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universally adopted. The total number of infantile deaths in the Borough in 1903 was 657,
viz : —428, 179 and 50 for the sub-divisions of Bermondsey, Rotherhithe and St. Olave's, the
corresponding figures for 1902 being 678 for the whole Borough, and 455, 174 and 49 for its
divisions. This gives an infantile mortality of 156 for the Borough, the other figures being 153
Bermondsey, 160 Rotherhithe and 176 St. Olave's. It is very regrettable that while our mortality
is decreasing at all ages up to 60, our infantile mortality is practically at a standstill. It shows
that while hygiene has increased the well being of all classes and all ages, it has left
untouched the principal cause of mortality among infants. As pointed out in my report for 1901
the chief causes of infantile mortality are: —
1. Premature birth, congenital defects, and debility.
2. Hereditary tendencies. Under this head is included such diseases as syphillis,
and other diseases brought on by vice and drunkenness of the parents.
3. Neglect of mothers from carelessness or inexperience.
4. Employment of mothers in various industries both during pregnancy and
shortly after childbirth. In these cases the infants are generally left to the care of an
older daughter or a neighbour. They are improperly fed, generally on some unwholesome
farinaceous food instead of milk, and when the latter is given it is seldom boiled.
5. Insanitary and dirty surroundings, and overcrowding.
6. Improper food —fed on artificial foods generally instead of the natural food, viz.,
the breast.
7. By accident and negligence, such as suffocation in bed. This cause of death is
closely allied to drunkenness in the parents. Dr. Ogle found that these deaths
generally occurred on Saturday night, when drunkenness is most prevalent.
In my report for 1902 in commenting on the causes here mentioned the following statement
is further made : —
In commenting on this subject in last year's Report, I mentioned some seven
causes of infantile mortality. Some of the causes are much more important than
others, so much so that they might also be reduced to two, viz., improper feeding,
and insanitary surroundings, and of these two the first cause is the principal. The
more one considers the subject the more importance does improper feeding assume
in infantile mortality. In looking at Table IV. of Appendix it will be seen that in
deaths under one, year of age, gastro-intestinal diseases (including tubercular diseases)
and respiratory diseases account for the majority. But these do not quite represent
the true state of matters, for improper feeding, when not giving rise to distinct intestinal
disorders, undoubtedly paves the way for many of the deaths from respiratory and
other diseases by weakening and undermining the system, so that I am inclined to
give it a much more important role than a glance at this table would suggest.
Improper feeding is due mainly to poverty, ignorance and actual carelessness on the
part of parents with regard to the feeding of their infants. On making enquiries on this
matter I have been greatly struck by the want of knowledge among mothers respecting
the methods of infant feeding. Improper feeding takes two forms, and consists (1) of
not feeding children on their mother's milk, and (2) giving unsuitable artificial
food.
The principal cause of infantile mortality being then, in my opinion, due directly or
indirectly to gastro-intestinal disorders, it naturally follows that modern hygiene should be
directed to feeding of infants and the improvement of the natural food of infants—viz., milk.
This is a part of hygiene which is very sadly neglected in all our large towns, and could be
remedied by attention to our milk supply and systematic instructions to mothers on infant
feeding. The question of the milk supply is adverted to later. In the following table will be
found the figures relating to this subject:—
Table D.-Infantile Mortality.
Bermondsey.
Rotherhithe.
St. Olave.
Whole Borough.
London.
Year.
Rate per
1000 Births.
No. of
Deaths.
Rate per
1000 Births.
No. of
Deaths.
No. of
Deaths.
Rate per
1000 Births.
No. of
Deaths.
Rate per
1000 Births.
No. of
Deaths.
Rate per
1000 Births.
168
227
165
141
822
165
21,746
164
58
1893
537
1894
451
146
218
161
55
114
724
147
18,604
143
148
1895
520
162
193
88
205
801
162
22,013
165
159
1896
513
160
214
159
64
153
791
21,695
160
1897
605
190
219
174
67
154
891
183
21,106
158
158
21,931
1898
485
157
220
169
47
132
752
166
187
169
147
842
180
1899
574
215
53
22,129
166
120
185
1900
526
186
243
205
48
817
20,730
158
132
1901
497
170
215
176
42
754
169
19,412
148
149
156
1902
455
159
174
49
153
678
18,478
139
157
Average for
years
1893 to 1902.
516
168
214
167
57
145
787
20,784
166
1903
428
153
179
50
657
156
16,978
130
176
160
7