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48
brought about such spectacular successes in reducing infant mortality
in previous years will not suffice to subjugate the seemingly
intractable problems of perinatal deaths.
Almost 24% of infant deaths resulted from respiratory causes,
viz., acute tracheo bronchitis, respiratory distress syndrome and
bronchopneumonia. Pathogenesis is still obscure in respect of
tracheo bronchitis, often a cause of precipitate death in apparently
healthy infants, and also of respiratory distress syndrome and,
until their respective aetiologies have been firmly established,
therapy in respect of such cases will perforce, continue to be
largely supportive and confined to relief of symptoms.
Prematurity is by far the most common cause of infant mortality
and it may well be that, in many instances, the mere occurrence of
a premature birth is an indication of the existence of conditions, as
yet occult or perhaps not fully understood, which are not conducive
to the establishment of a viable infant.
Determination of the aetiology of prematurity and a greater
knowledge of human cytogenetics will undoubtedly lead to the
reduction of infant mortality to its minimum.
One aspect of the problem, however, is quite clear. It is a
fact that unmarried mothers still seek ante natal help much later
than their married counterparts and their children are more likely
to be born prematurely. Of all the deaths under 1 year of age
occurring in children of Borough residents during 1968, 17% were
in respect of illegitimate infants whose infant mortality rate was
almost double that of the legitimate rate. Even with the situation
as it now is, here is a field in which, with the concerted efforts of
voluntary and statutory bodies, some improvement should be
possible.
Congenital malformations, however, present us with much more
substantial obstacles as do the inherited metabolic diseases. Nevertheless,
some progress has been made within the last decade, for
genetically determined deviations arising from chromosomal aberrations
are becoming easier for the expert to recognise. Moreover,
familial patterns can be traced and the giving of advice and the
suggestion as to suitable action to be followed have now become
practicable propositions. Counselling of prospective parents at
"genetic clinics" where investigations could be instigated may be
viewed as a logical extension of local authority health services.
Registering a decrease of 2.94 from that calculated for 1967, the
present infant mortality rate for the Borough, viz., 17.33, compares
favourably with the rates of 18.3 and 18.6 returned for England
and Wales and Greater London respectively. Inner London
recorded a rate of 19.8.