again, the rural rate is generally below that of the cities and considerably below the infant mortality of the mining and industrial centers. Compared with Scotland, the entire country has a decided disadvantage. Yet the nature of the problem is somewhat simplified on reflection that the results of an earlier investigation of death rates disclosed the fact that the mortality of the sons of peers before the age of six was less than one third of that obtaining among the rest of the population. On the other hand, many English and American cities record rates lower than the average rate prevailing in the rural district—an eloquent argument for the possibilities of many of our cities. The, statistics of 1881-90 for Massachusetts showed average variations during the decade from 111 to 239 deaths per 1,000 births. The former rate marked the healthfulness of a residential town, the latter portrays the conditions existing in an industrial center. Yet in some of the manufacturing towns where no tenement-house evil existed the infantile death rate was comparatively low. Other American cities show variations equally wide, and even within the same city the most contrasting conditions continue to exist. The lowest rates for cities of considerable size are recorded for Seattle, St. Paul and Minneapolis. The prevailing rates are approximately 100 deaths per 1,000 births, according to their records, which some authorities have, ho.wever, pronounced as giving too favorable a showing. Many of the larger cities double the death rate for infants, while in numerous southern cities it rises to almost criminal proportions. John Spargo has pointed out the differences that may exist within a single city and exemplifies them by quoting a rate of 94.4 per 1,000 in the Back Bay district of Boston against a proportion of 252.1 for one of its poorer districts. Some of our own cities have clearly blazed the path of progress. Buffalo and Rochester, N. Y., have during the decade 1890-1900 made notable reductions in the percentage of loss from infant mortality. Better inspection of the milk supply and increased watchfulness of contagious diseases, especially those of children, have contributed to this end. In Buffalo compulsory vaccination of school children was instituted and circulars distributed which contained instructions concerning the care of children. Among cities which have done noble service during the same decade in reducing the mortality of children under five are Lowell, Lawrence and Haverhill, Mass., Newark and Jersey City. All these had high rates of mortality and present rates still exceed those of many of our cities in which conditions are naturally more favorable. The many remarkable ameliorative changes of the past fifteen years only indicate the possibilities whose limits have not yet been reached, while much pioneer work still remains to be done. In view of the declining rates and the wide variations in them, the existing differences refuse to be explained away, and we can not assign them all to natural causes. Some cities, especially those of the Pacific coast and the moun-
