ter, and fuel, and we begin to have some faint conception of the perils which surround infant-life in a large proportion of cases. Without adequate nourishment, and improperly cared for in every respect, life is one sharp struggle with want, and it is little wonder that want often gains the victory. In England, for the ten years ending with 1875, an average of eighty-two deaths annually was assigned to starvation alone. But privation and destitution exercise a controlling influence over the mortality of infancy under other names than this. What the form of death shall be is determined by various circumstances. It occurs largely from the diseases of denutrition and debility, rickets, scrofula, consumption, and other constitutional diseases.
Exposure to cold and wet, especially in the sharp vicissitudes of our winter climate, and more particularly when this is added to the causes already named, results in a largely increased prevalence of the acute lung-diseases. These are extremely fatal even in adults, and the mortality is proportionately large in children. Says Routh, in his work on "Infant Feeding": "Among the most pernicious influences among young children we may include cold. It is a household word among us, which takes its origin from the Registrar-General's returns, that a very cold week always increases the mortality of the very young and the very aged." The same statement is true in America, though it may be in a somewhat less degree, owing to the fact that our houses are better provided against extreme cold than are those of the English. Throughout England, one sixth of all deaths from lung-diseases occur under five. In London, forty-four per cent of the deaths from pneumonia and bronchitis take place under that age. In Massachusetts, the proportion of deaths from pneumonia under five is thirty-four per cent. These deaths occur largely in the inclement portions of the year. In England, both bronchitis and pneumonia attain their maximum in the first quarter of the year, decline during the second quarter, reach their minimum during the third, and begin to increase during the fourth. In Michigan, Dr. H. B. Baker has shown that the greatest prevalence of the acute lung-diseases is in February, and the least in August. In Massachusetts, March has the largest number of deaths, and August the least.
Four distinct but closely related causes combine to produce the diarrhœal diseases, which result in one fourth of the entire mortality under five. These are heat, improper feeding, filth, and overcrowding. The influence of heat is seen in the facts that, in our climate, the overwhelming majority of cases in these diseases occur during the hottest months of the year; that their prevalence is greater in the southern portions of the temperate zone than in the northern, and in unusually hot summers than in those whose
