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26
particular area However, because approximately one third of all
infants dying in one year will be found to have been born in the
previous year, great care must be exercised when drawing conclusions
from any rise or fall in infant mortality rates, for such
rates are not comparable year by year unless the birth rates remain
more or less constant Further, it must be borne in mind that
as infant mortality has now reached relatively small proportions,
any slight deviation in the number of deaths tends to misleading
fluctuations in the rate
Although, during the last two or three decades, great advances
have been made in chemotherapeutics and in diagnostic techniques
which have resulted in startling reductions in infant mortality in
England and Wales, there is no cause for complacency for other
countries, namely, the Netherlands, New Zealand, Australia and
Sweden, all have infant mortality rates which are perceptibly lower
than our own
During the last 100 years there has been a fall in the infant
mortality rale from 150 per 1,000 to 216, the figure for 1962.
Encouraging though this picture might appear at first sight, it is
important to realise that such success as has been achieved in the
latter years has largely been confined to the reduction of deaths
occurring after the first month of life Deaths of infants during the
first week of life, which still account for some 60% of all infant
deaths, constitute a proportion which has remained more or less
constant for the past 20 years and it has become increasingly clear
that, for any further improvement to be made in the saving of
infant life, a change in emphasis would be necessary
It has long been recognised that, as man is the result of nature
and nurture, these are the main two aetiological factors to be
reckoned with in the prevention and control of disease In previous
years, Medical Officers of Health and their staffs have, of
necessity, concentrated chiefly on improving the environmental and
personal health services—the nurture aspect of the problem Indeed
to such good effect that there has been an appreciable increase in
the average life span and it has been estimated that, had the death
rates of the early 30's continued until today, some 380,000 people
now living would have died This hard won advantage has
enabled more effort to be devoted, in recent times, to the exploration
of other avenues likely to lead to an amelioration of the infant
mortality problem—the nature aspect
Nevertheless, despite a great deal of research which has been
directed towards elucidating the causes of infant mortality and
the adoption of various methods for its reduction, the crux of the
problem, viz perinatal mortality, remains refractory It is evident,