dickson asked over fifty years ago, "How shall we prevent the early extinction of half the new born children of men?" While powerless to solve all the mysteries connected with this subject, an attempt will be made to answer the practical question. Can they be reduced? Space will not permit to enter into details of infant hygiene, but we must at least point out the fact that the mortality can be greatly reduced by improving the original stock, i. e., the physique and habits of the parents, and placing them, as well as their offspring, under more suitable environments, especially with reference to fresh air, sunlight, exercise, suitable clothing, and habitations, and last but not least, proper food. The influence of favorable hygienic conditions was demonstrated by |