52 ADDRESS 



tuberculosis. And I trust that there is a future of lasting use- 

 fulness and power before this Association equal to that which has 

 been demonstrated to have been the outcome of the work accom- 

 plished already in these few years by the Tuberculosis Asso- 

 ciation. 



There is, of coure, no need of my saying anything more than 

 has already been said as to the fundamental importance of the 

 subject of infant mortality. Statistics are tiresome for most 

 people, but, trite as it may be, it certainly is enough to arrest 

 one's attention, no matter how busy he may be, to learn 

 that in the State of Maryland over one-fifth of all the deaths 

 of all ages occur under one year of age ; that one-third of all the 

 deaths occur under five years of age. The rate is a little higher 

 in this State in consequence of our negro population than in some 

 other parts of our country. In the registration area of this coun- 

 try the deaths under one year of ; age are a little less than one- 

 fifths of all deaths at all ages, and about one-third under five 

 years of age. In the first three months of life, one-ninth of all 

 the deaths occur. Such figures as these are enough, of course, 

 to indicate the fundamental importance of this subject. 



When one inquires into the leading causes of death during this 

 period one finds that the greater number are operative in the first 

 months of life. Some of these are sometimes spoken of as un- 

 avoidable, but, as Dr. Jacobi has said, most of them are not. We 

 do not think, however, that the crusade in the prevention of infant 

 mortality will yield the quickest results if directed against those 

 causes which to some seem unavoidable such causes as pre- 

 mature births, congenital defects, hereditary taints, accidents 

 at birth, causes of that kind. It is more especially against an- 

 other set of causes of infant mortality, namely, the so-called 

 diarrhceal and digestive disorders, the acute respiratory dis- 

 eases, bronchitis and pneumonia and the infections that the 

 campaign should be directed. Probably the infection.', play a 

 very important part in the digestive disorders, and tubercu- 

 losis we know plays a by no means unimportant part in the 

 deaths during the first year of life. During this period espec- 

 ially in nurslings the infectious diseases which we associate 

 with childhood are less common than after the first year of 

 life. Whooping cough and measles occur, but scarlet fever 

 is uncommon and this is especially true among those that are 

 nursed at the breast. This is in itself suggestive ; it shows 

 that the infant receives from the mother a certain measure of 

 protection against diseases toward which she is herself immune. 

 There are many reasons why the cow's milk can never be an 

 entirely satisfactory substitute for the mother's milk, and one 

 reason is that the protective substances in the cow's milk admir- 



