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by alien races who are propagating themselves faster than we are,
and as in monetary affairs this can only be done in two ways, by
increasing our income or birth rate and decreasing our expenditure
or loss of population by premature death. Unfortunately, as
regards the first there is a general tendency for the birth rate in all
civilized countries to decrease steadily, and while an endeavour
should be made to check this, we, as a sanitary authority, are
more concerned with decreasing the waste of human life. Up
to the present we have succeeded very well in preserving the lives
over one year of age, but, unfortunately, the death rate of the first
year of life shows little evidence of the permanent fall which has
occurred in the later age periods. There are three periods in which
a large wastage is taking place which I will call (1) The ante-natal
period, (2) the natal period, and (3) the post-natal period. In the
ante-natal period, which comprises the 40 weeks before birth, it is
estimated that 150 infants die out of every 1,000, which includes 120
foetal deaths, i.e., deaths during the first 27 weeks of pregnancy
when the child, if born, is incapable of a separate existence, and 30
stillbirths, i.e., infants dying in the last 12 weeks of pregnancy when,
had they been born alive, they would have had a chance of surviving
to adult life. In Bermondsey, with its total of 3,800 births, this
means an annual loss of about 570 potential lives. The post-natal
period for our purposes will comprise the infant life up to the end
of the first 12 months. Deaths occurring during the last period are
generally spoken of as ' Infantile Mortality,' and are calculated as
so many occurring to every 1,000 births. Thus, the infantile mortality
of 1914, in London, was 104, and in Bermondsey 129, a total
annual loss for this Borough of 487 infants in the first year of life.
If now we add to this figure the estimated ante-natal and natal loss
of 570 we get a total annual wastage of potential and actual infant
life of over 1,000. This figure might well be considerably increased
if the loss of life through the fall of the birth rate, which I have
omitted, were taken into account. The causes of this wastage are
general classed as maternal and foetal. Maternal causes may be
constitutional, such as venereal disease, kidney disease, diabetes and
acute fevers, or they may be local, such as uterine tumour or disease,
pelvic deformities and the like. Other causes may be termed
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