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38
was 82.1 per cent. Early neo-natal deaths, similarly calculated, are
55.9 and 71.4 per cent respectively.
In my Report for last year, I gave a full resume of the various
agencies which were influencing perinatal mortality as disclosed
by the survey of perinatal mortality instituted by the National Baby
Trust Fund. In general, these covered the relationship of age, social
class, parity, bad obstetric histories, previous abortions, number of
premature and still births, postmaturity, etc., and the varying effects
that the institutional and domiciliary maternity and midwifery
services had on the perinatal deaths.
It is becoming clear that methods which brought about the
spectacular successes of recent years in reducing the sum total of
all infant deaths under 1 year will not prove so effective in achieving
a lowering of the neo-natal and perinatal deaths. Indeed, investigations
reveal that hazards to infant life no longer arise as a result of
malnutrition or infectious diseases but mainly from prematurity,
congenital malformations and inherited metabolic disease.
In previous reports I indicated that human variation is due to
genetic or environmental difference or a combination of both and,
of necessity, the main emphasis of control has been on the "nurture"
aspect. As a direct result of the concentration by Medical Officers
of Health and their staffs on the environmental and personal health
services there has been a perceptible increase in the average life
span. In this respect it would appear that such avenues have been
almost fully explored and the time has now come for greater efforts
to be made in the sphere of "nature". This approach, viz. the field
of genetics, is likely to prove most rewarding.
It has been claimed, with some justification, that dominant
mutant genes, inter alia, lead to disabilities such as achondroplasia,
familial polyposis, Huntington's chorea, and recessive mutant genes
to fibrocystic disease of the pancreas, phenylketonuria and galactosaemia
while haemophilia, diabetes insipidus and a type of muscular
dystrophy are attributed to sex-linked recessive mutant genes. Moreover,
recent research has pointed to a genetic predisposition in
certain common illnesses such as diabetes mellitus, gastric and
duodenal ulcers, rheumatic fever, mental retardation and some
forms of insanity and epilepsy.
Genetics, in relation to common disorders, are extremely
complex and difficult to unravel but there is no doubt that a number
of diseases and malformations are genetically determined. We have
already become familiar with the detection and treatment of
haemolytic disease of the newborn, an inherited complication
involving the Rh factor in the blood. Conditions resulting from
chromosomal abnormalities such as mongolism and the syndromes