636 
Table 7. 
Charleston, S. C - 419. 5 
Savannah, Ga 387. 5 
Mobile, Ala ’ 344.5 
Key West, Fla 311. 8 
Biddeford, Me 311. 6 
Atlanta, Ga 306.0 
Fall River, Mass 304.7 
Lynchburg, Ya 301. 7 
Richmond, Ya 300. 7 
'Laconia, N. H 294.6 
Shreveport, La 293. 5 
Jacksonville, Fla 287. 6 
Norfolk, Va 284. 6 
Lowell, Mass 275. 5 
Washington, D. C 274. 5 
The figures in connection with the German cities concern places of 
a population in excess of 100,000, while the cities returning rates in 
this country are, many of them, considerably smaller than this. As 
Harrington points out, our methods of registration are so incomplete 
that full returns would probably indicate a condition worse than now 
is manifest, and that we have every reason to suppose, in view of the 
extreme heat of our summers, that the diarrheal death rate in this 
country forms at least as great* a proportion of the total mortality as 
it does abroad. 
SEASONAL FLUCTUATION. 
Nor does the infantile death rate maintain itself constantly 
throughout the year at the same general leYel. On the contrary, it 
is well known that it is subject to enormous fluctuations, being ex- 
tremely high during the months of July, August, and September, fol- 
lowed by a sharp decline in the autumn. This accession to the 
infant death rate is due to the great numbei of deaths from diarrhea 
alone in those months, as the rate of mortality due to other infantile 
diseases remains pretty constant throughout the year. 
For example, at Leipzig, whose percentage (54.9) of deaths from 
diarrhea is higher than that of any other city in Germany, a com- 
parison of the birth rate, the infantile death rate, and the diarrheal 
death rate by months shows that in August, with an infant death 
rate of 570 to 1,000 births, 430 of these, or 75.6 per cent, were due to 
gastro-enteritis, whereas in Februar} T the total infantile mortality had 
sunk to 131, of which diarrheal diseases constituted a proportion of 
only 37 to a thousand, a decrease of 1,100 per cent. 
In England the report of the registrar-general’s office, compiled 
from the weekly returns of births and deaths from 76 of the largest 
cities of England and Wales in July, August, and September, 1906, 
shows that the total births for these months were 110,209, the total 
deaths under 1 year 23,058, of which no less than 14,306, or over 
50 per cent, were due to diarrhea. 
It is manifest from the foregoing that gastro-intestinal disease, 
causing as it does one-third to one-half of all infant deaths under 1 
