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36
INFANTILE MORTALITY
Infant Mortality of any given locality is measured by relating
the number of deaths of children under one year of age recorded
during the year to the number of live births registered for that
particular area during the same period.
Bad housing, overcrowding, poor sanitation, low standards of
education, illegitimacy, all tend to produce higher infant mortality
rates. It follows therefore that the infant mortality rate should
provide a reasonably accurate indication of the social circumstances
of any 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 and only a long term
appraisal is likely to reflect the true position.
It is generally agreed that there is a direct relationship between
foetal loss and the amount of ante natal care received. Some 60
years or so ago in the early 1900's there were no cyetic examinations
at all and even when examinations were introduced at about 1909
they were carried out for ascertainment of presentation and detection
of albumin only. Undoubtedly the introduction of regular ante
natal examination and subsequent treatment will rank as one of
the greater achievements of preventive medicine of this century.
Nevertheless, despite the introduction of these services and
the great advances in chemotherapeutics and diagnostic techniques
and notwithstanding the amount of research directed towards
elucidating the causes of infant mortality, there still remains the
refactory core of perinatal deaths for, in this brief period of life,
there are as many deaths as will occur during the next 40 years
among the survivors.
This is not to say, however, that substantial improvements
have not been achieved. On the contrary; in 1901 the infant
mortality rate in Greenwich was 130 per 1,000 live births, the
actual number of children dying before reaching the age of 1 year
being 362. Comparable figures for the current year are 19.21 and
28. But although there has been a real reduction in the total number
of infant deaths the neo-natal deaths in recent years have not
decreased pro-rata. For example, in 1946 the neo-natal deaths, i.e.
those infants dying within four weeks of birth, represented 59.3
per cent of all infant deaths under 1 year, whereas in 1964 the figure