are:
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(b) The main killing diseases in order of their importance
(1) Bronchopneumonia which is the cause of half of the
mortality at these uges.
(2) Gastro-enteritis.
(3) Prematurity.
The Committee feels, however, that these names are labels rather than accurate diagnosis. In an interview with one of the doctors, we discovered that most of the infants at an institution accepting moribund babies were given the diagnosis of prematurity without sufficient scientific evidence to confirm the diagnosis. We feel that this applies to many other cases as well.
(0) Other diseases which influence the high mortality are:-
(1) Tuberculosit. This is another important factor in the high mortality rate. This is to be exported in a society where the tuberculous infection ja so prevalent. In addition, we feel that many cases that die, and are certified as maramus, mal- nutrition, unspecified meningitis and bronchopneumonia were due to tuberculosis.
(2) Syphilis. It was agreed that syphilis Is a major indirect cause of death in the case of prematurity, miscarriages and abortions. Doctors emphasized the font that, for obvious reasons, congenital syphilis was not commonly given as a cause of death on rertificates.
(d) The following are important general factors in the high infantile mortality rate:
(1) Overcrowding, bad ventilation and sanitation, and poverty.
These factors, which were found to have a great bearing on the high mortality rate in all big overcrowded cities in England same fifty years ago, are very much worse in Hong Kong today. (2) Belief in aged and harmful customs, superstitions and Chaners
medicine:
The importance of these cannot be overestimated,
The great majority of the poor, and to a lesser extent the rich, when a child is ill, either seeks the advice of a friendly neighbour, or rushes straight to a Chinese medicine shop to accept the advice of the man behind the nounter, or consults a herbalist and many women- folk week temple advice. It is only late in the course of the disease that a western trained doctor is consulted. There is atill a wide belief that Chinese medicine is good for internal diseases, especially for measles, bronchitis and influenza,
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(3) Ignorance of the importance of fresh airs
The majority of Chinese do not realise the value of fresh air, wither in health or sickness. They do not ventilate their rooms enough, Whenever thero is sickness in the family, especially with fever, all windows are immediately closed and the patient is covered with layers and layers of clothes and blankels. All practitioners ace familiar with the picture that is associated with the physical examination of a baby. If there is any window or door that is open, it is immediately fully closed. There is no much thing as taking off the clothes so that the doctor may make a thorough examination. The great heaps of clothes are merely pulled outwards and a little upwards and the doctor has to slip his stethoscope way up in order to listen to the chest. Any part of the allomen that is uncovered by such a procedure, is in- mediately covered by the anxious mother or analı They fear the exposure and the catching of a cold. Further, in such discuses as measles, whooping cough, and bronchopneumonia, where fresh air and oxygen form an essential part of western treatment it is contra-indicated in Chinese therapeutics, One can understand their objections to direct draught, but to event draught is one thing and to stop entirely fresh air from entering the sick rooma. is another. This single factor is one of the most important causes of respiratory diseases, dirently or indirectly.
(4) Improper feeding:
There is an increasing tendency among the upper classes to substitute artificial feeding for breast feeding. Mothers of the poorer class, however, are quite eager to suckle their ofspring, Int, through force of giremmstaures, have to give up entirely or give partial feeding only. As cows milk in any form is beyond their means, starch, congee or potatoes are given as early as two in three months of age, very often with math to mouth feeding or by premastication by the mother. Of those that have breast milk, over-feeding in the early months is common, and breast feeding is frequently carried on for unduly prolonged periods, sometimes for "mmel" longer than ane your. Improper feeding undoubtedly is an important cause of gastroenteritis.
(5) Female Labour.
This canses the mother to discontinge breast feeding and to neglect the baby,
(0) Overclothing.
With the exception of the very poor who are under-clothed in winter, most Chinese tend to over-clathe their babies in all
SEASONS.
(7) Excessive fondling and carrying of the baby.
This ocenes both in health and in sickness. The popular conception amung the Chinese is that ton manch erging may produne a hoarse voice which may list throughout life. It may weaken the abdominal wall and produce umbilical hernia. What is most