200 SECTIONAL ADDRESSES. 
it arises that the better spaced out the children are, the more survive. 
It is also significant that the change should have come about in the second 
generation of universal elementary education, suggesting the possibility 
that when the influence both of grandmother and mother is exerted in 
the direction of the sentiment for cleanliness inculcated in the school, the 
child reaps the benefit. 
The mortality in the early years of life is greater in the cities than in 
the small towns and in these than in the rural areas; it is greater in the 
north than in the south for all classes of the community, but it must be 
noted that with the great fall in the present century the gap between urban 
and rural areas has been closing. This again suggests that education and 
a higher standard of personal hygiene are important factors, for the 
country is always more conservative in its actions and beliefs. In the same 
way, comparing the social classes, the death rate is lowest in the upper 
classes, particularly among the children of professional men, and the 
agriculturists, but highest among the unskilled workers and the miners. 
This indicates that the influence of custom as well as the direct effects of 
urbanisation may be factors to be considered. 
Special causes of morbidity are to be found in each of the main classes 
of workers. The mortality of the infants of agricultural labourers is 
below that of those of any other class of manual workers, not only as far 
as diarrhoeal diseases are concerned—here, perhaps, they have better 
chances of obtaining fresh milk—but also from measles, tuberculosis and 
respiratory diseases generally. Some of the difference may be due to the 
rural child, on the average, being older than the townschild at the time 
he is attacked by infections; for, whereas infantile infections spread 
through towns about every second year, in the country districts there may 
be an interval of five years between periods of epidemic prevalence. 
The infant mortality among textile workers is especially due to diarrhoea,?® 
which may be ascribed in many instances to artificial feeding during the 
mother’s absence at the mills. The children of this class also die notably 
from congenital malformation and prematurity, which might naturally 
have been attributed to the mothers working until a late stage of pregnancy, 
were it not that the mortality from these causes is even higher among the 
children of miners, whose women seldom work outside their own homes. 
The general infant mortality among the miners is higher even than among 
the unskilled and casual labourers in the towns, and if diarrhcea, gastritis 
and convulsions be taken together, their death rate from these causes is 
he highest of any class. In the Glamorganshire coal-fields the standardised 
child mortality in 1911 was 217 per 1,000 births for miners, and 176 for 
the rest of the workers in the area.2”__ This may be due to improper feeding, 
to insanitary conditions, or possibly expresses some difference in traditional 
methods of infant care ; though it should be noted that as the miners have 
the larger families there must be less individual attention available for 
each child. 
On the whole the evidence goes to show that morbidity, and especially 
infant morbidity, is closely associated with the aggregation of population, 
26 Various Annual Reports of Registrar-General, England and Wales, and especially 
Supplement to 75th Annual Report. 
27 Census of England and Wales, 1911, vol. xiii., pt. ii., table li. 
