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

MONTHLY DEATHS FROM INFANTILE DIARRHEAL DISEASES DURING 1906 COMPARED WITH AVERAGE MONTHLY DEATHS FOR PAST TEN YEARS.

Deaths from Diarrheal Diseases during 1906.

Average annual deaths from Diarrheal Diseases for 7 years.

Reproduced from Report of the Health Officer, District of Columbia, 1907.

Casper's statistics, published as early as 1825, showing that the infant mortality rate among royal children was only 57, as compared with 345 per 1,000 among the infants of the poor. Of 170 deaths from infantile diarrhea, investigated by Helle in Graz in 1903 and 1904, not one belonged to a rich family, and but 9 to the well-to-do class, while 161 belonged to the poor and the very poor. Clay calculates that of every 100 children born in England, 90 will be alive at the end of the first year of those born in aristocratic families; 79 in the mercantile class, and 68 among the laboring classes. The relation of infantile mortality to the occupation of the women has already been discussed in a previous report.

Dr. George Reid, at the National Conference on Infantile Mortality, held in London in June, 1906, contrasted the infantile mortality in two districts, identical in health conditions, but with the important difference that in one women are largely employed in industrial pursuits, and in the other there is practically no employment for them, with the result that the infantile mortality varied from 149 to 198 per 1,000.

The infantile mortality returns in the United States, also, indicate that we are dealing with a class mortality, which is highest in communities where women are employed in mills and other gainful occupations, and in consequence the children fall victims to ignorance and neglect. Contrast, for example, the census rates for 1900 of Fall River, Mass. (304.7); Lowell, Mass. (275.5); Nashua, N. H. (261.2); Lawrence, Mass. (246.5); Manchester, N. H. (238.4); all typical mill towns, with the rate at Cambridge, Mass., which was 186.5. The seasonal and climatic influences are, of course, the same, and presumably, also, the general quality of the milk supply, hence we must look largely to sociological factors for an explanation, such as has been offered on pages. 68-70,* and may be summed up in ignorance and poverty. The same explanation applies to the excessive rates among colored infants in many of our States and in our own city. During the year 1906 the number of children under two years of age who died in Washington from diarrheal diseases and inflammation of the bowels was 318, 146 white and 172 colored. The corresponding death rate per 100,000, calculated on the basis of the entire population, was for the white population 63.1 and for the colored population 181. If any further argument is necessary to show the influence of sociological factors, it will be found in the fact that 1,792 of the 2,711 infantile deaths, investigated by Neuman in Berlin in 1903, cccurred in one-room dwellings, 754 in two-room, and 165 in threeroom and larger dwellings.

*Kober's "Industrial Hygiene."