xcess of ten per cent, occasionally falling as low as three
per cent. In the hospital reports on the contrary the death-rate begins
at twenty per cent and climbs to thirty, forty, and forty-five per cent.
It is only fair to say, of course, that hospital statistics probably
include a larger percentage of more serious cases, the milder ones being
taken care of at home, or not presenting themselves for treatment at
all. But even when this allowance has been made, the contrast is
convincing.

A similar influence is exercised by age. Although pneumonia is common at
all ages, its heaviest death-rate falls at the two extremes, under six
years of age and over sixty, with a strong preponderance in the latter.
Under five years of age, the mortality may reach twenty to thirty per
cent; from five to twenty-five, not more than four to five per cent;
from twenty-five to thirty-five, from fifteen to twenty per cent; and so
on, increasing gradually with every decade until by sixty years of age
the mortality has reached fifty per cent, and from sixty to seventy-five
may be expressed in terms of the age of the patient. One consoling
feature, however, about it is that its mortality is lowest in the ages
at which it is most frequent, namely, from ten to thirty-five years of
age. And its frequency diminishes even more rapidly than its fatality
increases in later years. So that while it is much more serious in a
middle-aged man, he is less liable to develop it than a younger one.
Where the mortality from pneumonia is highest, is in the most densely
populated wards, especially among negroes and foreigners of the hospital
class, in individuals who are victims of chronic alcoholism, and also
among those who are for long periods insufficiently nourished. Lastly,
it is only within comparatively recent years that we have come clearly
to recognize the large role which pneumonia plays in giving the
finishing stroke to chronic diseases and degenerative processes. It is,
for instance, one of the commonest actual causes of death in Bright's
disease, in diabetes, in lingering forms of tuberculosis, and in heart
disease; and last of all, in that progressive process of normal
degeneration and decay which we term "Old Age." It is one of the most
frequent and fatal of what Flexner described a decade ago as "terminal
infections." Very few human beings die by a gradual process of decay,
still less go to pieces all at once, like the immortal "One-Hoss Shay."
J