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45
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 refractory 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 the area now known as the London Borough of Greenwich was
130 per 1,000 live births, the actual number of children dying before
reaching the age of 1 year being 818. Comparable figures for the
current year are 18.30 and 68. But although there has been a real
reduction in the total number of infant deaths the neonatal deaths
in recent years have not decreased pro-rata. For example, in 1948
(the year in which the transfer of all M. & C.W. services to the L.C.C.
took place) the sum total of all infant deaths amounted to 118.
During the current year, a figure of 68 was returned showing a
reduction of over 42% during the period. Neonatal deaths however,
which, in 1948, represented 66.9% of all infant deaths, now form
63.2% of the total, indicating only a very slight improvement. Early
neonatal deaths, similarly calculated, are even less impressive, the
percentage actually rising from 54.2 to 56.0 respectively.
In my Report for last year, I intimated 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 stillbirths, 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 neonatal 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, inherited metabolic disease and the
possible teratogenic effects in early pregnancy of radiation and
certain modern drugs.
Minimal use of certain drugs and X-rays during the first
trimester of pregnancy is one obvious step towards reducing infant
mortality and closer medical supervision of the mother prior to