It is needless to dwell on the hand-feeding of infants as one of the great causes of mortality in infancy, and of sickliness in later life. The statistics of Foundling Hospitals bear sad testimony to the fact of its dangers, and the researches of physicians show that a peculiar form of disease is produced by it, attended by symptoms, and giving rise to appearances after death, peculiar to the form of slow starvation from which the infant has perished. I will add, because it is not generally known, one fresh illustration of the influence of artificial feeding in aggravating the mortality of infants. In Berlin the certificates of death of all infants under the age of one year, are required to state whether the little one had been brought up at the breast, or on some kind or other of artificial food. Of ten thousand children dying under the age of one year, one-fourth had been brought up at the breast, three-fourths by hand.[3] It is, as I said in the preface, no part of my plan to enter on any details with reference to the management of children in health. It may, therefore, suffice to have pointed out the four great causes of preventible disease among the wealthier classes of society; namely, the intermarriage of near relatives, the transmission of constitutional taint, the insanitary condition of the dwelling, and the injudicious selection of the food of the infant. FOOTNOTES: [1] This is the proportion stated in Quain's _Dictionary of Medicine_, to which the writer, Dr. Theodore Williams, adds that of 1,000 cases in the upper classes 12 per cent. showed direct hereditary predisposition, and 48 per cent. family predisposition. [2] Many useful suggestions will be found in Mrs. Gladstone's little tract, _Healthy Nurseries and Bedrooms_, published as one of the Health Exhibition Handbooks. [3] The actual numbers are 2,628 and 7,646. See _Generalbericht ueber das Medizinal-und Sanitaetswesen der Stadt Berlin im Jahre 1881_. 8vo. Berlin 1883, p. 19. CHAPTER II. THE GENERAL SIGNS OF DISEASE IN INFANCY AND CHILDHOOD. The signs of disease at all ages may be referred to one or other of three great classes: disorder of function, alteration of temperature, complaint of pain.