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This substantial reduction reflects the national trend (the rate
for England and Wales being 21.6 and that for London 21.5) and
serves to emphasize the inestimable value of the preventive health
services which, together with advances in chemotherapeutics and
in diagnostic techniques, has brought about such a remarkable
transformation. Today, generally speaking, hazards to infant life
come not from malnutrition nor infectious disease but arise mainly
from prematurity, congenital malformation and inherited metabolic
disease. Nevertheless, medical research has enabled the damaging
effects of disabilities such as phenylketonuria, diabetes and haemolytic
disease of the newborn to be assessed and has pointed the
way to their control if not elimination. Surgery has also played its
part in overcoming a number of abnormalities present at birth
thus assisting many infants with congenital defects to attain a
maturity and expectation of life once thought impossible.
However gratifying this picture may appear there is certainly
no room for complacency for infant mortality in England and
Wales is still continuing at a higher rate than in many foreign and
Commonwealth countries. For instance, in the Netherlands the
infant mortality rate is only 16 per 1,000 live births and in
Australia, New Zealand and Sweden the figures are 20, 19 and 16
respectively.
Infants who die before reaching the age of one month and
more especially, those who die in the first week of life form
the crux of the problem in that, although there has been a real
reduotion in the total number of infant deaths, the neo-natal
deaths have not decreased pro rata. This point is amply demonstrated
in the following graph which clearly shows that, in this
Borough, the total of neo-natal deaths, when given as a percentage
of the total infant deaths, is higher now than it was in 1946.
In a recent study of perinatal mortality involving approximately
4,500 cases, it was found, as expected, that developmental difficulties
formed the under-lying cause of still and neonatal births which
resulted in congenital malformations or incomplete development,
viz. prematurity or immaturity but that, happily, modern techniques
have helped to reduce infant deaths arising from difficulties of
labour.