INFANT MORTALITY. 
EDWARD JARVIS, M. D. 
[From the Fourth Annual Report of the Massachusetts 
State Board of Health.] 
BOSTON: 
WEIGHT & POTTEE, STATE PEINTEES, 
19 Province Street. 
1873. INFANT MORTALITY 
By EDWARD JARVIS, M. D. 2 
STATE BOARD OF HEALTH. 
[Jan. 
INFANT MORTALITY. 
The perfect child comes to the world with all its organs in 
complete condition,—the stomach to digest its food, the heart 
to circulate the blood, the lungs to purify it, the nutrient ar- 
teries to convert it into flesh, the skin for protection, the bones 
and muscles for motion, and the brain to preside over all. 
“ Death in childhood is an unnatural event, inasmuch as the regular series 
of development of the human structure, from the germ-cell to the perfect 
man in his prime and in his last declining stage of existence, is interrupted.” 
“ But life, at all ages, depends upon so many conditions, and is exposed to 
so many risks, that out of given numbers of living some die at every age, 
and we can only take for a practical standard the lowest authenticated rates 
of mortality.”* 
This is the physiological view of the early condition of man. 
There is no gift to humanity so great, so valuable, none that 
offers so rich a source of happiness and comfort, as a child to a 
parent. There is nothing of which so much may be made. 
There is no such treasure offered; no such responsibility 
placed upon a family. 
The child is the promise of all the hereafter. The whole 
future of the world is wrapped in him. Unless he fulfil this 
promise and grow to manhood, the family ceases, the state 
perishes, the human race comes to an end. The family have 
the intensest interest of affection in his preservation, and all 
the pride and power of the nation rests upon his life. 
But as soon as the child appears among us, with all the 
promise of life, it is beset wTith manifold perils, that assail its 
vitality and tend to destroy it. These influences of evil ap- 
pear on every side, to which it has but little power of resist- 
ance. Although perfectly organized and endowed with all 
the means of carrying on the processes of life, the child is 
fragile, it has a small amount of vital force and requires 
* Reg. Gen. England, Supplement to 25th Rep. p. ix. 1873.] 
STATE BOAKD OF HEALTH. 
3 
favorable conditions and incessant care to protect it from the 
dangers that may threaten it. 
Death then begins at once to assail these hopes of man, and 
in the first week, the first month, the first year, and onward, 
children perish in large numbers. 
Beaugrand says :— 
“ For a long time liygeists have been occupied with the enormous mor- 
tality of infants in their first year. A great number of works have been 
published on this important question. Statisticians have been called to aid 
in the explanation of the complex condition of this social problem.” 
Everywhere in the world, and in all ages from the begin- 
ning, there is and has been the great cry of disappointment 
and sorrow at this great loss. There is and has been a great 
diversity in the mortality of children in various places. These 
differences are connected with varying conditions and circum- 
stances. The seasons, local and endemic influences, and 
more than all, the means and manners of life in the family 
seem to be prominent as friends or foes, to aid or impair the 
infant constitution, in its struggle against the adverse influences 
that threaten it. 
To the wise and the faithful are accorded the best results of 
their endeavors, to save their infants from destruction. But 
no community is free from this danger or loss. The records 
of all nations show a large proportion of the children that 
perish, on the way,_from birth to maturity. 
Massachusetts is one of the most favored States in the world 
for the intelligence, at least of its native population, and for their 
thrift and wisdom in management. In this Commonwealth, 
during the fifteen years ending 1870, there were 514,233 
children born ; and 71,526, or 13.91 per cent, of these died in 
their first year, and 131,784, or 25.52 per cent, before they 
had completed their fifth year. This includes the record of 
the foreigners, whose infant mortality was in a larger ratio, as 
well as that of the native families whose infant mortality was 
at a lower rate, than this average. 
The following table shows the experience of most civilized 
nations in this respect:— 
* Annales de l’Hygiene, 2d series, xxiv. 218. 4 
STATE BOARD OF HEALTH. 
[Jan. 
Births. 
Deaths. 
Ratio of Deaths to Births. 
COUNTRY. 
Period. 
Under One. 
Under Five. 
Under One. 
Under Five. 
Massachusetts,1 . 
1856-1870, . 
514,233 
71,526 
131,784 
13.91 
25.62 
Michigan,1 . 
1868-1870, . 
78,786 
- 
11,072 
- 
14.05 
England,1 . 
1851-1860, . 
6,471,650 
996,630 
1,706,583 
15.40 
26.37 
Scotland,1 . 
1855-1868, . 
1,331,250 
180,363 
353,906 
13.55 
26.58 
Sweden,2 . 
1856-1860, . 
404,829 
90,135 
159,993 
14.34 
25.46 
Norway,3 . 
1856-1868, . 
677,967 
72,651 
127,635 
10.71 
18.82 
Prussia,4 
1852-54, 
2,292,150 
411,398 
678,875 
17.94 
29.61 
Austria,5 
1860-61-65,. 
3,076,811 
775,082 
1,175,598 
25.19 
38.19 
Bavaria,6 . 
1857-62, 
823,468 
280,353 
335,687 
34.04 
40.64 
Netherlands,7 
1850-59, 
1,075,979 
260,112 
379,153 
24.17 
35.24 
France,8 
1857-62, 
5,739,275 
964,434 
1,560,480 
16.80 
27.18 
Italy,9 
1868, . 
900,416 
204,300 
366,200 
23.80 
40.67 
Spain,10 
1858-62-65-68, 
5,334,958 
993,115 
2,052,212 
18.61 
38.16 
1 Annual Reports. 
2 Officiela Statistik Helso och. Sjukvarden. 
3 Officiela Statistik. 
* Preussische Statistische, 1862-3-4-9. 
3 Statistische Jahrbuch, Oesteriche. 
6 Statistik der Konig-Bayern. 
2 Statistisch Jaarboek, Nederland. 
8 Mouvement de la Population. 
9 Statistica de Regno d’ltalia, 1868. 
10 Annuario Estadistico de Espana 1866-67. 
Showing the Births and Deaths under one and under five, and the ratio of each to Births. 1873.] 
STATE BOARD OF HEALTH. 
5 
Another method of comparison is the proportion of deaths 
to the living at the same age. This is stated in the English 
and Scotch reports, and may be calculated for others. 
A less reliable ground of comparison, but none the less 
certain as evidence of early mortality, is the proportion of 
deaths that fall on any age to the total number of all ages. 
The following table shows the proportion of the total deaths 
that fell on those under one and under five years :— 
COUNTRY. 
Ratio per cent, of 
all Ages. 
COUNTRY. 
Ratio per cent, of 
all Ages. 
Under 1 
Under 5 
Under 1 
Under 5 
Massachusetts,1 . 
19.43 
36.61 
Norway,4 . 
Prussia,5 . 
Austria,6 . 
18.82 
33.33 
Kentucky,1. 
21.87 
41.61 
21.25 
47.52 
So. Carolina,1 
23.31 
45.59 
30.39 
49.96 
Michigan,1 . 
25.93 
33.21 
Holland,7 . 
31.94 
46.58 
England,1 . 
21.24 
40.53 
France,8 
20.92 
32.71 
Scotland,1 . 
19.35 
37.96 
Italy,9 
27.72 
47.26 
Russia,2 
Sweden,3 . 
22.26 
52.60 
39.52 
Spain,10 . 
18.61 
38.46 
1 Annual Reports. 
3 Government Report. 
8 Officiela Statist. Helso. 
4 Officiela Statist. 
5 Preussische Statist. 
6 Statist. Jahrbueh. 
7 Statist. Jaarboek, 
8 Mouvement de la Population. 
9 Statistica del Regno. 
10 Annuario Estadistico de Espana 1866 67. 
Here are manifestly very different proportions. This dif- 
ference may be, in part, due to the difference of the composi- 
tion of the living population. 
In a State just settled by immigrants a very large propor- 
tion of the people are youths and middle-aged, and compara- 
tively few children, and still fewer infants and old people, 
and of course, in their mortality, there would be a correspond- 
ingly large proportion in middle life, and small in infancy and 
old age. Soon they marry, and in a few years the young 
children and infants form a large and the aged a small propor- 
tion of the population. Consequently the reports of deaths in 
the same period, show a large proportion of infants, a smaller 
proportion of the middle-aged, and very small of the very 
old. Nevertheless, in old and fixed populations, these dif- 
ferences indicate something more than the difference of the 
proportions of the living. 6 
STATE BOARD OF HEALTH. 
[Jan. 
Whatever may be the explanation of the difference of the 
proportion of infants to total mortality, still the irresistible 
fact remains that from nearly one-fifth to nearly a third of all 
the deaths fall upon infants under one; and from a third to a 
half upon children under five ; and the still more decided and 
indicative fact that from a seventh to one-fourth of all that 
are born, fail to pass their first year, and twenty-five to forty 
per cent, perish before they have completed their fifth year. 
Reasons. 
The first question that arises is, whether it is a necessary con- 
dition of human life that so many should perish in the outset. 
Are these proportions of children endowed originally with such 
feeble constitutions, that they cannot endure the burden of 
earthly life beyond the period of one or five years ? Are they 
endowed with only sufficient living force to run the vital machine 
for these brief periods ? 
There is no doubt that with many it is so, that some chil- 
dren are born with low and imperfect organizations, and with 
constitutions too weak to sustain the process of development, 
and therefore more or less must fall by the way. This ex- 
plains a part of this great proportion of infant mortality. 
Premature Birth. 
The security of infant as well as of adult life, depends 
primarily on its constitutional force, or power of performing 
its organic functions with vigor and comfort, even amidst the 
causes of disturbance and disease. 
The primordial constitution depends on prenatal conditions 
which belong to or may be controlled by the parent. Life pro- 
ceeds from life, like forms like. The parents can give only such 
as they have in themselves. The feeble, the scrofulous, the in- 
temperate, those who are themselves vitiated or impaired by 
heritage, by disease and exhaustion, or by sensual indulgence, 
have no fulness of power to impart to their children. The 
parents who in any way waste or vitiate their own vital force, 
or unwittingly suffer it to be vitiated or reduced, do or suffer 
this for their offspring that afterward proceed from them. 
Their constitution, whatever it may be, is an entailed estate 
that must pass, with all its worth and incumbrances, to the 1873.] 
STATE BOARD OF HEALTH. 
7 
heirs of their own bodies. The misfortunes and sufferings 
as well as the iniquities of the fathers and mothers are visited 
upon their children, possibly, even to the third and fourth 
generation. 
The conception and the prenatal being of the child are thus 
entrusted to the parent, and it requires for its full development 
and preparation for outward life and exposure, all the 
mother’s care and devotion. If she fail to regard her new 
condition, and recognize her new responsibility, and adapt her 
habits of action, costume and diet to the wants of the pro- 
spective child; if she, from influence of fashion, desire of 
concealment or other motive, refuse to allow the child oppor- 
tunity of expansion, or if she expend her forces in excessive 
labor or exposure, or dissipation of gay or vulgar society, or 
if she suffer from privations of proper food, or indulge in 
unsuitable diet, and thus impair her digestion, or embarrass her 
nutrition, she diminishes her power of giving her child the 
full development that can only be secured by a healthy 
and well ordered life in the parent. 
All these conditions and habits as they occur in the parent, 
have their natural effect on the constitution of the child, and 
diminish its power to bear the exposure of the world, and to 
resist the causes of disease. 
The first and immediate danger from any irregularity of 
the mother is premature birth, which sends the child abroad 
before it has completed the prenatal development that nature 
intends for her perfect children. Those who are thus born 
before their time are generally, almost universally, feeble, and 
imperfectly prepared for outward life. 
In England, during the six years, 1858 to 1863, inclusive, 
among 626,340 children that died in their first year, 45,814 
were prematurely born,* and had incomplete development, and 
therefore, were imperfectly prepared for the contact with the 
outward world. These constituted 7.31 per cent, of all the 
deaths of children, under one year old. In the ten years, 
1861 to 1870, the deaths of 85,118 children, or 1.75 per cent, 
of the whole, are ascribed to this cause alone, f 
* Supplement to the Reg.-Gen. 25th Report p. vi. 
f Reg.-Gen. 24th to 33d Reports. 8 
STATE BOAED OF HEALTH. 
[Jan. 
There is no record to show how many of the children were 
prematurely born in this period, but it is not to be supposed 
that they made any approach to the proportion. The prema- 
ture children have a much harder struggle to live, than those 
that are born at full time, and a much larger proportion 
succumb before the trials that they encounter. 
“ At the Maternity Hospital in Paris, in 1869, there were 1,320 births at 
full time and 641 premature, 1,961 in all. 127 or 9.5 per cent, of these horn 
at full time, and 332, or 51.8 per cent, of those prematurely born, died early. 
The proportion of mortality in the last was almost six times as great as in 
the class more completely developed and prepared for the chances and ex- 
posures of life.” * v 
Difference of Constitutional Force. 
In the question of mortality or liability to death, there is 
ever to be held in mind, both the power of the disease or the 
destructive agent, and the constitutional power of resistance. 
A child inheriting a weak constitution or prematurely born, 
with constitution incompletely developed, or with constitu- 
tional force reduced by imperfect nutrition, exposure to cold 
or extreme heat, or by neglect, must yield before a smaller force 
of morbific agency than one born at full time, with constitu- 
tional powers completely developed and sustained by proper 
and successful care. 
Healthy Districts. 
Philosophical vital statisticians make several classes of dis- 
tricts, divided according to their sanitary conditions and vital 
results. Those that have the lowest rate of mortality, show at 
least the natural liability or capability of living, belonging to 
the human constitution in the best condition and under the most 
favorable circumstances. In table, on page 196, the lowest 
rates of mortality, as compared with the births, were 10.71 
per cent, in the first year, and 18.82 per cent, under five, in 
Norway. 
In Massachusetts, the mortality, under one, was 13.91 per 
cent., and under five, 25.62 per cent. 
Iii Sweden, these proportions were severally 14.34 and 
25.46 per cent. 
* Beaugrand, Ann. Hyg. xxiv, 2d series. 1873.] 
STATE BOARD OF HEALTH. 
9 
They were 15.40 and 26.37 per cent, in England, and in 
Prussia 17.94 and 29.61 per cent. 
On the other extreme, the deaths were 25.19 per cent, 
under one and 38.19 per cent, under five in Austria, including 
Hungary. They were 24.17 and 35.24 per cent, in Holland, 
and 23.80 and 40.67 per cent, in Italy, and the highest rates 
were 34.04 and 40.64 per cent, in Bavaria. 
Thus we see, that the infant mortality was more than twice 
as great in Italy and Holland, two and a half times as great 
in Austria, and almost three and a half times as great in 
Bavaria, as it was in Norway; and the proportion of deaths 
of children, under five, was twice as large in Spain, Italy, 
Austria and Bavaria as it was in that colder but more healthy 
country of the Norwegians. 
Thus, as often as 1,000 infants died in Norway, 1,298 died in 
Massachusetts, 1,338 in Sweden, 1,438 in England, 1,738 
in Spain, 2,222 in Italy, 2,257 in Holland, 2,352 in Aus- 
tria, 3,178 in Bavaria, among the same numbers born in 
each country. 
It is not to be supposed that it is the primary intention of 
nature that the little children should perish so much more 
frequently in Bavaria, than in Norway or Massachusetts. The 
Norwegian rates of mortality, 10.71 per cent, under one, and 
18.82 per cent, under five, are the lowest for infants and 
children that are found in the record of any nation. This, 
however, includes the whole country of Norway,—all its 
districts, healthy and unhealthy, all its people, discreet and 
indiscreet, favorably and unfavorably situated. 
If a selection of districts, and people, and families could 
be made, and the experience of only the best included, there 
would be found a much lower rate of early death than these 
figures present for the whole nation. 
Yet taking these rates of 10.71 per cent, under one and 
18.82 per cent, under five, and admitting that so much is 
unavoidable, certainly in any large community it is worth 
while to inquire whether the excess that is found elsewhere, 
or even a part of that in Norway, may not be due to causes 
that are, in greater or less degree, subject to human control, 
and whether if guided by the best intelligence and under the 10 
STATE BOARD OF HEALTH. 
[Jan. 
best moral discipline in those that have the care of infancy 
and childhood, the death-rate in these periods may not be 
reduced everywhere to the Norwegian standard. 
From their exceedingly delicate sensibility, infants are 
susceptible of injury from manifold causes, either in the 
omission of what is necessary in appropriate food, in pure 
air, in temperature, in protection from cold, in the many 
attentions that tender and judicious nursing may give to 
develop the constitution or to sustain it during the progress 
of growth. 
These morbific influences are found in various degrees and 
proportion in all countries and among all people. No one 
stands alone anywhere, but each may have a prominence and 
do most of the deadly work on those feeble lives. 
Care of Infancy. 
The most difficult task undertaken by man is the creation 
and development of life. Gardeners watch their tender 
germinating seeds and shooting plants with unfailing attention. 
They regulate all the influences that can bear upon them. 
They provide in due measure appropriate soil, nutriment, 
moisture, air and warmth, knowing that from any neglect of 
these matters the health of the feeble plant must suffer, and 
life may fail. 
Farmers watch the young of their animals with assiduous 
solicitude; they inquire iuto every circumstance and deter- 
mine its probable effect on the new life ; they give the tender 
beings every favorable influence, and defend them from all 
that may harm them,—cold, rain, and improper food. 
No other form of life, whether in the animal or plant, is so 
tender and so susceptible of injury as that of a child; it is 
the most delicate of all creatures, and demands the most 
exact obedience to the conditions of its being and the appropriate 
supply of its wants. It bears no neglect without suffering, 
no injudicious interference without injury. 
Deaths in Early Weeks and Months 
This extreme tenderness is in the inverse ratio of the age 
of .the, child. The largest ratio of death is in the first week 1873.] 
STATE BOARD OF HEALTH. 
11 
and the first month. It gradually diminishes from the 
beginning of the child’s days. 
In France, the record shows that of 1,000,000 children 
born,— 
29,123 die in the first week. 
22,128 “ “ second week. 
22,236 “ “ sixteen following days. 
73,487 die in the first month.* 
In England, according to the Life-Table, of 1,000,000 that 
are born,—f 
46,503 die in the first month 
17,195 “ “ second “ 
12,178 “ “ third ’ “ 
10,100 “ “ fourth “ 
9,550 “ “ fifth “ 
9,033 “ “ sixth “ 
8,547 “ “ seventh “ 
8,087 “ “ eighth “ 
7,657 “ ** ninth “ 
7,253 *-* “ tenth “ 
6,872 “ i( eleventh “ 
6,518 “ ** twelfth “ 
149,493 die in the first year. 
From these it appears that in France, one in 34 died in the 
first week, one in 44 in the second, and the same proportion 
in the next sixteen days, and one in 14 the first month. 
In England, one in 21 died in the first month, one in 56 in 
the second, one in 77 in the third, and one in 131 in the 
twelfth. 
With its exceedingly delicate susceptibilities, the infant 
demands every favorable condition of care, clothing, warmth, 
* Reg. General England, Sup. to 25th Rep. p. vii., calculated from the French 
Reports. » 
t English Life-Table, p. xxiii. 12 
STATE BOARD OF HEALTH. 
[Jan. 
air, food and circumstances. It wilts under every privation of 
any of these means of life, and sinks under any adverse 
influence, from whatever cause. 
Diseases of Infancy and Childhood. 
The diseases that destroy life in infancy and childhood are 
found in all countries and climates, yet in very different 
proportions. The following tables show the ratios of deaths 
from each cause or class of causes, of children in the United 
States, Massachusetts and England :— 
Showing the Proportion of Deaths from each Cause, or Class of 
Causes, to all Deaths under five, in the United States and Massa- 
chusetts. 
CAUSES. 
Massachusetts.* 
United States.! 
Both Sexes— 
1870. 
Males— 
1859 - 60. 
All Causes, 
10,000 
- 
Disease of Brain, 
138 
214 
Bronchitis, 
102 
70 
Cephalitis, 
355 
474 
Cholera Infantum, 
1,740 
327 
Consumption, 
323 
255 
Convulsions, 
480 
523 
Croup, 
414 
942 
Debility, 
195 
52 
Diarrhoea, 
257 
412 
Diphtheria, 
157 
52 
Dysentery, 
288 
489 
Enteritis, 
94 
202 
Typhus Fever, 
134 
164 
Hydrocephalus, 
457 
207 
Canker, 
133 
- 
Measles, 
203 
184 
Infantile, 
476 
427 
Pneumonia, 
685 
739 
Premature Births, 
252 
_ 
Scarlet Fever, 
714 
1,075 
Tabes Mesenterica, 
274 
44 
Teething, 
292 
322 
Whooping-cough, 
327 
447 
Burns, 
55 
- 
Casualty, 
25 
450 
Lung Diseases, 
29 
113 
Scrofula, 
55 
83 
* Annual Report. t Census, 1860. Mortality Vol. 1873.] 
STATE BOAED OF HEALTH. 
13 
Showing the Proportion of Deaths from each Cause, or Class of 
Causes, under one year in England.* 
CAUSES. 
Males. 
Females. 
All Causes, 
1,000,000 
1,000,000 
Disease of Brain, 
223,209 
208,015 
Disease of Lungs, 
146,561 
137,218 
Cholera, Diarrhoea, Dysentery, 
90,218 
93,619 
Other zymotic diseases, 
39,431 
43,118 
Whooping-cough, 
33,174 
45,068 
Hydrocephalus, 
27,794 
24.587 
Disease Stomach and Liver, .... 
23,490 
19,810 
Sci'ofula, Tabes Mesenterica, .... 
23,373 
23,865 
Measles, 
13,669 
14,446 
Phthisis, 
12,548 
13,975 
Scarlet Fever, 
11,252 
11,299 
Violence, 
10,488 
12,109 
Small-pox, 
9,773 
11,201 
Typhus Fever, 
5,762 
6,010 
Heart Disease and Dropsy, .... 
4,151 
4,481 
Disease of Skin, ...... 
2,829 
3,225 
Diphtheria, 
1,931 
1,798 
Disease of Kidneys, 
376 
272 
Disease of Joints, 
316 
446 
Cancer, 
154 
209 
Disease of Generative Organs, 
79 
59 
Other Causes, 
318,768 
324,905 
Thus it is seen that diseases of the digestive organs 
caused more than one-quarter of the deaths, under five, in 
Massachusetts, and about one-ninth, in England. Diseases of 
the brain and nervous system, including dropsy and con- 
vulsions, destroyed about one-seventh in Massachusetts, and 
one-fourth in England. Disturbances connected with the 
lungs and respiratory organs, including croup and whoop- 
ing-cough, caused nearly one-fifth of the deaths of children 
in both countries. 
These are the leading causes of death in infancy and 
childhood, in all nations, but differing in their proportions. 
Both in Massachusetts and in England the reports include 
a considerable number of deaths, mostly in infancy, under the 
causes termed "Debility,” "Atrophy and Debility,” "Inani- 
tion,” "Premature Birth,” all resting upon imperfections of 
* Calculated from Table in Supplement to Reg. Gen., 25th Rep., p. 2. 14 
STATE BOARD OF HEALTH. 
[Jan. 
constitutional development or force, and inability to digest 
food and obtain from it sufficient nutriment for the body. 
Food and Nutrition. 
The prominent wants of the infant are food, warmth and 
air. 
The first is provided by nature in the mother’s milk, which 
is exactly adapted to the feeble and tender digestive organs 
of the child, and changes in its character with the necessities 
and capacities of the new-born consumer. 
No other aliment can take the place of the human milk. 
The milk of other animals,—cows, goats, etc., are not so 
well adapted to the powers and wants of infants. Their 
stomachs find great difficulty in digesting it, and their 
assimilative organs often are unable to extract from it sufficient 
aliment to supply the wants of the textures. 
The nurse-bottle, which is used, too frequently for the 
child’s good, from seeming or actual necessity, is filled some- 
times with contents less acceptable and more injurious to the 
infant’s stomach—gruel, chicken-broth, pap of manifold kinds. 
Beaugrand, in his article on the early death of the new-born, 
calls the nurse-bottle deadly, "funeste,” and shows how 
the children that are fed by it sometimes die from inanition, 
as it is termed, from want of power to convert the food into 
flesh. Whether the child has nothing to eat, or has its stom- 
ach filled with food which it cannot digest, or of which the 
nutrient arteries cannot make flesh, it is all the same to the 
child; it is actually starved for want of nourishment in the 
textures, the place where it is needed. 
The infant not only needs the mother’s milk, but wants it 
frequently. The fountain should never be long absent. 
Mother’s Temporary Absence. 
The nursing children of those mothers whose labor or 
business or pleasure require their protracted absence from 
home, suffer much from hunger and defective nutrition. 
Some pine away, and some at length sink into death. Among 
the poor there are some who are called from their homes, to 
work abroad during the day. They are with their babies and 
can nurse them only in the morning, before they go to their 1873.] 
STATE BOARD OF HEALTH. 
15 
work abroad, at noon when they return to their own dinner, 
and at night after their day’s labor is finished. And some 
even are absent through the whole day. The infants are 
thus left to be fed at home by cow’s milk, goat’s milk, farina- 
ceous food and other unnatural and unsuitable means. 
This is common in England, where women work on the 
farms, often distant from their homes, and in the factories. 
Dr. Husband says :— 
“ In some of the agricultural districts of England we find a very high rate 
of infant mortality. The medical officers of health, after investigating the 
subject, found that the cause of the excess was the employment of female 
labor. The mothers are employed at out-of-door work, and their children are 
left in the hands of bad nurses, or children not much better. 
“ It is found that in certain families, child after child is horn, which as 
regularly dies, and the neighbors know as well as may be, that the child ter- 
minates its existence, not through accidental death, but from carelessness 
and deprivation of food.” * 
Beaugrand says, that in the neighborhood of great manu- 
facturing establishments, in France, the children of the female 
operatives perish in their early weeks or months of life from 
this cause. The mothers in their straitened circumstances, 
feel obliged to contribute as much as possible to the support 
of their families, by working in the mill. So they get back 
to the factory as soon as possible, after their confinement; 
consequently, the sickness and mortality of the infants of 
these mothers are increased. This was manifested in many 
industrial centres. In Manchester, England, the death-rate 
of these children of the operatives rose to 22 to 23 per cent., 
and in Mulhouse, a large manufacturing town of France, it 
rose as high as 30 even 38 per cent. This attracted the 
attention of Mr. Dolfus, the wealthy proprietor of one of 
the establishments, whose wisdom and success were only 
equalled by his thoughtful benevolence. He then ordered that 
every one of his female operatives, who should be confined, 
should remain at home and attend to her child, for six 
weeks, after it was born; but that her wages should be paid 
the same as if she were at work. This was the first of No- 
vember, 1862. There were then 1,050 women employed in 
his factory; one hundred and eight of these were confined 
* Social Science Transactions, 1854, page 506. 16 
STATE BOARD OF HEALTH. 
[Jan. 
within the next year, and twenty-five of the children died. 
This was but two-thirds of the proportion of the previous 
year’s mortality. In the next year, the mortality was still 
farther reduced. 
Mr. Dolfus was so well satisfied with the result of his hu- 
mane plan, that he proposed to other manufacturers, who 
employed married women, to adopt it as a permanent rule for 
their establishments. 
Dr. Beaugrand adds, in his admirable article, in the 
Annales de l’Hygiene, 1866—" We proclaim these facts abroad, 
in trust that all establishments may follow the example of 
these manufacturers of Mulhouse, who have already amelio- 
rated so greatly the condition of their working-women.” 
To meet this difficulty, establishments called creches have 
been opened in Paris, London, Manchester and other places, 
where mothers can deposit their little children, while they are 
at work away from their homes during the day. Here doubt- 
less these infants are taken care of, as well as possible, in the 
circumstances. But they are deprived of their natural food, 
and have a lower chance of health and life, than if they were 
not separated from their mothers. Dr. Husband adds, 
" This is after all a very poor substitute for the care and at- 
tention of the mother, and a very inadequate provision for 
the comfort of the child, but no doubt it saves many an infant 
life.” * 
The necessities of infant nutrition are the same in all ranks 
of life, and the child suffers from the want of sufficient and 
appropriate food, at short intervals, in its early and feeble 
being. Whenever the mother is kept away, from whatever 
cause, whether by the necessities of earning bread for herself 
and her other children, or by the calls of society, or the 
simple power of ignorance or indifference, the child hungers 
and is weakened, and sometimes takes the steps that lead to 
death. The necessity of appropriate nutrition with the 
mother’s milk, and at due times, admits of no relaxation, and 
cannot bear neglect without injury to the child, through the 
early months, even to a year or more. 
The English and Irish reports include a considerable 
* Social Science Transactions, 1864, page 509. 1873.] 
STATE BOARD OF HEALTH. 
17 
number that died for "want of breast-milk.” Dr. Husband 
says this privation leads to debility, inanition, difficult 
teething and general impairment of health, and consequent 
inability to resist attacks of disease. And many a child, that 
was robust as long as it had the natural food, withered away 
when it was put upon an artificial diet, and finally sank under 
a mild attack of diarrhoea. 
The French statistics show that in one part of France 
" when children are given to wet-nurses and have the human 
milk, though not the mother’s, the mortality is 37.1 per cent. 
But in the class of children that are brought up by hand on 
cow’s and goat’s milk, or other food, through the nurse-bottle 
or the spoon, the mortality rises to 63.9 per cent.” This 
difference is noticed in the neighborhood of Paris, to which 
many of the children are sent from the maternity and found- 
ling hospitals of the city. 
Effect of Food on Milk. 
It is well known to farmers, especially to those who are 
milk-producers, that the milk is very materially affected by 
the food they give to their cows. If they eat onions, the milk 
has a taste of garlic. Turnips impart a peculiar and un- 
pleasant flavor, and sometimes the cattle eat noxious herbs in 
the pastures, which are discovered only by the offensive state 
of the milk. 
Distillery-Milk. 
A few years ago, there was a great complaint of the milk in 
New York, which was supplied to the market from cows that 
were kept at the distilleries and fed upon the waste vegetable 
matter, the residuum of the process of distillation. The sani- 
tary authorities caused the milk to be chemically examined, 
and they watched its effect upon the children and adults who 
drank it. The milk was found to be bad. It was different 
in elementary character from that produced by cows that 
were fed upon grass, hay or grain. It was not so well 
digested in the stomach, nor had it the nutritive power to 
create flesh and sustain strength. The children lost flesh or 
failed to gain it. Their skins were pallid, sometimes dis- 
colored and corrugated. Their countenances had the appear- 18 
STATE BOARD OF HEALTH. 
[Jan. 
ance of old age, rather than the bright and lively bloom of 
childhood. They suffered from diarrhoea and dysentery and 
great debility, and many died. 
The French have had this matter under consideration ; for 
they found that although the distillery-fed cows had a great 
flow of milk and were profitable to the owners, yet the chil- 
dren that drank it suffered a great deal from waste of flesh 
and strength, and the loss of infant-life was great. 
Some years ago, several persons in Malta were poisoned. 
On investigation, it was found that they had drank the milk 
of goats that had eaten of the Euphorbia Helioscopia, a 
poisonous plant that grows in the pastures of that island. 
The characteristic poison was imparted to the milk, and 
through this it was given to the consumer. 
The same relation of diet to milk holds with woman as well 
as with domestic animals. As the nurse feeds herself, so is 
the food she offers from her body to the infant that is 
nourished by her. Those who are meagrely and improperly 
fed offer meagre and unfitting food to their nursling's. 
Women who drink beer, porter or spirit for appetite, or with 
the honest intention to increase the milky secretion, run the 
risk of providing a vitiated nutriment for their infants. 
Even the morbid condition of the mother may be conveyed 
through her milk to the child. A physician in Massachusetts 
being called to a nursing-child, suffering from diarrhoea, was 
informed by the mother that she had the same trouble, and 
also that she had eaten green corn, which usually had this 
effect upon her. The physician did nothing for the child, 
but directed the suspension of this food. The disturbance 
ceased at once with both. But the mother being very fond of 
this diet ventured again twice, and at both times the same 
effect followed in both mother and child, and in both ceased 
on the suspension of the corn. 
Even the medication of the mother is felt also by the child. 
In July, 1872, there was in Roxbury an infant fatally narcotized 
through the mother. Suffering from great distress, she con- 
sulted her physician, who gave her fifteen grains of chloral 
hydrate aud one-fourth of a grain of sulphate of morphine. 
In three-quarters of an hour after taking this medicine, she 
nursed the child, which to all appearance was perfectly well 1873.] 
STATE BOARD OF HEALTH. 
19 
at the time. But soon afterwards he went to sleep, and mani- 
fested the usual effects of narcotism, and died in about twelve 
hours. Although strict inquiry was made, no cause of poison- 
ing could be discovered except through the milk taken from 
the mother.* 
Purgatives taken by the nurse sometimes act also on the 
child. 
It is manifest that the character of the milk and the health 
of the child depend very materially on the manner of the 
mother’s self-management, and that much of the ill-health of 
nursing-children and some of their mortality are connected 
with the errors in the maternal digestion. Among the poor, 
who have no choice of food, but must take such as their lim- 
ited means allow; among the ignorant, who consider, if they 
think at all, that the stomach is indifferent as to the matters 
that are put into it, and will digest all alike ; among the sens- 
ual and self-indulgent, whose appetites or caprices are their 
ruling motives in selection of food, it is easy to suppose that 
some will occasionally, more probably very frequently, err in 
diet. They fail to nourish themselves as they should, and to 
produce in their own persons the nutriment best suited for 
the health of their babes. Their children therefore are often 
badly nourished, they suffer from inanition and debility, and 
from disorders of the digestive-system, which may end in 
death. 
The deaths from diseases of the digestive organs among 
children under five in Massachusetts were over 7,900 in the last 
three reported years, and in England, over 80,000 under one 
and over 115,000 under five, in the years 1867 to 1870. 
These numbers show that the nutritive system is exceed- 
ingly susceptible of disturbance, and while it is the abso- 
lutely needful agent in the maintenance of life it may become, 
under improper management, as from other causes, a fre- 
quent agent of death. 
The poverty of the poor, as a class, reaches beyond their 
outward pecuniary condition. They have a small portion of 
the world’s goods, and as a consequence, in a very large pro- 
The Poor. 
* Boston Medical and Surgical Journal, LXXXVII. 116. 20 
STATE BOARD OF HEALTH. 
[Jan. 
portion of cases, and as a cause of this fact, in many others, 
they have a lower bodily health and shorter duration of life. 
They are compelled to engage in the hardest and most 
dangerous labors. They suffer more from exposure and 
from accident. They have less means of sustenance for 
themselves and their families. Their houses are necessarily 
cheap, often in the less desirable and healthy places. They 
live often in wet and unwholesome localities in the country, 
and in the narrow and crowded streets of cities. They can 
have but small space around and in the house for themselves. 
They can have but few rooms, some have but three, others 
have but two, and many have but a single room for the whole 
family of father, mother and children. In these, or in this, 
they do all their domestic work. Here they cook and eat, 
they wash, dress and sleep, and here they are sick and here 
they die. Their narrow quarters are filled with the fumes of 
the cooking processes, sometimes with the smoke of the fire, 
and often with tobacco-smoke of the self-indulgent father and 
his visitors. Add to these the emanations from the lungs 
and the skins of the family, and it is manifest that the air 
they breathe is corrupted and overloaded, and there is but 
small opportunity for the dwellers to purify their blood with 
a good supply of oxygen. 
The air of such crowded rooms becomes loaded with an 
intensely oppressive odor, that attaches itself to the persons 
and clothing of those who live in them, and is carried abroad 
through long distances of travel in the open air. There is 
little opportunity for ventilation, or even motive, for the air 
abroad, that would first enter their room, is also foul and 
unhealthy. 
The surroundings of these tenements of the poor arc often 
no better than their inward condition; offal is thrown out, 
filth accumulates, and sends forth its effluvia to poison the 
air above it. 
Iii the city, their streets are narrow, and the yards of their 
houses still narrower, and frequently wanting. Their rooms 
or tenements, both in city and country, are frequently cold. 
They are sometimes old houses, deserted by the more favored 
previous occupants, as unfit to be inhabited. Some are new 1873.] 
STATE BOARD OF HEALTH. 
21 
but badly constructed, and built with as little cost as possi- 
ble, to accommodate the narrow circumstances of the poor. 
Their clothing and other means of personal protection are 
equally uncertain, and often inadequate for their comfort or 
their health. 
In the market they must consult their finances rather than 
their digestive powers or their wants of nutrition. They 
therefore buy the cheaper rather than the most nutritious 
food, and the cookery is often as imperfect as the material 
which they prepare. 
So all the means that they have of sustaining and of pro- 
tecting life—the air they breathe, the food they eat, and the 
shelter ar.d clothing that protect them from the elements 
are of a lower character than the more favored are able to 
obtain. 
Hence their life and strength are less developed and sus- 
tained. They have more sickness and less power to resist 
its ravages, and they sink earlier beneath its force. 
Dr. Marc D’Espine, the celebrated and learned Swiss 
writer on mortality, says :— 
“Wealth and comfortable circumstances increase vitality and longevity. 
They raise the mean or average of life. They lessen the mortality at all 
ages, and especially in infancy. But poverty and misery have the con- 
trary effect.” * 
The children, especially the infants, with the extreme deli- 
cacy of organization and great susceptibility of influence, par- 
ticularly for evils belonging to their years, feel the force of 
all these depressing conditions and circumstances more than 
the adults. 
The hard necessities and the severe labors of the mother 
often prevent her from giving the prenatal child opportunity 
of development, and after birth she cannot give the little 
nursling the attention that is needed for the establishment of 
its physical constitution on the best basis for endurance. 
Moreover with the ignorance and uncertain discipline of the 
parents and household, the child is submitted to regimen as 
to diet, clothing, air and exercise unsuited to its wants and 
powers, and frequently injurious to its health. 
* Annales de L’Hygiene, xxxvii. 325. 22 
STATE BOARD OF HEALTH. 
[Jan. 
Dr. Fraser says, in respect to a district of Glasgow, tinder 
liis inspection:— 
“Within no very limited area, none of the children that I saw were well, 
and I found that more than one-half of the whole, horn alive, had died 
very young. One woman had five living children, hut had lost six. In 
another family three survived and seven had died.” 
“It is no uncommon thing to find in families having originally seven, 
nine, eleven and even thirteen children, one or two only reaching adult-life. 
Fearful as this is it is to he found in nearly every considerable city in the 
kingdom.” * 
The records of sickness and mortality confirm these deduc- 
tions, which are drawn from seeing the condition and habits 
of the poor. Mr. Chadwick, in his report on the sanitary 
condition of the laboring classes, page 161, says, that he 
found in fourteen cities and districts that the average age, at 
death, of 1,232 members of the most comfortable classes 
including the children and infants was 44 years. Of 5,035 
persons in families less comfortably circumstanced, it was 27.47 
years, and 20,385 persons in families of the poor had enjoyed 
an average life of only 19.58 years. The average longevity in 
the most favored class exceeded that in the poorest by 125 
per cent. 
The difference was most in the deaths of the children. 
Compared with the number living under one year, the deaths 
were 20 per cent, in the best, 44.4 per cent in the middle 
class, and 50 per cent, in the poorest. 
The experience of Paris gives a similar result. Yillermie 
says, that in three arrondissments, where only 7 to 11 per 
cent, were exempt from tax on account of poverty, the deaths 
of infants, at their homes, were only one in sixty-four of the 
living, while in other districts, in which 31 to 33 per cent, 
could pay no tax, the deaths, were one in forty-five. 
The deaths of infants at home and in hospitals were one in 
forty-three living in the richer, and one in twenty-six in the 
poorer districts. 
There are no records in this country that show the mor- 
tality of the comfortable and the poorer classes separately. 
But in Massachusetts and in Boston, the births and deaths in 
the American and foreign families are separately recorded. 
* Traus. Social Science, 1860, page 650. 1873.] 
STATE BOARD OF HEALTH. 
23 
The record of the American families include all the native 
poor as well as the prosperous. But a much larger propor- 
tion of the foreigners are poor. 
In Boston, during ten years, 1862 to 1871, there were 
born 20,867 children of American and 42,582 of foreign 
fathers. In the same time, the deaths were 3,438 under one 
year, and 5,428 under five years, of the first class, and 7,719 
under one year, and 13,943 under five years, of the second 
class.* 
Of those that were born in American families, 16.47 per 
cent, died under one, and 26 per cent, under five years. Of 
those born in foreign families, 18.13 per cent, died under one, 
and 32.79 per cent, under five years.* 
The mortality of the foreigners’ children was 10 per cent, 
greater under one, and 26 per cent, greater under five than 
that of children of natives.* 
In Massachusetts, in the four years, 1867 to 1870, of the 
children born of both foreign parents, the ratio of deaths 
under one year exceeded that of the children of Americans 
by 10 per cent., and under five years by 28 per cent.* 
In this connection the comparative ratio of infants and chil- 
dren to those of all ages buried in the Mount Auburn and the 
Catholic cemeteries in the vicinity of Boston agree with these 
deductions. During the periods examined there were of all 
ages, 19,735 buried in the Catholic cemeteries, of whom 
5,688 or 28.7 per cent, were under one, and 11,486 or 58.2 
per cent, under five. At Mount Auburn 16,949 were buried, 
of whom 1,973 or 11.6 per cent, were under one, and 4,771 
or 28.1 per cent under five.f 
The Catholic families are immigrants, and therefore have a 
very small proportion beyond middle age. But they have a 
much larger proportion of young children than the families 
whose members are buried at Mount Auburn, but the propor- 
tion of this excess of their living is much less than is shown 
of their dead children. 
Records of the mortality of Concord, Mass., for sixty-five 
years, and of Dorchester, for seventeen years, show the occu- 
pation and social positions, as well as the age of the deceased. 
* Annual Mortality Reports. 
t Condensed and calculated from the records of the cemeteries. 24 
STATE BOARD OF HEALTH. 
[Jan. 
The proportion of deaths under two years in the families of 
the farmers that owned their farms, was 11.94 per cent, of 
those of all ages, and in the laborers’ families the proportion 
was about double, or 23.5 percent. In order that the farmer 
should own his farm, it is necessary that his wife, who is his 
partner and cooperator, should be wise, discreet and thrifty. 
This wisdom and discretion, which she brings to the manage- 
ment of the general affairs, is shown in the care of her 
children, and this is the result. 
Education and Ignorance 
The infant’s life is in the care of the mother, and its safety 
depends upon the intelligence and discretion that she can 
give to this responsibility. There is no record that discrimin- 
ates between the intelligent and the ignorant of the mothers, 
showing the number of each class. Nor is there any record 
of the deaths of the infants of these educated and uneducated 
parents. But there is an approximation to these facts on a 
large scale in the registration reports of England. 
In England every person when married is recorded, and 
required to sign the register; and if unable to write, the 
groom and bride must make the mark. 
The reports show the numbers and proportions of both 
grooms and brides in each district, who wrote their names or 
made their marks. 
The same records show the births and the deaths at each 
age. For the purpose of showing the connection between the 
education of the parents and the life of their children, the 
records of twenty-five years, including 3,362,742 marriages, 
have been analyzed, and divided into several classes, accord- 
ing to the proportions of the brides who wrote their names in 
the register. 
Ill the most*intelligent class, there were 648,260 marriages, 
and 20 to 30 per cent, of the women made their mark. In 
the least intelligent class, there were 661,929 marriages, and 
60 to 70 per cent, of the brides made their mark. In the 
first class there were 2,231,959 children born, and 327,040, or 
14.65 per cent., died under one year old. In the last class 
1,776,547 children were born, and439,359, or 24.87 percent., 
died before they passed their first year. As often as 1,000 1873.] 
STATE BOARD OF HEALTH. 
25 
died in their first year, in the more intelligent class, 1,698 
died in the least intelligent class among the same number 
born in each. 
These classes are both large ; each includes city and country, 
commercial, mining, manufacturing and agricultural districts. 
The only difference apparent is the diverse proportion of the 
mothers who could write their names. 
It is not to be supposed here, that the simple fact of in- 
ability to write caused the death of infants. But this ina- 
bility to write is a representative fact. It represents a want 
of education and intelligence, a lower degree of discipline 
and thrift; with these mental and moral conditions are asso- 
ciated more poverty, and even destitution, the more frequent 
want of means of support and the comforts of infant life, a 
more careless and indiscreet management, more intemper- 
ance, and neglect of children. In the best class 20 to 30 per 
cent, could not write, and in the worst class 30 to 40 per cent, 
had this accomplishment, but if these could be excluded, and 
none but the educated be in the first, and none but the 
ignorant in the last class, the difference in the chances of 
infant-life would be found to be much greater. 
Overlaid—Suffocation. 
A cause of death of infants is found in the British and Irish 
reports, termed overlaid, or smothered by the parent or nurse 
in bed. The reports of England show that in the eight years, 
1863 to 1870, 1,125 were destroyed in this manner; this is 140 
a year. But perhaps these are not all. In these eight years-, 
there were 7,580 deaths from suffocation; 5,588 of these were 
children under one year, 1,125 were overlaid, and 3,606 
were said to be "suffocated by bedclothes.” 
How many of the last were overlaid is not known. But 
from evidence given in a discussion of this matter, at a meet- 
ing of the Social Science Association, 1864, it may be feared, 
that many more infants were overlaid and put to death by 
their parents than these figures indicate. Dr. Lankester, the 
learned and scientific coroner of London, said, "I find that in 
one year I held inquests on ninety children who have been 
suffocated in bed.” Mr. Raper said, " It appears that seventy- 
two cases of deaths of infants that had occurred from suffoca- 26 
STATE BOARD OF HEALTH. 
[Jan. 
tion between Saturday and Monday, were brought before the 
coroners’ courts of Liverpool.” 
Dr. French: "The parents having been paid their wages 
Saturday, get drunk and neglect their children.” Dr. Raper : 
"The great bulk of these, nearly the whole, occur through 
the drunkenness of their parents. The beer-bill created 
8,000 beer-shops in Lancashire.” " The removal of that law 
would remove the temptation to that vice, that produces a 
great deal of our infant mortality.” Dr. Lankester : "A large 
number of these children are found dead on Sunday morning, 
and, I fear, many of them are caused by the Saturday-night 
orgies. Drunkenness is the frequent and fruitful cause of 
infant mortality.” * 
The term overlaid does not appear in the mortality reports 
of other countries. But suffocation is given as the cause of 
ninety-two deaths of all ages, of whom sixty-three were under 
five, in Massachusetts, within the five years ending with 1870. 
The last census of the United States reports 1,255 deaths 
from this cause, in the year 1870-71, of which 931 were of 
infants under one, and 1,023 were under two. In the 
"Southern Medical Reports” printed in New Orleans, about 
twenty-five years ago, Thomas Affleck, Esq., of Washing- 
ton, Mississippi, in an article on the hygiene of cotton-planta- 
tions states, that "the mortality of negro children is two to 
one when compared with the whites ; ” " not a few are overlaid 
by the wearied mother, who sleeps so dead a sleep as not to 
be aware of the injury to her infant.” This finds some 
corroboration from the mortality report of the last census. 
In the year 1869-70, in eight Southern States, with a popu- 
lation of 7,222,409, of whom 3,271,321, or 45.3 per cent, of 
all, were colored, there were 552 deaths from suffocation ; 479, 
or 86 per cent, of these, were of children under one year. In 
ten Northern States, with 17,622,493 inhabitants, of whom 
306,254, or 1.7 per cent., were colored, there were 406 
destroyed by suffocation; 228, or 56 per cent., were under 
one. Most of the others were adults suffocated in mines by 
charcoal fumes, etc. 
Iii the States where the colored population forms a large 
proportion of the whole, the deaths from suffocation were 
* Transactions, 1864, p. 651. 1873.] 
STATE BOARD OF HEALTH. 
27 
one in 13,084 living, and the babes were 86 per cent, of the 
whole. In the other States, with a very small proportion of 
colored people, the deaths from this cause were one in 48,405, 
and the infants were only 56 per cent, of the victims. 
Illegitimacy 
Quetelet, speaking of illegitimate children in his work, 
Sur lTIomme, p. 231, says, "The deadly heritage of vice 
attends the infant before birth, and pursues him for a long 
time afterwards.” 
The depressing circumstances, conditions and influences 
that sometimes attend and impair the life of children born in 
wedlock, are more intensified and destructive, and hover more 
frequently about those who have no legitimate fathers. 
The mother, oppressed with shame and sorrow, endeavors to 
conceal her state, by all the means of dress and compression. 
Practically denying her condition she can ask no favor of 
family or society, but assumes and bears the burdens and 
labors that are assigned to the healthy and unencumbered. 
The child is deprived of the requisite opportunity of devel- 
opment and growth. Means are often used for its premature 
removal, and result in its injury, and when at length it is 
born, its constitution is generally lower than that which belongs 
to the children of honest parentage. 
As soon as the unwelcome child is born, its exceedingly 
feeble life is surrounded with foes on every side, and finds 
few friends to protect and sustain it. An object of fear and 
anxiety to the mother, who is allowed but little or no oppor- 
tunity to attend to its wants and caress it, an object of 
aversion and even of disgust to the family and associates, 
there are few or none to offer their tender and affectionate 
attentions to this frail waif of humanity, and make its differ- 
cult path to strength as easy and sure as to other children. 
Family, friends and society, or the inexorable force of cir- 
cumstances, deny the claim of the child upon its mother for 
parental care. But they demand of her that she shall bear 
her part of the burden of the world and work with her hands, 
as if she had no maternal love and no object to expend it upon. 
Most frequently society recognizes in this forlorn, deserted 
woman, no other attribute of motherhood than the fountain 28 
STATE BOAED OF HEALTH. 
[Jan. 
of nutriment which nature has provided in her person for her 
own offspring. But even this she feels compelled to sell, 
with all her power of motherly sympathy and attention, in 
order to obtain bread for herself and her babe. Thus the well- 
born child of affection and honor drinks the milk and enjoys 
the exclusive watchfulness that naturally belongs to another, 
while the base-born child of infamy and sorrow is deprived 
of its only heritage of good; it is made an outcast, and 
sent to live with hirelings. Although these strangers have no 
motive but gain, they are poorly paid for their responsibility. 
They have neither the intelligence nor the heart, still less the 
time to give that which the infant most needs,—a mother’s 
judicious and affectionate care. They may feed it with the 
natural food, but generally with the milk of animals and 
diet less digestible and less fitted to sustain its life and health. 
The child’s feeble constitution has a hard struggle with 
these unfavorable conditions and circumstances, and often 
sinks beneath their weight. 
In Prussia, during fourteen years, while 17 percent, of the 
legitimate infants died in their first year, 25 per cent, of the 
illegitimate died at the same age. In Berlin, 19.8 per cent, 
of the first class, and 36.2 per cent, of the other died in 
infancy. In Stettin, in the five years, 1854 to 1858, these 
proportions were 22.3 and 45.1 per cent, respectively. 
In Bavaria, through five years there were born in wedlock 
633,119, and out of wedlock 190,349 children. The deaths 
in the first year were : legitimates 207,750, or 32.8 per cent. ; 
illegitimates, 72,663, or 38.29 per cent.* 
In Austria in 1861, 1862 and 1865, and in Hungary in 
1865, the births were :f— 
Legitimate, ....... 2,705,536 
Illegitimate, 371,275 
Deaths under one :— 
Legitimate, .... 645,663, or 23.86 per cent. 
Illegitimate,. . . . 129,419, or 34.85 per cent. 
Quetelet, quoting from Sussmilclie, says " that for every ten 
of the legitimate that die in each of these several periods, 
* Statistiche Konig Bayern, 1861. 
t Oesteriche Jaarbucli, condensed. 1873.] 
STATE BOARD OF HEALTH. 
29 
there are deaths of the illegitimate in the first month, twenty 
to forty; in the second and third months, twenty; in the 
fourth to sixth months, seventeen; in the seventh to twelfth 
months, fifteen, out of the same numbers born in each class.”* 
The reports of France and other nations tell the same 
story, showing the universal law, that infants born out of 
wedlock suffer the necessary consequences of neglect, the 
frequent privation of maternal care and appropriate food. 
They have therefore a lower vitality, and a larger proportion 
of them die in infancy and childhood, than among those 
that are allowed to enjoy the tender, faithful care and 
appropriate food that nature intends for her little children. 
Foundlings—Abandoned Children. 
Beneath the low depths of wickedness and suffering just 
described, there is a still lower depth connected with the 
children,—those that are abandoned by their mothers and 
left in the street to take their chance of death, or of being 
rescued by the pity of strangers, or sent to the foundling- 
hospitals with a somewhat better chance of life. This is 
usually the last act in the long process of concealment 
practised by the mother whose condition and suffering have 
been known only to herself and one or more confidants. 
Some of these infants have been the subjects of attempts 
to procure abortion. From all these causes these children come 
to the world, with the lowest vital force, the smallest hope of 
continued life. Then they are rarely fed,—almost never 
properly,—as they are hurried away before the natural nourish- 
ment is provided. To prevent the crying that might lead to 
discovery at home or on the way from the place of birth to 
the stranger’s doorsteps or to the foundling-hospital, the 
child is often stupefied with opium. On the way to either, or 
while waiting in the street, if left there, the little spark of 
life suffers another cause of extinguishment, from exposure 
to the air to which it is unused, and to cold which it cannot 
resist. 
However discreet and kind the people may be into whose 
hands the child may fall when left at their door, they are not 
* Sar 1’Homme, 231. 30 
STATE BOARD OF HEALTH. 
[Jan. 
prepared for such a responsibility ; they cannot meet its neces- 
sities, they are not nurses, they have not the natural food. 
Through the transition from its first resting-place, through 
the police, the station-house, to the asylum, if such there be, 
to the almshouse, or possibly to some charitable heart, that is 
willing to receive, and even adopt it, the infant finds no 
strengthening, but is subject to continual exhaustion, and 
when it arrives at its destination, its life is very low, and 
gives but little promise of continuance. 
With such children nothing but the best appliances will 
avail. More than others they need the human milk, yet few 
can be indulged with it, and even they, with rare exceptions, 
can have only a part, a small part, of their nourishment from 
this source. Their main dependence must be on the bottle- 
nursing. But the best care, protection, warmth and food are 
necessary, and even these sadly fail in a large proportion of 
these waifs. In the best institutions, even in the Massachu- 
setts Infant Asylum, managed with the best charity and wis- 
dom of the State, provided with the tenderest and most discreet 
attendance, with airy, properly warmed and ventilated 
rooms, with clothing most suitable and food most digestible 
and nutritious that can be obtained, including wet-nursing as 
part of the nutriment, with all these means of sustaining 
life, 48 per cent, have died in its four years’ operation. 
The New York City Foundling-Hospital was opened in 
November 1869; in the first year 1,480 infants were ad- 
mitted, and 826, or 55 per cent., died within that period.* 
In almshouses, that have no especial provision for the care 
of these feeble children, where the extreme tenuity of their 
thread of life is not understood, and especially where economy 
is the ruling principle, the rate of infant mortality is much 
greater. 
Foundling-hospitals are plentiful in Europe. They have 
received multitudes of abandoned children. And the general 
history of their operations shows how small is the vital force 
of those committed to their care, and how few of them can be 
saved. 
In Rome, the mortality was 57 per cent. 
* Rep. Board of Health, 1870, p. 279. 1873.J 
STATE BOARD OF HEALTH. 
31 
Sir James Simpson, in his lecture on health, before the 
Social Science Association, in 1867, said, "I mention the 
frightful mortality in foundling-hospitals, where all the laws of 
health are set at defiance. In the old Dublin Foundling- 
Hospital, of the last century, only some 135 lived out of 
12,000 infants admitted.”* 
This, however, has been improved, for out of 52,000 ad- 
mitted in thirty years, 1795 to 1826, only 41,000 died.f 
Effect of Cold. 
Children need fresh air for respiration, but little infants 
suffer from cold. "It is the custom in France to carry in- 
fants, within a few days of their birth, to the office of the 
mayor of the town, in order that the birth may be registered 
and the child become possessed of its civil rights.” This is 
done through all seasons. The proportion of death within a 
limited period after birth wras much greater in winter than in 
summer. "It was greater in the northern than in the 
southern parts of France.” "It was greater in the sparse 
districts, where the children 'were carried long distances, than 
in the densely peopled places.” } 
In Russia, the deaths of children varied from 31.6 in the 
warmest provinces to 69.1 per cent, in the coldest. These 
differences follow the isothermal lines rather than latitudes. 
Wherever, from geographical structure, mountains and val- 
leys, exposure to or protection from winds, the climate was 
colder or warmer, the same variation of infants’ life and death 
was manifested ; the cold air destroyed, the warm air saved 
many. 
Here, however, we are met with the fact, that in Norway 
was the lowest rate of death within one year after birth. This 
is to be explained by the domestic character of the Nor- 
wegian mothers. They are mostly wives of farmers, discreet 
and faithful to their responsibilities in the care of their house- 
holds, and especially of their children. 
The constitution of children is strengthened by exercise in 
the open air, under proper conditions of protection, yet the 
* Trans. 1867, p. 122. 
t Porter’s Progress of the Nation, III., 288. 
J Edwards’ Influence of Physical Agents on Life, 216. 32 
STATE BOARD OF HEALTH. 
[Jan. 
plan of hardening, which some attempt, is destructive. It 
destroys the weak and weakens the strong. 
Country and City. 
It seems to be a universal law that condensation of popula- 
tion lessens the chances of life. The ratio of mortality is 
greater in city than in country, and this increases as the 
people live nearer together in the city. 
The supplement to the English Registrar-General’s twenty- 
fifth report, pages xxxviii to lviii, gives a table show- 
ing the number of deaths in 10,000 living, and average num- 
ber of people to an acre of land, in each of the six hundred 
and twenty-three districts of England and Wales. 
In the districts which had 100 to 250 persons to the acre, 
the annual deaths were 262 in 10,000 living. 
In those which had one to two acres for each inhabitant, the 
deaths were 214 in 10,000. 
In the thinly settled districts, with twelve or more acres 
for each, the deaths were only 168 in 10,000. 
In the cities the mortality increased with the crowding of 
the living, as shown by the reports of deaths in the four 
places below. 
TOWN. 
Living to 
Square Mile. 
Annual deaths 
in 10,000 living. 
London, . 
50,000 
251 
Leeds,. . 
87,256 
272 
Manchester, 
100,000 
337 
Liverpool, 
138,000 
348 
The excess of mortality falls in greater proportion on 
childhood than on maturity. 
The deaths in the healthiest districts were 10,604 in 100,- 
000 children under one year. 
In Westmoreland and North Wales they were 11,884. 
In fourteen city districts, 25,858. 
In Liverpool, 28,005. 1873.] 
STATE BOAED OF HEALTH. 
33 
The annual deaths under five in the period, 1849 to 1853, 
were, in thirty cities, 338,990, and in healthy country dis- 
tricts 135,478, in the same population in each. As often as 
100 died in the healthy country, 250 died in the city, among 
the same number living.* 
The life-table, founded upon the most rigid observations, 
makes the proportions of deaths of children to be 5.29 per 
cent, for the country and 13.34 in the city, or as 100 to 252. 
The reports of births and deaths of Scotland make three 
divisions of the people. 
1. Those living on the islands. 
2. Those living in the country of the mainland. 
3. Those living in the great cities. 
During the fourteen years reported, the proportions of 
deaths of children, for every hundred births in each .class, 
were— 
Under one. 
Under five. 
Islands, 
8.05 
15.58 
Mainland country, 
9.80 
18.26 
Cities, 
14.91 
30.90 
As often as 1,000 died on the islands, 1,217 died on the 
mainland country, and 1,852 in the cities, under one; and 
1,172 in the rural, and 1,983 in city districts, under five. 
There are similar differences in France. The deaths in 
1861 to 1865 were less than twelve per cent, in two depart- 
ments ; less than fifteen per cent, in six; less than seventeen 
per cent, in nine departments, and 39.07 per cent, in Paris, 
in the same number living under one year, f 
A chart recently published by Bertilon, shows the dif- 
ferent rates of mortality of children under one and under five 
in each department, by the varied shading from perfect white, 
for the healthiest, to perfect black, for the most unhealthy. 
* Reg. Gen. Sup., XXY. Rep., p. xxvii. 
t Mouvement de la Population, 1861-1865, p. lxvii. 34 
STATE BOARD OF HEALTH. 
[Jan. 
It is a little noticeable that the department of the Seine, 
in which is Paris, is not the blackest, but it is somewhat 
lighter, and its rate of infant mortality is 268.6 in 1,000; 
while seven of the neighboring departments are black, with 
rates of 277 to 359 in 1,000. The explanation is easy. It 
is the custom of the officials of the maternity and foundling 
hospitals of Paris, to send a large part of the infants to the 
country to be cared for, and their frequent deaths swell the 
rates of infant mortality in these districts, while that of the 
city is thereby diminished. Nevertheless, even these have a 
better chance of life in the country than they would have in 
Paris. 
In 1863 the public administration of charities in Paris had 
charge of 22,829 infants; 17,759 of these were sent into the 
country, and there 1,359, or 7.65 per cent., died; 4,397 were 
retained in the city, and there 469, or 10.6 per cent., died. 
Dr. Berg, the chief of the Royal Statistical Bureau of 
Sweden, says : "The difference between the towns, especially 
the large towns, and the rural districts has an important 
effect on the mortality of children of that country.” 
Dr. Herz makes the same report of Austria. And the 
records of mortality of other European nations give similar 
accounts.* 
"In the least unhealthy rural districts of England, the 
death-rates of children, in their first year, are not more than 
one in twelve or fourteen. In the least unhealthy urban dis- 
tricts, there dies one in eight or nine, in the first year. In 
Manchester, one in five dies, under one, and one-half of all 
that are born there are dead, soon after their fifth year. But 
in Berlin, Prussia, one out of every three dies within the first 
year, and half of all that are born there, are dead within two 
and a half years after their birth. In 1871, 31,262 children 
were born, and 10,072, or 32.2 per cent., died within that 
year.” f 
* Journal Statist. Society, London, March, 1866. 
t Edwin Chadwick, in Journal of Society of Arts, London, Dec. 20, 1872, p. 87. 1873.] 
STATE BOARD OF HEALTH. 
35 
In Massachusetts these facts were as in the following table, 
during the ten years, 1861-1870 :— 
Births. 
Deaths— 
under one. 
Ratio of deaths under 
one, to births. 
Boston, 
60,354 
11,537 
19.11 per cent. 
Thirteen other cities, .... 
80,088 
13,863 
17.30 “ 
Rest of State, ..... 
198,030 
24,547 
12.39 
The rate of infant mortality, in comparison with the births, 
in the thirteen smaller cities, exceeded that of the open country 
by 39.60 per cent., and that in Boston had an excess of 54.23 
per cent. Among the same number of children, born in each 
of these classes of places, as often as 1,000 died in the coun- 
try, 1,396 died in the smaller cities, and 1,542 in Boston, 
under one year. 
There are differences in the same city. In four of the dis- 
tricts of London, the deaths under five were from 50 to 59 ; 
and in four other districts, these rates were from 101 to 108 
in 1,000 living, of the same age. Between these extremes, 
there were all intermediate grades of mortality in other dis- 
tricts. This is due in part to the different densities of the 
population, and in greater degree, to the difference in their 
domestic condition. 
Similar differences were found in Boston in 1870, the year 
of the census. The State Board of Health divided the city 
into twenty-four districts, according to their sanitary condition. 
Some of these were low and wet, others were hilly and dry. 
Some were laid out with wide streets, open grounds, broad 
sidewalks, and were inhabited by the wealthy and comfortable 
classes. Others were filled with narrow streets, lanes and 
courts, and in these were crowded the dwellings and families 
of the poor. In the most favored districts, the deaths of in- 
fants under one, were 86, 100, 167 and 171 in 1,000 living 
at that age. In the unhealthy districts the mortality was 
359, 379, 409 and 486 in the same number of living infants.* 
* Report State Board of Health of Massachusetts, 1871, p. 350. 36 
STATE BOARD OF HEALTH. 
[Jan. 
In the most unhealthy districts are the abodes of the 
poor. Their hard and exhausting labors, their domestic and 
personal privations, make all external aids of health more 
necessary to them than to others. But their necessities com- 
pel them to live in small tenements, with one, two or three 
rooms for a family. Dirt, filth, offal constantly gather in their 
narrow and undrained streets, lanes, alleys and courts, and in 
their yards, if they be so fortunate as to have them. The 
public authorities and their agents the scavengers and sweepers, 
feel little motive to cleanse the places that so soon become 
foul again, and often, with all their faithfulness and energy, 
find it impossible to keep the pavement in satisfactory condi- 
tion. The air without is befouled with the emanations from 
the ground. And the air within the dwellings is corrupted 
with the exhalations from the persons of the family and their 
necessary processes of labor. 
There is but little chance for the children or adults to de- 
carbonize their blood with fresh air within, and not much in- 
ducement to look for it abroad. The broad streets, where 
pure breezes blow, the wide sidewalks, where children can 
play, the parks, commons, squares, that are kept open for the 
health of the city, are not in their neighborhood, nor within 
their physical or moral reach, nor are they for such as these 
who need them most. 
Here the family of all ages, and the infants more than the 
others, have a hard struggle for life, but find no fulness 
thereof; for " impure air resulting from overcrowding, im- 
perfect ventilation and decaying refuse of every kind, is by 
far the most fatal and widespread of the morbific agents to 
which the young are exposed; and this is the most potent 
among the physical causes of disease.” "Moreover, the en- 
feebled state of the system, induced by the deteriorating 
effects of vitiated air, is most unfavorable in rendering chil- 
dren unable to withstand the force of epidemic and contagious 
diseases, to which they are so liable,” * and which have their 
favorite haunts in the crowded districts of cities and among 
the poor. Hence their high rate of infant mortality. 
* Dr. Fraser, in Social Science Trans. 1860, p. 650. 1873.] 
STATE BOARD OF HEALTH. 
37 
Effect of Civilization. 
One of the most happy consequences or evidences of the 
advance of civilization is the improvement in human health. 
The rate of mortality is diminished in every successive age of 
the civilized world, and especially in infancy and childhood. 
More infants now survive to the full development of maturity 
than in the previous centuries. The period of vigor is pro- 
tracted, old age is deferred, death comes later and the average 
longevity is increased. 
The records of Geneva in Switzerland are the most full 
and satisfactory for the earlier periods of the world. 
The deaths in 10,000 born were,—* 
PERIOD. 
Under 1. 
Under 5. 
Sixteenth century, 
2,592 
4,435 
Seventeenth century, 
. 2,372 
4,100 
Eighteenth century, 
2,012 
3,316 
1814 to 1833, . . 
1,385 
2,440 
In the first period, one-half died before they completed 
their ninth year. In the last, one-half survived their forty- 
fifth year. 
Dr. Farr, in Macculloch’s Statistical Account of the British 
Empire, II., 543, says, that the proportion of children raised, 
has doubled within a hundred years. In London, the pro- 
portion of deaths under five were,— 
1730 to 1749, ...... 74.5 per cent. 
1770 to 1789, 51.5 “ 
1851 to 1870, 29.8 “ 
"So great was the rate of infant mortality in London, that 
an Act of Parliament was passed in 1767, ordering that all 
parish infants should be nursed six years in the country. 
* Mallet in Ann. Hyg., XVII., p. 98. 
5* 38 
STATE BOARD OF HEALTH. 
[Jan. 
Before this, almost all parish children died in their first six 
years.” * 
According to the Life-Tables, 32 per cent, of all that were 
born in the ten years, 1728 to 1737, died under one. One 
hundred years later, only 12.5 per cent, died at this tender 
age.f 
The diseases—especially the epidemic and contagious 
diseases—were formerly more prevalent and virulent among 
children in the earlier ages than at the present time. 
In London, from 1675 to 1732, convulsions, mainly a 
disease of childhood, caused 23.91 per cent, of all the deaths.} 
From 1862 to 1870, only 3.3 per cent, of the whole died from 
this disease, and in Massachusetts, only 1.8 per cent, since 
1843* 
In the ruder and less intelligent society that existed one 
and two hundred years ago, the morbific influences that wasted 
the lives of children were more prevalent and effective than 
in the later times. Civilization includes among its manifold 
blessings, the increase of human life ; all ages enjoy its benefits, 
but none so much as infancy and childhood. 
The growth of intelligence, the increase of wealth, with 
ameliorations in the personal and domestic condition of the 
people, the improvements in the comforts of home, in 
dwellings, in clothing and food, the purification of morals, 
the softening of manners, the higher conscientiousness and 
broader and warmer charity,—all are blessings in themselves, 
and still more in their effects on the human organization. 
Each one and all these elements of civilization, in as far as it 
pervades and influences society, families and persons, con- 
tributes its due proportion to the development of the 
constitution, and enables it to ward off the attacks of disease, 
or to resist its destructive power when it comes. 
On the contrary, wherever any of these elements are want- 
ing, wherever ignorance, poverty, privation, negligence or 
exposure exists, its effect, according to its degree, is felt by 
the exceedingly sensitive constitution of early life. 
Civilization, which in itself is an unqualified good to both 
manhood and childhood, is yet not unaccompanied with evil. 
* Price Annuities, II., 32. + Price Annuities, II., 45, 297. 
I Corbyn Morris. Past and Present Growth of London. 1873.] 
STATE BOARD OF HEALTH. 
39 
More plentiful means of life bring temptations and opportuni- 
ties for indulgence in food and clothing that maybe injurious. 
Fashion, which is not founded on wisdom as its permanent 
rule, sets at naught sanitary principles when they stand in its 
way. It often clothes children in a manner rather to please 
the external eye, than to protect them from the elements and 
give the tender body that genial warmth that it needs. Some- 
times the child is buried in clothes and heated beyond 
measure. Sometimes one part is overloaded, while another is 
naked. The head is sometimes oppressively wrapped in 
cape or hood, while the arms or legs or parts of them are 
exposed to the full power of the cool atmosphere. 
The Child Needs the Mother’s Care. 
A child is the most precious gift offered to mankind, and 
brings with it the most sacred and exacting responsibility. 
To develop its constitution and protect it from morbific influ- 
ences, require special knowledge of its nature, wants and dan- 
gers, and unremitting care and faithfulness in its management. 
Nothing is accomplished without the best intelligence and 
preparation for the purpose. Youth is the time to prepare 
for the burden of life. Men, regarding this law, seek their 
way, through pupilage, study, observation, apprenticeship 
and labor to their field of service in agriculture, mechanics, 
trade or other pursuits; and when sufficiently trained and 
educated, they are allowed and encouraged by the world, to 
become responsible managers and operators in their respect- 
ive occupations. Then they succeed, in proportion to the 
intelligence and devotion they bring to their work, and the 
skill which they apply to the business they undertake. 
From the beginning, the law was established that people 
should marry, and that children should follow marriage. 
Whatever may be said of the sphere of woman, this precious 
charge of new-born humanity has ever been entrusted to her. 
She has ever claimed or accepted this trust. Her physical 
and moral organization, her possession of the natural nutri- 
ment, her tender affection, her inimitable tact and facility of 
adaptation, give her alone the power to fulfil this responsibility; 
and more than all others is the mother fitted for this duty. 40 
STATE BOARD OF HEALTH. 
[Jan. 
Intelligent Mothers. 
Yet even the mother requires something more than her 
natural capacities, her loving instincts and her ready sym- 
pathies. It is necessary that she be acquainted with the 
infant nature—its wants and liabilities. But ordinarily she 
comes to her first motherhood, without preparation, without 
knowledge of what needs to be done and how she shall do it. 
With all her good-will and conscientiousness, numerous mis- 
takes are made, the child suffers from errors in diet, clothing, 
from exposure, from too much or too little nursing. Disease 
may attack the infant, whose feeble constitution is unable to 
resist it, and sinks beneath its destructive force. 
The records of infant mortality offer a melancholy illustra- 
tion of the necessity of the mother’s previous preparation for 
the care of her children. The first-born die in infancy in much 
larger proportion than their successors in the family. The 
mother learns at the cost of the first child, and is better pre- 
pared for the care of the second, and still better for the third 
and fourth, whose chances for development into the fulness of 
strength and life, are greater than those of the oldest brothers 
or sisters. 
Children’s Nurses. 
When the strength or time of the natural family is insuffi- 
cient for all its diverse operations, and strangers are called 
to aid in various ways, they are selected on very different 
principles. Before the dress-maker is employed, assurance 
must be given that she has so learned her art, that by no 
error in judgment or of hand, the garments and outward 
adornments will fail to lit the frame or meet the unrelenting 
law of taste. 
But no such caution is manifested in the employment of a 
nurse for the little children. The same measure of skill in 
her occupation is not required. She is not expected to under- 
stand the infant’s constitution, or to be familiar with its wants, 
weaknesses and dangers. Nor is the same assurance of dis- 
cretion and faithfulness demanded of her as of the maker and 
fitter of garments, before she is allowed to begin her work. 
It is not surprising, then, that she sometimes errs in judg- 1873.] 
STATE BOARD OF HEALTH. 
41 
ment, in respect to the food of the child at home or elsewhere, 
or to the clothing, the protection from or exposure to the cold 
or the heat abroad, or that she he occasionally careless or 
even wilfully negligent. As a necessary consequence, the 
child’s health suflers in proportion to the ignorance and un- 
faithfulness of its guardian, as the dresses would if the man- 
tua-makers were selected with no more evidence of fitness, 
or as the father’s business would, if his agents had no better 
preparation for their responsibility than the nurse. 
With all the perils that surround the frail organization of 
the infant, nothing short of the mother’s undivided interest 
and watchfulness can give it the best protection from danger 
and the best assurance of health and life. This is her highest 
responsibility; and its wise and faithful fulfilment insures the 
richest and most enduring reward. 
Civilization has more to do for Human Life. 
Civilization has done and is still doing much for human life, 
but it has not yet wrought its perfect work. There yet remain 
in the nation, in families and in persons, many of the causes 
of low vitality, and especially in infancy. There are yet 
poverty and ignorance, with their painful inability to develop 
the human constitution to its fullest power. There are yet 
crowded, uncleaned and unventilated districts of cities, with 
their withering influences on childhood. There are the igno- 
rant, the selfish, the sensual and the self-indulgent parents, 
to whom the care of infancy is a burden. But these, and 
many other obstacles to the progress of humanity are grad- 
ually diminishing, and with this improvement, infancy be- 
comes stronger and more able to resist the attacks of dis- 
ease, and fewer children sink by the way from birth to the 
fulness of maturity.