DEATHS UNDER TWO YEARS FROM DIARRHEA AND ENTERITIS PER 100,000 POPULATION In 1911, 45,868 children in the registration area died from these diseases, and the total mortality for the United States at the same rate must have been approximately 73,000, or four times the number of deaths from diphtheria and croup. About fourfifths of these deaths occur during the first year of life. The urban rate is much higher than the rural rate, and the industrial cities show a distinctively heavy mortality. In the decade 1900-1910, the rate throughout the registration area fluctuated but slightly, the year 1905 marking a high point. The year 1911, however, was noted for a much lower death rate - lower than any during the preceding decade. Many individual cities have successfully reduced their mortality from the intestinal diseases by insisting upon the proper preventive measures. Among cities having a population of more than 100,000, Fall River, Massachusetts, reported the highest rate in 1911, its mortality being 318.9 per 100,000 of population, or more than three times the average rate for the registration cities. Local social and industrial conditions are largely responsible for this fact. Likewise in Lowell and in other manufacturing cities the rates tend to remain stationary or to decline but slowly, because of the high proportion of ignorant, non-English speaking people. Here the city officials are less alert, and the instruction of mothers is a difficult problem. In some of the smaller towns also almost unbelievable rates still prevail. Several large cities have, however, in spite of the difficulties attending the work, succeeded in reducing the mortality from the diarrhoeal diseases. Greater New York City lost 4590 children under two years of age in 1911, and while the absolute number of deaths has remained almost stationary, the rate has decreased considerably since 1895, when a decided fall in the mortality from this source first took place. In spite of its size and congestion, New York City has made splendid progress, while Philadelphia, with ample room and many homes, has a much higher rate. So has Chicago, although vigorous attempts have been made to diminish the digestive diseases there. The lowest rates occur in the rural districts of the Northwest and the far West. direct The distribution of the diseases throughout the different months of the year is most significant, as in no other case does the death rate vary so heavily from season to season. The predominating influence of weather conditions as a cause or indirect of the violent fluctuations in rates is therefore at once apparent. The following table shows the proportion of deaths each month of the year, according to figures based on the mortality in the registration area of the United States during the year 1911. PROPORTION OF DEATHS FROM DIARRHEA AND ENTERITIS.1 (CHILDREN This table shows that during the winter and spring months the mortality is comparatively low, that it rises as summer approaches, reaches its highest point in August, and then gradually declines. The rate for August is six times that of the 1 United States Bureau of the Census, Mortality Statistics, 1911. winter months, and more than half of the deaths occur during the summer season. Particularly hot summers also cause an excessive death rate from these diseases; but as they are germ diseases, heat must be regarded as a contributory rather than a primary cause. Attention must, therefore, be given to the fundamental causes, so that the heat will not aggravate them. After the first month of life, the diarrhoeal diseases are the principal single cause of death for the remainder of the first year; in fact, during the second quarter of the year, over 40 per cent of the deaths are caused by these diseases. The rates, however, decline slowly month by month but remain comparatively high during the first half of the second year because of weaning and the subsequent use of cow's milk and milk substitutes. In many cities half of the deaths during the second quarter of the first year are due to diarrhoea and enteritis, — a fact due largely to a failure to institute the preventive measures which have been so successful in some localities. e. Diseases of Early Infancy. The diseases of early infancy have not received much attention from social workers until recently, since deaths from these causes have been considered inevitable. Malformations were responsible in 1911 for about 10,000 deaths in the United States. Probably very little can be done to reduce this mortality, although prenatal work might lessen the number of abnormalities. From the eugenic point of view the race would be strengthened by the elimination of this group. Premature birth and congenital debility are the principal diseases of early infancy, having caused 42,119 deaths in the registration area in 1911 and probably 66,000 throughout the United States. Two-thirds of the deaths during the first day of life are due to these two causes, which are also responsible for more than half of the mortality of the first month. Nearly all of the fatal premature birth cases die before the child is four weeks old, but many congenital debility cases linger beyond this time. However, nearly all the deaths occur before the end of the third month. The death rate in the United States from the entire group of diseases classed under the term "early infancy" shows but little change. There are slight fluctuations from year to year, but the mortality rate in 1911 was higher than during the years 1901-1905. It appears therefore that practically no progress has been made against the conditions responsible for this very heavy mortality. In England, where the death rate from these causes is higher than in the United States and is 40 per cent of the entire infant mortality, the rate is increasing — a fact which is a cause of great concern. The so-called, "wasting diseases," which include premature births, congenital defects, lack of breast milk, starvation, atrophy, debility, and marasmus, are a cause of half of the infant mortality. It seems that the rate is higher among the poor than among the wellto-do, and that it is lower in the country than in the cities. These differences indicate that social and industrial conditions affect the rates and that heredity is not the only factor. The prenatal condition of the mother is also an important consideration, and may outweigh all other factors. f. Meningitis and Convulsions. Another ailment responsible for many fatalities among children is meningitis, which destroys about as many children as does measles, although the death rate has fallen more than 50 per cent during the last decade. Physicians are seeking earnestly for some specific with which to cure the disease, for it cripples a large number of the children it attacks. More than 4000 children died in 1911 in the registration area from "convulsions." This term is used loosely in designating deaths that really result from some preceding cause, such as diarrhoea or injuries at birth, a severe case of which may cause convulsions. Then the victim dies, although the fatality would not have occurred but for the principal disease. g. Proportionate Mortality from Principal Diseases. Having completed this short summary of children's diseases, the following table showing the distribution of mortality among several groups of diseases is particularly significant. PROPORTIONATE MORTALITY FROM PRINCIPAL DISEASES IN THE REGISTRATION AREA OF THE UNITED STATES IN 19111 This table indicates that three groups of diseases are responsible for nearly three-fourths of the deaths of infants, and for over 60 per cent of the deaths of children under five. The first group causes nearly one-third of the infant mortality more than any other cause. How much is due to constitutional weakness of father and mother? How much to overwork and improper care of the prospective mother? How much to malnutrition? These are questions still unanswered. So enormous is the proportionate mortality from diseases of early infancy that a study of prenatal conditions is necessary to determine what particular environmental factors contribute to this result. The general failure to reduce these rates within the last decade indicates that new lines of attack are necessary, although the evidence that a large percentage is preventable is very strong. Consequently in the near future this will furnish a fertile field for the operations of the social workers, especially in view of the constantly declining birth rates. The next group diseases of the digestive system cause more than one-fourth of all deaths under one and an almost equal percentage of the mortality under five. Here we are dealing almost exclusively with post-natal conditions, and the great majority of all these deaths are preventable, for the causes are well known, and the eugenic consideration hardly 1 Computed from Report of the United States Bureau of the Census, Mortality Statistics, 1911. |