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DIAGRAM I.-A GRAPHIC COMPARISON OF THE ANNUAL FLUCTUATIONS IN THE INFANT MORTALITY RATES OF ENGLAND AND WALES, PRUSSIA, FRANCE, AND THE STATE OF MASSACHUSETTS, FOR THE TWENTY-FIVE YEARS, 1881-1905, INCLUSIVE, ON THE BASIS OF DEATHS UNDER 1 YEAR PER 1,000 BIRTHS, STILL-BIRTHS EXCLUDED.

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For many years the annual reports of the Registrar-General have presented the most compact abstracts anywhere obtainable of the birth-rates, marriage-rates, death-rates, and deathrates under 1 year to each 1,000 children born, in practically all the European countries-and certain countries in other sections of the world. Taking those tables in the current (sixtyninth) annual report as a basis, the writer has prepared the following tabulation, which affords a comprehensive picture of the infant mortality experience of the principal countries of Europe and Australasia for the last quarter of a century. The Registrar-General's report announces that in each case the figures were obtained from the statistical department of the country named, and that still-births have been eliminated in the case of both births and deaths, and in the preparation of the following tabulation the birth-rates and infantile deathrates for each five-year period named have been obtained by adding the rates for the 5 years and dividing the totals by 5. The general averages for the entire period under observation have been deduced by adding all the annual rates given in each case, and dividing the total by the number of years which each total represents. Had the actual numbers of births and deaths for each year for each country been available-as was the case with the restricted table of Dr. Eröss-instead of the birthrates and death-rates, the five-year and total averages of course would have been slightly more exact, but the death figures are not given in the Registrar-General's returns from other countries, and, doubtless, the margin of error is so narrow as to be practically inappreciable. So explained, the tabulation in question speaks for itself, and is as follows:

TABLE III.

BIRTH-RATES, AND DEATH-RATES UNDER AGE 1 PER 1,000 BIRTHS, OF THE PRINCIPAL FOREIGN COUNTRIES FOR THE LAST TWENTY-FIVE YEARS, BY FIVE-YEAR PERIODS AND FOR THE ENTIRE TWENTY-FIVE YEAR PERIOD STILL-BIRTHS EXCLUDED IN BOTH CASES.

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Europe.

Australasia

Other Lands

†Grand Averages

35.1

35.3 163 34.3 162 33.7 169 33.3 162 32.4 153 33.8 162 35.5 117 34.9 111 31.7 105 27.5 111 27.0 95 31.3 108 32.9 184 32.7 177 34.0 206 35.3 207 36.2 208 34.2 196 155 34.2 152 33.3 159 32.2 157 31.6 147 33.3 154

* Returns for one or more years wanting, and averages have been calculated on basis of returns for other years of period in question.

+ Computed by division of totals for all countries represented in table by number of countries in question.

Italicized figures represent estimates for periods for which no returns were available, estimate in each case being average of actual returns for balance of entire twenty-five year period.

So far as the writer is aware, the preceding table is the first detailed comparison ever compiled of the birth-rates and infantile death-rates of the leading countries of the world by fiveyear periods for an entire quarter of a century, and the continuity of comparisons sheds considerable light on many mooted questions which have been raised in the protracted discussion of infant mortality. Unfortunately, in a few cases returns were wanting, and in order to round out the averages for the periods and countries in question it was necessary to substitute estimates for actual returns. As stated in the appended foot-note, however, all estimates for five-year periods were based on the averages of returns for the balance of the twenty-five year period, and the margin of error, therefore, is probably so slight as to make no material difference in the general showing.

The first and all-important point to be noted in the tabulation is the uniformity of the infantile death-rate for the world at large for the last quarter of a century, and its comparatively slight fluctuations by five-year periods in particular countries or sections of the world. Thus it will be noted, in the thirtyone widely remote countries for which returns are presented, in 1881-85 the rate of infant deaths per 1,000 births was 155, and in the period commencing twenty years later was practically identical, then standing at 154. As is shown by a subsequent table herein presented, the apparent infantile death-rate in this country in the States recognized as registration States at the time of the Twelfth Census was 144.7 in 1900 and 162.6 in 1890, thus averaging 153.7; and, as is demonstrated by another table showing the annual infant mortality rates in Massachusetts from 1856 to 1905, the average infant deathrate under age 1 per 1,000 living births in that Commonwealth for the last fifty years has been 152.4. Succinctly stated, the infantile death-rates for these various sections and periods were as follows:

TABLE IV.

THE UNIFORMITY OF THE INFANTILE DEATH-RATE IN ALL SECTIONS OF THE WORLD IN RECENT YEARS.

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In view of the many material changes in the living habits and industrial conditions of the world's population in the last generation, the great advance in medical knowledge, and the marked decrease in the general death-rate, the practical uniformity of the infantile death-rate the world around is simply astounding. On the face of the above showing it apparently has a regularity in keeping with that of the American Experience Table of mortality; and, bearing in mind the point noted in H. Llewellyn Heath's book,—namely, that in the sixteenth century the infant deaths constituted 25.9 per cent. of all the deaths at Geneva and in 1904 were 25 per cent. of all the deaths in England and Wales,-there is an almost weird suggestion of the pitiless inflexibility of Fate in the death-rate of infants. Of course there are wide variations in the infant death-rates of individual communities, but, as the tables herewith presented will show, the fluctuations in long-established and stable communities would seem to be comparatively slight, and, as has apparently been demonstrated by the preceding tables, when a really broad average has been attained the change in the infantile death-rate of the world at large in a long stretch of years apparently is almost infinitesimal.

In most, if not all, countries-and certainly in nearly all the States of the United States-there are more or less serious defects in the registration of vital statistics, especially in the recording of births. That subject has been so thoroughly

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