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59
or because of various unfavourable general conditions affecting
them after birth, and the Pneumonia which follows as a remote
effect of the common infectious diseases and when all
characteristic symptoms of the primary illness have disappeared.
If the general causes predisposing to, and the special
conditions associated with, pneumonia amongst young children
are viewed broadly; it will be found that in the first year of life
gross defects of development and ante-natal infection with
syphilis have a distinct influence. It will be found also that
many of the deaths in the first year are associated with Marasmus,
whether that condition is due to prematurity of birth, or be caused
by artificial feeding. The broncho-pneumonia, which is the chief
cause of the heavy mortality from diseases of the respiratory
system in children, is believed to be, in the main, an effect of
direct infection of the lung, occurring usually under conditions
of general enfeeblement in which the power of resistance of the
lung against bacterial invasion from without is lowered.
It may be taken as a conservative estimate that more than
one-half of the deaths under I year are due to ante-natal causes.
But the subject is of still greater importance. It is calculated
that the total number of foetal deaths amount to over i1 per
cent, of the number of births, and when we are brought face to
face with the statement that practically as many infants die
during foetal life as during the first year of their independent
existence, we are confronted with a problem which clearly requires
that means should be concerted with the view of attempting to
prevent this waste of human life. There can be little doubt that
suitable measures in this direction would be immediately followed
by beneficial results, but how the complete solution of the problem
is to be reached is not so obvious. Hitherto our efforts have
been almost entirely directed to the feeding of infants, and the
success attending them has been made sufficiently obvious by
the reduction of infantile mortality.
Our efforts to improve some of the ante-natal conditions
are at present necessarily of a very limited character, but it is
hoped that a small beginning may be made through the agency