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10. The cycle of the rise and fall of admissions and deaths is almost identical in both Convents for the various months of the year. The rise begins in the month of April, continues rising steadily to its maximum in August, then declines to its minimum between January and March. The curve is therefore seasonal, rising and falling with the temperature.
11. Causes of the Chinese infantile mortality
(a.) Trismus.--This is the commonest cause of deaths of children under 2 weeks of age in the two Convents. The Sisters of the two Convents are very familiar with this disease and are always able to recognise the condition on admission of the child. The great bulk of these cases are in children who are left at the Convent door in a dying condition and often die within 24 hours to 3 days. The Lady Superioress of the Italian Convent informed us that no cases of Trismus recover. The Chinese themselves recognise the discase and call it "So Hau" or Lock Jaw(); they further look upon it as a hopeless disease and as soon as it is recognised the infant is carried off to one or other of the Convents and dumped at the door or handed in to avoid the burial expenses and further trouble and especially as Chinese children under one month old are not recognised as such in their genealogical tree. The symptoms of this disease are as follows, from the 3rd to the 5th day after birth the infant gives up sucking and its cry becomes a muffled and feeble one. On the 6th or 7th day their jaws become clenched together and no food can be given by the mouth owing to rigidity of the masseters. Soon after this waves of convulsive spasms, with slight frothing at the mouth, pass over the child on any movement or touching. This passes on to general rigidity of the body, so that the child can almost be rolled about like a ball. Death soon follows these symptoms. Clinically therefore this disease among Chinese children is indistinguishable from Trismus which has so classically been described in the reports of the Rotunda Hospital where the disease once assumed epidemic proportions. Dr. HUNTER reports that bacteriologically he has been un- able to isolate the tetanus bacillus in these cases but as his
post-mortems are probably all after the 8th or 9th day, it is possible that the growth of the "hoards of micro-organisms," may have attenuated and des- troyed the tetanus bacillus but only after it has done its damage. Far- ther it is possible that these tetanic convulsions may be produced by one or other of these "hoards of micro-organisms" themselves. This is a point which may yet have to be solved.
(b.) Marasmus.--Under this heading the largest number of post-mortem returns are made of children over 2 weeks. This disease heads Dr. HUNTER'S list with a total of 205 out of 606 post-mortems in children under two years, i.e., 33.8 per cent. Apart from hereditary conditions, the causes of this group of diseases are chiefly assignable to conditions of mal-nutrition and defective assimilation. These conditions may be traced a step farther and would have their origin in many causes. Want of cleanliness and over-crowding in Chinese dwellings are undoubtedly largely responsible for these. The crass ignorance and utter disregard of all hygienic principles among the lower classes of Chinese, the improper dieting of infants amounting to indirect starvation, and the system of "baby farming" as practised at the Convents, all contribute important factors in the Chinese infantile mortality. At the French Convent from a very early age the children are given out ostensibly to "wet nurses or foster-mothers who are never medically examined. A number of these women are in the constant employ of the French Convent and over whom there is no proper supervision, many of these nurses do not give the children their milk, but instead rice which they have chewed themselves, and also rice cakes. Among the poorer classes children at birth are never even washed, but simply wiped with a coarse Chinese paper and dressed; often as not this paper and under-clothing has been lying on the floor prior to use. It is a very common sight to see children
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