It is therefore entirely natural that the statistics of infant mortality are concerned more particularly with the of the stomach and bawds. We must not fail to consider the objection often raised to statis tical tables of deaths from diseases of the alimentary canal, that the data are untrustworthy. Apart from the fact that many infants die without medical attendance, and so without a professional determination of the cause, even the calling in of a physician affords, in many cases, no guarantee that, in case of death, a correct diagnosis will be given.
The importance of such defects in the data is clearly shown by a com pilation by Wilrzburger, published by Schlossmann. According to this, out of 8600 children under one year old. who died during the years 1891 1896, the cause of death was certified by a physician in only 4245 cases, or 493 per cent. According to von Mayr, it may be seen from the gen era] report on sanitary administration in Bavaria that, in the very places where the death rate among children is the highest the percentage of medical attendance is the least. In the year 1893, for example, in 10 districts with an infant mortality of from 40 to 60 per cent. only from one to eleven per cent. of the children received medical attendance. In the district with the highest mortality, 46' per cent., only one and one-tenth per cent. of the cases were attended by physicians. The value of the data is materially impaired by this fact.
A mortality curve essentially the same as that of the Hamburg statistics may be obtained wherever artificial nourishment of infants predominates, and even where many are nursed at the breast. This holds good especially when breast-fed babies are given other forms of nourish meat.
Researches into the influence of nutrition on infant mortality are very numerous. Boeckh has analyzed the Berlin statistics along these lines with the greatest care. Not only has he inquired into the nutri tion of every deceased infant, but he has also caused the various methods of nutrition of living infants to be ascertained at each census. The sur vivors for each month, as given in the Table of Mortality, have been classified according to the data. of nutrition in the census. In the same wav the deaths at each age have been classified according to the statis tics of mortality. Westergaard considers that only still-born infants
and those dying on the clay of their birth should be disregarded. For the years 1S95-1S96, so far as the two chief means of nutrition are con cerned (milk from the breast and milk from animals), the following figures are obtained. Of 10,000 children there died in each month: The mortality of children nursing at the breast is thus consid erably lower than is the mortality of those fed artificially. The follow ing table compiled by Westergaard is also instructive. It shows the predominant influence of the mortality from digestive diseases where children are fed on animal milk, and particularly when they are fed on substitutes, whether these are used in combination with milk or not.
Among the further details of Boeckh's researches, the determination of the influence of the method of nutrition in the case of legitimate and illegitimate children deserves especial attention, as will be seen by referring to Table 7.
The influence of illegitimate birth upon the well-being of infants and children has been made the subject of numerous statistical inquiries, and always with the result that the illegitimate are found to die in greater numbers. In extending such statistics over a protracted period, we must bear in mind that a considerable part of the children born out of wedlock arc eventually legitimized. According to Wiirzburger, dur ing the years from 1S94 to 1S9S barely a third of all illegitimates in Dresden attained their sixth year without being legitimized by the mar riage of their parents. Boeckh, in order to eliminate this source of error, carefully scrutinized the mortality records at Berlin, and obtained the following results for the year 1SS5: The mortality of illegitimates is at first strikingly greater than is that of legitimates, but it decreases constantly until illegitimates from 4 to 5 years old show a power of resistance nearly equal to that of legiti mate children of the same age.
The figures given for foundlings are even more unfavorable. Their first-year mortality, particularly with artificial nutrition, amounts to 663- per cent. These conditions, however, have greatly altered. Found ling asylums have in most cases materially improved, and the mor tality has consequently greatly diminished.