EDWARD BUNNELL PHELPS, M. A., F. S. S. 177 



in the last 10 years, and in many other cities and districts the 

 increase in the percentage of registered births has doubtless 

 been very much larger. Consequently, the actual decline in 

 infant mortality in the Registration States of this country un- 

 questionably is much smaller than the apparent decline, and in 

 at least some foreign countries the same exception must be 

 noted and taken into account in comparing their official infant 

 mortality figures. 



By far the largest percentage of deaths under age 1 due to 

 any one class of causes is that of infant deaths caused by diseases 

 of the digestive system, which in 1909 for illustration amounted 

 to 29.5 per cent. That is to say, almost one-third of all the 

 deaths under age 1 in the Registration Area of the United 

 States in the last year were due to that one class of diseases. 

 Deaths due to diseases of early infancy ranked second in num- 

 erical importance, footing up 23.9 per cent., or nearly one-quarter 

 of the dread total, and diseases of the respiratory system ac- 

 counted for 16.5 per cent, of the infant deaths in the Registration 

 Area. All told, these three classes of causes carried off 69.9 per 

 cent, of all the babies under 1 year of age who died in that area 

 in 1909. 



As that eminent authority on the diseases of children, Dr. L,. 

 Emmett Holt, put it in his address on ''Infant Mortality and 

 Its Reduction, Especially in New York City," before the Sec- 

 tion on Diseases of Children of the American Medical Asso- 

 ciation, in June, 1909 : "The fundamental causes of infant mor- 

 tality, as we may call them, are mainly the result of three 

 conditions poverty, ignorance and neglect. The curve of 

 diarrhoeal diseases is so important that it practically controls 

 the curve of infant mortality. This group embraces acute gas- 

 tritis, gastroenteritis, all forms of acute diarrhoea, dysentery 

 and cholera infantum and makes up the largest part of the im- 

 mense summer mortality. It is these diseases which cause 

 regularly each year the sharp rise in the death curve in July and 

 August." In citing these quotations from Dr. Holt's paper, I 

 have deliberately associated, and brought together, his authori- 

 tative statement of the fundamental causes of infant mortality 

 poverty, ignorance and neglect and his comment on the com- 

 manding importance of diarrhoeal diseases especially in con- 

 nection with the immense summer mortality although they were 

 not associated in his address. For, it seems to me, if a layman 

 may venture to express an opinion on a phase of the infant 

 mortality problem which the specialists in pediatrics are so much 

 more competent to discuss, that the fundamental causes named 

 by Dr. Holt poverty, ignorance and neglect in the natural 

 course of things are much more potent factors, in the summer 



