694 
(125 in 1903), Scotland (1900-1901, 128, highest in 50 years), Nor- 
way (105, average 20 years 1874-1893), Sweden (87, 1902), Ireland 
(96.6, average 20 years 1874-1893), and is almost as high as the total 
death rate of France (137 in 1903). The average death rate from 
diarrhea in all these 42 cities was 80.34 — figures of great significance 
when we come to investigate the seasonal distribution and the cause 
of the prevalence of gastro -enteritis in the neonate. 
It is worthy of note that the census report of 1900 shows that in 
our country there are no less than 15 cities having a total death rate 
greater than that of Chemnitz, viz : 
Charleston. S. C . 
Savannah, Ga 
Mobile, Ala 
Key West, Fla__. 
Bicldeford, Me__. 
Atlanta, Ga 
Fall River, Mass. 
Lynchburg, Va_ 
Table 7. 
419. 5 
387.5 
344.5 
311.8 
311. 6 
306.0 
304. 7 
301.7 
Richmond, Ya 
Laconia, N. H 
Shreveport, La__. 
Jacksonville, Fla_. 
Norfolk, Ya 
Lowell, Mass 
, Washington. D. C. 
300. 7 
294.6 
293. 5 
287.6 
284.6 
275. 5 
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 level. 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 number 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 February the total infantile mortality had 
