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38
INFANTILE MORTALITY.
Assuming that the prevalence and excessive mortality from "diarrhœa" are favoured by
high temperatures both of air and earth, and by a deficient rainfall, 1899 should be (as it
was) the worst year for diarrhœal mortality, and 1903 the best (as it was). Judging by the
meteorological data, last year should have had a total number of deaths from "diarrhœa"
next to that of 1899—i.e., second—but the actual number recorded places the year fifth in
order.* It is permissible to express some satisfaction in the improvement hinted at by the
change in position, although a wholesome respect must be accorded to the post hoc, propter hoc
fallacy.
It is not intended to convey by the foregoing paragraphs that weather agencies are the
prime factors in causing the mortality from "diarrhœa," but only to show that there is a
connection between the two. Undoubtedly the improper feeding of the children is a far
more efficient cause of the disease than the weather. It may, however, be safely concluded
that in some way the latter acts prejudicially on the former, almost always artificial (as
distinguished from the natural, i.e., breast milk), whereby a zymotic fermentation is set up
in the food, producing those gastric disturbances and systemic poisoning, of which the
diarrhœa is but a sign. There is reason to believe that the source of the micro-organisms
necessary for that fermentation is to be found in decomposing animal and vegetable matters,
and that flies, mostly the ordinary house variety, but also the blue-bottle, are the agents
whereby the infection is conveyed to the food. Rain is fatal to flies and in this way favours
a low diarrhœal mortality, in addition to the benefits accruing from the flushing and cleansing
of streets, etc.
Evidence in support of the foregoing explanation is afforded by the results of inquiries
made after deaths from "diarrhœa." Thus, of 112 children under the age of 2 years whose
deaths formed the subject of inquiry, 92 (82 per cent.) were under ten months old. Of the
latter, only 9 (less than 10 per cent.) had been naturally fed up to their deaths, while 62
(67 per cent.) had been fed entirely by hand. The remaining 21 had been fed naturally for
various periods, some of them however having had mixed (that is, natural and artificial) foods
since birth. Of the 20 children aged from 10 months to 2 years, 5 had been fed naturally from
birth (4 of them having had the breast alone for more than a year), 10 had been artificially
reared from birth, and the remainder (5) had been either given the breast alone for very
short periods, or had had breast milk and artificial foods from birth. Grouping the whole of
the deaths, it appears that—
10 of the deceased, 8.8 per cent., had been properly fed, i.e., had had the breast up to death,
or 10th month of life;
12, or 10.7 per cent., had been brought up on "mixed" feeding from birth;
72, or 64.2 per cent., had had artificial food only;
14, or 12.5 per cent., had been weaned too early; and
4, or 3.4 per cent., had been suckled too long.