measures both of prevention and cure can be and are carried out by the well-to-do, but the disease must remain where there are the conditions of the slums.  Of all the conditions favoring infant mortality poverty comes first.  In Erfurt, a small city of Germany, of one thousand infants born in each of the different classes, there died of the illegitimate children three hundren and fifty-two; of those of the laboring class, three hundred and five; of those in the medium station (official class largely), one hundred and seventy-three; of those in higher station, eighty-nine.  The same relation of infant mortality to poverty becomes apparent when estimated in other ways.  In Berlin, with an average infant mortality of one hundred and ninety-six per thousand, the deaths in the best districts of the city were fifty-two and in the poorer quarters four hundred and twenty.  The effect of poverty is seen particularly in the bottle-fed infants; with natural nursing the child of poverty has almost as good a chance as the child of wealth.  From reasons which are almost self-evident, the mortality in illegitimate infants is almost double that of the legitimate.  The greater infant mortality in poverty is due to the more numerous children preventing individual care, the separation of the mother from the nursing child in consequence of the demand made upon her earning capacity, and the decline in breast nursing.  Wealth is on the whole more advantageous from the narrow point of view of disease than is poverty, but if we regard its influence on the race its advantages are not so evident.  Nothing can be worse for a race than that it should die out, and wealthy families have never reproduced themselves.  Conditions always tending to destruction are a necessary part of the environment of poverty; wealth voluntarily creates these conditions, and chiefly by the pernicious influence of its amusements on the young.

A new and in many respects a nobler conception of medicine has been developed.  Formerly medical practice was almost exclusively a personal service to the sick individual, and measures looking toward the general relief of disease and its prevention received scanty consideration.  The idea of a wider service to the city, to the state, to the nation, to humanity rather than the personal service to the individual, is becoming dominant in medicine.  This is seen in the establishment of laboratories by boards of health in cities and states in which knowledge obtained by exact investigations can be made of direct service to the people; in the medical inspection of schools and factories; in promulgating laws directed against conditions which affect health, in the extension of hospitals, and in divers other ways.  The idea of public service and of returning to the people in an effective way some of the results of their labor also underlies the large donations which have been given for the creation of special laboratories and institutes in which, through research, greater knowledge of disease may be obtained and made available.  The researches which have been made on the nutrition of man and the nutritive value of different foods are of great importance, and this knowledge has not yet begun to be applied as it should be.