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Table VII shows the worse environment found associated with the deaths of illegitimate infants.

BRONCHITIS AND BRONCHO-PNEUMONIA.
"Bronchitis" Group.
In this group of cases death is no respecter of houses or incomes. In the large majority of cases the mother's
employment before or after confinement could not have affected the baby's health; more than half the cases
were entirely breast-fed. From Table III it will be seen that there are 37 deaths from "Bronchitis" in families
with "good" or "fairly good" incomes. In Table IV (no "C" entries at all), there are 23 deaths. None of
these cases are illegitimate infants, and their home environment—entirely "A" or "B"—is probably above the
average for the Borough. In Table V also (Class "A" incomes only) there are 23 deaths.
To account for these deaths it seems likely that there are other factors involved not shown on the lists,
which are capable of causing ill-health and death, or that some factors estimated as satisfactory are really unsatisfactory,
or there may be a combination of these malign influences.
To gain further knowledge as to the nature of these factors, it is perhaps easiest to consider cases of Bronchopneumonia
in three groups—those between six months and twelve months, those in the neo-natal group, and lastly,
those between one month and six months.
In the first group—i.e., six months to twelve months, some cases occur in apparently well-nourished children,
but a large proportion of them exhibit manifestations of rickets (vide B.M.J., October 12th, 1919, article on
"Control of Measles," and correspondence, October 19th to November 9th).
Rickets is due to a deficiency of Vitamin D in the diet, and those foods which contain Vitamin D are those
which contain Vitamin A, which protects against infections. It would appear, then, that an avitamosis in A and
D would be sufficient to account for the occurrence of Broncho-pneumonia associated in varying degree with symptoms
of rickets in infants between 6 and 12 months old.
The Committee has had little clinical experience of bronchitis, etc., in infants of less than one month old,
but thought that, to account for deaths at such an early age, there might be some other factors present, such as
aspiration pneumonia or marasmus. Table VI, however, shows close correspondence between the figures for
neo-natal deaths and those for the total "Bronchitis" deaths. (Compare lines 1 and 2). It is very unlikely
that this similarity would be found if all the neo-natal deaths were cases of aspiration pneumonia, unless of course,
the proportions of A, B and C environments appearing in these cases were the average environments of all infants
in the Borough. Table VI shows also that there is little resemblance between the figures for neo-natal "Bronchitis"
cases, and those for "Marasmus," either neo-natal or total. (Compare lines 3, 4 and 6). Altogether
it seems likely that the neo-natal "Bronchitis" deaths are a true sample of the total "Bronchitis" deaths.
The Committee find it difficult to believe that an entirely healthy infant will die in less than a month as a
result of any of the factors mentioned. It seems much more probable that early infant deaths occur among those
born with a decided tendency to suffer from bronchitis, etc. It is now recognised that such an innate tendency
may be present in an infant, if the environment, feeding, etc., of the mother during pregnancy have been
unsuitable.
The following is an extract from an article by Professor Stuart J. Cowell, Professor of Dietetics in the University
of London. ("Public Health," July, 1929).
"There is another fat soluble vitamin that may influence the well-being of the young child, namely.
Vitamin A, which has recently been called by Mellanby the anti-infective vitamin. The frequency with
which mild grade infections attack young infants brought up in poor surroundings must have struck every
observer; the nasal and bronchial catarrh and the attacks of enteritis which are so frequently met with may,
in all probability, in many cases result from a deficiency of Vitamin A. Seeing that this vitamin can be
stored up in the liver of young animals in very considerable amounts when the pregnant or lactating mother
receives a liberal supply, it seems surely worth while seeing that the mother gets the necessary quantity so
that her child may start off his independent life with a supply which may prove of great help to him in fighting
infections he may have to encounter almost immediately after birth."
In cases where death occurs between one and six months, it is suggested that the causes are partly those
mentioned in the preceding paragraphs, and partly deficiency in diet, as in older children. Clinical
observation seems to confirm this. Great improvement has been seen in cases of bronchitis and broncho-pneumonia,
both in breast-fed and bottle-fed infants, where vitamin preparations have been administered as well as
the ordinary remedies.
So fax, then, it would seem that an avitaminosis is a constant factor in the causation of these diseases during
the first year of life. The question at once arises, "How is it that breast-feeding has failed to protect these
children ?"
It will be noticed that 30 infants were entirely breast-fed, 18 partly breast-fed, and 7 were artificially fed.
From Table III, it will be seen that in families with good or fair incomes there are 17 deaths in entirely breast-fed
babies, and 12 among those partially breast-fed. In Table IV, there axe still 15 deaths in entirely breast-fed
babies, and 5 among partly breast-fed.