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8
priorities for expectant and nursing mothers which has ensured a
sufficiency of special types of foods, has been the main cause of the
average higher state of nutrition in expectant mothers as a group, and
this in its turn has caused part of the decline in the stillbirth rate.
Maternal mortality is also influenced, but to a much lesser extent, by the
nutrition of the mother and it probably has been more greatly influenced
by advances in treatment of maternal infections. This rate too has
shown a very considerable decrease over the years. It was 3.9 per
thousand births in 1901, it had a maximum of 5.2 per thousand in 1929,
while in 1947 it had dropped to 1.0 and in 1948 to 0.46.
What then of the future ? These rates can be still further improved.
There is no reason why maternal mortality should not be almost zero.
At the moment there is no such hope of reducing infant mortality to
zero, mainly because there will be for some considerable time a number
of developmental defects in the baby which we are unable to treat before
birth. On the other hand, advances have been made, and are still being
made ; it is only in recent years that it has been noticed that there is a
correlation between certain congenital defects in the baby and an
infection of the mother during early pregnancy. Thus, certain defects
in the development of the eyes of the baby can be correlated with the infection
of german measles in the pregnant woman at a time when the
baby is undergoing particularly rapid development. It may be that
other similar reasons for developmental defects in the baby will come to
light and by preventing the infection of the mother or by other ways,
including therapeutic abortion, it will be possible to prevent a baby
from being born maimed for life.
Table 4 on page 14 gives a detailed analysis of the causes of death
in the 120 babies who died during the year. The first seven causes of
death, accounting for 38 of the 120 cases (or nearly one-third), are in
theory preventable and to these can be added certain other causes shown
in the table. Even at present therefore it could be said that the infant
mortality rate might be halved, i.e., brought down to about 14 per
thousand, but it is doubtful if in the present state of medical knowledge
it could be brought down further. Such low rates have in fact been
approached in different countries, and Iceland in 1947 had a rate of
only 22 per thousand; the New Zealand rate was 27. Little is known
of the figure to which stillbirths might be reduced but it is certainly less
than the present 15 per thousand and may be, in our present state of
knowledge, about 10 per thousand, thus giving a reproductive wastage
rate of say 14 plus 10, or 24 per thousand. Then there is a whole field
of effort in preventing deaths of children from 1 to 5, of which 28 died
last year. In other words there are goals which should be attainable
in the fairly near future, and it will be interesting to see how quickly
the very large health authority now responsible for maternity and
child welfare services in London reaches them. Meanwhile, the Council
can, on looking back, be reasonably satisfied with the results obtained;
they will also have in mind that the maternity and child welfare staff,
particularly the health visitors, were also factors in the improvements.