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It will be noticed that in 1913, more than one-fifth 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 124 deaths, or more than one-third of the total number, and here
there is no doubt scope for preventive work. Sixty-two deaths were due to diarrhœa or enteritis,
diseases to which further reference will be made under the heading of " Epidemic Diarrhœa."
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 81 took place in the first week, and 124 or
more than one-third in the first four weeks of life. Premature birth and congenital defects
accounted for 61 or half the deaths occurring at this early period. Fifteen 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.
Alt this period, there were only 6 deaths from pneumonia and bronchitis and four deaths from
diarrhoea. 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 27 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 diseases, it is
interesting to note that infants in the first half year are practically immune to measles, and that all
the 17 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 three 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.—Fifty-six deaths occurred among illegitimate infants. The illegitimate
births numbered 163. The mortality among the illegitimate was accordingly equivalent to a rate
of 344 deaths per 1,000 births, as compared with a rate of 99 among those born in wedlock.
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 1913, 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.
A comparison of the percentages shown in the Table suggests that the death-rate is distinctly
greater amongst the infants of mothers engaged in laundry work and other occupations, than it
is amongst the infants of married women whose work is confined to the performance of household
duties. These results are consistent with those obtained in former years.
Artificial Feeding.—On the grounds that congenital debility is the predominating cause
of death in the newly born, 68 infants who died before the age of seven days have been excluded
from the figures in the Table that relate to methods of feeding. The records which were made
of 181 deaths between the ages of 7 days and 12 months, show that 45 per cent. occurred in
infants who were being artificially fed before the onset of their fatal illness, whereas the records
of previous years suggest that less than 35 per cent. of the total infant population are
artificially fed in the same age period. The fact that the artificially fed contribute more than
their share to the total number of infant deaths is established, and for this reason it has not been
considered necessary to make an annual census of their numbers at several age periods. The
firs visit is made between the ages of 10 and 20 days, and it is to this period that the records
of the feeding of children who survived to the end of the year 1913 relate. They show that
94 per cent. were still being fed on the breast alone in their second or third week of life, but
cannot be used for the purpose of comparison with the records of the deaths of infants at later
ages.