138 DR. ARTHUR RANSOME ON THE 



If it were allowable to extend the analogy of these places 

 to the whole of England, the stationary condition of the 

 death-rate of the country would have to be accounted for 

 by discovering some causes that had diminished the death- 

 rate by at least two or three per thousand, and had saved 

 about 40,000 or 50,000 lives every year. 



I cannot help thinking that in many parts of England 

 this statement falls short of the truth, and that we have to 

 thank sanitary effort for saving the country from a still 

 greater loss. 



3. The third element in the positive increase of the 

 death-rate is the infant mortality. Now this I have already 

 included to some extent under the head of " preventible 

 mortality •" but whilst it is, perhaps, more under the con- 

 trol of proper hygienic conditions than any other form of 

 death, these conditions are rather to be ranged under the 

 subtitle of domestic arrangements than as pertaining to 

 the ordinary sanitary work of local authorities. It is less 

 likely than adult mortality to be at once affected by the 

 more common mechanical improvements of districts, such 

 as improved sewage and good water supply ; and it requires 

 for its amelioration better house accommodation, more 

 efficient house- drainage, a freer supply of pure" air, clean- 

 liness, a proper supply of suitable sustenance, and adequate 

 protection against infection. 



It cannot be said that these points have yet received full 

 attention from the sanitary administrators of the country ; 

 and hence the death-register of infants can hardly be quoted 

 as evidence of their failure. 



On the other hand, children are more exposed than 

 adults to the already-mentioned causes of ill health : they 

 are more directly affected by over-crowding ; and they are 

 the first to feel the effects of the neglect arising from 

 intemperance. This indirect consequence of the abuse 



