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39
of Klinefelter and Turner have long been recognised, but only since
1956 has it been possible to verify their aetiologies for it was then
that methods evolved by cytologists enabled chromosomes to be
accurately counted and examined. By this one advance alone, the
cause of an appreciable proportion of mental defect and male
sterility has been explained and it is now possible to distinguish
from among others, those families with a high risk of mongolism
and advice can be given accordingly. Clarification of intra
embryonic mortality and congenital deformity may well be the
result of further progress in chromosome studies.
It seems paradoxial, but the solving of these perinatal problems
will pose more difficult questions. Now that environmental causes
of illness and infection are, on the whole, being eliminated,
successful treatment of disabilities which are genetically determined
or partly genetically determined will, unless countered, result in
them becoming more numerous, for a greater number of children
will survive to pass on the adverse genetic predispositions. Furthermore,
with the change from natural to planned parenthood,
artificial selection is replacing natural selection, a situation which
engenders new moral issues and launches us into eugenics.
Fortunately, perhaps, it is the role of the preventive health
services to concentrate on the more immediate practical problems
of resisting the effects of inherited biochemical disorders and to
institute treatment before irreversible changes occur, and also to
anticipate and counter the genetically conveyed susceptibility to
drugs.
Infant mortality is a very pressing and human problem and
early and adequate ante natal attention can go a very long way in
reducing deaths in this category. Nevertheless, it must be recognised
that further substantial reduction in the infant death rate will be
attained only by the practical application of modern scientific
knowledge and society must face the complicated medical, social,
educational and religious problems inherent in such a policy.
The present infant mortality rate for the Borough, viz. 19.21,
represents an increase of 4.84 over that for the previous year
(which itself was the lowest ever recorded for Greenwich) but is
still 1.07 lower than the average for the last 10 years and compares
favourably with the rates for London and England and Wales
which were 21.2 and 20.0 respectively.
The following table shows the comparative Infantile Mortality
Rates for the year 1901 and the quinquennial periods since 1931,
together with the Rate for 1964:—