234 THE MILK QUESTION 



sequences of bad surroundings such as excessive heat of 

 summer and cold in winter, insufficient rest and recreation, 

 etc. Ignorance of the simple facts of hygiene and infant 

 feeding is an immense factor, which is quite as disas- 

 trous, H not more so in its consequences, than is the use 

 of bad milk or improper food. Neglect may be due to in- 

 temperance or vice in the parent, but often is the result of 

 poverty. 



The chief causes of death during the first year of life 

 among 44,226 deaths under one year of age in the cities 

 of New York, Chicago, Boston, and Philadelphia are as 

 follows : 



Acute gastro-intestinal diseases 28 per cent 



Premature congenital debility and marasmus ... 25 



Acute respiratory diseases 18.5 



Acute infectious diseases 5.4 



Tuberculosis (all forms) 2 



Syphilis 1.2 



Malformations, injuries at birth, and other con- 

 ditions of the newborn 5.8 



Convulsions 3.4 



All other causes 10.2 



From this total it will be seen that the diarrhoeal diseases 

 are so important that they practically control the curve 

 of infant mortality. These are all grouped under the familiar 

 term "summer complaints." One of the most striking facts 

 about the curve of infant mortality is its seasonal preval- 

 ence. The great bulk of the slaughter occurs during the 

 heated term of the summer. The reasons for this are the 

 depressing effect of the heat itself, the activity of the bac- 

 teria, and a complication of other factors which influence 

 the delicate mucous membranes of the baby's stomach and 

 intestines. 



One of the overshadowing factors in infant mortality is 

 artificial feeding. In New York the health department 

 estimates that eighty-five per cent of all infant deaths are 



