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44
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 20.27 and 73. 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.
During the current year, 68.5% of all infant deaths occurred
during the neonatal period, indicating a somewhat disconcerting
proportional increase of 1.6% since 1948. Early neonatal deaths,
i.e. those taking place during the first week of birth, when similarly
calculated, are equally disturbing, the percentage rising from 54.2
to 57.5.
My previous Reports have indicated the relationship existing
between age, social class, parity, bad obstetric history, previous
abortions, premature and still births, postmaturity, etc., and perinatal
mortality and the effects which institutional and domiciliary
maternity and midwifery services have had on its reduction. However,
it is becoming increasingly obvious that methods which brought
about such spectacular successes in reducing infant mortality in
previous years will not suffice to subjugate the seemingly intractable
problems of perinatal deaths.
Whilst not discarding former effective procedures we must be
alive to the fact that these early deaths arise mainly from prematurity,
congenital malformation, inherited metabolic disease and
the possible teratogenic effects in early pregnancy of virus infections,
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 confinement
is another but congenital malformations, however, present us with
much more substantial obstacles as do the inherited metabolic
diseases. It seems evident that until human cytogenetics has
advanced sufficiently to resolve more of the hidden problems of