Motherhood, wet-nursing and nation: nineteenth-century Brazilian medical perspectives.

This paper explores the viewpoints of nineteenth-century Brazilian physicians regarding women's roles as the 'propagators of the race'. It emphasises their perspectives on reproduction, breast feeding, and the involvement of enslaved wet nurses in a society grappling with significant paradoxes and conflicts as it sought to embrace modernisation. It also examines various aspects of women's health and childcare, encompassing topics like miscarriage and puériculture Through an analysis of medical discourse, this paper underscores physicians' profound influence in shaping societal assumptions surrounding maternal roles in Brazil. These understandings were instrumental in shaping the expectations for a 'modern nation', where racial considerations intertwined with broader discourses about female bodies. Drawing on diverse sources from the latter half of the nineteenth century, including newspapers and medical records, this paper also highlights the lived experiences of mothers-both tangible realities and imagined constructs. It emphasises how these experiences became integrated in ideological debates that centred on maternity, race, nationhood and modernity within a South Atlantic context. Conducting a discourse analysis of published medical sources, the paper finally uncovers the intricate interplay between reproductive politics, biological risk perceptions and national defence. It dissects how these elements coalesced into the language of biopolitics, moulding regulations and institutional control over the bodies of both white and black women. This exploration aims to enrich discussions about the intricate dynamics shaping institutional actions within the realms of reproductive health and national interests.

Reconstructing breastfeeding and weaning practices in the Bronze Age Near East using stable nitrogen isotopes.

OBJECTIVES: Breastfeeding and childhood diet have significant impact on morbidity and mortality within a population, and in the ancient Near East, it is possible to compare bioarchaeological reconstruction of breastfeeding and weaning practices with the scant textual evidence. MATERIALS AND METHODS: Nitrogen stable isotopes (δ15 N) are analyzed here for dietary reconstruction in skeletal collections from five Bronze Age (ca. 2,800-1,200 BCE) sites in modern Lebanon and Syria. We employed Bayesian computational modeling on cross-sectional stable isotope data of collagen samples (n = 176) mainly from previous studies to test whether the bioarchaeological evidence aligns with the textual evidence of breastfeeding and weaning practices in the region, as well as compare the estimated weaning times to the global findings using the WARN (weaning age reconstruction with nitrogen isotope analysis) Bayesian model. RESULTS: Though the Near East sites in this study had different ecological settings and economic strategies, we found that weaning was introduced to the five sites at 0.5 ± 0.2 years of age and complete weaning occurred around 2.6 ± 0.3 years of age on using the WARN computational model. These weaning processes are within the time suggested by historical texts, though average estimated weaning age on the Mediterranean coast is later than inland sites. DISCUSSION: Compared globally, these Near Eastern populations initiated the weaning process earlier but completed weaning within the global average. Early initial weaning may have created short spacing between pregnancies and a high impact on demographic growth within these agricultural populations, with some variation in subsistence practices accounting for the inland/coastal discrepancies.

Barium distributions in teeth reveal early-life dietary transitions in primates.

Early-life dietary transitions reflect fundamental aspects of primate evolution and are important determinants of health in contemporary human populations. Weaning is critical to developmental and reproductive rates; early weaning can have detrimental health effects but enables shorter inter-birth intervals, which influences population growth. Uncovering early-life dietary history in fossils is hampered by the absence of prospectively validated biomarkers that are not modified during fossilization. Here we show that large dietary shifts in early life manifest as compositional variations in dental tissues. Teeth from human children and captive macaques, with prospectively recorded diet histories, demonstrate that barium (Ba) distributions accurately reflect dietary transitions from the introduction of mother's milk through the weaning process. We also document dietary transitions in a Middle Palaeolithic juvenile Neanderthal, which shows a pattern of exclusive breastfeeding for seven months, followed by seven months of supplementation. After this point, Ba levels in enamel returned to baseline prenatal levels, indicating an abrupt cessation of breastfeeding at 1.2 years of age. Integration of Ba spatial distributions and histological mapping of tooth formation enables novel studies of the evolution of human life history, dietary ontogeny in wild primates, and human health investigations through accurate reconstructions of breastfeeding history.

Societal perceptions and lived experience: Infant feeding practices in premodern Japan.

OBJECTIVES: A change in how children were treated and valued occurred in premodern Japan, as popularized ideas of an inheritance-based family system led to more careful and affectionate child-rearing practices by lower social-status groups. A number of books were written, advising that breastfeeding should last approximately 3 years. The objective of this study is to reconstruct and compare breastfeeding and weaning practices before and after the transition, to illuminate the impact of documented changes in child-rearing practices on subadults' lived experience. MATERIALS AND METHODS: Carbon and nitrogen stable isotopic data were obtained from 40 subadult skeletons excavated from the Sakai Kango Toshi 871 (SKT871) site (late 17th-19th century, Osaka, Japan). Isotopic results from SKT871 were compared with previously reported results from the Hitotsubashi site (AD 1657-1683, Tokyo, Japan). Hitotsubashi and SKT871 represent urban populations of lower status before and after the transition of societal perception of subadults. RESULTS: The most probable age at the end of weaning reconstructed in SKT871 was 1.9 years (1.4-2.7 years with a 95% credible interval) and was lower than that in Hitotsubashi (2.1-4.1 years with a 95% credible interval). DISCUSSION: The age at the end of weaning became younger after the transition of societal perception toward subadults, and this younger weaning age is inconsistent with written recommendations for the duration of weaning in premodern Japan. It is possible that an increased need for inheritors under the inheritance-based family system led to earlier weaning and shorter inter-birth intervals, but authorities recommended an ideal practice of a longer breastfeeding period.

Let's talk about stress, baby! Infant-feeding practices and stress in the ancient Atacama desert, Northern Chile.

AIMS AND OBJECTIVES: The transition to an agricultural economy is often presumed to involve an increase in female fertility related to changes in weaning practice. In particular, the availability of staple crops as complementary foods is hypothesized to allow earlier weaning in agricultural populations. In this study, our primary aim is to explore whether this model fits the agricultural transition in the Atacama Desert using incremental isotopic analysis. A secondary aim of this study is to identify isotopic patterns relating to weaning, and assess how these may be differentiated from those relating to early life stress. MATERIALS AND METHODS: We use incremental isotopic analysis of dentine to examine changes in δ15 N and δ13 C values from infancy and childhood in sites of the Arica region (n = 30). We compare individuals from pre-agricultural and agricultural phases to establish isotopic patterns and relate these patterns to maternal diet, weaning trajectory and physiological stress. RESULTS: We find that there is no evidence for systematic temporal or geographic variation in incremental isotopic results. Instead, results from all time periods are highly variable, with weaning completed between 1.5 and 3.5 years. Characteristics of the incremental profiles indicate that both in utero and postnatal stress were a common part of the infant experience in the Atacama. DISCUSSION: In the Atacama Desert it appears that the arrival of agricultural crops did not result in uniform shifts in weaning behavior. Instead, infant and child diet seems to have been dictated by the broad-spectrum diets of the mothers, perhaps as a way of mitigating the stresses of the harsh desert environment.

Breastfeeding, weaning, and dietary practices during the Western Zhou Dynasty (1122-771 BC) at Boyangcheng, Anhui Province, China.

OBJECTIVES: Here we investigate breastfeeding and weaning practices and adult dietary habits at the Western Zhou Dynasty (1122-771 BC) site of Boyangcheng () located in Anhui Province, China. In addition, we utilize the differences in bone collagen turnover rates between rib and long bones from the same individual to examine past life histories, such as changes in diet or residence. MATERIALS AND METHODS: Bone collagen from both the rib and long bones (either femora or humeri) of 42 individuals was measured for stable isotope ratios of carbon (δ13 C) and nitrogen (δ15 N). In addition, δ13 C and δ15 N values are reported for 35 animals (dogs, cows, horses, pigs, and deer). RESULTS: The human δ13 C values range from -20.7‰ to -12.0‰ with a mean value of -18.8 ± 1.6‰. The human δ15 N values range from 9.1‰ to 13.4‰ with a mean value of 10.9 ± 1.0‰. The animals display a wide range of δ13 C (-21.5‰ to -8.2‰; -15.8 ± 4.5‰) and δ15 N values (4.0‰ to 9.5‰; 6.5 ± 1.8‰). CONCLUSIONS: The adult δ13 C and δ15 N results indicate that mixed C3 (rice) and C4 (millet) terrestrial diets with varying levels of animal protein (mostly pigs and deer) were consumed. The elevated subadult δ15 N results return to adult levels by approximately 3-4 years of age, indicating that the weaning process was completed during this period. Individuals between 2 and 10 years old, with lower δ13 C and δ15 N results than the adult mean, possibly consumed more plant-based diets, and this is consistent with Chinese medical teachings ∼1500 years later during the Tang Dynasty (AD 618-907). The isotopic offsets between the ribs and long bones revealed that five adults experienced dramatic dietary shifts in their later lives, switching from predominately C3 /C4 to C3 diets. This research provides the first isotopic information about ancient Chinese breastfeeding and weaning practices and establishes a foundation for future studies to examine diachronic trends.

Weaning practices among pastoralists: New evidence of infant feeding patterns from Bronze Age Eurasia.

OBJECTIVES: This paper investigates infant feeding practices through stable carbon (δ13 C) and nitrogen (δ15 N) isotopic analyses of human bone collagen from Kamennyi Ambar 5, a Middle Bronze Age cemetery located in central Eurasia. The results presented are unique for the time period and region, as few cemeteries have been excavated to reveal a demographic cross-section of the population. Studies of weaning among pastoral societies are infrequent and this research adds to our knowledge of the timing, potential supplementary foods, and cessation of breastfeeding practices. MATERIALS AND METHODS: Samples were collected from 41 subadults (<15 years) and 27 adults (15+ years). Isotopic reference sets from adult humans as well as faunal remains were utilized as these form the primary and complementary foods fed to infants. RESULTS: Slight shifts in δ13 C and δ15 N values revealed that weaning was a multi-stage process (breastfeeding, weaning, and complete cessation of nursing) that began at 6 months of age, occurred over several years of early childhood, and was completed by 4 years of age. DISCUSSION: Our results indicate that weaning was a multi-stage process that was unique among late prehistoric pastoralist groups in Eurasia that were dependent on milk products as a supplementary food. Our discussion centers on supporting this hypothesis with modern information on central and east Eurasian herding societies including the age at which complementary foods are introduced, the types of complementary foods, and the timing of the cessation of breastfeeding. Integral to this work is the nature of pastoral economies and their dependence on animal products, the impact of complementary foods on nutrition and health, and how milk processing may have affected nutrition content and digestibility of foods. This research on Eurasian pastoralists provides insights into the complexities of weaning among prehistoric pastoral societies as well as the potential for different complementary foods to be incorporated into infant diets in the past.

Infant feeding practices and childhood diet at Apollonia Pontica: Isotopic and dental evidence.

OBJECTIVE: This study analyzes deciduous dental pathology and stable isotopes to investigate the relationship between diet, feeding practices, and oral health in a subadult skeletal sample from the Greek colonial site of Apollonia Pontica, Bulgaria (mid-5th to mid-3rd Centuries BC). METHODS: Stable carbon and nitrogen isotope analysis was conducted on 74 bone collagen samples, and the deciduous dentitions of 85 individuals aged 8.5 months to 11 years were examined for evidence of caries, calculus, antemortem tooth loss, abscesses, and occlusal tooth wear. RESULTS: δ(13) C and δ(15) N values of the collagen samples indicate that weaning began between the ages of 6 months and 1 year, and was complete for most individuals by the age of 3. The isotopic data are consistent with a mixed diet of primarily terrestrial C3 resources. The dental pathology data indicate that complementary foods provided to young children had an impact on their oral health early on. Four outliers exhibited elevated δ(15) N values compared with the adult female range and lower levels of tooth wear than other members of their age groups. Possible explanations include prolonged breastfeeding, the consumption of diets elevated in (15) N, and physiological/nutritional stress. CONCLUSIONS: The deciduous dental data correlate well with the isotopic data and are consistent with later textual sources regarding the timing and duration of weaning, and the composition of complementary foods. The results of this research demonstrate the value of combining isotopic and dental evidence to investigate the dietary practices of infants and young children and the impact of these practices on oral health.

[The Changing Value of Mother's Milk. Feeding Premature and Sick Newborns Since the Late 19th Century]. / Wie wertvoll ist Muttermilch? Die Ernährung Früh- und Neugeborener seit dem ausgehenden 19. Jahrhundert.

In the 1960s/early 70s there was a widespread conviction in West Germany that mother's milk was no longer essential even for premature infants given the availability of improved industrial milk products. But today the superiority of human milk is again undisputed, and progress in neonatology has created a growing target group of extremely premature infants who show clear benefits from being fed with human milk, particularly regarding improved outcomes. Currently there is a revival of donor milk banks (FMB). Globally there are around 500, 15 in Germany. Until the 1960s, mother's milk was the preferred means of German pediatricians to counter infant mortality. During the German Empire and the Weimar Republic doctors widely recommended nursing and engaged wet nurses to meet the demand for human milk and the first donor milk banks were set up; during the Nazi regime there were dozens. The GDR continued using donor milk, while FRG milk banks were shut down in the 70s. The history of milk banks has been shaped not only by science, but also by culture, politics and economics. In the German Empire and the Weimar Republic, social, national and eugenic considerations became intertwined in the struggle against infant mortality. In Nazi Germany human milk was used to strengthen the "German Volksgemeinschaft" ("community of the German people"), particularly individuals who were considered as "erbgesund" ("hereditarily healthy"). Massive advertising of the baby food industry in the West and public debate about pollutants and HIV/AIDS increased doubts about the advantages of natural feeding. In East Germany the planned economy, state health system and censored media significantly contributed to the survival of milk banks.

Selection criteria for wet-nurses: Ancient recommendations that survived across time.

This article will describe the content of the key criteria for the selection of wet nurses that persisted across time and the authors who transmitted this advice. Where relevant, it will include variations, such as additional recommendations or a different weighting being given to one or other criterion by a particular author. The focus is on the selection of a wet nurse for the employer's baby. The factors that led a woman to enter this employment and the consequences for her own baby will not be addressed here as they will be discussed elsewhere. The article is an historical one, drawing on primary sources, where possible, and important secondary sources. Guidelines for the selection of wet-nurses have existed from antiquity to the early 20th century. The key recommendations managed to survive across the centuries because they were considered useful by influential ancient and Early Modern and later authors who passed them on through copying and translations. It is tempting to assume that the prescriptive advice was followed by physicians and mothers. However, the discussion will raise doubts about whether the criteria were adhered to by physicians and parents, particularly when wet nurses were in scarce supply.

From royal wet nurses to Facebook: The evolution of breastmilk sharing.

Wet-nursing was an essential practice that allowed for infant survival after many mothers died in childbirth. The story of wet-nursing is complicated by both religious pressures and cultural expectations of women. It is likely that these historical practices have shaped our current social, political and legislative environments regarding breastfeeding. The aim of this article is to provide a historical perspective on the practice of wet-nursing, with a focus on: 1) social views of wet nurses, 2) breastmilk evaluation and 3) the ideal wet nurse. Historical perspectives from Ancient Egypt, Ancient Greece and Rome, 19th and 20th century America and current practices are examined. An appreciation for the evolution of breastmilk sharing provides clinicians and lactation advocates with the historical origins which provided the template for current practice as it relates to donor milk, breastfeeding culture and relevant legislation.

Weaning age in an expanding population: stable carbon and nitrogen isotope analysis of infant feeding practices in the Okhotsk culture (5th-13th centuries AD) in Northern Japan.

OBJECTIVE: The Okhotsk people were sedentary hunter-gatherer-fishers who lived and prospered in Sakhalin, Hokkaido, and the Kurile Islands during the 5th to 13th centuries AD. They expanded rapidly along the northeastern coast of Hokkaido. We reconstructed infant feeding practices of the Moyoro population of the Okhotsk culture in eastern Hokkaido, Japan. METHODS: Stable isotope ratios in 58 subadult human skeletons were measured. RESULTS: The results suggest that complementary foods with a relatively low carbon isotope ratio were consumed during and after weaning, as observed in ethnographic descriptions of northern human populations such as the Ainu and isotopically suggested in ancient northern hunter-gatherer-fisher populations. Nitrogen isotope ratios of subadults showed that the age at the end of weaning in the Moyoro population was 1.8 (1.4-2.2 in 95% credible interval) years, which is earlier than that in other northern hunter-gatherer-fisher populations. CONCLUSIONS: Because weaning age is one of the most important determinants of fertility, a shorter breastfeeding period suggests increased fertility. Furthermore, better nutrition would further promote the population increase, and thus populations of the Okhotsk culture could expand into new regions. These findings are consistent with recent emerging evidence of great contributions of the Okhotsk to the formation of later Ainu populations and culture.

Oxygen isotope analysis of human bone phosphate evidences weaning age in archaeological populations.

Here we report bone phosphate oxygen (δ(18)Op) values from perinates/neonates and infants (<3.5 years; n = 32); children (4-12 years; n = 12); unsexed juveniles (16-18 years; n = 2); and adult bones (n = 17) from Wharram Percy, North Yorkshire, England, in order to explore the potential of this method to investigate patterns of past breastfeeding and weaning. In prior studies, δ(15)N and δ(13)C analyses of bone collagen have been utilized to explore weaning age in this large and well-studied assemblage, rendering this material highly appropriate for the testing and development of this alternative method targeting the inorganic phase of bone. Data produced reveal (18)O-enrichment in the youngest perinatal/neonatal and infant samples, and an association between age and bone δ(18)Op (and previously-published δ(15)N values), with high values in both these isotope systems likely due to breastfeeding. After the age of 2-3 years, δ(18)Op values are lower, and all children between the ages of 4 and 12, along with the vast majority of sub-adults and adults sampled (aged 16 to >50 years), have δ(18)Op values consistent with the consumption of local modern drinking water. The implications of this study for the reconstruction of weaning practices in archaeological populations are discussed, including variations observed with bone δ(15)Ncoll and δ(18)Op co-analysis and the influence of culturally-modified drinking water and seasonality. The use of this method to explore human mobility and palaeoclimatic conditions are also discussed with reference to the data presented.

Urban and rural infant-feeding practices and health in early medieval Central Europe (9th-10th Century, Czech Republic).

In the Central European context, the 9th and 10th centuries are well known for rapid cultural and societal changes concerning the development of the economic and political structures of states as well as the adoption of Christianity. A bioarchaeological study based on a subadult skeletal series was conducted to tackle the impact of these changes on infant and young child feeding practices and, consequently, their health in both urban and rural populations. Data on growth and frequency of nonspecific stress indicators of a subadult group aged 0-6 years were analyzed. A subsample of 41 individuals was selected for nitrogen and carbon isotope analyses, applying an intra-individual sampling strategy (bone vs. tooth). The isotopic results attest to a mosaic of food behaviors. In the urban sample, some children may have been weaned during their second year of life, while some others may have still been consuming breast milk substantially up to 4-5 years of age. By contrast, data from the rural sample show more homogeneity, with a gradual cessation of breastfeeding starting after the age of 2 years. Several factors are suggested which may have been responsible for applied weaning strategies. There is no evidence that observed weaning strategies affected the level of biological stress which the urban subadult population had to face compared with the rural subadult population.

Milk demystified by chemistry.

This article traces the decline of milk from a heavenly elixir to a tradeable food. Early cultures regarded milk not as a simple nutrient, but a living fluid. Heroes and gods were believed to have been nurtured by animals after being abandoned. Character traits were assumed to be transmitted by milk; infantile diseases were attributed to "bad milk", whereas "good milk" was used as a remedy. With chemical methods developed at the end of the 18th century, it became known that human milk was higher in sugar and lower in protein than cow's milk. During the 19th century, "scientific" feeding emerged that meant modifying cow's milk to imitate the proportion of nutrients in human milk. In Boston from 1893, Rotch initiated the "percentage" method, requiring a physician's prescription. In Paris from 1894, Budin sterilized bottled infant milk. In Berlin in 1898, Rubner measured oxygen and energy uptake by calorimetry, prompting feeding by calories, and Czerny introduced regulated feeding by the clock. These activities ignored the emotional dimension of infant nutrition and the anti-infective properties of human milk. They may have also enhanced the decline in breastfeeding, which reached an all-time low in 1971. Milk's demystification made artificial nutrition safer, but paved the way for commercially produced infant formula.

Diets, stress, and disease in the Etruscan society: Isotope analysis and infantile skeletal palaeopathology from Pontecagnano (Campania, southern Italy, 730-580 BCE).

Susceptibility to morbidity and mortality is increased in early life, yet proactive measures, such as breastfeeding and weaning practices, can be taken through specific investments from parents and wider society. The extent to which such biosocialcultural investment was achieved within 1st millennium BCE Etruscan society, of whom little written sources are available, is unkown. This research investigates life histories in non-adults and adults from Pontecagnano (southern Italy, 730-580 BCE) in order to track cross-sectional and longitudinal breastfeeding and weaning patterns and to characterize the diet more broadly. Stable carbon and nitrogen isotope analysis of incrementally-sampled deciduous and permanent dentine (n = 15), bulk bone collagen (n = 38), and tooth enamel bioapatite (n = 21) reveal the diet was largely based on C3 staple crops with marginal contributions of animal protein. Millet was found to play a role for maternal diet and trajectories of breastfeeding and feeding for some infants and children at the site. The combination of multiple isotope systems and tissues demonstrates exclusive breastfeeding was pursued until 0.6 years, followed by progressive introduction of proteanocius supplementary foods during weaning that lasted between approximately 0.7 and 2.6 years. The combination of biochemical data with macroscopic skeletal lesions of infantile metabolic diseases and physiological stress markers showed high δ15Ndentine in the months prior to death consistent with the isotopic pattern of opposing covariance.

Epidemiology and public health in 1906 England: Arthur Newsholme's methodological innovation to study breastfeeding and fatal diarrhea.

In 1906 Arthur Newsholme linked artificial feeding and fatal diarrhea in infants aged one year and younger on the basis of two independent sources of information: mortality registration and a three-year (1903-1905) census of infants from Brighton, United Kingdom. Artificial feeding was more common in the infants who had died (89.3%) than in those in the survey (22.3%). However, boldly assuming the two data sources were nested, Newsholme computed the risks of fatal diarrhea: these were 48 times greater for infants fed fresh cow's milk and 94 times greater for those fed condensed milk than for infants who were exclusively breastfed. This mode of computing risks and risk ratios before the invention of the cohort study design was more innovative than was the usual investigation techniques of his contemporary epidemiologists. Newsholme's conclusions were consistent with the current knowledge that breastfeeding protects against fatal diarrhea.

Weaning at Anglo-Saxon Raunds: Implications for changing breastfeeding practice in Britain over two millennia.

This study investigated stable-isotope ratio evidence of weaning for the late Anglo-Saxon population of Raunds Furnells, Northamptonshire, UK. δ(15)N and δ(13)C values in rib collagen were obtained for individuals of different ages to assess the weaning age of infants within the population. A peak in δ(15) N values at about 2-year-old, followed by a decline in δ(15) N values until age three, indicates a change in diet at that age. This change in nitrogen isotope ratios corresponds with the mortality profile from the site, as well as with archaeological and documentary evidence on attitudes towards juveniles in the Anglo-Saxon period. The pattern of δ(13) C values was less clear. Comparison of the predicted age of weaning to published data from sites dating from the Iron Age to the 19th century in Britain reveals a pattern of changing weaning practices over time, with increasingly earlier commencement and shorter periods of complementary feeding in more recent periods. Such a change has implications for the interpretation of socioeconomic changes during this period of British history, since earlier weaning is associated with decreased birth spacing, and could thus have contributed to population growth.

Stable isotope ratio analysis of breastfeeding and weaning practices of children from medieval Fishergate House York, UK.

Rib collagen of 51 juveniles and 11 adult females from the late medieval Fishergate House cemetery site (York, UK) were analyzed using nitrogen and carbon stable isotope ratio analysis to determine the weaning age for this population and to reconstruct diet. The juveniles' ages ranged from fetal to 5-6 years, while the females were of reproductive age. Previous researchers suggested that the children from Fishergate House might have been weaned later than the medieval British norm of 2 years, based on a mortality peak at 4-6 years of age. The results show weaning was complete by 2 years of age, agreeing with previous British weaning studies. The adult female δ(15) N values have a mean of 11.4‰ ± 1.1‰ and the δ(13) C values have a mean of -19.4‰ ± 0.4‰. These findings are consistent with previous isotopic studies of female diet in York during this period, though slightly lower. The weaned juvenile nitrogen values were found to be higher than the adult females (12.4‰ ± 1.0‰ for δ(15) N and -19.7‰ ± 0.5‰ for δ(13) C), which might indicate a dependence on higher trophic level proteins such as marine fish or pork. Marine fish is considered a high status food and children are considered low-status individuals at this time, making this a particularly interesting finding. Weaning does not appear to coincide with peak mortality, suggesting environment factors may be playing a larger role in child mortality at Fishergate House.