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from the main causes of death during the first year of life
(which at one time were gastro-enteritis and bronchopneumonia)
to deaths during the neo-natal period (the first
four weeks of life, the commonest causes of death being
congenital malformations and prematurity) and, latterly, to
the perinatal period in which the deaths during the first
week of life are studied alongside with stillbirths. The latter
highlights the combined effects of toxaemia of pregnancy
and prematurity and, in a few cases, obstetrical difficulties
and it will be seen on analysis of the Table on page 20 that
the perinatal mortality during 1957 was 36.8 per 1,000 related
births. It is, indeed, remarkable that of the 27 Bexley babies
on whom the infant mortality rate is based, no less than 22
died within the first week of life. It is clear that a closer
study needs, now, to be made of the causes of toxaemia
and of the significance of maternal infections in early pregnancy
(particularly german measles and, possibly, other virus
diseases as well) in relation both to prematurity and congenital
malformations. The fall in deaths during the perinatal
period has not kept pace over the past 25 years with
the fall in infant mortality generally and further improvements
in the infant mortality rate depend on further research
on these lines as well as on the maintenance of satisfactory
conditions of living and levels of child care generally.
The number of deaths from cancer of the lung during
1957 was 40 as against 28 in 1956 and 48 in 1955. The fact
that there is an association between smoking and cancer of
the lung has received very wide publicity and is now. I
think, accepted by most reasonable people. There is no
evidence, however, that this has had much effect on the
smoking habits of people in general although one does meet
individuals, here and there, who have given up cigarette
smoking as a direct result of this newly-gained knowledge.
It appears that the general attitude among the majority of
smokers is a fatalistic acceptance of the risk; which can only
mean that the smoking habit may fulfil a deep physical and
psychological need in the stressful world in which we live.
It is good to learn, therefore, that attempts are being made,
by selective cultivation of particular varieties of tobacco
leaf and by other means, to reduce the amount of carcinogenic
substances in tobacco and I believe that some progress
is being made in this respect. I have given a number of
talks on this subject to senior schoolchildren and have been
impressed by the grasp shown by them in regard to the
hazard of lung cancer in relation to smoking. Nevertheless,
although they received the information in a responsible way,
one could not help feeling that the remoteness of the risk
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