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the supposition of an average distribution of deaths from diarrhœa
among infants fed in different ways. The same excessive mortality
in the hand-fed continues up to the ninth month of life. In the
last three months of the first year of life the diarrhœa mortality
approximates to the average. The immediate cause of the high
death rate from diarrhœa among children whose mothers do not
suckle them is polluted milk, but there are other factors which do
not come far behind in importance.
Insufficient nourishment is not strictly speaking a cause of
diarrhœa, but it may well be a potent predisposing cause of death
from this disease. Whether the food is insufficient in quantity or
in nutritive power, or whether the fault lies in the inability of a
child to digest what it is given, the same condition of malnutrition
will result, and ill-nourished children will always succumb rapidly
and in large numbers to epidemic diarrhœa. The poorer classes
dilute the condensed milk they give to their infants to an extent
which makes it deficient in nutritive power, and give both condensed
and cows' milk in insufficient quantities and in a manner totally
unsuited to the digestive capacity of their children. So that if the
pollution of milk is the cause of the onset of diarrhœa, it is at least
probable that a previous condition of malnutrition is as often as not
responsible for a fatal termination.
The diminution in the death rate from diarrhœa in the
artificially fed, after the ninth month, would appear to be due to
the well-nourished condition of bottle-fed children at this age.
Sixty per cent. of them have been started in life with six months at
the breast, and have thus acquired powers of resistance which
result in the comparatively low mortality from which they suffer
when they come to be fed on cows' milk of doubtful purity.
Again, the mortality after the ninth month is comparatively high
among the breast-fed, many of whom obtain insufficient nourishment
from the milk of mothers who are not equal to the strain of
nine months' lactation, but do their utmost to continue suckling
their babies, in order to save the cost of cows' milk and to
minimise their chances of again becoming pregnant. Out of 148
mothers visited, no less than 22 had suckled their babies for 18