THE MARCH OF MEDICINE—WINTROBE 395 
nurses or to be bottle fed with inadequate feeding formulas, the infant 
death rate was frightful. In Dublin, during the period 1775-1796, the 
mortality rate at the Foundling Hospital was 99.6 percent (4). At 
the beginning of the nineteenth century it was estimated that about 
one-quarter of all children died before they reached 2 years of age. In 
London, during the period 1790 to 1805, 41.3 percent of all children 
died before reaching the age of 5 years. The great historian Gibbon 
was the sole survivor of 7 children. Even as late as 1870, when proper 
mortality records first began to be kept in New York City, more than 
38 percent of infants born alive died before the age of 1 year. Infant 
mortality started to make a sharp decline about 1870. Today it is less 
than one-tenth of the figure at that time. 
A comparison has been made of life expectancy. Tables of life 
expectancy were made in Ancient Rome (4). These showed that 2,000 
years ago the expectation of life at birth was about 22 years. In 
Massachusetts and New Hampshire in 1789 the expectation of life at 
birth was 28.2 years. In 1855 the figure had risen to 39.8. In 1901 it 
was 49 years. ‘Today it is well over 60 years. 
Such statistics indicate only deaths and fail to reveal the unhappi- 
ness and the economic loss produced by illness. These are difficult to 
record in numbers. 
The expectancy of life in infants, children, and young adults has 
increased greatly and even the middle-aged person can expect today 
a longer life than could his ancestors of similar age. The data are 
favorable up to the age of 50, but after this age there is comparatively 
little difference between the Roman citizen’s expectations and that of 
the man of 55 or more today. This is a very significant fact because 
it points the way to the problems of the future. The leading listed 
causes of death in the United States in 1900 were influenza, pneumonia, 
bronchitis, tuberculosis, diarrhea, and heart disease, in the order 
named. These conditions accounted for almost 7 deaths per 1,000 pop- 
ulation and of this number heart disease took about 1. In 1939, ap- 
proximately the same number of deaths were caused by the following, 
in the order named: heart disease, cancer, brain hemorrhage, kidney 
disease, and lastly influenza, pneumonia, bronchitis, and tuberculosis. 
Heart disease accounted for almost 3 of the 7 deaths, and cancer aver- 
aged more than 1, whereas in 1900 a number of other diseases took 
precedence over it. 
The true significance of these facts can only be gathered by con- 
sideration of the average age of our population, because heart disease 
and cancer become much more frequent as age advances. The pro- 
portion of people over 65 years of age has almost doubled since 1900. 
This is due to the fact that the greatest advances in medical science 
have been made in the attack against the diseases of childhood and 
of young adults. These are the age periods in which the control of 
725362—47——.27 
