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of infant mortality where the emphasis has shifted 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
This 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 figures that the perinatal
mortality during 1957 was 43 4 per 1,000 related births It is,
indeed, remarkable that of the 17 Crayford babies on whom the
infant mortality rate is based, no less than 12 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 15 as against 12 in 1956 and 10 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 newlygained
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 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
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