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however, that, today, hazards to infant life no longer arise as a
result of malnutrition or infectious disease, but mainly from prematurity,
congenital malformations and inherited metabolic
diseases
The science of genetics appears to be one approach likely to
provide part of the solution to a reduction in infant mortality for
certainly a number of diseases are known to follow the Mendelian
laws of inheritance and, although most of these are comparatively
rare, as a result of the study of human chromosomes it is now
possible to predict the possibility of their occurrence in other
members of the same family For example, in mongolism, a
chromosomal abnormality, it is already possible to distinguish
families with a high risk from others and advice can be given
accordingly
Except for the reproductive cells, each human cell contains
within its nucleus 23 pairs of chromosomes and it has been estimated
that each chromosome carries about 1,000 parental genes
Each gene has the ability to convey special and specific instructions
in relation to body metabolism and structure and, when one
considers the 50,000 genes involved with their inherent possible
permutations and combinations, it can easily be seen how man's
infinite variety arises But it is also apparent that the slightest
aberration in the alignment of genes at fertilisation can give rise
to abnormalities in the embryo, some of which are likely to be of
extreme importance in perinatal mortality
Recent developments in medical genetics may enable us not
only to assess the prospects of inherited biochemical disorders such
as galactosaemia and phenylketonuria and to institute treatment
before irreversible changes occur, but also to anticipate and counter
genetically conveyed susceptibility to drugs Full practical application
of the knowledge gained in this field is likely to be delayed
due to a shortage of persons skilled in chromosome studies for it
is thought that, in one year, a single technician could hardly be
expected to handle more than 100 cases
However, substantial progress has been made in detecting and
treating haemolytic disease of the newborn, an important cause of
perinatal mortality Statistics show that of every 1,000 births occurring
in England and Wales, 6 will be affected by haemolytic disease
due to Rh incompatibility, of which, one will be stillborn It has
been suggested in a recent memorandum from the Standing Medical
Advisory Committee that much can be achieved in these cases for,
if properly treated, the mature child has a 95% chance of survival
Early and adequate antenatal attention can go a very long way
in reducing deaths from this cause.