AMERICAN STATISTICAL ASSOCIATION. NEW SERIES, No. 83 SEPTEMBER, 1908. A STATISTICAL STUDY OF INFANT MORTALITY. BY EDWARD BUNNELL PHELPS. Considerably more than a generation ago (in 1865), Dr. Farr brought the subject of Infant Mortality before the [Royal] Statistical Society, and frequently discussed it in his historic contributions to the annual reports of the Registrar-General's office. On December 19, 1893, Dr. Hugh R. Jones read before the Royal Statistical Society an exhaustive paper on "The Perils and Protection of Infant Life," which had the distinction of being the Howard Medal Prize Essay of that year. In the interim of more than forty years since Dr. Farr inaugurated the statistical discussion, so to speak, infant mortality has been a prolific subject in medical works and journals, has received perennial treatment in the reports of practically all bureaus of vital statistics, and the bibliography of the subject even up to ten years ago would constitute quite an impressive library, were all the papers on, and extended references to, this particular phase of human mortality assembled and properly indexed. In a general way, however, it may be said that only within the last few years has the topic been presented in such a light as to attract serious attention at the hands of the public at large, the discussion up to the end of the nineteenth century having practically been restricted to medical men, government officials, and professional statisticians. To be sure, as early as 1876 a Society for Nursing Mothers was established in France, and pro vision thus made on a small scale for caring for destitute mothers immediately before and after childbirth. The Crèches of France and the Krippen of Germany, or day nurseries, in part supported by private charity and in part by State or municipal aid, long since became well-known institutions. For many years both Germany and Switzerland have had laws prohibiting women from working in factories for certain periods before and after confinement, and providing for their partial support during those periods of compulsory idleness; and Section 61 of the Factory and Workshop Act (of 1901) of Great Britain enjoins factory employers from knowingly allowing women to work in their factories within four weeks of childbirth. Furthermore, some fifteen years ago Nathan Straus began the establishment of his milk depots in New York City with a view to supplying pasteurized milk at nominal price for children's use, and since then the plan introduced by Mr. Straus has been copied in various quarters. But all of these institutions of nineteenth-century origin were the outcomes of individual realization of the growing importance of the problem of infant mortality, rather than of a public appreciation of its far-reaching bearing on the future of the race, and their establishment in no way controverts the previous statement that practically only since the dawn of the twentieth century has the subject been so brought forward as to attract serious attention at the hands of the thinking public. The fact that such an era has now arrived is due to a variety of causes. In the first place, even the most pronounced cynic, if he be a well-informed and reasoning person, must admit that the community at large has begun to take more interest than ever before in "how the other half lives." So obvious and indisputable a truth calls for no demonstration, and the growing interest in "how the other half dies" is an inevitable corollary of the ascending interest in how the unfortunate or less fortunate section of the community lives. Perhaps this general development of the humanitarian instinct is primarily responsible for the civilized world's awakening to the appalling conditions of infant mortality. Men are beginning to realize that the caste lines once so rigidly drawn between the various classes are, like most national boundaries in one sense at least, purely imaginary lines, and that the health and welfare of any one section of the community directly concern the health and welfare of the community at large. As Dr. Margaret Alden so well puts it in her very recent work on "Child Life and Labour," in the chapter on infant mortality (p. 16): "A thorough understanding of the subject should be the concern of every true citizen for three reasons: 1. Because such a wastage of human life is a loss of the nation's best capital. 2. Because the conditions which make for the death of infants, make also for disease. 3. Because this question appeals to us on humanitarian grounds." By way of secondary, indirect, cause for the general dawning interest in the subject, probably the material advance in medical knowledge and in established principles of hygiene and sanitation has played the most important part. As an immediate result of this advance has come the gradual decrease in the general death-rate of recent years in practically all civilized countries, but as Dr. George Reid, Medical Officer to the Staffordshire County Council, points out in his contribution to the cyclopedic work on "Dangerous Trades" in the paper on "Infantile Mortality and Factory Labour" (pp. 84-85): “Although a steady decline has taken place in the general mortality of the country coincident with, and, no doubt, in the main, consequent upon sanitary progress, it cannot be said that the infant mortality has diminished in like proportion." That fact has been so generally noted, and so repeatedly emphasized, by both physicians and statisticians, that it could scarcely have failed to make at least some impression on the public mind. And now that it has been so graphically stated, as, for instance, in H. Llewellyn Heath's recent book on "The Infant, the Parent, and the State," small wonder is it that thoughtful people of all classes are beginning to realize that it is high time some united action were taken with a view to devising remedies for so anomalous a situation. Mr. Heath's indirect indictment of the previous apathy on the subject, on the first page of his book, is put in this blunt way: "In the year 1904, England lost 137,392 of her children before they had reached the short span of twelve months of life. The deaths of these infants constituted 25 per cent. of all the deaths in England and Wales during the year we are considering. Geneva has kept registers of births, marriages, and deaths since 1549. In the sixteenth century their infant deaths constituted 25.9 per cent. of their total deaths at all ages." In other words, as Mr. Heath thus makes clear, despite all the hygienic and sanitary progress of modern times, and despite the marked decline in the general death-rate, the ratio of infant mortality to total mortality remains practically the same in England and Wales to-day as it was in Geneva nearly three hundred and fifty years ago; and, it might be added, present conditions in the United States are only slightly better, the ratio of infant deaths to deaths at all ages in the registration States of this country in the last census year, as is shown in one of the tables accompanying this paper, having been no less than 20.06 per cent. as compared with Geneva's percentage of 25.9 more than three centuries ago. The general tendencies in the direction of an increased public interest in the subject of infant mortality, above briefly outlined, of course have been materially supplemented and intelligently directed by the more or less frequent contributions to the discussion of Dr. Farr, Dr. Bertillon, Dr. Newsholme, Sir John Simon, Dr. Greenhow, Dr. Reid, Dr. Newman, and other statisticians and physicians; and so it happens that in the last three years no less than five congresses have been held in various European countries with a view to grappling seriously with the problems of infant mortality. The first of the five in question was an International Congress on the Functions of Infants' Milk Depots, which was held in Paris in October, 1905. The mayor of Huddersfield, the chairman of the Health Committee of Glasgow, and various other representatives from Great Britain attended the congress, and as the immediate result of their attendance a National Conference on Infantile Mortality was held at Westminster, on June 13-14, 1906. A complete steno graphic report of the proceedings of that conference has been published (London, 1906), and the demand for copies from all parts of the world was so unexpectedly large that the first edition of 3,000 copies was speedily exhausted, and a second edition made necessary. In the preface to the second edition the Executive Committee thus summarizes the former apathy and the present general interest in infant mortality above alluded to: "The Conference of 1906 was the first attempt to bring before the public one of the most important of the many aspects of the social problem of physical and social degeneration. Prior to the Conference the problem of the appalling death-rate of infants under one year attracted only the attention of medical men—and merely a small proportion of that profession-and of a few philanthropists and social reformers, and the Executive Committee, who organized the Conference of 1906, hardly ventured to hope that their efforts would result in one of the most successful conferences, from a public health and social reform point of view, which has been held in this country." The conference was held in the rooms of the Westminster City Council, under the patronage of their Majesties King Edward VII. and Queen , Alexandra. The Right Hon. John Burns, M.P., president of the Local Government Board, presided; and the chairman and vicechairman, respectively, were Alderman Evan Spicer, M.P., chairman of the London County Council, and the Hon. Lord Provost of Glasgow, William Bilsland, Esq. The Lord Mayors of Liverpool, Manchester, Leeds, York, and Belfast, the Lord Provosts of Glasgow, Edinburgh, and Aberdeen, various other governmental officials, and some of the foremost medical officials of Great Britain served as vice-presidents of the conference, and the enlistment of these notables gave a decided impetus to the new movement. A second National Conference on Infantile Mortality, with an even more distinguished list of vice-presidents and delegates, was held at Westminster, March 23, 24, 25, 1908, and, largely as a result of the previous conference, the Notification of Births Act of 1907 was adopted by Parliament. A complete report of the proceedings and |