SIX GROUPS The first of these includes the deaths due to prematurity, congenital defects and debility, and to accidents at birth. They are responsible for about 25 per cent. of the deaths. These are largely due to parental influences, to diseases of the parents, such as syphilis and gonorrhea, alcoholism, overwork of the mother during the latter portion of the pregnancy, edampsia, pelvic deformities and the maladministration of incompetent mid-wives. Many of these are associated with the death of the mother. While the majority of the deaths in this group are not directly due to preventable causes, yet a considerable por tion must be regarded as due to causes which are indirectly preventable.
The second group comprises the nutritional disturbances and the acute gastro-intestinal diseases. These are responsible for about 35 per cent. of the mortality. These must be regarded as primarily due to bad feeding. This fact is emphasized by finding that 85 per cent. of infantile deaths are among the bottle fed and further that 90 per cent. of the deaths from diarrheal diseases are among those fed from the bottle. Bad feeding of infants is largely a question of artificial feeding, so as a consequence we must regard all deaths in this group as preventable. Closely associated with bad feeding is the in fluence of hot summer temperatures, which not only exercises a directly injurious influence on the baby, but also on the keeping qualities of his food.
The third group includes the acute respiratory infections, bronchitis, bronchopneumonia and lobar pneumonia. These produce about 20 per cent. of the deaths. They largely arise as a result of overcrowding or bad ventilation.
The fourth group includes the acute infectious diseases. These at this age period are of lesser importance, causing only about 3 per cent. of the deaths. Whooping cough is the prin cipal member of this group as far as infants are concerned. Fifty-seven per cent. of the deaths from whooping cough occur during the first year and 23 per cent. during the second year. An infant is susceptible from birth to whooping cough. To ward many of the other acute infections an infant presents a considerable immunity which persists for several months.
Tuberculosis, chiefly meningeal in type, causes about 2 per cent. of the deaths. Infants should not come in contact with adults having open lesions of tuberculosis, nor be fed upon the milk of tuberculous cows.
Syphilis causes only about r per cent. of the deaths. It operates chiefly as a cause of prematurity and miscarriages.
Nearly everywhere infant mortality is greatest in the most unsanitary and crowded areas. As a consequence the extent of infant mortality is a good index of sanitary conditions.