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It will be seen that the main causes of death in the first week
were prematurity, conditions incompatible with life and birth
injuries. All of the five birth injuries investigated were apparently
due to difficult labour.
Of the deaths that occurred between the first month and
the end of the first year of life there were two principle causes,
gastro enteritis and broncho pneumonia. Of the 10 children who
died of gastro enteritis only three were breast fed at the time of
their death. Sex sub-division shows little of interest except for
deaths in the first week where there was a preponderance of males.
Prematurity, gastro enteritis and bronchitis account for no less
than 40 of the 58 infantile deaths.
It is somewhat difficult to generalise as to the cause of prematurity.
It is probably associated with a way of life and possibly
with toxaemia or abnormalities of pregnancy, and I believe that
there is evidence to show that it diminishes as social amenities
improve. Gastro-enteritis and broncho-pneumonia are diseases
that should be preventable in babies. It is to the prevention of
the above three conditions that we must look for a reduction in
our infantile mortality to a level comparable with that obtained
in parts of American and the Scandinavian countries before the
War.
A low infantile mortality rate does not mean the survival
of the unfit. It means that the health of the children in a community
has been so improved in all directions as to enable its
youngest members, i.e., those most susceptible to disease to resist
infection or overcome it.
During July, Circular 2831 was received from the Ministry
of Health. It deals with the cleanliness and habits of children
under the age of five years, makes recommendations as to the
steps that might be taken to improve them where they are bad,
and asks that a reference to the subject be made in the Annual
Report of the Medical Officer of Health.
It will be remembered that a prior Circular on this matter
was issued in 1941 when an investigation was carried out by the
Health Visitors as to the condition of cleanliness in children under
five years in Enfield. This investigation had shown that there
were very few children in the district under five years of age whose
heads were infested with nits or vermin.
Upon receipt of Circular 2831, I called a meeting of the Assistant
Medical Officers and the Health Visitors to discuss the position
in Enfield and to take such steps as might appear desirable.
At this conference it was determined to see if we could