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It should be stated in this connection that the births which occur in lying-in institutions have not
been distributed to the districts in which the mothers reside. Especially in group No. IV. the death-rates
have a tendency to be lower than they would otherwise be, for in that group of districts are situated the
two lying-in hospitals in which many women are confined whose homes, in some proportion of the cases,
would be situated outside the districts comprising the group. Allowing, therefore, for some irregularity
of the figures on this account, it will be seen that the mortality among children under one year of age
increases with the proportion of the population living under overcrowded conditions. When the
figures for each of the trimesters are considered the same behaviour of the mortality is observable, but
it is deserving of notice that the difference in the mortality between the least and most overcrowded
groups is least marked in the first three months of life, more marked in the second, still more marked
in the third, and most marked in the fourth three months of life.

When the mortality in the first month of life is considered, it is seen that the mortality of the
most overcrowded group is not higher than that of the least overcrowded group, but indeed, so far as the
figures for one year show, is somewhat less. In all probability this is in part due to the more complete
registration of births and deaths in the better-circumstanced districts. It may be noted, however,
that the differences become more accentuated as age progresses and this may be due either to decrease
in the difference of the completeness of registration of deaths of infants in the several groups as
age increases or to the effect of environment becoming more and more marked as it is afforded a longer
time in which to operate. The incidence of mortality upon children aged under one month and the
increasing divergence in the rates of mortality in the several groups as the age of the child progresses,
in the several groups of districts, do not lend support to the view that ante-natal conditions constitute
a predominant factor, if any, in determining infant mortality. Inferences of this character can, however,
obviously be more safely drawn when the figures for a series of years are available for this
purpose.
A subject of much interest and importance is the maintenance of the infantile mortality rate,
while the death-rate of older persons has greatly decreased. In a table contained in the report of the
Inter-departmental Committee on Physical Deterioration, Dr. Tatham has compared the infantile
mortality in two periods of five years, 1873-77 and 1898-1902, both in urban and rural counties. In
the latter of these periods the infantile mortality in the urban districts was somewhat higher than in
the former, the maintenance of the rate being especially due to deaths from diarrhœal diseases and
diseases of the stomach, and from premature birth and congenital defects. Dr. Sykes has in his annual
report made an interesting analysis of the infantile mortality in St. Pancras in the years 1877 and 1901,
having respectively mortalities of 1524 and 154.7 for 1,000 births. These figures show especially that
the mortality rate from premature birth and congenital defects was, in 1901, about double that of the
rate of 1877, and that it was almost entirely confined to infants in the first week of life. The mortality
rate from diarrhceal diseases and from diseases of the stomach and liver had increased by some 50 per
cent. in the second period. He states " that mortality statistics in St. Pancras indicate that infants
are dying at a younger and younger age, apparently due to increased immaturity at birth, diminished
viability or capacity for survival, and increased artificial feeding."

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