strating an increasing success in bringing children through the most critical stages of life and in lessening the necessary waste. The thousands who die are not the victims of the law of natural selection. It is not largely an elimination of the unfit. More definitely than ever before is it being established that most children enter life with an endowment of native vitality sufficient to weather the ordinary conditions of adversity. The great variations in death rates after the first few months are due largely to postnatal influences, to the social and economic environment in which the child is caught, from which it has no appeal, and which make or mar its future.
The wide range of infant mortality from the lowest rates of the healthful country districts to the fearful massacre of infants in the crowded and unsanitary portions of our larger cities indicates the magnitude of the task still before us. That eminent authority on vital statistics—Dr. Farr—estimated that the annual unnecessary deaths of infants in England during the decade 1851-60 numbered more than 64,000. The conditions in respect to food, water, cleanliness, malnutrition and midwifery, he regarded as the chief causes of this needless loss of life. The proportion of loss suffered from these sources has since undoubtedly diminished, but the aggregate number is greater now than then. The effect of the various factors which influence the rate of our annual loss of children is marked in the difference between our urban and rural rates, and between those of white and colored children. The comparative healthfulness of rural life is attested to by ample evidence. It is indicated not only by the farmer's long expectation of life, but also by the low death rate prevailing among his children. A comparison of the chances of the child in the country and in the city is a proof of the wholesome influence of a favorable environment. It suggests the need of increasing effort to raise the city to the high level of rural vitality. In the registration states the infant mortality for white children varied in 1900 from an average of 116 per 1,000 births in the rural districts to 180 in the cities. The urban rate seems to be more than 50 per cent, higher than that observed among the country population. For every two infants dying in the country, three are sacrificed in the city districts. Yet this is not everywhere the case, nor is it necessarily so. In parts of Germany the rural death rate is enormous. Especially is this true in the agricultural districts of southern Bavaria, where an almost hopeless infant mortality is recorded. The rural region of Prussia shows higher rates than do our American cities, but they still possess a slight advantage over Prussian urban centers. This heavy mortality indicates a social lethargy and backward conditions among the agricultural population, which in spite of many natural sanitary advantages remains handicapped by unfavorable social and industrial surroundings; and these preclude proper attention to the wants of children. In England,
