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7
the personal health services, as under the National Health Service Act
these were transferred to the county council on 5 July, 1948. This
present report therefore, as far as maternity and child welfare statistics
go, deals in the main with those up to 5 July, but it quotes various
statistics for the full year because the borough council must be held
responsible in large measure for the rest of the period since there must
be a time lag of several months or even a year or more before the effects
of the new regime will be reflected in statistics. Since, therefore, this is
the last report which will deal in detail with any maternity and child
welfare work it is perhaps not out of place to make one or two general
comments. As an illustration I am including a graph (page 10) which
indicates the infant mortality rate in the borough since the year 1901.
Infant mortality means the deaths of live-born infants up to the age
of one year. It does not cover those who are born dead — those for
whom the mother and the family have undergone all the preparation for
a birth which has not come to a successful conclusion. These are
the stillbirths, which, by definition, include any child born dead after
the 28th week of pregnancy. Stillbirths were not separately notified
until the late '20's and statistics were not available in this borough until
1930 onwards. The stillbirth rate since 1930 has been added to the chart
by means of outlined figures superimposed on the corresponding infant
mortality rates, and the two together may be regarded as the reproductive
wastage rate. The reproductive wastage rate in fact shows the number
of late pregnancies per thousand live births which do not result in the
birth of a child who lives beyond the age of one year. It includes therefore,
the number of stillbirths and the number of babies dying in the
first year of life. It should also strictly include the number of abortions
but as these are not notifiable and as the vast majority occur within the
first month or two of pregnancy they may be regarded as of less account
than children dying any time between the sixth month of pregnancy
and the end of the first year of life.
There are several points of interest in the chart. First, the considerable
reduction in the infant mortality rate since 1901. This
reduction, from 128 to 28, is rather less than that which some areas are
able to claim, mainly, I think, because Lewisham was an open, relatively
uncrowded borough for many years before the war and therefore started
to the left of the graph with a lower figure than occurred in many other
areas. Nevertheless the drop in the rate of deaths of infants has been
quite noteworthy. Even more spectacular, though not so well appreciated
by the public, is the drop in the stillbirth rate. This rate reached
39.4 per thousand births in 1937 and last year it was only 14.8. The
factors in the stillbirth rate are numerous and complex, but it is probable
that nutrition of the mother is the most important. Nutrition in itself is
a complex factor, but good food and varied food insofar as the main
classes of foodstuffs are concerned is perhaps the most important of
the sub-factors. I am quite certain that the general system of rationing
which has occurred from 1939 onwards and has ensured fair distribution
of all essential foods, combined with the special system of rationing