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It will be noticed that in 1912, more than one-fourth of the deaths were due to premature birth
or congenital defects, that is to say to antenatal causes. Until the nature of these causes has
been determined, it is not likely that any considerable reduction will be effected in the number of
the deaths returned in each year under these two heads. Wasting diseases, bronchitis and
pneumonia together produced 102 deaths, or more than one-third of the total number, and here
there is no doubt scope for preventive work. Improper feeding through ignorance is not only
a cause of wasting, but also a frequent predisposing cause of the condition in which a child is
specially liable to be attacked by bronchitis or pneumonia with fatal results. Among the exciting
causes of the latter diseases may be mentioned insufficient and improper clothing, and exposure
to cold either in the home or out of doors.
Diarrhoea, which caused 32 deaths, is no doubt due in a certain proportion of cases to improper
feeding. In years marked by excessive heat during the summer months, when the deaths from
this cause in infants alone may exceed 120 as they did in 1911, the diarrhoea in the great majority
of cases should probably be regarded as a symptom of a specific infectious disease, which the
greatest care on the part of the mother may fail to prevent. The deaths from congenital venereal
disease (syphilis) amounted to 15, as compared with 7 deaths and 1 death from the same cause in
the years 1910-11. On the whole it seems probable that this increase is only apparent, and has
resulted from the entry of the true cause of death on the death certificate in place of the symptoms
of syphilis, such as debility or wasting to which deaths from congenital venereal disease appear to
have been ascribed in past years.
The Effect of Age.—In its bearing on the scope of preventive work, the age incidence
of death in infants is important. Of the total deaths 91 took place in the first week, and 132 or
more than one-third in the first three weeks of life. Premature birth and congenital defects
accounted for 74 or more than half of the deaths occurring at this early period. Thirty-two
children died of wasting or debility before the age of 14 days, and of this number a large proportion
were no doubt either born prematurely or with some constitutional or physical defect. The
conclusion suggested is that in the first three weeks of life close on 100 deaths occurred which
were not preventable, in the sense that they took place in defective children whom no ordinary care
could have saved. At this period, there were only 3 deaths from pneumonia and bronchitis and
cne death from diarrhcea. After the first month a large proportion of the deaths, which decline
steadily in number with advancing age, may be regarded as an unnecessary and avoidable loss to
the community. The dangers of weaning and artificial feeding are shown by the appearance of
13 deaths from diarrhoea in the age period 3—6 months, and of deaths from tuberculosis after the
fourth week, whilst the deaths from wasting must now be accepted as directly due to want of breast
milk and improper feeding, rather than to congenital debility. In regard to infectious disease, it
is interesting to note that infants in the first halt year are practically immune to measles, and
that all the nine deaths from this disease in infancy occurred after the age of six months.
Unfortunately the same cannot be said of whooping cough, which caused deaths from the age of
four weeks onwards. A detailed analysis of the deaths in infants according to age and cause will
be found in Table IV. in the Appendix.
Illegitimacy.—Sixty-five deaths occurred among illegitimate infants. The illegitimate births
numbered 182. The mortality among the illegitimate was accordingly equivalent to a rate of 357
deaths per 1,000 births, as compared with a rate of 79 among those born in wedlock. With the
lamentable exception of syphilis, which in proportion to the total numbers, caused four times as
many deaths among the illegitimate, there has been no striking difference between the two classes
in the incidence of the chief causes of death or in the incidence of death at various ages in the
first 12 months of life. If these somewhat unexpected results are not due to fallacies arising from
the inadequacy of the numbers under consideration, the inference suggested is that the preventable
deaths among the legitimate are due to disabilities of the same kind, if not of the same degree,
as those which lead to the death of the infants of single women. Thus the lot of a child which
is put out to be minded during the day by the grandmother or some other elderly woman is much
the same, whether the mother is obliged to go out by a lazy, drunken husband, or by the fact
that she has no husband to support her. In either case it is to be feared that the antiquated
methods of the grandmother cannot be regarded as an unimportant factor in the causation of excessive
infantile death-rates.
Occupation of Mother.—The subjoined Table shows the occupation of the mother and
other particulars recorded by the Health Visitors in their visits to the homes of infants who died
in 1912, and of infants who were notified in and survived to the end of the same year. No
particulars have been obtained in the case of infants in homes where the income presumably exceeds
40s. per week, as this class of home is not visited and illegitimate children have been excluded.