110 EEPOET OF THE No. 55 



possible to make comparison with other years with any degree of reliability. In 

 addition, in the case of the smaller cities it will be noticed that the difference of 

 very few deaths would make considerable difference in the ratio per thousand, 

 which is the usual basis of comparison. 



MORE IN FIRST YEAR THAN FOLLOWING FORTY. 



These figures, it will be noted, exclude still-births, which would have materi- 

 ally increased the percentage, but which cannot fairly be included in considering 

 preventive methods. They show that out of every thousand children born alive in 

 Ontario cities, one hundred and sixty die in the first year', or, in other words, more 

 die in the first year than in the succeeding forty. Because of this enormous pre- 

 ponderance of deaths under one, over deaths in any other year of life, consideration 

 in detail has herein been confined to that class alone, but at the same time it should 

 not be overlooked that the same methods which in other places have reduced tlie 

 mortality under one have reduced the mortality between one and five. Altogether 

 in Ontario cities the number of deaths under five years of age aggregate 3,527 and 

 constitutes 32.68 per cent., almost one-third of the entire number of deaths from 

 all ages and all causes. It necessarily follows, however, that improvements which 

 will conduce to greater healthfulness in the first year of life will conduce to greater 

 healthfulness in the years that follow. 



CONSIDERABLE CAN BE PREVENTED. 



To merely state that more die" in the first year of life than in the following 

 forty, is, unfortunately, not new. What appears to be sadly new in this Pro- 

 vince is that a considerable portion of this awful toll can be prevented. The cold 

 fact that out of every thousand children born alive, sixteen more die in On- 

 tario cities than in New York, four more die than in Chicago, and forty-four more 

 die than in London, in spite of the slums and congestion reputed to these great 

 cities, should touch the sympathies and arouse the consciences of Ontario cities 

 and Ontario citizens. It is true that conditions differ, but in general it may be 

 said that the two main influences whch affect all life adversely or favorably are, (1) 

 heredity and (2) environment. This second heading includes such influences as 

 food and drink, including tea, coffee, alcohol and narcotic drugs ; air, sunshine, cli- 

 mate (heat and cold), clothing, occupations, healthful or harmful exercise, rest 

 and recreation, cleanliness, including bacteria and the cause of contagious and in- 

 fectious diseases. Of course infants born with a bad heredity or "poor constitution" 

 have little chance of surviving in a bad environment and especially with bad or un- 

 wholesome food. It might be urged that the evenness* and comparative moderation 

 of climate contribute somewhat to the low rate in England, but, on the other hand, 

 the congestion, slums and poverty frequently attributed to English cities in horrify- 

 ing pictures, must be reckoned with as an influencing factor. A closer analogy to 

 Ontario cities from the standpoint of size and climate is found in Rochester, with a 

 population of 200,000 and an infantile mortality of 86 per thousand, almost half 

 the average for Ontario cities. The great fact, however, which stands out as a 

 beacon light of hope alike from the experience of British and American cities is 

 that the rate has been very materially reduced. Where the problem has been hon- 

 estly faced and grappled with, success has invariably followed, although there are 



