A strikingly rapid decrease in the rate is noted up to the age of ten years, the last United States census showing a drop from 165'4 in the first year to 46'6 in the second, and a more gradual decrease to 3'3 for the period between ten and fourteen years. After that a steady rise begins, gradually increasing also in rapidity to 75'2 between seventy and seventy-four years, r ro'5 between seventy-five and seventy-nine years, and 165'8 (just about equalling the infantile rate) between eighty and eight3'-four years. For the next three periods of five years each we find the rates of 241'3, 339'2, and 418'9 respectively. Another method of depicting the relation of age to mortality is by estimating the " expectation of life " at various ages ; that is, the average of the length of time a man at that age has yet to live. Corresponding with the death-rate, the expectation of life increases up to five years, at which time, as computed by Dr. Ogle's English Life Tables, it is 5o'87 years for a man, and 53'o8 for a woman. Thence it decreases, being at the age of fifty years 18'93 for man, and for woman, at seventy-five years 634 for man, and 6'87 for woman, and at one hundred years r'61 for man, and 1'62 for woman.
There is no doubt that marriage has an influence on mortality, but in order to ascertain that influence, it is necessary to compare the death-rate of those married with the death-rate of those single at the same age. By so doing we find that the death-rate at all ages is less among married men than among single men ; and for women the same holds true, with the exception of the period devoted to child-bearing, when it is slightly greater.
Accidental deaths, although furnishing but a small proportion of the total number, afford some interesting variations, due chiefly to the industrial character of the region considered. Mining and shipping industries furnish a large proportion of fatal accidents, and mountainous localities like Switzer land make up with fatal falls their lack of facilities for drowning. Sex and age also control the kind of accident. In England the accidents common to children under five are, in order of their frequency : suffocation, burns, scalds, and explosions. As the age increases, accidents by drowning conk to the front and remain pretty prominent all through life, although in middle life accidents in travelling and in working about mines and machinery take a foremost place. As accidents from other causes remain fairly constant throughout the year, the large number of drowning accidents in the summer months makes the total number of accidental deaths reach its maximum at that time of the year. Every summer holiday contributes its contingent, and a glance at any Monday morning paper during this season will convince the reader that statistics must be materially affected by the fatalities attending boating and bathing.
Two causes which really affect the mortality-rate but slightly, never theless claim a special interest by reason of the ethical element involved. These are suicide and homicide. The rate for the first, although varying largely in different localities, remains surprisingly constant from year to year. The largest numbers of suicides occur in Paris and in the kingdom of Saxony, the latter place being a sort of " suicide centre," in radiation from which the rate grows lower. A very interesting study might be made of the relation of age, sex, race, religion, conjugal condition, and industrial position to the occurrence of suicide, but only the most general statements can be given space in an article of this nature. It is believed that people of Germanic race have a greater tendency to suicide than others, although this may be modified by other influences. The Jews invariably show a pro nounced aversion to suicide. The figures available give Ireland the lowest suicide-rate, while the United States compares favourably with most other countries. Climate shows no constant effect ; but marked changes of
temperature, such as occur in the opening weeks of the hot weather, tend to increase the number of suicides. Bad times, wars, famines, etc., as might be expected, have the same effect. More men than women commit suicide, and the number increases with age. The proportion is also greater among the unmarried than among the married. In the United States almost one-half of the suicides are by poison, with hanging as second choice.
Homicide has a still smaller effect upon statistics, and involves even greater difficulty in anything like comparative estimates. Consequently, any information on that point must be sought in special studies of criminology.
To take up the question of death by disease, and attempt to classify the statistics, constitutes a colossal task. Only approximately correct results can be hoped for, owing to variations in diagnosis, methods of classification, and care in the collection of facts. Comparison of different countries is necessarily unfair, owing to the impossibility of uniform methods in arriving at figures, as well as to the wide variation in natural conditions. Vet certain broad general statements may be gathered from the mass of statistics. In the records alike of European countries and of the United States, tuberculosis is far in the lead as a cause of death, its closest second in America being pneumonia, with a record of about nine-tenths as many deaths as are claimed by the great white plague. In Italy its greatest rival is typhoid fever, and in Prussia diphtheria ; but each of these kills only a little more than half as many as does tuberculosis. In the United States the most fatal diseases after tuberculosis and pneumonia are, in order of mortality : Diseases of the heart, typhoid fever, Bright's disease, cancer, apoplexy, cholera infantum, paralysis, bronchitis, enteritis, meningitis, debility, influenza, diphtheria, convulsions, malarial fever, premature birth, measles, croup, dysentery, inanition, dropsy, and brain-diseases of various kinds. Old age can scarcely be termed a disease, hut the number of deaths due to senility would place it after cancer and before apoplexy. " Heart-disease," which may include a number of specific maladies in its general term, causes not much more than half as many deaths as pneumonia alone. It is pneumonia which furnishes the maximum death-rate in 1\larch. Diseases of the digestive system, on the other hand, are especially fatal during the hot weather, and typhoid fever is at its worst in autumn. All are familiar with the fact that age largely governs the occurrence of certain diseases. The so-called " childhood diseases " (chicken-pox, whooping-cough, measles, mumps, and scarlet fever) seldom attack adults ; whereas, on the other hand, certain diseases are prac tically unknown in children—as, for instance, cancer. Sex, also, has a bearing on the comparative mortality of diseases, that among males being greater for consumption, smallpox, measles, scarlet fever, diarrhcea, and diseases of the nervous system and of the respiratory organs ; and that of females being greater in diphtheria, whooping-cough, and cancer. In 1904 the death-rate from consumption was 178'1 ; but, about ten years earlier, it had been 245'4, a fact full of encouragement, and imperative in its insistence upon a continuation of the intelligent struggle against this preventable disease. On the other hand, the death-rates from cancer and tumour show a decided rise in the years between 1890 and 1904 ; and investigators are engaged in a determined attempt to discover means of controlling it. For further particulars regarding the death-rate in various diseases, see table on page 673.