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5
the summer. The death-rate among infants under one year of age per thousand
born in 1922 was 75, as compared with 81 in 1921 and 76 in 1920. In the following
table the deaths per 1,000 births from the principal causes of infant mortality
are shown for 1922 and preceding periods:—
Cause of Death.
1911.
to
1914.
1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922.
Measles 3.40 4.81 1.74 4.92 3.89 0.67 2.02 0.57 3.30
Whooping-cough 3.63 4.72 3.54 2.51 7.02 0.87 2.89 2.34 3.92
Influenza 0.27 0.31 0.16 0.27 3.65 1.38 0.46 0.26 1.12
Tuberculosis—-
*Pulmonary 0.57 056 0.38 0.81 0.51 0.34 0.35 0.26 0.33
Other 2.83 2.92 2.43 3.07 2.14 1.32 1.17 1.19 1.10
Bronchitis 6.41 7.60 5.29 6.96 7.02 5.10 5.65 2.89 4.05
Pneumonia 12.28 16.10 11.69 15.28 16.78 10.25 12.62 11.54 16.00
Diarrhoea 24.28 20.82 13.89 16.03 13.67 14.75 8.98 18.63 6.26
Premature birth 18.16 17.60 16.40 17.22 18.47 20.42 15.32 16.17 16.10
Congenital defects 14.69 15.18 13.86 15.22 14.39 12.70 11.53 11.53 9.30
All causes 108 112 89 104 108 85 76 81 75
*Including acute miliary tuberculosis.
The chief cause contributing to the low infant mortality of the last four years,
compared with the four years 1911-1914, is the reduced mortality from diarrhoea
and enteritis, but apart from this considerable decrease is shown in the deaths from
congenital defects, premature birth, bronchitis and measles. The period 1919-1922
includes two epidemics of influenza, otherwise no doubt the decrease in bronchitis
would have been larger, and pneumonia would also have declined. The deaths
from premature birth and congenital defects show a remarkable fall in mortality
in the past three years; such deaths are not in any large measure governed by
extremes of summer or winter temperature, as are diarrhceal and respiratory
deaths, and their reduction points to some other factors. The gradual replacement
of the unqualified midwife by nurses with special training, the grant of maternity
benefit, and the increasing amount of concern shown for the expectant and nursing
mother, especially in more recent times, in maternity and child welfare centres,
both municipal and private: these all play a part in the general reduction of infant
mortality, but more especially in the mortality attributed to congenital defects
and premature birth. There must certainly be added to them the decrease in
drunkenness, and the increased extent to which mothers are availing themselves
of institutions for confinement. In considering, however, the notable decline which
has taken place since the beginning of the present century the effect of the Elementary
Education Act of 1870, as has been pointed out in these reports, must not be lost
sight of.
On comparing the infant mortality rates for the period 1911-14 with 1919-22
in the metropolitan boroughs it is found that generally speaking the greatest decline
has taken place in the boroughs which in the earlier period had the highest mortality,
and these are also the boroughs in which the birth-rate in recent years has fallen most.
The boroughs in which improvement, relatively to London as a whole, is greatest
are Greenwich, Battersea and Poplar; while St. Pancras and Kensington have
lost place. With regard to the latter borough, the infant mortality is very high
considering the favourable position in respect of social condition prevailing in a
large portion of the borough. In 1921 the infant mortality of Kensington was only
exceeded by one London borough, namely, Shoreditch, and Dr. Fenton, in his
report for that year, gives an analysis of the incidence of the infant mortality from
respiratory and diarrhceal diseases showing that the high death-rate falls mainly
upon the occupants of dwellings in mews throughout the borough and of tenement
houses in North Kensington. The proportion of illegitimate births in the borough
is high, and, as the illegitimate mortality is more than double the legitimate, the
borough rate is further weighted by this circumstance.