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A STATISTICAL STUDY 
 
 OF 
 
 INFANT MORTALITY 
 
 EDWARD BUNNELL PHELPS, M.A., F.S.S. 
 Editor, The American Underwriter, of New York City 
 
 Reprinted from the Quarterly Publications of the American Statistical Association 
 New Series, No. 83 (Vol. XI.), September, 1908 
 

 
 Gift 
 Author 
 
A STATISTICAL STUDY 
 
 OF 
 
 INFANT MORTALITY 
 
 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 partic- 
 ular 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 Creches 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 reali- 
 zation 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 fives." So obvious and 
 indisputable a truth calls for no demonstration, and the grow- 
 ing interest in "how the other half dies" is an inevitable corol- 
 lary of the ascending interest in how the unfortunate or less 
 fortunate section of the community fives. Perhaps this gen- 
 eral 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 under- 
 standing 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 con- 
 ditions which make for the death of infants, make also for dis- 
 ease. 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 medi- 
 cal knowledge and in established principles of hygiene and 
 sanitation has played the most important part. As an immedi- 
 ate 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 Staf- 
 fordshire County Council, points out in his contribution to the 
 cyclopedic work on "Dangerous Trades" in the paper on "In- 
 fantile 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 mortal- 
 ity has diminished in like proportion." That fact has been so 
 generally noted, and so repeatedly emphasized, by both physi- 
 cians 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. Llewel- 
 lyn 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 
 
4 
 
 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 consider- 
 ing. Geneva has kept registers of births, marriages, and deaths 
 since 1549. In the sixteenth century their infant deaths con- 
 stituted 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 discus- 
 sion 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 Commit- 
 tee 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 philan- 
 thropists 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 vice- 
 chairman, 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 con- 
 ference, and the enlistment of these notables gave a decided 
 impetus to the new movement. A second National Con- 
 ference 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 
 
papers of the second conference was also published (London, 
 1908). 
 
 Practically simultaneous with the first National Conference 
 at Westminster, an exposition was held at Berlin for the pur- 
 pose of inaugurating a comprehensive study of all the various 
 phases of the infant mortality problem, and some idea of the 
 scope of its work may be gained from the mere announcement 
 that the exposition was continued for nearly three weeks. In 
 its issue of Oct. 13, 1906, Charities and the Commons presents 
 a summary of the work of the exposition, in part as follows: 
 "Accompanying the exhibits were exhaustive explanatory 
 leaflets and monographs by the most celebrated specialists, and 
 a catalogue containing every possible and minute detail to 
 instruct and enlighten. A bare outline even of the rich mass of 
 material presented would go far beyond the limits of our space, 
 and give subjects for numbers of articles. The striking feature 
 of the exhibit is the increasing solicitude of governments to 
 concern themselves in questions affecting the well-being and 
 happiness of people, and the rapidly increasing co-ordination 
 between private, or voluntary, and civic and national, or au- 
 thoritative, reforms. The conditions of infant mortality in 
 the German Empire have for a long time and with reason been 
 the cause of grave anxiety to German social and political scien- 
 tists, since statistics have been showing that, of the 2,000,000 
 infants born annually, 400,000, or one-fifth, do not survive 
 the first year of existence. This disquieting fact has given rise 
 to the founding of an institute, where, as a central point for the 
 whole empire, the subject of infant mortality, its direct and 
 accessory causes, will be studied with a seriousness worthy of the 
 subject, and with all the co-ordinated thoroughness and science 
 known to the German municipality and the German medical 
 profession. From the side of medicine is to be given the fullest 
 inquiry into physiological, and from the municipality into social, 
 contributing causes." 
 
 In September, 1907, an international conference on the sub- 
 ject was held at Brussels, under the name of the Second Inter- 
 national Congress of Gouttes de Lait, and it was decided that 
 
its scope should be extended, and that the next congress should 
 be termed the International Congress for the Protection of 
 Infant Life. Were any further evidence of the increasing 
 interest in the subject necessary, it possibly might be supplied 
 by citing the fact that the subject selected by the Council of 
 the Royal Statistical Society for essays in competition for 
 the Howard Medal in 1908-09 is: "A Statistical Study of In- 
 fantile Mortality in Great Britain and Ireland, and of its 
 Causes." 
 
 Even this brief summation of recent movements — move- 
 ments international, governmental, and statistical — in the 
 direction of trying to discover some means of coping with the 
 substantially stable death-rate among young children the 
 world around, makes it evident, it seems to the writer, that the 
 subject of infant mortality has at last begun to impress its 
 importance upon the thinking element of the civilized world, 
 and will unquestionably receive more and more attention in 
 the next few years. In view of that fact a review of the sub- 
 ject from an up-to-date statistical stand-point may not be inop- 
 portune. As above noted, the compilation of vital statistics 
 in Geneva dates back to 1549, and it might almost be said that 
 from that time down to date there have been more or less com- 
 plete compilations of the statistics of infant mortality. In 
 England local statistics on those lines are practically co-ex- 
 istent with the Registrar-General's office, the Massachusetts 
 statistics of infant mortality for an even half-century are pre- 
 sented in a table accompanying this paper, and about eighteen 
 years ago Dr. Jacques Bertillon prepared for the Encyclo- 
 pedic d'Hygiene et de Medecine Publique a compilation of 
 infant mortality statistics for the various countries of Europe, 
 dating back as far as 1862 in one case. 
 
 The annual reports of the Registrar-General's office contain 
 abstracts of the infant mortality rates of all the leading coun- 
 tries of the world, substantially down to date, and Dr. George 
 Newman's recent work on " Infant Mortality — A Social Prob- 
 lem," contains a mass of statistical information reprinted from 
 various sources. The Tenth, Eleventh, and Twelfth Census 
 
8 
 
 Reports, and the three subsequent Special Reports of the 
 Census Office inaugurating the prospective annual reports of 
 mortality statistics of this country, present a great array of 
 information — such as it is — regarding deaths of children under 
 the ages of 1 and 5 in the United States, and the reports of all 
 the countries and States having bureaus of vital statistics also 
 contain more or less data along these lines. Consequently, 
 there has been no lack of infant mortality statistics for the 
 last fifty years and more, but, so far as the writer is aware, 
 there has been no previous accumulation of this widely scattered 
 information in such a way as to permit of any reasonably 
 accurate, up-to-date, international comparisons of the mortality 
 among infants. As subsequently noted, the statistics of the 
 United States at large are wofully defective, and in the case of 
 nearly all the registration States the margin of error is unques- 
 tionably a wide one, but by means of various methods of com- 
 parison an effort has been made to reduce the statistics of this 
 country to a fairly accurate basis, and it is hoped that a work- 
 able plan of contrasting the infant mortality rates of the United 
 States and other countries has been found. Unless otherwise 
 specified, the term " infant mortality rate," wherever used in 
 this paper, is to be construed as invariably referring to the rate 
 of deaths under 1 year per 1,000 births — still-births excluded. 
 
 The table of Dr. Bertillon, above mentioned, is generally 
 recognized as the earliest fairly accurate summary of the infant 
 death-rate in Europe, and perhaps may best serve as the start- 
 ing-point of this statistical review of the subject. Under the 
 heading of "Tableau LXXXIII, Mortalite de a 5 ans dans 
 les principaux pays de l'Europe," it appears in Bertillon's 
 chapter on " Demographie " in the Encyclopedic d'Hygiene 
 (vol. i, p. 254), and, rearranged so as to present the various 
 European countries in the order of their several death-rates 
 under age 1, is as herewith reproduced. In its original form 
 the table presents the supposed figures of the late '70's for 
 Massachusetts, Rhode Island, and Vermont, which are omitted 
 in the appended transposed reprint. 
 
TABLE I. 
 
 Mortality from to 1 and to 5 Years in the Principal Countries of 
 Europe Prior to 1883, according to the Bertillon Table. 
 
 Countries. 
 
 Period of 
 Observation. 
 
 Of 1,000 
 Born Alive, 
 Died under 
 
 1 Year. 
 
 Of 1,000 
 Born Alive, 
 Died under 
 
 5 Years. 
 
 Ireland 
 
 Norway 
 
 Scotland . . . . ' . 
 
 Sweden 
 
 Denmark .... 
 
 Greece 
 
 Belgium 
 
 England and Wales 
 
 Portugal 
 
 Finland 
 
 France 
 
 The Netherlands . 
 Switzerland . . . 
 
 Prussia 
 
 Italy 
 
 Alsace-Lorraine . . 
 
 Croatia 
 
 Roumania .... 
 
 Austria 
 
 Baden 
 
 Russia in Europe . 
 
 Saxony 
 
 Bavaria 
 
 Wiirtemberg . . . 
 
 1865-83 
 
 1866-82 
 
 1865-81 
 
 1866-82 
 
 1870-82 
 
 1878-82 
 
 1867-83 
 
 1866-82 
 
 1862 
 
 1878-80 
 
 1875-82 
 
 1878-81 
 
 1869-80 
 
 1874^82 
 
 1872-83 
 
 1872-81 
 
 1874^-82 
 
 1875-82 
 
 1866-83 
 
 1866-83 
 
 1867-78 
 
 1865-70 
 
 1866-83 
 
 1871-81 
 
 95.9 
 104.9 
 122.0 
 131.9 
 137.5 
 137.7 
 148.2 
 149.2 
 150.0 
 164.9 
 166.2 
 193.2 
 195.2 
 207.8 
 209.7 
 212.7 
 234.0 
 250.0 
 255.3 
 261.7 
 266.8 
 270.0 
 308.4 
 312.5 
 
 164.6 
 179.1 
 230.9 
 222.5 
 204.9 
 264.5 
 253.2 
 249.3 
 
 251.1 
 
 266.3 
 316.2 
 378.5 
 298.0 
 423.8 
 339 6 
 389.9 
 346.9 
 422.9 
 373.5 
 393.2 
 397.1 
 
 The totals are not given with the tabulation as presented 
 by Bertillon, but, dividing the total of 4,685.7 deaths under 
 age 1 for 24 countries and the total of 6,366.0 deaths under 
 age 5 for 21 countries, it appears that the averages for the 
 European countries in the period stated were 195.2 for deaths 
 under age 1 and 303.1 for deaths under age 5. In a general 
 way, such were the infant death-rates of Europe a generation 
 ago, if the returns on which Bertillon's table was based were 
 correct. The question which naturally follows a study of them 
 is: How have the infant death-rates of the intervening years 
 compared with those of from thirty to forty years ago, in view 
 of all the humanitarian, hygienic, and medical developments 
 of this latter period ? In the main, the conditions favorable to 
 
10 
 
 better health, and a reduced death-rate, have materially im- 
 proved. Has there been a corresponding improvement in the 
 general health of infants, and a corresponding decrease in 
 the death-rate of the little ones? Only the official vital sta- 
 tistics of the various countries can answer those questions, 
 and, as the following tables will demonstrate, the answer is a 
 sadly disappointing one. 
 
 The first attempt of any importance to assemble information 
 on these lines, subsequent to the preparation in 1890 of the 
 Bertillon table above reproduced, was made by Dr. Julius 
 Eross, and its results embodied in a paper presented before 
 the Section for Children-Hygiene of the International Congresses 
 for Hygiene and Demography at Budapest in 1894, under the 
 title of "Ueber die Sterblichkeitsverhaltnisse der Neugeborenen 
 und Sauglinge." The text and tables of Dr. Eross's paper were 
 subsequently published in the Zeitschrift fur Hygiene und Infec- 
 tionskrankheiten, the important work periodically published at 
 Leipzig under the editorial direction of Dr. Robert Koch and 
 Dr. C. Fliigge, and the statistics therein presented form a con- 
 necting link, as it were, between those of the Bertillon table 
 and the infant mortality figures up to 1905 especially compiled 
 by the writer for this paper, and presented in subsequent tables. 
 The statistical data of Dr. Eross's paper as published in the 
 Zeitschrift (vol. xix, pp. 371-392) begin with Table I (p. 372), 
 showing the " Infant Mortality of 0-1 Year at Rate of the Living 
 Born and the Total Mortality in Thirteen European States," 
 which, we are informed, was compiled from the various statis- 
 tical year books. Translating its percentage ratios into rates 
 per 1,000, for the sake of conformity with all the other tabula- 
 tions of this paper, and taking the liberty of substituting in 
 the list of countries for the name of Sweden that of Norway, 
 which investigation of the official figures for both countries 
 proves to have been the country with which the figures given 
 for Sweden were identified, the table is as follows: — 
 
11 
 
 TABLE II. 
 
 Bihths, Deaths under Age 1, Total Deaths, and Infant Mortality Rates per 1,000 
 Births and per 1,000 Total Deaths, Still-births excluded, in Thirteen of 
 the Principal European Countries, according to Dr. Eross's Table. 
 
 Countries and Periods. 
 
 Number of 
 Living 
 Births. 
 
 Died 
 under 
 1 Year. 
 
 Rate 
 
 per 
 
 1,000 
 
 Births. 
 
 Total 
 Mortality. 
 
 Rate of 
 
 Deaths 
 
 under 1 
 
 per 1,000 
 
 Total 
 Deaths. 
 
 Ireland 1884-88 
 
 Norway 1881-90 
 
 Scotland 1885-90 
 
 England (and Wales) 1885-91 
 
 Belgium 1881-91 
 
 France 1885-90 
 
 „ „ , ( 1880-82 1 
 
 HoUand J 1885-90 i 
 
 Italy 1884-91 
 
 Prussia 1886-92 
 
 Hungary 1884-87 
 
 Austria 1886-87 
 
 Saxony 1886-92 
 
 Bavaria 1879-88 
 
 570,710 
 
 600,489 
 
 745,986 
 
 6,234,373 
 
 1,940,197 
 
 5,337,880 
 
 1,332,266 
 
 8,980,579 
 7,681,839 
 2,641,797 
 1,765,541 
 987,248 
 2,014,195 
 
 54,049 
 
 58,471 
 
 89,858 
 
 900,310 
 
 309,766 
 
 882,909 
 
 239,466 
 
 1,727,067 
 
 1,594,039 
 
 560,220 
 
 435,763 
 
 277,857 
 579,203 
 
 94 
 97 
 120 
 144 
 159 
 165 
 
 179 
 
 192 
 207 
 212 
 246 
 
 281 
 
 287 
 
 439,635 
 
 331,209 
 
 446,179 
 
 3,770,281 
 
 1,325,696 
 
 5,049,223 
 
 817,216 
 
 6,420,910 
 4,622,216 
 1,912,419 
 1,350,760 
 639,208 
 1,535,781 
 
 123 
 176 
 213 
 238 
 233 
 174 
 
 293 
 
 268 
 344 
 292 
 322 
 434 
 376 
 
 Totals 
 
 40,833,100 
 
 7,708,978 
 
 183 
 
 28,660,733 
 
 269 
 
 
 
 The periods of observation whose returns are presented in 
 the above table in all cases overlap on the period with which 
 the subsequent table for the last twenty-five years deals, and 
 no detailed analysis of the tabulation of Dr. Eross is necessary 
 at this point, as its lessons are brought out with intensified 
 force in the later table. That is to say, in this case, as in all 
 cases, the greater includes the less. It may, however, be 
 remarked, en 'passant, that all the countries included in the 
 above table were also named in the Bertillon table, with the 
 single exception of Hungary, and that the average infant mor- 
 tality rate per 1,000 living births in those twelve countries in 
 the period covered by Bertillon's table was 186, as compared 
 with 187 in the period with which Dr. Eross dealt. This 
 startling inflexibility of infant mortality rates, when measured 
 by broad averages of either countries or periods, is discussed 
 at some length on subsequent pages of this paper. 
 
12 
 
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 For many years the annual reports of the Registrar-General 
 have presented the most compact abstracts anywhere obtain- 
 able of the birth-rates, marriage-rates, death-rates, and death- 
 rates under 1 year to each 1,000 children born, in practically all 
 the European countries — and certain countries in other sec- 
 tions of the world. Taking those tables in the current (sixty- 
 ninth) 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 death- 
 rates 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. Eross — instead of the birth- 
 rates 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 coun- 
 tries, 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 tears, by Five-year Periods and for the Entire 
 Twenty-five Year Period — Still-births excluded in Both Cases. 
 
 
 1881-85. 
 
 1886-90. 
 
 1891-95. 
 
 1896- 
 
 -1900. 
 
 190] 
 
 -05. 
 
 Averages . 
 1881-1905. 
 
 Countries. 
 
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 99 
 
 30.8 
 
 96 
 
 30.2 
 
 98 
 
 30.2 
 
 96 
 
 28.6 
 
 81 
 
 30.2 
 
 04 
 
 
 23.9 
 
 94 
 
 22.8 
 
 95 
 
 23.0 
 
 102 
 
 23.3 
 
 106 
 
 23.2 
 
 98 
 
 23.2 
 
 99 
 
 
 29.4 
 
 116 
 
 28.8 
 
 105 
 
 27.5 
 
 103 
 
 26.9 
 
 101 
 
 26.1 
 
 92* 
 
 27.7 
 
 104* 
 
 
 37.0 
 
 81 
 
 36.1 
 
 95 
 
 37.7 
 
 140 
 
 41.3 
 
 143 
 
 40.9 
 
 145* 
 
 38.6 
 
 120* 
 
 
 33.3 
 
 117 
 
 31.4 
 
 121 
 
 30.5 
 
 126 
 
 30.0 
 
 129 
 
 28.9 
 
 120 
 
 30.8 
 
 123 
 
 
 32.4 
 
 134 
 
 31.5 
 
 137 
 
 30.4 
 
 139 
 
 30.0 
 
 132 
 
 29.0 
 
 119 
 
 30.7 
 
 132 
 
 
 35.5 
 
 162 
 
 34.5 
 
 144 
 
 31.8 
 
 145 
 
 32.6 
 
 139 
 
 31.4 
 
 131 
 
 33.2 
 
 144 
 
 England and Wales, 
 
 33.5 
 
 139 
 
 31.4 
 
 145 
 
 30.5 
 
 151 
 
 29.3 
 
 156 
 
 28.1 
 
 138 
 
 30.6 
 
 146 
 
 Switzerland .... 
 
 28.6 
 
 171 
 
 27.5 
 
 159 
 
 27.7 
 
 155 
 
 28.5 
 
 143 
 
 28.1 
 
 134 
 
 28.1 
 
 153 
 
 Belgium 
 
 31.1 
 
 156 
 
 29.5 
 
 163 
 
 29.2 
 
 164 
 
 28.9 
 
 158 
 
 27.7 
 
 148 
 
 29.3 
 
 158 
 
 
 46.3 
 
 157 
 
 43.7 
 
 158 
 
 43.3 
 
 172 
 
 40.0 
 
 159 
 
 38.8 
 
 149 
 
 42.4 
 
 159 
 
 
 24.7 
 
 167 
 
 23.1 
 
 166 
 
 22.3 
 
 171 
 
 22.0 
 
 159 
 
 21.3 
 
 139 
 
 22.7 
 
 160 
 
 The Netherlands . . 
 
 34.8 
 
 181 
 
 33.6 
 
 175 
 
 32.8 
 
 165 
 
 32.1 
 
 151 
 
 31.6 
 
 136 
 
 33.0 
 
 162 
 
 
 38.0 
 
 175 
 
 37.5 
 
 175 
 
 36.1 
 
 185 
 
 34.0 
 
 168 
 
 32.6 
 
 168 
 
 35.6 
 
 175* 
 
 
 36.4 
 
 193 
 
 36.0 
 
 186* 
 
 35.3 
 
 185 
 
 34.3 
 
 185 
 
 35.3 
 
 173 
 
 35.5 
 
 185* 
 
 
 37.4 
 
 207 
 
 37.3 
 
 208 
 
 37.0 
 
 205 
 
 36.5 
 
 201 
 
 34.9 
 
 190 
 
 36.6 
 
 202 
 
 Roumania .... 
 
 41.8 
 
 182 
 
 40.9 
 
 195 
 
 41.0 
 
 220 
 
 40.2 
 
 216* 
 
 39.4 
 
 203 
 
 40.7 
 
 203* 
 
 
 38.2 
 
 223 
 
 37.8 
 
 223 
 
 37.5 
 
 223 
 
 37.3 
 
 226 
 
 35.6 
 
 213* 
 
 37.3 
 
 223* 
 
 
 44.4 
 
 226 
 
 43.5 
 
 226 
 
 41.7 
 
 250 
 
 39.4 
 
 219 
 
 37.2 
 
 212 
 
 41.2 
 
 226* 
 
 Russia in Europe 
 
 49.1 
 
 271 
 
 48.2 
 
 264 
 
 48.2 
 
 276 
 
 49.3 
 
 261 
 
 48.6 
 
 268 
 
 48.6* 
 
 268* 
 
 Averages for Europe, 
 
 35.3 
 
 163 
 
 34.3 
 
 162 
 
 33.7 
 
 169 
 
 33.3 
 
 162 
 
 32.4 
 
 153 
 
 33.8 
 
 162 
 
 New Zealand . . . 
 
 36.3 
 
 90 
 
 31.2 
 
 84 
 
 27.7 
 
 87 
 
 25.7 
 
 80 
 
 26.6 
 
 75 
 
 29.5 
 
 83 
 
 
 34.5 
 
 109 
 
 34.6 
 
 103 
 
 32.7 
 
 94 
 
 28.2 
 
 98 
 
 29.0 
 
 90 
 
 31.9 
 
 99 
 
 South Australia . . 
 
 38.5 
 
 101 
 
 34.7 
 
 105 
 
 32.0 
 
 99 
 
 27.0 
 
 112 
 
 24.5 
 
 87 
 
 31.3 
 
 101* 
 
 Queensland .... 
 
 36.5 
 
 136 
 
 37.4 
 
 119 
 
 34.1 
 
 103 
 
 29.2 
 
 104 
 
 26.7 
 
 95 
 
 32.8 
 
 111 
 
 New South Wales . 
 
 37.7 
 
 124 
 
 36.4 
 
 115 
 
 32.9 
 
 111 
 
 28.0 
 
 113 
 
 26.7 
 
 97 
 
 32.3 
 
 112 
 
 Victoria 
 
 30.8 
 
 122 
 
 32.7 
 
 131 
 
 31.0 
 
 111 
 
 26.2 
 
 111 
 
 24.9 
 
 96 
 
 29.1 
 
 114 
 
 Western Australia . 
 
 34.5 
 
 135 
 
 37.0 
 
 123 
 
 31.4 
 
 130 
 
 27.9 
 
 160 
 
 30.3 
 
 126 
 
 32.2 
 
 135* 
 
 Averages for Austral- 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 35.5 
 
 117 
 
 34.9 
 
 111 
 
 31.7 
 
 105 
 
 27.5 
 
 111 
 
 27.0 
 
 95 
 
 31.3 
 
 108 
 
 Japan 
 
 26.0 
 
 104 
 
 28.5 
 
 116 
 
 28.6 
 
 147 
 
 31.1 
 
 153 
 
 31.8 
 
 154 
 
 29.2 
 
 135 
 
 
 28.6 
 
 158 
 
 30.2 
 
 158 
 
 31.7 
 
 169 
 
 37.1 
 
 168 
 
 38.6 
 
 171 
 
 33.2 
 
 165 
 
 
 37.6 
 
 158 
 
 36.7 
 
 170 
 
 38.4 
 
 171 
 
 38.9 
 
 175 
 
 39.0 
 
 174 
 
 38.1 
 
 169 
 
 Chili 
 
 39.4 
 
 314 
 
 35.2 
 
 264 
 
 37.2 
 
 336 
 
 34.1 
 
 333 
 
 35.2 
 
 332* 
 
 36.2 
 
 314* 
 
 Averages for Coun- 
 
 
 
 
 
 
 
 
 
 
 
 
 
 tries Named . . . 
 
 32.9 
 
 184 
 
 32.7 
 
 177 
 
 34.0 
 
 206 
 
 35.3 
 
 207 
 
 36.2 
 
 208 
 
 34.2 
 
 196 
 
 Recapitulation. 
 
 Australasia .... 
 Other Lands . . . 
 
 35.3 
 35.5 
 32.9 
 
 35.1 
 
 163 
 
 117 
 184 
 
 34.3 
 34.9 
 
 32.7 
 
 162 
 111 
 177 
 
 33.7 
 31.7 
 34.0 
 
 169 
 105 
 206 
 
 33.3 
 27.5 
 35.3 
 
 162 
 111 
 207 
 
 32.4 
 27.0 
 36.2 
 
 153 
 
 95 
 
 208 
 
 33.8 
 31.3 
 34.2 
 
 162 
 108 
 196 
 
 fGrand Averages 
 
 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. 
 
 t 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. 
 
15 
 
 So far as the writer is aware, the preceding table is the first 
 detailed comparison ever compiled of the birth-rates and infan- 
 tile death-rates of the leading countries of the world by five- 
 year periods for an entire quarter of a century, and the con- 
 tinuity 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 ap- 
 pended 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 tabula- 
 tion 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 thirty- 
 one 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 terminating 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 death- 
 rate 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: — 
 
16 
 
 TABLE IV. 
 
 The Uniformity of the Infantile Death-rate in All Sections of the World in 
 
 Recent Years. 
 
 Sections. 
 
 Periods of 
 Observation. 
 
 Deaths under 
 
 Age 1 per 
 1,000 Births. 
 
 31 Countries of Europe, Australasia, and other lands 
 Registration States of the United States in 1900 . 
 
 1881-1905 
 *1890 and 1900 
 1856-1905 
 
 154 
 
 153.7 
 
 152.4 
 
 
 
 * Census years ending May 31. 
 
 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 uni- 
 formity 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 Experi- 
 ence 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 com- 
 munities 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 
 
17 
 
 threshed out as to call for no comment here. But, to a certain 
 extent, the defects of one country's registration system would 
 be offset by the comparative perfection of that in force in some 
 other country, in a tabulation of world-wide scope, and in the 
 case of the twoscore countries and States dealt with in the last 
 table it is not improbable that the percentage of error is sub- 
 stantially uniform. Even were the inquiry restricted to the 
 two English-speaking sections whose registration systems are 
 generally regarded as freest from defects— to wit, England 
 and Wales on one side of the Atlantic and the State of Massa- 
 chusetts on this side of the water— the variations in their infant 
 mortality rates in the last twenty-five years and the averages 
 for the entire period differ but slightly, the infant death-rates 
 in England and Wales for the five latest five-year periods hav- 
 ing been in the order of 139, 145, 151, 156, and 138, and those of 
 Massachusetts for the same periods having been 160, 161, 161, 
 153, and 138. The widest range of five-year variation in the 
 case of England and Wales was 18 per 1,000 births, and that 
 in the case of Massachusetts 23 per 1,000 births. Their 
 respective averages for the twenty-five year period were 146 
 and 154. 
 
 In the tabulation of infant mortality in the principal 
 countries of Europe compiled and published in 1890 by Dr. 
 Bertillon and reproduced in transposed form on a previous 
 page of this paper, the latest date of observation was the year 
 1883,— that is to say, twenty-five years ago,— and some of the 
 figures dated back to 1862. In those days the registration of 
 vital statistics in many— if not most— of the countries of 
 Europe was far less advanced than it has become of late years, 
 and, taking into account the well-known fact that approximate 
 completeness in the registration of deaths almost inevitably 
 precedes that of registration of births, it might naturally be 
 assumed that the apparent rates of infant deaths to births 
 would have been much larger in the case of the records of 
 1862-1883 than in those of 1881-1905, the divisor in the pre- 
 vious calculation presumably having been much farther re- 
 moved from the correct figure. As to how well founded that 
 
18 
 
 assumption proves, the following comparison of the death- 
 rates in the Bertillon table and that compiled by the writer of 
 this paper will indicate. 
 
 Some considerable apparent decreases in the infant mortality 
 rates of certain countries are to be noted in the following table, 
 
 table v. 
 
 A Comparison op the Infant Mortality in the Principal, Countries op Europe in 
 the Last Twenty-five Years with the Earlier Periods Named in Bertillon's 
 Table and the Decrease or Increase and Relative Rank in the Case op Each 
 of the Countries. 
 
 
 Infant Mortality 
 in Periods Named. 
 
 Deaths 
 
 per 1,000 
 
 Births, 
 
 Decrease 
 or 
 
 Rank in Order of 
 
 Lowest Infant 
 
 Mortality. 
 
 
 
 
 
 
 Period of 
 Observa- 
 tion. 
 
 Deaths 
 
 per 1,000 
 
 Births. 
 
 1881- 
 1905. 
 
 Increase. 
 
 Early 
 Period. 
 
 Later 
 Period. 
 
 
 1865-83 
 
 95.9 
 
 99 
 
 3.1* 
 
 1 
 
 2 
 
 
 1866-82 
 
 104.9 
 
 94 
 
 10.9 
 
 2 
 
 1 
 
 
 1865-81 
 
 122.0 
 
 123 
 
 1.0* 
 
 3 
 
 4 
 
 
 1866-82 
 
 131.9 
 
 104 
 
 27.9 
 
 4 
 
 3 
 
 
 1870-82 
 
 137.5 
 
 132 
 
 5.5 
 
 5 
 
 5 
 
 
 1867-83 
 
 148.2 
 
 158 
 
 9.8* 
 
 6 
 
 9 
 
 England and Wales . 
 
 1866-82 
 
 149.2 
 
 146 
 
 3.2 
 
 7 
 
 7 
 
 
 1878-80 
 
 164.9 
 
 144 
 
 20.9 
 
 8 
 
 6 
 
 France 
 
 1875-82 
 
 166.2 
 
 160 
 
 6.2 
 
 9 
 
 10 
 
 The Netherlands . . 
 
 1878-81 
 
 193.2 
 
 162 
 
 31.2 
 
 10 
 
 11 
 
 
 1869-80 
 
 195.2 
 
 153 
 
 42.2 
 
 11 
 
 8 
 
 
 1874-82 
 
 207.8 
 
 202 
 
 5.8 
 
 12 
 
 13 
 
 Italy 
 
 1872-83 
 
 209.7 
 
 175 
 
 34.7 
 
 13 
 
 12 
 
 
 1875-82 
 
 250.0 
 
 203 
 
 47.0 
 
 14 
 
 14 
 
 
 1866-83 
 
 255.3 
 
 223 
 
 32.3 
 
 15 
 
 15 
 
 Russia in Europe . . 
 
 1867-78 
 
 266.8 
 
 268 
 
 1.2* 
 
 16 
 
 16 
 
 
 
 174.9 
 
 159.1 
 
 15.8 
 
 
 
 * Increase. 
 
 and on the face of the returns it would seem that those coun- 
 tries were to be congratulated on having somehow succeeded 
 in devising ways and means of reducing this phase of the 
 mortality problem in which the vast majority of countries have 
 notably failed, whether through lack of serious attention to 
 the subject or for other reasons. But is such the case? Let 
 
19 
 
 us go behind the returns, locate the countries which have scored 
 the largest apparent decreases, and consider for a moment 
 whether those countries might naturally be expected to be 
 found in the forefront of the movement for the reduction of 
 infant mortality. 
 
 Of the sixteen countries named in the table, eight show an 
 apparent annual decrease of more than 10 deaths per 1,000 
 births since the early 80's, the decrease ranging from 10.9 in 
 the case of Norway up to the remarkable figure of 47 in the 
 case of Roumania, and the other countries in the order of the 
 largest seeming decrease being Switzerland, Italy, Austria, the 
 Netherlands, Sweden, and Finland. And yet none of these 
 countries has ever attained any particular prominence in the cru- 
 sade for the protection of children's lives. Austria is the only 
 one of the eight which could be even seriously considered as 
 among the great European powers, and, as will be noted, none 
 of the indisputably first-class powers appears in the list. In 
 England, France, and Prussia the decrease in the death-rate 
 was merely nominal, and, as the registration systems of those 
 countries would probably be regarded as superior to that in 
 any of the eight countries which have scored the apparent large 
 decreases in the infant death-rate, it would seem not only pos- 
 sible, but extremely probable, that the decrease in the last-named 
 countries was more apparent than real — in other words, was a 
 decrease in figures only, very likely due to the material increase 
 in the registration of births and the consequent decrease in the 
 ratio of deaths under age 1 to births. In England, France, and 
 Prussia the registration of births was probably much more 
 complete thirty or forty years ago than in most of the smaller 
 countries of Europe, and, if such was the case, there naturally 
 would be much less fluctuation in the mortality rates in the 
 case of those leading countries. Therein probably lies the ex- 
 planation of most of the apparent large decreases in the last 
 twenty-five years. 
 
 In default of positive evidence it would be absurd to believe 
 that the little country of Roumania, with its limited resources, 
 had succeeded in effecting a reduction of its infant death-rate 
 
20 
 
 by nearly 20 per cent, in the last twenty-five years, and thereby 
 materially distanced every other country in the world. Further- 
 more, as shown in Table III, the record of its infant death- 
 rates by five-year periods proves that the rate has been almost 
 continuously in the ascendant for that same period. The British 
 Registrar-General's office was unable to obtain any infantile 
 death-rates from Austria up to 1896, or from Italy up to 1891, 
 and in those obtained since those dates there is no sign of any 
 sharp decline. Norway, Sweden, Finland, the Netherlands, and 
 Switzerland have apparently shown material decreases in the 
 infant death-rate in most of the five-year periods of the last 
 quarter of a century, but improved registration of births prob- 
 ably accounts for that fact in most, if not all, of those cases, 
 and it would therefore seem that the pronounced differences 
 in some cases between the death-rates of the old-time Bertillon 
 table and the up-to-date table presented in connection with 
 this study are unworthy of any serious attention. In the face 
 of the surprising uniformity of the mortality rate in question 
 in the world at large, and especially in countries having 
 thoroughly established registration systems, only the most ir- 
 refutable evidence will convince any student of infant mor- 
 tality of a permanent reduction in the infant death-rate in 
 any country up to this time. 
 
 In so far as the infantile death-rate in the United States as 
 a whole — either now or at any previous time — is concerned, 
 there are absolutely no authentic data. In his contribution to 
 the Eleventh Census Report on Vital and Social Statistics, 
 published in 1896, Dr. Billings accounted for that fact by au- 
 thoritatively stating (Part I, p. 21) that "we have no fully com- 
 plete and accurate registration of births in any part of the 
 United States. The most accurate registration is probably in 
 Massachusetts, in which it is estimated that the deficiency is 
 not greater than 2 per cent." Again, in Volume III of the 
 Twelfth Census Reports (Vital Statistics, Part I, p. xlix) the 
 late William A. King, Chief Statistician for Vital Statistics, 
 commenced his discussion of births with the admission that 
 "the data relating to births are the most incomplete and unsatis- 
 
21 
 
 factory of any treated in this report. Were it not considered 
 desirable to give such results as bear upon the question for the 
 information of students of the statistics, the subject might be 
 dismissed with the statement that they are entirely inadequate 
 to determine, directly, the general birth-rate of the country, or, 
 what is of equal practical importance, the relative birth-rate 
 of different classes of population. A number of the States and 
 cities have laws requiring the registration of births, but it is 
 doubtful if there is a single place in which births are registered 
 as fully as deaths." 
 
 DIAGRAM II.— THE INFANT MORTALITY RATES OF ENGLAND AND WALES, 
 PRUSSIA, FRANCE, AND THE STATE OF MASSACHUSETTS BY FIVE-YEAR 
 PERIODS FROM 1881 TO 1905, ON THE BASIS OF DEATHS UNDER 1 YEAR 
 PER 1,000 BIRTHS, STILL-BIRTHS EXCLUDED. 
 
 I 
 
 <no 
 oo© 
 oo co 
 
 I 
 
 COO 
 
 coo 
 
 GCO! 
 
 210 up 
 Deaths per 1 ,000 Birth? i§ 
 Prussia 
 
 200 
 
 190 
 180 
 
 170 
 France 
 
 Massachusetts . 160 
 150 
 
 140 
 England and Wales 
 
 130 
 Prussia; 
 
 France; 
 
 I Massachusetts ; 
 
 England and Wales. 
 
22 
 
 As the census authorities have repeatedly stated, the data 
 regarding the number of living children under 1 year of age are 
 also utterly incomplete and inaccurate, owing to the fact that 
 the number so returned is too small in practically all localities, 
 partly owing to the practically universal tendency to report 
 children in the later months of the first year as 1 year old. For 
 these reasons it would be utterly futile to attempt the com- 
 pilation of any figures of the infant mortality rate in the United 
 States at large for purposes of comparison with the returns for 
 other countries presented in the preceding tables. In the Regis- 
 trar-General's annual reports for some years past, returns of 
 this character from thirty-two countries have been presented, 
 but the United States has been the one great country in the 
 world for which no figures were given. 
 
 In the light of these conditions it might at first seem practi- 
 cally impossible to obtain even an approximate idea of the status 
 of infant mortality in this country, but such is not the case, the 
 number of registration States and the magnitude of their com- 
 bined population being sufficient to afford a fairly accurate index 
 of the conditions in Continental United States as a whole. The 
 registration systems of these States greatly differ in point of 
 comprehensiveness and reliability, but by common consent 
 that of Massachusetts is regarded as of foremost importance, 
 and the complete record of infant deaths in that State for the 
 last half-century undoubtedly affords by far the best available 
 standard of measurement and comparison in a study of infant 
 mortality in this country. In the Twenty-eighth Annual Re- 
 port of the State Board of Health of Massachusetts, published 
 in 1897, there appeared a comprehensive study of "The Vital 
 Statistics of Massachusetts — A Forty Years' Summary," which 
 was prepared by Dr. Samuel W. Abbott, secretary of the 
 Board of Health. This chapter of more than 100 pages (pp. 
 711-829) begins with a graphic tracing of the "Marriage, Birth, 
 and Death Rates and Infantile Death-rate, Massachusetts, 40 
 Years, 1856-95," and contains a complete tabulation of "Infant 
 Mortality, Massachusetts, 1856-95, Forty Years," presenting 
 the annual figures for each of those years. 
 
23 
 
 For some reason not explained in the text, the birth statis- 
 tics in that tabulation begin with July 1, 1856, and end with 
 June 30, 1895, whereas the deaths under 1 year in the same 
 table are taken from the calendar-year records, thus making 
 the birth and death rate figures materially differ from those in 
 the twenty-year infant mortality record presented in recent 
 Massachusetts registration reports of births, marriages, and 
 deaths. It has seemed desirable to eliminate this discrepancy, 
 and the following tabulation of infant mortality in Massachusetts 
 for the fifty years ending Dec. 31, 1905, has therefore been 
 compiled in part from Dr. Abbott's table of infant mortality 
 (p. 750), in so far as deaths under 1 from 1856 to 1895, inclusive, 
 are concerned, and partly from his tabulation of marriages, 
 births, and deaths from 1842 to 1895 (pp. 721-722), the supple- 
 mental figures for births and infant deaths in the calendar years 
 1896 to 1905, inclusive, being taken from the twenty-year table 
 of infant mortality in the current (sixty-fifth) Massachusetts 
 Report of Births, Marriages, and Deaths (p. 205). The com- 
 posite tabulation of infant mortality herewith presented is thus 
 made complete for the fifty calendar years ending with 1905, 
 and, in order to permit of comparison with the statistics of 
 foreign countries presented in the previous tables accompanying 
 this article, is supplemented with a column containing the annual 
 birth-rates in Massachusetts for the last fifty calendar years, as 
 presented in the Sixty-fifth Massachusetts Report of Births, Mar- 
 riages, and Deaths (pp. 141-142). Still-births have been ex- 
 cluded in all cases. 
 
TABLE VI. 
 
 A Complete Record of Births, Deaths under Age 1, the Infantile Death-rate 
 per 1,000 Births, and the Birth-rate in Massachusetts for Each of the Fifty 
 Years 1856-1905, Inclusive, excluding Still-births. 
 
 
 
 Deaths under 1 Year. 
 
 
 
 Births. 
 
 
 Birth-rate 
 
 Calendar Year. 
 
 
 
 per 1,000 
 
 
 
 Number. 
 
 Rate per 
 1,000 Births. 
 
 Population. 
 
 1856 
 
 34,445 
 
 4,226 
 
 122.7 
 
 29.91 
 
 1857 
 
 35,320 
 
 4,160 
 
 117.8 
 
 30.17 
 
 1858 
 
 34,491 
 
 4,197 
 
 121.7 
 
 28.97 
 
 1859 
 
 35,422 
 
 4,175 
 
 117.9 
 
 29.28 
 
 1860 
 
 36,051 
 
 4,821 
 
 133.7 
 
 29.28 
 
 1861 
 
 35.445 
 
 5,167 
 
 145.8 
 
 28.63 
 
 1862 
 
 32,275 
 
 4,216 
 
 130.6 
 
 25.92 
 
 1863 
 
 30,314 
 
 4,545 
 
 149.9 
 
 24.20 
 
 1864 
 
 30,449 
 
 4,693 
 
 154.1 
 
 24.17 
 
 1865 
 
 30,249 
 
 4,869 
 
 161.0 
 
 23.87 
 
 1866 
 
 34,085 
 
 4,699 
 
 137.9 
 
 26.16 
 
 1867 
 
 35,062 
 
 4,763 
 
 135.8 
 
 26.17 
 
 1868 
 
 36,193 
 
 5,421 
 
 149.8 
 
 26.26 
 
 1869 
 
 36,141 
 
 5,368 
 
 148.5 
 
 25.50 
 
 1870 
 
 38,259 
 
 6.206 
 
 162.2 
 
 26.25 
 
 1871 
 
 39,791 
 
 5,996 
 
 150.7 
 
 26.63 
 
 1872 
 
 43,235 
 
 8,390 
 
 194.1 
 
 28.21 
 
 1873 
 
 44,481 
 
 7,911 
 
 177.8 
 
 28.31 
 
 1874 
 
 45,631 
 
 7,489 
 
 164.1 
 
 28.32 
 
 1875 
 
 43,996 
 
 7,712 
 
 175.3 
 
 26.63 
 
 1876 
 
 42,149 
 
 6,700 
 
 159.0 
 
 25.12 
 
 1877 
 
 41,850 
 
 6,343 
 
 151.5 
 
 24.57 
 
 1878 
 
 41,238 
 
 6,189 
 
 150.1 
 
 23.85 
 
 1879 
 
 40,295 
 
 5,855 
 
 145.3 
 
 22.95 
 
 1880 
 
 44,217 
 
 7,190 
 
 162.6 
 
 24.80 
 
 1881 
 
 45,220 
 
 7,389 
 
 163.4 
 
 24.93 
 
 1882 
 
 45,670 
 
 7,445 
 
 163.0 
 
 24.75 
 
 1883 
 
 47,285 
 
 7,515 
 
 158.9 
 
 25.14 
 
 1884 
 
 48,615 
 
 7,735 
 
 159.1 
 
 25.46 
 
 1885 
 
 48,790 
 
 7,625 
 
 156.3 
 
 25.12 
 
 1886 
 
 50,788 
 
 7,848 
 
 154.5 
 
 25.42 
 
 1887 
 
 53,174 
 
 8,514 
 
 160.1 
 
 25.86 
 
 1888 
 
 54,893 
 
 8,870 
 
 161.6 
 
 25.95 
 
 1889 
 
 57,075 
 
 9,105 
 
 159.5 
 
 26.23 
 
 1890 
 
 57,777 
 
 9,625 
 
 166.6 
 
 25.81 
 
 1891 
 
 63,004 
 
 10,186 
 
 161.7 
 
 27.53 
 
 1892 
 
 65,824 
 
 10,649 
 
 161.7 
 
 28.13 
 
 1893 
 
 67,192 
 
 10,990 
 
 163.6 
 
 28.09 
 
 1894 
 
 66,936 
 
 10,899 
 
 162.8 
 
 27.37 
 
 1895 
 
 67,545 
 
 10,564 
 
 156.4 
 
 27.02 
 
 1896 
 
 72,343 
 
 11,765 
 
 157.8 
 
 28.27 
 
 1897 
 
 73,205 
 
 10,751 
 
 146.9 
 
 27.96 
 
 1898 
 
 73,110 
 
 11,012 
 
 150.6 
 
 27.29 
 
 1899 
 
 70,457 
 
 10,532 
 
 149.5 
 
 25.70 
 
 1900 
 
 73,386 
 
 11,500 
 
 156.7 
 
 26.16 
 
 1901 
 
 71,976 
 
 9,952 
 
 138.3 
 
 25.07 
 
 1902 
 
 72,219 
 
 10,075 
 
 139.5 
 
 24.58 
 
 1903 
 
 73,584 
 
 10,269 
 
 138.3 
 
 24.48 
 
 1904 
 
 75,014 
 
 9,992 
 
 133.2 
 
 24.39 
 
 1905 
 
 75,022 
 
 10,519 
 
 140.2 
 
 24.98 
 
 Totals 
 
 2,511,188 
 
 382,627 
 
 152.4 
 
 26.32 
 
25 
 
 Thanks to the early establishment of the registration system 
 of Massachusetts, recognized the world over for many years as 
 the most reliable index of American vital statistics, the preced- 
 ing table unquestionably affords by far the most comprehensive 
 and most authoritative tracing of infant mortality in at least 
 one section of this country which is now obtainable from any 
 or all sources. The pronounced annual fluctuations in both 
 birth and death rates are somewhat misleading, however, and 
 the appended tabulation of births and infant deaths by five-year 
 periods not only puts the case much more comprehensibly, but 
 also reduces the Massachusetts tabulation to the basis followed 
 in the preceding foreign tabulations, and thus makes possible a 
 comparison by five-year periods. Thus arranged, the state- 
 ment of births and infant deaths in Massachusetts for the last 
 half-century is as follows : — 
 
 TABLE VII. 
 
 Births, Birth-rates per 1,000 Population, and Deaths under 1 Year and their 
 Rate per 1,000 Births in Massachusetts by Five-tear Periods for the Fifty 
 Years 1856-1905, Inclusive — Still-births excluded in Both Cases. 
 
 
 Living Births. 
 
 Deaths under 1 Year. 
 
 Five-Year Periods. 
 
 Number. 
 
 Birth-rate 
 
 per 1,000 
 
 Population. 
 
 Number. 
 
 Rate per 
 1,000 Births. 
 
 1856-60 
 
 1861-65 
 
 1866-70 
 
 1871-75 
 
 1876-80 
 
 1881-85 
 
 1886-90 
 
 1891-95 
 
 1896-1900 
 
 1901-05 
 
 175,729 
 158,732 
 179,740 
 217,134 
 209,749 
 235,580 
 273,707 
 330,501 
 362,501 
 367,815 
 
 29.52 
 25.36 
 26.07 
 27.62 
 24.26 
 25.09 
 25.85 
 27.63 
 27.08 
 24.70 
 
 21,579 
 23,490 
 26,457 
 37,498 
 32,277 
 37,709 
 43,962 
 53,288 
 55,560 
 50,807 
 
 122.8 
 148.0 
 147.2 
 172.7 
 153.9 
 160.1 
 160.6 
 161.2 
 153.3 
 138.1 
 
 Totals 
 
 2,511,188 
 
 26.32 
 
 382,627 
 
 152.4 
 
 Recapitulation by Twenty-five Year Periods. 
 
 1856-1880 
 1881-1905 
 
 941,084 
 1,570,104 
 
 26.57 
 26.07 
 
 141,301 
 241,326 
 
 150.1 
 153.7 
 
26 
 
 When the summary for the last twenty-five years, in the last 
 line of this table, is compared with the corresponding figures 
 for foreign countries presented in Table III of this paper, one is 
 immediately impressed with the surprising uniformity of the 
 infant mortality rate the world around, which has already been 
 alluded to. In the thirty-one foreign countries, in widely re- 
 mote parts of the world, dealt with in Table III, the general 
 average of deaths under 1 year to each 1,000 births in the 
 twenty-five years ending with 1905 was 154 : in the same period 
 the infant death-rate in Massachusetts was 153.7. In the 
 twenty European countries whose returns are presented in 
 Table III — Austria, Hungary, and Russia, with their abnormally 
 high death-rates, included — the average infant death-rate for 
 the last twenty-five year period was 162 as compared with the 
 Massachusetts rate of 153.7, and for the five five-year periods 
 involved the European infant death-rates were, in order, 163, 
 162, 169, 162, and 153, as compared with death-rates of 160.1, 
 160.6, 161.2, 153.3, and 138.1 in Massachusetts. In fact, the 
 correspondence between the infant death-rates of Europe and 
 its leading countries and those of Massachusetts is so strik- 
 ingly close that it can only be appreciated by means of a tabu- 
 lar statement, such, for instance, as the following : — 
 
 TABLE VIII. 
 
 A Comparison of the Infant Mortality Rates per 1,000 Births of the World at 
 Large and Leading European Countries with those of Massachusetts by 
 Five-year Periods, 1881-1905, Inclusive. 
 
 
 1881 
 
 to 
 1885. 
 
 1886 
 
 to 
 1890. 
 
 1891 
 
 to 
 1895. 
 
 1896 
 
 to 
 1900. 
 
 1901 
 
 to 
 
 1905. 
 
 1881 
 
 to 
 1905. 
 
 31 foreign countries in all parts of the world . . . 
 
 155 
 163 
 171 
 153 
 
 152 
 162 
 173 
 156 
 
 159 
 169 
 176 
 161 
 
 157 
 162 
 172 
 158 
 
 147 
 153 
 156 
 139 
 
 154 
 162 
 
 
 169 
 153 
 
 
 160 
 
 161 
 
 161 
 
 153 
 
 138 
 
 154 
 
 
 
27 
 
 This table tells its own story, and would seem to prove beyond 
 all peradventure that there is a general uniformity in the un- 
 dulations of the infant mortality wave at various periods, in 
 the world at large, however mysterious and inexplicable may 
 be the undiscovered influences which regulate it. As will be 
 observed, in all the different groups of countries above presented, 
 there was a gradual rise in the death-rate up to 1891-95, and a 
 gradual falling from 1895 to 1905, in each case the top notch 
 being arrived at in 1891-5, and in every case except that of 
 Massachusetts the death-rate for the entire twenty-five year 
 period being practically identical with that of the first five-year 
 period. The Massachusetts rate for the twenty-five years was 
 lower by 6 deaths per 1,000 births than was the rate for the 
 first five years, whereas in the case of all the other sections of 
 the world named the largest decrease in the twenty-five year 
 average as compared with the rate for the first five years was 
 only 2 deaths per 1,000 births; and the comparison of the Massa- 
 chusetts figures with those for England and Wales, France, and 
 Prussia, is a particularly reliable one for the reason that the 
 registration systems of those sections are presumably freer from 
 error than any others which could be selected. 
 
 In short, this latest tabulation strongly confirms the broad 
 average showings of Table III, and again suggests the question 
 before raised— namely, why this surprising uniformity in the 
 infant death-rate the world around? Furthermore, why the 
 general rise in the death-rate from 1881 to 1895, and why the 
 general fall in the death-rate from the last-named date down to 
 1905? No living man can rationally answer those grave ques- 
 tions. It would be pleasant to believe that, as the world ad- 
 vances in knowledge, in hygiene and sanitation, and in humani- 
 tarianism, infant mortality correspondingly decreases; but only 
 a substantially continuous decline in the infant death-rate 
 for a long term of years, in countries with thoroughly estab- 
 lished registration systems, could substantiate any such opti- 
 mistic theory. 
 
 As previously stated, the fifty-year record of Massachusetts 
 affords the very best available standard of measurement and 
 
28 
 
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 CQ « 
 
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 W Ph 
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 w 
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 E 
 
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 < 
 
 w 
 
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 w 
 
 w 
 
 W 
 
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29 
 
 comparison for any study of infant mortality in this country, 
 and in comparison with that standard the reports of recent 
 decennial censuses of the United States, at best dealing with 
 single twelvemonths ten years apart, are of but little value. 
 In his interesting paper issued under the title of "A Discussion 
 of the Vital Statistics of the Twelfth Census" by the Bureau 
 of the Census in 1904 (Bulletin 15), Dr. Billings thus clearly 
 explains this fact (pp. 7-8): "If the purpose in consulting 
 these reports be to obtain comparative data showing the 
 result of varying conditions upon the general mortality, or to 
 show the relative death-rates at different ages, from different 
 causes or of different classes of population in the same or differ- 
 ent places during a series of consecutive years, the informa- 
 tion must be sought from the local reports on this subject 
 issued by the States or cities for which comparisons are wanted. 
 Here the student or analyst finds great difficulty in securing 
 any comprehensive information, owing to lack of tables cover- 
 ing the details sought. Very few of the cities make any exten- 
 sive compilation of the material at their command, and in such 
 compilations which are most complete, as well as in the State 
 reports, there are differences in the forms of tables and in the 
 methods of classifying the data which prevent carrying com- 
 parisons very far, even if they do not entirely preclude them. 
 ... No State has a complete registration of births, the ones 
 that come nearest to it being probably Massachusetts, Rhode 
 Island, and Connecticut, but the results of the registration 
 in these States should be sought, not in the census report, but 
 in the State reports of births, marriages, and deaths. The 
 only States which had (at the time the Twelfth Census was 
 taken) a registration of deaths sufficiently complete to make 
 the death-rates worth calculating were Connecticut, Maine, 
 Massachusetts, Michigan, New Hampshire, New Jersey, New 
 York, and Rhode Island, which with the District of Columbia 
 (and Vermont) form the group referred to in the census report 
 as the 'registration' States." 
 
 Having secured by the courtesy of the registration officials 
 of all the registration States copies of their recent reports, and 
 
30 
 
 carefully studied them with a view to the compilation, if pos- 
 sible, of a general resume of the infant death-rates in those 
 States for a period of sufficient length to warrant at least cer- 
 tain general deductions, the writer is more than ready to agree 
 with Dr. Billings that "in the State reports [of vital statistics] 
 there are differences in the forms of tables and in the methods 
 of classifying the data which prevent carrying comparisons 
 very far, even if they do not entirely preclude them." 
 
 The Massachusetts report affords by far the best data for 
 that purpose, containing a compact tabulation of infant mor- 
 tality and the rate per 100 living births for each of the last 
 twenty years. But no such thoroughly welcome data are to 
 be found in any of the other registration States' current re- 
 ports. The Connecticut report, which probably ranks second 
 in general utility, has a ten-year table of mortality and death- 
 rates by ages, but the death-rates for children under 1 year 
 are the percentage ratios to total mortality. The New Jersey 
 report's data and diagram dealing with infant mortality are 
 made up on a basis of deaths under 5 years. The Rhode 
 Island report states the annual infant death-rates to births 
 for the last five years, but presents the rates for the previous 
 fifty years in the abbreviated form of three ten-year and one 
 twenty-year ratios. Most, if not all, of the other registration 
 reports are even less serviceable in any extended compilation 
 of infant mortality, in some cases still-births having been in- 
 cluded in the figures up to very recent dates ; and after a study 
 of them all it became apparent that the United States census 
 reports afford the only practicable means of securing within 
 any reasonable time a comparative showing of the infant mor- 
 tality in even the registration States for any considerable 
 stretch of time, that is to say, with all the figures compiled 
 and tabulated on a common basis. For reasons already stated 
 an attempt to tabulate the returns from the country at large, 
 including the non-registration States, would have been un- 
 worthy of serious consideration. 
 
 In the introductory remarks to his analysis of the vital sta- 
 
31 
 
 tistics of the Twelfth Census, the late William A. King noted 
 (vol. iii, p. xii) that "the census utilization of registration 
 records as a source of information commenced with the Tenth 
 Census (1880), when copies of the records of two States, Mas- 
 sachusetts and New Jersey, were secured and used as the basis 
 of the statistics for those States. At the Eleventh Census 
 (1890) the registration area was extended to include seven 
 other States, namely: Connecticut, Rhode Island, New Hamp- 
 shire, Vermont, New York, Delaware, and the District of Co- 
 lumbia, with the cities therein and 83 cities in other States." 
 As stated in the introduction to the inaugural volume of the 
 present annual mortality statistics, issued in 1906 by the 
 Bureau of the Census (p. xiv), when the Twelfth Census was 
 taken the registration area included all of the last-named 
 States, and in addition the States of Maine and Michigan, and 
 153 cities of 8,000 or more population in other States. 
 
 The census utilization of registration records not having 
 commenced until the taking of the Tenth Census, in 1880, 
 any inquiry regarding infant mortality in this country as 
 recorded in the census reports is obviously restricted to the 
 Tenth Census for the earliest records of any value whatsoever, 
 and the tables which have been prepared for this paper are 
 therefore confined to the records of the Tenth, Eleventh, and 
 Twelfth Censuses. Although Massachusetts and New Jersey 
 were the only States whose registration records were used in 
 the compilation of the Tenth Census, most, if not all, of the 
 other registration States of 1900 had established bureaus of 
 vital statistics as early as 1880. All of them except Maine and 
 Michigan were included among the registration States when 
 the Eleventh Census was taken, and, in order to make the com- 
 parison complete for the three latest censuses, the figures for 
 both 1880 and 1890 of all the registration States of 1900 
 are included in the following tables. Prior to the Twelfth 
 Census, still-births, which were then excluded, had been in- 
 cluded in the United States census mortality figures, but in all 
 of the tables here presented the still-births for all three census 
 years have been eliminated. 
 
32 
 
 In the second annual report of the Registrar-General's office, 
 issued in 1840, in his discussion of the mortality of children, 
 Dr. Farr laid down the rule (p. 16) that, "even though the 
 registration of births is still deficient, yet, even with this ad- 
 mitted probable deficiency, the number of births, if applied as 
 an element of calculation, will show a mortality much less than 
 it appears in the Comparative Table of Deaths," and from that 
 day to this that method of calculating the infant mortality rate 
 has practically been regarded by all statistical authorities on the 
 subject as freest from error, and hence the most reliable of all 
 known methods of measuring the rate. By applying this stand- 
 ard of measurement the deaths under 1 year and rates per 1,000 
 births in 1880, 1890, and 1900 in the registration States of 1900, 
 have been as shown in the appended table, according to the 
 United States census reports for the years in question. 
 
 Many and serious as the defects in this table are — especially 
 for the earliest year, 1880, when Massachusetts and New Jersey 
 were the only registration States — it probably provides at 
 
 TABLE IX. 
 
 Births, Deaths under 1, and Death-rates per 1,000 Births in Each of the Registration States 
 
 op 1900, according to the tenth, eleventh, and twelfth census reports still-births 
 
 excluded in Each Case. 
 
 
 Census Year 1900. 
 
 Census Year 1890. 
 
 Census Year 1880. 
 
 States. 
 
 Births 
 during 
 Census 
 Year. 
 
 Deaths 
 under 
 1 Year 
 of Age. 
 
 Deaths 
 
 under 1 
 
 per 
 
 1,000 
 
 Births. 
 
 Births 
 during 
 Census 
 Year. 
 
 Deaths 
 under 
 1 Year 
 of Age. 
 
 Deaths 
 
 under 1 
 
 per 
 
 1,000 
 
 Births. 
 
 Births 
 during 
 Census 
 Year. 
 
 Deaths 
 under 
 1 Year 
 of Age. 
 
 Deaths 
 
 under 1 
 
 per 
 
 1,000 
 
 Births. 
 
 Registration States of 
 1900 
 
 418,321 
 
 60,524 
 
 144.7 
 
 329,823 
 
 53,645 
 
 162.6 
 
 297,490 
 
 36,036 
 
 121.1 
 
 District of Columbia . 
 Massachusetts .... 
 New Hampshire . . . 
 
 Rhode Island .... 
 
 21,757 
 
 5,612 
 
 14,716 
 
 67,228 
 
 58,800 
 
 8,872 
 
 48,158 
 
 175,334 
 
 10,472 
 
 7,372 
 
 3,101 
 1,306 
 1,946 
 
 10,754 
 6,570 
 1,384 
 7,292 
 
 25,492 
 
 1,854 
 
 825 
 
 142.5 
 232.7 
 132.2 
 160.0 
 111.7 
 156.0 
 151.4 
 145.4 
 177.0 
 111.9 
 
 15,864 
 
 5,314 
 
 11,761 
 
 48,156 
 
 51,931 
 
 6,918 
 
 36,351 
 
 139,642 
 
 7,732 
 
 6,154 
 
 2,344 
 1,382 
 1,124 
 8,792 
 4,667 
 1,063 
 6,939 
 25,208 
 1,490 
 636 
 
 147.8 
 260.1 
 
 95.6 
 182.6 
 
 89.9 
 153.7 
 190.9 
 180.5 
 192.7 
 103.3 
 
 13,825 
 
 * 5,454 
 
 13,447 
 
 41,338 
 
 45,244 
 
 6,557 
 
 31,069 
 
 126,740 
 
 6,603 
 
 7,213 
 
 1,387 
 * 1,283 
 
 912 
 5,891 
 3,744 
 
 589 
 
 4,296 
 
 16,632 
 
 711 
 
 591 
 
 100.3 
 * 235.2 
 
 67.8 
 142.5 
 
 82.7 
 
 89.8 
 138.3 
 131.2 
 107.7 
 
 81.9 
 
 * Including still-births, no returns for still-births being given in reports of Tenth Census. 
 
33 
 
 least an approximate idea of the relative death-rates among 
 children under 1 year of age in the States in question in the 
 census years 1880, 1890, and 1900. The District of Columbia 
 has been included solely for the reason that it was part and 
 parcel of the registration area in 1900, but its death-rate is not 
 to be seriously considered, including as it does the heavy mortal- 
 ity among colored children, the colored infant death-rate being 
 nearly twice as high as the white rate in each case. As the 
 District of Columbia was the only portion of the registration 
 area in 1900 having any considerable percentage of colored 
 population, and as the comparatively unimportant colored mor- 
 tality in the registration States is a negligible quantity so far 
 as affecting the general mortality rates is concerned, it was not 
 deemed advisable to attempt to separate the white and colored 
 mortality in the preparation of the tables in this paper based 
 upon the census reports. The District of Columbia figures 
 are, therefore, of practically no importance in this analysis of 
 the statistics of infant mortality, and may properly be disre- 
 garded in the study of any of the tables in which they appear. 
 With them eliminated, it will be noted that in 1880 Massachu- 
 setts apparently led all the States named in its apparent infant 
 death-rate of 142.5, but that Rhode Island took the lead in 1890 
 and retained it in 1900. According to the census reports, 
 Massachusetts' infant death-rates in the census years 1880, 
 1890, and 1900, were respectively 142.5, 182.6, and 160.0 as 
 compared with rates of 162.6, 166.6, and 156.7 for the calendar 
 years in question, according to the registration records of the 
 State as presented in Table VI. 
 
 The above table undoubtedly presents the most accurate 
 showing of infant mortality in the districts dealt with which 
 can be compiled from the census reports for the years in ques- 
 tion, but, in order to perfect the statistical record of the subject, 
 it may be worth while to find space for the infant death-rates in 
 the several States named, as measured, (1) by the rate of deaths 
 under 1 year per 1,000 of the supposed living population of 
 that age, and (2) by the ratio of infant deaths to total deaths. 
 The census figures in both cases are presented in Tables X and 
 XI herewith appended : — 
 
TABLE X. 
 
 The Infant Mortality Rate in 1880, 1890, and 1900 in Each of the Registration States of 1900, 
 as Measured by the Rate of Deaths under 1 Year per 1,000 Living Population of that Age, 
 according to the tenth, eleventh, and twelfth census report still-births excluded. 
 
 
 Census Year 1900. 
 
 Census Year 1890. 
 
 Census Year 1880. 
 
 States. 
 
 Popula- 
 tion at 
 End of 
 Census 
 Year. 
 
 Deaths. 
 
 Death- 
 rate 
 per 
 1,000 
 Living. 
 
 Popula- 
 tion at 
 End of 
 Census 
 Year. 
 
 Deaths. 
 
 Death- 
 rate 
 per 
 1,000 
 
 Living. 
 
 Popula- 
 tion at 
 End of 
 
 Census 
 Year. 
 
 Deaths. 
 
 Death- 
 rate 
 per 
 1,000 
 Living. 
 
 Registration States of 
 
 379,951 
 
 60,524 
 
 159.3 
 
 298,154 
 
 53,645 
 
 179.9 
 
 273,559 
 
 36,036 
 
 131.7 
 
 
 19,774 
 
 3,101 
 
 156.8 
 
 14,469 
 
 2,344 
 
 162.0 
 
 12,879 
 
 1,387 
 
 107.7 
 
 District of Columbia . 
 
 4,758 
 
 1,306 
 
 274.5 
 
 4,467 
 
 1,382 
 
 309.4 
 
 4,624 
 
 *1,283 
 
 *277.5 
 
 
 13,503 
 
 1,946 
 
 144.1 
 
 11,158 
 
 1,124 
 
 100.7 
 
 12,812 
 
 912 
 
 71.2 
 
 Massachusetts .... 
 
 60,492 
 
 10,754 
 
 177.8 
 
 43,043 
 
 8,792 
 
 204.3 
 
 37,587 
 
 5,891 
 
 156.7 
 
 
 54,161 
 
 6,570 
 
 121.3 
 
 48,954 
 
 4,667 
 
 95.3 
 
 42,585 
 
 3,744 
 
 87.9 
 
 New Hampshire . . . 
 
 8,048 
 
 1,384 
 
 172.0 
 
 6,347 
 
 1,063 
 
 167.5 
 
 6,141 
 
 589 
 
 95.9 
 
 
 43,571 
 
 7,292 
 
 167.3 
 
 32,087 
 
 6,939 
 
 216.2 
 
 28,192 
 
 4,296 
 
 152.4 
 
 
 159,521 
 
 25,492 
 
 159.8 
 
 124,977 
 
 25,208 
 
 201.7 
 
 115,847 
 
 16,632 
 
 143.6 
 
 Rhode Island .... 
 
 9,368 
 
 1,854 
 
 197.9 
 
 6,890 
 
 1,490 
 
 216.3 
 
 6,132 
 
 711 
 
 115.9 
 
 
 6,755 
 
 825 
 
 122.1 
 
 5,762 
 
 636 
 
 110.4 
 
 6,760 
 
 591 
 
 87.4 
 
 * Including still-births, no returns for still-births being given in reports of Tenth Census. 
 
 TABLE XI. 
 
 The Infant Mortality Rate in 1880, 1890, and 1900 in Each of the Registration States of 1900, 
 as Measured by the Rate of Deaths under 1 Year per 1,000 Deaths at All Ages, according 
 to the Tenth, Eleventh, and Twelfth Census Reports — Still-births excluded. 
 
 
 Census Year 1900. 
 
 Census Year 1890. 
 
 Census Year 1880. 
 
 States. 
 
 Total 
 Deaths 
 during 
 Census 
 
 Year. 
 
 Deaths under 
 Age 1 during 
 Census Year. 
 
 Total 
 Deaths 
 during 
 Census 
 
 Year. 
 
 Deaths under 
 Age 1 during 
 Census Year. 
 
 Total 
 Deaths 
 during 
 Census 
 
 Year. 
 
 Deaths under 
 Age 1 during 
 Census Year. 
 
 
 Deaths. 
 
 Rate 
 per 
 1,000 
 at All 
 Ages. 
 
 Deaths. 
 
 Rate 
 per 
 1,000 
 at All 
 Ages. 
 
 Deaths. 
 
 Rate 
 per 
 1,000 
 at All 
 Ages. 
 
 Registration States of 
 1900 
 
 301,670 
 
 60,524 
 
 200.6 
 
 262,149 
 
 53,645 
 
 204.6 
 
 191,230 
 
 36,036 
 
 188.4 
 
 
 15,422 
 
 3,101 
 
 201.1 
 
 13,863 
 
 2,344 
 
 169.1 
 
 8,977 
 
 1,387 
 
 154.5 
 
 District of Columbia . 
 
 6,364 
 
 1,306 
 
 205.2 
 
 5,449 
 
 1,382 
 
 253.6 
 
 *4,192 
 
 *1,283 
 
 *306.1 
 
 
 12,148 
 
 1,946 
 
 160.2 
 
 9,974 
 
 1,124 
 
 112.7 
 
 9,384 
 
 912 
 
 97.2 
 
 Massachusetts .... 
 
 49,756 
 
 10,754 
 
 216.1 
 
 43,102 
 
 8,792 
 
 204.0 
 
 31,752 
 
 5,891 
 
 185.5 
 
 
 33,572 
 
 6,570 
 
 195.7 
 
 24,118 
 
 4,667 
 
 193.5 
 
 19,144 
 
 3,744 
 
 195.6 
 
 New Hampshire . . . 
 
 7,400 
 
 1,384 
 
 187.0 
 
 6,856 
 
 1,063 
 
 155.0 
 
 5,503 
 
 589 
 
 107.0 
 
 
 32,735 
 
 7,292 
 
 222.7 
 
 28,455 
 
 6,939 
 
 243.8 
 
 18,434 
 
 4,296 
 
 233.0 
 
 
 130,268 '25,492 
 
 195.7 
 
 117,837 
 
 25,208 
 
 213.9 
 
 84,450 
 
 16,632 
 
 196.9 
 
 Rhode Island .... 
 
 8,176 j 1,854 
 
 226.8 
 
 7,234 
 
 1,490 
 
 206.0 
 
 4,507 
 
 711 
 
 157.7 
 
 
 5,829 ■ 825 
 
 141.5 
 
 5,261 
 
 636 
 
 120.9 
 
 4,887 
 
 591 
 
 120.9 
 
 * Including still-births, no returns for still-births being given in reports of Tenth Census. 
 
35 
 
 Were the tabulation of the census records of the infant death- 
 rate per 1,000 of living population under 1 year at the end of 
 each census year unaccompanied by tables based on other stand- 
 ards of measuring infant mortality, affording ready means of 
 checking the various figures and thus measuring the probable 
 margin of error, it would be comparatively valueless. For, as 
 previously stated, the census authorities have often admitted 
 that the data regarding the number of living children under 1 
 year of age are utterly incomplete and inaccurate. As Dr. 
 Farr put it in discussing the mortality of infants (Supplement 
 to 25th Annual Report of the Registrar-General, pp. v-vi), "The 
 infants in the first year of life are to some extent mixed up with 
 infants in the second year of age." And, as Dr. Billings ex- 
 plained in his remarks regarding infantile mortality published 
 in the Report on Vital and Social Statistics in the United States 
 at the Eleventh Census (Part I, p. 21): "Unfortunately, these 
 data are incomplete and inaccurate, not only for the United 
 States as a whole, but for all parts of the registration area. This 
 is due to the fact that the number of children returned as being 
 under 1 year of age is too small in every locality, owing partly 
 to omissions in the enumeration, and partly to the tendency of 
 those reporting the age of infants to report those who are be- 
 tween 9 and 12 months of age as being, in round numbers, 1 
 year old, which last is a defect common to the censuses of all 
 countries." 
 
 The apparent living population under 1 year of age for these 
 reasons being much understated in the returns, of course the 
 alleged rates of deaths under 1 to the living population at that 
 age are almost invariably in excess of the actual rates on that 
 basis: hence the table worked out on those lines would be of 
 little value by itself. The tabulation of rates of infant deaths 
 per 1,000 deaths at all ages probably is open to less objection, 
 but that table, too, is open to much more intelligent interpre- 
 tation when supplemented with tables prepared on other bases 
 of measurement, and especially with one laid out on the gener- 
 ally accepted plan of death-rates to births. But for the presence 
 of the last-named table, it would not have been considered 
 
36 
 
 worth while to present in this article the two other tables above 
 mentioned. 
 
 The death-rate of persons over 1 year of age is a natural com- 
 plement to the death-rate of infants under 1 year, if both are 
 prepared on a common basis, and materially aids in deter- 
 mining whether a high infant mortality is presumably, in part 
 at least, due to unsanitary conditions or to independent causes. 
 In none of the works on the subject of infantile mortality which 
 the writer has examined does such a tabulation appear, and by 
 way of adding at least some information to the statistical rec- 
 ords of the subject the following table has been prepared, on 
 the basis of the census reports for 1880, 1890, and 1900: — 
 
 TABLE XII. 
 
 Deaths over 1 Year op Age and Rate per 1,000 Population over 1 Year in 1880, 1890, and 1900 
 in the Registration States of 1900, according to the Tenth, Eleventh, and Twelfth Census 
 Reports. 
 
 
 
 Census Year 1900. 
 
 Census Year 1890. 
 
 Census Year 1880. 
 
 States. 
 
 u d 3 
 p. c3*0 c3 
 
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 CD'd ^ 
 
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 -w<< co 
 
 * § 
 
 •* » 
 
 fl) CD 
 
 cd a 
 OS'S 
 
 iZ 
 
 OJO 
 
 o 
 "■go's 
 
 Q, cST) cS 
 O CD C <D 
 
 "- 1 i . 
 
 gT3g 
 
 CO o d 
 -t3 hQ 
 CD CD CK) 
 
 P!*.2 
 
 <D CD 
 
 < 
 
 t» * 
 
 1 <W 
 
 5o 
 
 oSO 
 
 CDO 
 
 lH +=* CO 
 
 S> d 
 
 > 8> CD 
 O 6fo 
 
 d"^ 
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 d t,_ >-' 
 
 O CD a CD 
 
 r-4 ' 
 
 U • 
 
 * 3 fe 
 £^ 0) 
 
 to"o d 
 
 CD CD «o 
 
 Q^.2 
 
 «jo 
 
 CDO 
 
 Registration States 
 of 1900 .... 
 
 17,064,329 
 
 241,146 
 
 14.1 
 
 14,169,658 
 
 208,504 
 
 14.7 
 
 11,765,518 
 
 155,194 
 
 13.2 
 
 Connecticut . . . 
 District of Columbia, 
 Maine 
 
 888,646 
 
 273,960 
 
 680,963 
 
 2,744,854 
 
 2,366,821 
 
 403,540 
 
 1,840,098 
 
 7,109,373 
 
 419,188 
 
 336,886 
 
 12,321 
 
 5,058 
 
 10,202 
 
 39,002 
 
 27,002 
 
 6,016 
 
 25,443 
 
 104,776 
 
 6,322 
 
 5,004 
 
 13.9 
 18.5 
 15.0 
 14.2 
 11.4 
 14.9 
 13.8 
 14.7 
 15.1 
 14.9 
 
 731,789 
 
 225,925 
 
 649,928 
 
 2,195,900 
 
 2,044,935 
 
 370,183 
 
 1,412,846 
 
 5,872,876 
 
 338,616 
 
 326,660 
 
 11,519 
 
 4,067 
 
 8,850 
 
 34,310 
 
 19,451 
 
 5,793 
 
 21,516 
 
 92,629 
 
 5,744 
 
 4,625 
 
 15.7 
 18.0 
 13.6 
 15.6 
 9.5 
 15.6 
 15.2 
 15.8 
 17.0 
 14.2 
 
 609,821 
 
 173,000 
 
 636,124 
 
 1,745,498 
 
 1,594,352 
 
 340,850 
 
 1,102,924 
 
 4,967,024 
 
 270,399 
 
 325,526 
 
 7,590 
 
 2,909 
 
 8,472 
 
 25,861 
 
 15,400 
 
 4,914 
 
 14,138 
 
 67,818 
 
 3,796 
 
 4,296 
 
 12.4 
 16.8 
 13 3 
 
 Massachusetts 
 Michigan .... 
 
 
 14.8 
 9 7 
 
 New Hampshire 
 New Jersey . . . 
 New York . . . 
 Rhode Island . . 
 Vermont . . . 
 
 14.4 
 12.8 
 13.7 
 14.0 
 13.2 
 
37 
 
 In so far as the mortality reports of the Tenth, Eleventh, 
 and Twelfth Censuses contribute any really material data to the 
 records of infant mortality in the last three census years in the 
 States recognized as registration States in 1900, the preceding 
 table practically rounds out the information therein obtainable, 
 and it might now seem to be in order to make a comparison of 
 the infant death-rates in the several registration States as 
 measured by the standards of the various tables which have 
 been presented. By so doing, at least an approximate idea of 
 the actual relative rank of the States in question in point of 
 their respective infant death-rates may be obtained, and, pos- 
 sibly, some information of working value be contributed to 
 the rapidly growing bibliography of the subject. Perhaps the 
 shortest and most effective means of reaching this end will be 
 that of assembling at close contact the infant death-rates of each 
 State according to the various standards of calculation em- 
 ployed in the preceding tables, and attaching in each case the 
 numeral showing the relative rank of the State in question 
 from that point of view. In compact form here are the results 
 of an inquiry shaped on those lines, eliminating the District of 
 Columbia for reasons previously explained: — 
 
 TABLE XIII. 
 
 A Comparison op the Infant Mortality Rates— and Their Complement, the Death-rate at All 
 Ages over 1 Year— in 1900, 1890, and 1880 in the Registration States op 1900, and the Rela- 
 tive Rank op Each op the Nine States in the Order op Those Death-rates. 
 
 
 Death-rate under 1 Yeai 
 
 per 1,000 
 
 Death-rate under 1 Year per 1,000 of 
 
 
 
 Births. 
 
 
 
 that Age living at End of Census Year. 
 
 States. 
 
 1900. 
 
 1890. 
 
 1880. 
 
 1900. 
 
 1890. 
 
 1880. 
 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Connecticut . . . 
 
 142.5 
 
 6 
 
 147.8 
 
 6 
 
 100.3 
 
 5 
 
 156.8 
 
 6 
 
 162.0 
 
 6 
 
 107.7 
 
 5 
 
 Maine 
 
 132.2 
 
 7 
 
 95.6 
 
 8 
 
 67.8 
 
 9 
 
 144.1 
 
 7 
 
 100.7 
 
 8 
 
 71.2 
 
 9 
 
 Massachusetts . . 
 
 160.0 
 
 2 
 
 182.6 
 
 3 
 
 142.5 
 
 1 
 
 177.8 
 
 2 
 
 204.3 
 
 3 
 
 156.7 
 
 1 
 
 Michigan .... 
 
 111.7 
 
 9 
 
 89.9 
 
 9 
 
 82.7 
 
 7 
 
 121.3 
 
 9 
 
 95.3 
 
 9 
 
 87.9 
 
 7 
 
 New Hampshire . 
 
 156.0 
 
 3 
 
 153.7 
 
 5 
 
 89.8 
 
 6 
 
 172.0 
 
 3 
 
 167.5 
 
 5 
 
 95.9 
 
 6 
 
 New Jersey . . . 
 
 151.4 
 
 4 
 
 190.9 
 
 2 
 
 138.3 
 
 2 
 
 167.3 
 
 4 
 
 216.2 
 
 2 
 
 152.4 
 
 2 
 
 New York .... 
 
 145.4 
 
 5 
 
 180.5 
 
 4 
 
 131.2 
 
 3 
 
 159.8 
 
 5 
 
 201.7 
 
 4 
 
 143.6 
 
 3 
 
 Rhode Island . . 
 
 177.0 
 
 1 
 
 192.7 
 
 1 
 
 107.7 
 
 4 
 
 197.9 
 
 1 
 
 216.3 
 
 1 
 
 115.9 
 
 4 
 
 Vermont .... 
 
 111.9 
 
 8 
 
 103.3 
 
 7 
 
 81.9 
 
 8 
 
 122.1 
 
 8 
 
 110.4 
 
 7 
 
 87.4 
 
 8 
 
38 
 
 TABLE XIII— Continued. 
 
 
 Death-rate under 1 Year per 1,000 
 
 Death-rate for All Ages over 1 Year per 1 ,000 
 
 
 
 Deaths at All Ages. 
 
 
 of Those Ages 
 
 Living at End of Census Year. 
 
 States. 
 
 1900. 
 
 1890. 
 
 1880. 
 
 1900. 
 
 1890. 
 
 1880. 
 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Rate. 
 
 Rank. 
 
 Connecticut . . . 
 
 201.1 
 
 4 
 
 169.1 
 
 6 
 
 154.5 
 
 6 
 
 13.9 
 
 7 
 
 15.7 
 
 3 
 
 12.4 
 
 8 
 
 
 160.2 
 
 8 
 
 112.7 
 
 9 
 
 97.2 
 
 9 
 
 15.0 
 
 2 
 
 13.6 
 
 8 
 
 13.3 
 
 5 
 
 Massachusetts . . 
 
 216.1 
 
 3 
 
 204.0 
 
 4 
 
 185.5 
 
 4 
 
 14.2 
 
 6 
 
 15.6 
 
 4— 
 
 14.8 
 
 1 
 
 Michigan .... 
 
 195.7 
 
 5— 
 
 193.5 
 
 5 
 
 195.6 
 
 3 
 
 11.4 
 
 9 
 
 9.5 
 
 9 
 
 9.7 
 
 9 
 
 New Hampshire . 
 
 187.0 
 
 7 
 
 155.0 
 
 7 
 
 107.0 
 
 8 
 
 14.9 
 
 3— 
 
 15.6 
 
 4— 
 
 14.4 
 
 2 
 
 New Jersey . . . 
 
 222.7 
 
 2 
 
 243.8 
 
 1 
 
 233.0 
 
 1 
 
 13.8 
 
 8 
 
 15.2 
 
 6 
 
 12.8 
 
 7 
 
 New York . . . 
 
 195.7 
 
 5— 
 
 213.9 
 
 2 
 
 196.9 
 
 2 
 
 14.7 
 
 5 
 
 15.8 
 
 2 
 
 13.7 
 
 4 
 
 Rhode Island . . 
 
 226.8 
 
 1 
 
 206.0 
 
 3 
 
 157.7 
 
 5 
 
 15.1 
 
 1 
 
 17.0 
 
 1 
 
 14.0 
 
 3 
 
 Vermont .... 
 
 141.5 
 
 9 
 
 120.9 
 
 8 
 
 120.9 
 
 7 
 
 14.9 
 
 3— 
 
 14.2 
 
 7 
 
 13.2 
 
 6 
 
 A somewhat noticeable feature of this tabulation of compari- 
 sons is the fact that, materially differing though the infant 
 death-rates of any particular State do in any one census year 
 as measured by the ratios to births and to living population at 
 the age of 1 at the end of the census year, in every case the 
 relative rank of the State as determined by the two standards 
 remains the same in all three census years. For instance, 
 Massachusetts ranked first in 1880, third in 1890, and second 
 in 1900 in point of both death-rates to births and to living 
 population under age 1 at the end of the census year; New 
 Jersey ranked second in both 1880 and 1890, and fourth in 
 1900, by both measurements, and so on. In a general way, it 
 might be expected that there probably would be no radical 
 shift in the ranking of the States from census to census in point 
 of either the number of births or the population under age 1 
 at the end of the census years, but the coincidence of each 
 State's ranking remaining the same in any census year, whether 
 measured by the rate of infant deaths to births or to surviving 
 infants under age 1 at the end of the census year, is at least 
 passing strange, taking into account the habitual and historic 
 inaccuracy in the reporting of living infants under age 1. 
 
 Of course, if the infant migration and emigration in a census 
 
39 
 
 year were disregarded, if the infant deaths during the census 
 year were restricted to babies born during the year, and if 
 census returns were complete and absolutely accurate, the 
 number living under age 1 at the end of the year would be the 
 exact complement of the number dying during the year. But the 
 infant migration and emigration cannot be disregarded. A 
 minor but considerable percentage of the infant deaths in any 
 year are those of babies born in the later months of the previous 
 year; and the returns for births, deaths, and living population 
 by ages — especially for population under age 1 — are, and 
 always have been, notoriously incomplete and inaccurate. 
 Hence the absolute uniformity of the ranking of each State 
 in the last three censuses, whether measured by its infant 
 mortality rate to births or to living population under age 1, 
 is at least worthy of note. 
 
 Unfortunately, the figures of most of the registration States, 
 so far as the infant death-rate to births is concerned, have been 
 open to the suspicion of too glaring inaccuracies — at least up to 
 a very recent period — to warrant any attempt to make com- 
 parison between them and those of the European countries with 
 long-established registration systems. But the census returns 
 for these States in 1880, 1890, and 1900, herewith presented 
 for what they are worth, are none the less worthy of a careful 
 study from various view-points by those interested in the subject 
 of infant mortality. 
 
 In this paper the writer has aimed to supplement the work 
 of the numerous medical experts, who have long been probing 
 the puzzling problems of infant mortality, by bringing to- 
 gether from various sources and presenting in compact form 
 the most reliable statistical information now obtainable which 
 would warrant some definite conclusions as to the rise or fall 
 of the infant mortality rate in recent years throughout the 
 world, and the apparent present tendencies of the infant death- 
 rate. It has seemed possible that the presentation of specific 
 information on these lines might provide sound foundations, 
 in the way of authoritative facts and figures of international 
 scope, for the widely extended movement now being earnestly 
 
40 
 
 made for the reduction of the infant death-rate. If so, the 
 purpose of this paper will have been served, and possibly in 
 a later paper the writer may present some of the mass of data 
 as to the fundamental causes for the abnormally heavy infant 
 mortality in certain sections — and especially in certain factory 
 towns — which have accumulated in his hands, but have been 
 foreign to the purposes of this preliminary and purely statis- 
 tical study of the far-reaching subject which is just beginning 
 in these twentieth-century days to make its real importance 
 felt. In the consideration of it, and of the almost innumerable 
 problems involved in it, not only the prospective population, 
 but the general welfare, of the entire civilized world are deeply 
 concerned. As Dr. Alden has so gravely remarked, "A thor- 
 ough understanding of the subject should be the concern of 
 every true citizen." 
 
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