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must of course be taken only as an approximate estimate, in the
sense that they are the predisposing causes in the etiology of
infantile mortality, as in many instances the causes are numerous
and the conditions existing complex. But, on the whole, I think
that in the Limehouse District, the above figures are a fair index
of their relative importance. The least important undoubtedly
in this district are Illegitimacy and Insurance. This is fortunate
for us, as they are also factors which could be least influenced
by an efficient Sanitary Authority. The second condition, overlaying,
is more important and almost as difficult to suggest in
what direction legislation is needed. I can only suggest that it
be made compulsory that an infant of a certain age should not
sleep with the parents, but have a separate cot by the side of the
bed, even it be only an old box, which can be made comfortable.
As is only natural in a district such as this, Poverty is an
important question. Its dimensions are too vast to be touched
on in a Report of this nature. I have been Medical Officer of
Health for too short a time to express an opinion as to whether
or no an improvement has taken place in this respect. It would
be idle to expect legislation to abolish poverty.
If mothers must go out and work, some institutions, such as
the Creche in Stepney Causeway, might be established, where
the infants could be left and looked after during the day whilst
the mother is at work. Such institutions would be of undoubted
benefit for such mothers as are compelled to go out and work.
The question of unhealthy surroundings is to a great extent
intimately bound up with the question of Poverty. Useful
legislation has been enacted in respect to various trades in
centres of population. To carry reforms in this direction very
much further brings with it the risk of unnecessarily crippling
useful and indispensable manufactures.
To what extent legislation ought to be undertaken in respect
of Hereditary Diseases is a vexed and much-debated subject.
It is beset with many difficulties, and the prospect of legislation
is remote. For instance, from the standpoint of public health,
a law to prevent consumptive patients from marrying would be
an excellent step towards the eradication of Tubercular disease;
but any legislation that so interferes with the liberty of the
subject would hardly be tolerated in England at present.