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The facts as to the incidence of the excessive infant mortality in
the different counties of England and Wales, and the causes of this
excess (among which diarrhœal diseases bulk largely) show that
unsatisfactory municipal sanitation bears a large share in the continuance
of an excessive infant mortality." It is stated that alcoholism
can scarcely be placed in its proper relation to other causes of excessive
child mortality, unless it is regarded as a part of a vicious circle
of which ignorance and carelessness, poverty—in the sense of some
of the necessaries of life—and insanitary houses, yards, and streets
form other important portions. Dr. Newsholme further states in
his annual report as follows:— "Domestic cleanliness cannot be said
to have a fair chance so long as sanitary authorities permit the continuance,
in closely aggregated towns and in large compact villages,
of privies and other arrangements for keeping excretal matters near
the house; so long as they do not carry out scavenging satisfactorily;
and so long as they allow streets and yards requiring it to continue
unpaved."
As a part of the vicious circle already mentioned, insanitation
occupies a position against which effective action is at once practicable
in every district in which public opinion is equal to the effort.
" Insanitation, including overcrowding, is a serious cause of disease,
and disease in its turn is an important cause of poverty. Hence, by
a vigorous campaign against the conditions producing disease, much
poverty can be prevented, alcoholism and consequent neglect of
children can be diminished, and child mortalty can be lowered; and
this remains true, although it is also true that poverty, alcoholism, and
moral defects are fertile sources of excessive child mortality. A
vicious circle has one excellent virtue. It can be snapped at different
points, as opportunity best serves, and the sequence of events can
thus be inhibited. The greatest hope of success is secured when
workers at different parts of the circle co-operate for the common
end."
Thus the solution of the problem of infant mortality is to be
found in the circumstances surrounding the life of the mothers of
the poorer classes, and especially of the poorest class who are fighting