also Table XII on page 70, based upon the entire reproductive histories of the mothers included in this study. As all the children borne by these mothers are included, the base numbers in the latter table are larger and the figures therefore somewhat more significant. BABY'S AGE AT DEATH AND CAUSE (DISEASE) OF DEATH.

A baby who comes into the world has less chance to live one week than an old man of 90, and less chance to live a year than one of 80.-Bergeron.

The most dangerous time of life is early infancy; even old age seldom has greater risk. Death strikes most often in infancy. The Johnstown babies died during their first year of life at the rate of 134 per 1,000 born alive, and they paid their heaviest toll in their very earliest days. If the total of 196 deaths had been distributed evenly throughout the 12 months, 8.3 per cent of the babies would have died each month and 25 per cent during each quarter. But instead of that 37.8 per cent died in the first month; 9.2 per cent in the second, and 8.2 per cent in the third, or over 55 per cent in the first quarter.

TABLE 17.-NUMBER AND PER CENT DISTRIBUTION OF DEATHS OF BABIES, By Age AT DEATH.

The large number of deaths in the first few hours or days of life indicates that many babies are born with some handicap and that in many instances the mother has been subjected to some condition which resulted in the birth of a child incapable of withstanding the ordinary strain of life. Of the 45 babies who died in Johnstown less than a week after birth, 38 died of prematurity, congenital debility or malformations, or injuries received at birth. In one other case

the cause of death was given as "bowel trouble" and in six other cases it was not clearly defined. In addition to the 45 babies just referred to as having died in their first week, 12 died later either from prematurity or from congenital defects.

Of the deaths from causes arising after birth, 52 were attributed by the attending physicians to diarrhea and enteritis, 50 to respiratory diseases, and 44 to some other or to some ill-defined cause.

TABLE 18.-DISTRIBUTION OF DEATHS DURING FIRST YEAR AND INFANT MORTALITY RATE, ACCORDING TO CAUSE OF DEATH AND NATIVITY OF MOTHER.

The latest census report on mortality statistics characterizes diarrhea and enteritis as the "most important preventable cause of infant mortality" in the United States, and numerically at least it proves to be the most important cause of infant death in Johnstown.

Holt' says that one of the most striking facts about diarrheal diseases in infants is their prevalence during the summer season. In Johnstown the infant diarrheal deaths were least prevalent in the first quarter of the year, next in the second, next prevalent in the fourth, and most prevalent in the third or summer quarter.

Table 19.-DISTRIBUTION OF DEATHS, ACCORDING TO CAUSE OF DEATH AND QUARTER OF CALENDAR YEAR IN WHICH DEATH OCCURRED.

I The Diseases of Infancy and Childhood, by L. Emmett Holt. p. 345. New York, 1912.

Our figures are too small to admit of broad generalizations or a very full discussion of infant deaths according to the period of the

year.

This excess of infant deaths from diarrhea in the summer months has been established by statistics in many countries, and the cause of such an excess has been the subject of much discussion, but as yet there is no general agreement. Liefmann and Lindemann 1 conclude, however, that in this field of controversy there are certain facts which are at present well established, these being the dependence of the high summer mortality on methods of feeding, on hot weather, and on the living and social condition of the parents. The last factor mentioned by these authors, including as it does housing conditions, economic status, and degree of intelligence, is becoming more and more the subject of study and investigation. It has been shown that the distinctly harmful effect of hot weather on the infant is increased when the housing conditions are bad; in overcrowded homes with bad ventilation the indoor temperature may be many degrees higher than the outdoor temperature. The ignorance and carelessness of mothers has also been shown to increase the bad effect of hot weather. With hygienic care, including cool baths, much fresh air, and careful feeding, many infants are able to pass through extremely hot weather without diarrheal disturbances.

Respiratory diseases were reported as a cause of death with almost as great frequency as diarrheal diseases. As shown by Table 19, these deaths occurred principally in the colder months of the first and fourth quarters of the calendar year.

FEEDING.

2

Food is recognized as of such importance in relation to infant mortality that studies of this subject frequently resolve themselves into studies of feeding only. Invariably these demonstrate the truth of the statement of Dr. G. F. McCleary that "in human milk we have a unique and wonderful food for which the ingenuity of man may toil in vain to find a satisfactory substitute." Many mothers, however, still fail to appreciate the risk their young babies face in being given any except the natural infant food, and consequently babies are in large numbers wholly or partly weaned from the breast in the earliest months of their lives.

1 Liefmann, II., and Lindemann, H., Die Lokalization der Säuglingsterblichkeit und ihre Beziehungen zur Wohnungsfrage. Med. Klinik 1912, pp. 8, 1074.

2 Infantile Mortality and Infants' Milk Depots. London.

Breast feeding is far more general, comparatively, among the poorer mothers than among the well to do, as shown by the following summary which gives the number and per cent of babies of mothers with husbands earning varying incomes, who had been completely weaned from the breast when they were 3, 6, or 9 months of age, respectively. For each of the periods indicated the percentage completely weaned from the breast is much greater in the groups where earnings are highest.

TABLE 20.-DISTRIBUTION OF BABIES ALIVE At 3, 6, and 9 MONTHS OF AGE BY TYPE OF FEEDING AT EACH OF SAID AGES, ACCORDING TO ANNUAL EARNINGS OF FATHER AND NATIVITY OF MOTHER.

1 Includes those reported as earning "ample." "Ample," as used in this report has a somewhat technical meaning; when information concerning the father's earnings was not available and the family showed no evidences of poverty, the word "ample" was used. When, however, the family was clearly in a state of abject poverty, it was included in the group "Under $521."

2 Unmarried mothers' babies also included.

Breast feeding, wholly or in part, is continued for a longer period by foreign than by native mothers, as indicated in the preceding table, showing that 20.3, 26.1, and 34.1 per cent of the native mothers' babies as compared with 6.4, 9.7, and 18.6 per cent of the foreign mothers' babies had been weaned from the breast at the age of 3, 6, and 9 months, respectively.

Some additional details concerning the type of feeding of babies of native and foreign mothers are given in the next table.

TABLE 21.-NUMBER AND PER CENT OF BABIES Aged 3, 6, and 9 MONTHS WHO RECEIVED SPECIFIED TYPE OF FEEDING, ACCORDING TO NATIVITY OF Mother.

The following table shows that artificially fed babies die at a much more rapid rate than breast-fed babies. In the very earliest months exclusive breast feeding seems to be the only safe method. After four months the danger of giving some other food in addition to the breast milk does not seem to be so great.

TABLE 22.-DISTRIBUTION OF Babies Alive at End of EACH MONTH, FROM SECOND TO TENTH, INCLUSIVE, ACCORDING TO TYPE OF FEEDING DURING EACH MONTH SPECIFIED, NUMBER OF DEATHS DURING FIRST YEAR, AND RATE PER 1,000 ALIVE IN EACH GROUP.