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10
Annual Report of the London County Council, 1914.

It will be seen that while in 1911 the death-rate from premature birth among the illegitimate
both in London, and in England and Wales was below that from atrophy, etc., in 1913 the portion is
reversed. There may be other causes at work to account for this change, but on the face of it, the greater
facilities for medical attendance which the provision of maternity benefit has afforded to mothers since
the National Insurance Act came into force in July, 1912, must be largely in question.
These, it may be said, are comparatively minor considerations, and, in fact, all the difficulties are
fully explained, provided regard is paid to changing fashion in nomenclature. But there are more
important questions, For example, why, it may be asked, does a comparison of Diagrams C and D show,
first, a more or less steady decline throughout a period of some sixty years in the general death rate in
contrast with second, a much more recent, although rather more rapid, decline in the infant mortality rate.
The great improvement of environmental conditions brought about during the last half-century, it might
perhaps be suggested, has steadily and continuously influenced the general death rate, but this factor
has only begun to take effect upon the infant mortality in the last ten or fifteen years. There have
not been wanting those who have claimed that it was the absence of special attention directed to mothers
and babies until the end of the nineteenth century, and its effect upon being introduced during the
present century, which have been mainly responsible for the initial tardy and the later more rapid
decrease in the infant mortality. Without venturing to dispute that there is some justification
for this claim, it may be held that other and perhaps even more potent influences must also have been
at work. The steady improvement of hygienic conditions during the last half-century has, among other
factors, clearly resulted in the upgrowth of a generation of persons of child-bearing age, which compares
favourably in many respects, and particularly in respect of showing a lessened mortality from disease,
with the two or three preceding generations. It might, perhaps, be inferred, therefore, that the children
of living persons of child-bearing age should now in their turn manifest the cumulative effect of this
process of amelioration; and this process might, perhaps, be expected to display in full measure its
influence upon later generations only after time has been allowed for earlier generations to attain to
child-bearing ages. The fact that the phenomenon of recent decline in infant mortality is widespread
and not peculiar to London, or even England and Wales, suggests that its explanation must be looked
for not in some merely local cause, but in some such general cause as is here suggested, and one which
may be expected to be operative over a wide area. The effect of migration upon change in the social
status and physical characteristics (including resistance to disease) of the present-day parents, as
compared with the parents of fifty years ago, which has been already referred to, p. 6, must also
be regarded as having some influence upon infant mortality.
The decline in the rate of that mortality has, then, in part resulted from the definite though
apparently somewhat deferred effect of improvement of conditions of environment, and in part also
it has resulted from interchange between London and the country generally of certain elements of population;
to this latter factor, perhaps, almost as much importance should be attached as to the
former.
Under the Notification of Births Act, 1907, the London County Council receives particulars
of the births which have been notified to the medical officers of health of the several sanitary