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The conclusion to be drawn from the figures given is that the proportion of mothers with
histories of previous abnormal pregnancies is four times greater among those whose children die
of prematurity (class B) than it is among those whose children survive (class A). The same relative
excess is also shown by the class B mothers in the higher proportion of previous premature and still
births to total pregnancies.
It would thus appear that a considerable proportion of the large number of deaths from
premature birth which occur every year tend to be supplied by a certain section of mothers who
aie exceptionally prone to abnormal pregnancies rather than by the generality of mothers in the
population at large. Should this conclusion be confirmed by subsequent investigations, the facts
would be compatible with the assumption which is sometimes made that death from prematurity
selects the infants of a certain section of mothers who endeavour to limit their families by the use
of drugs for the purpose of preventing conception or producing miscarriage.
The nigher proportion of premature births ending in death which occur in the later pregnancies,
that is to say after the fifth, lends support to the same assumption, but the number available are
ooviously too small to justify even a tentative conclusion as to the true cause of premature birth.
Wasting Diseases.—During the year 53 deaths were attributed to wasting diseases, and
of this number eight occurred in children who were born prematurely. Five further deaths occurred
in infants less than three days old, making a total of 13 deaths which may be fairly attributed to
ante-natal causes. Seven deaths occurred in children who were twins and born weakly. Nine of
the children v\ ho died were illegitimate. The mother of one infant was feeble-minded and had borne
five illegitimate children. The death of another child is attributed by the health visitor to gross
neglect. 1 he mother in this case has borne six illegitimate children, and is described as well
known to the Inspector for the National Society for the Prevention of Cruelty to Children. The
social status of the infants who succumb to wasting diseases is indicated by the fact that 22 died,
whilst 14 were also born, in the Infirmary.
Illegitimate Births.—During the year the births of 172 children were registered as
illegitimate and of this number 52 died. The death-rate expressed as the number of deaths per
1,000 illegitimate births thus amounted to 302 as compared with an infantile death-rate of 135
among the infant population as a whole. In view of the disabilities imposed by society on these
unfortunate children and their mothers an even higher death-rate might have been expected. For
a certain number of illegitimate children, satisfactory provision is made by rescue workers, but for
the majority the Council's Health Visitors are unable to obtain the assistance that would be
necessary to bring about a material reduction in the illegitimate death-rate.
Still-Births.—The infants notified during the year as still born numbered 87, but this number
is not included in the total births or deaths from which the annual rates for the Borough have been
calculated. Information could only be obtained in regard to 46 out of the total number of stillbirths
notified. Five were noted as illegitimate, six were born dead from six twin pregnancies,
and six were born in wedlock of mothers employed in laundry work. Three mothers earned their
living as charwomen and 25 were ascertained to have followed no occupation during pregnancy.
Nine children were born from the first or second pregnancy, 15 from the sixth or some later conception
and 13 from intermediate pregnancies. The fact should perhaps be recorded that in six cases
the father of the child was occupied as a painter. In one of these instances the father had had
several attacks of lead poisoning. In another the mother whose husband was a painter had been
pregnant five times, all the pregnancies ended in still-birth, two at term and three at the end of the
seventh month.
PREVENTION OF INFANTILE MORTALITY.
Notification of Births Act, 1907.—The information supplied under this Act, which has
now been adopted throughout London, constitutes the starting point of the work of the Health
Visitors. The Act requires all births to be notified within 36 hours to the Medical Officer of Health
of the district in which they occur. During the year 3,223 births were registered as belonging to
the Borough, and of this number 2,825 or 88 per cent. have been notified in accordance with the
requirements of the Act. With the addition of 87 infants who were notified as still-born, the total
number of births notified during the year amounted to 2,912.
Work of the Health Visitors.—The two Health Visitors appointed by the Council have
been to the homes of 1,766 newly-born infants and have paid 5,302 visits or re-visits during the
}ear. The first visit is as far as may be possible timed to take place between the 10th and 20th
day after the birth of the child and if the midwife or doctor in charge of the case has ceased