View report page

2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960
Returning to the subject of infant mortality, it can be said that the
increase in the deaths of infants over the previous year was mainly
due to a miscellany of abnormal conditions presenting no clear-cut
common factor or form. To this extent, they may be regarded as
fortuitous, due to the chance variations which, from year to year
are to be expected. More light on the general causes of infant deaths
is given by the Table on page 13 which breaks down the infant deaths
under age at death. It is traditional to distinguish between deaths in
the first month of life, usually known as the neonatal infant death
rate, and those arising in months two to twelve. In addition, it is a
useful exercise to distinguish between deaths in the first 24 hours of
life and deaths in the first week of life. These are shown in the Table.
It is well-recognised that deaths within the first four weeks of life and
even more so within the first week of life and still more so within the
first 24 hours of life, are most likely caused by factors operating
before or during birth on the expectant mother and the unborn child.
It is clear from the figures shown in the Table that those harmful
influences which are likely to have an adverse effect on the child's
life and well-being during the first year of life are now of less importance
than those influences which affect the expectant mother and
unborn child. This is borne out by a study of the causes of infant
deaths in Wandsworth for 1960, although, for statistical purposes,
they are a small sample. The conditions which are most likely to
cause death within the first four weeks of life, are congenital malformations
and ill-defined conditions such as prematurity, which
accounted for 35 of the neonatal deaths.
It follows that the next big advance in the reduction in the infant
mortality rate is to be achieved by an attack on those adverse factors
which affect the expectant mother and her unborn child. These factors
and how they act, are much less clearly defined and understood than
are the adverse influences acting on the infant during its first year of
life which, in the main, are associated with environmental and social
conditions. To determine what these adverse influences acting during
pregnancy are and how they are likely to give rise to prematurity and,
what is more important, how they can be overcome, is a complex
problem involving the complicated interplay of many factors including
genetic, obstetric, biochemical, environmental and social matters
and probably others even less clearly understood. These complexities
are to be unravelled only by research of the most advanced kind. I have
not mentioned the problem of still-births but it is likely that the
adverse factors which cause prematurity and death within the first
week also operate to cause still-births and the combined still-births
and deaths in the first month of life is usually referred to as the
perinatal mortality. A good deal of attention has been paid to this
problem of perinatal mortality over recent years and we in this area
have participated in a nation-wide investigation into these problems.
At the moment, the results are being collated and they are awaited
with considerable interest.