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pneumonia) 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 33.8 per 1,000 related
births. It is, indeed, remarkable that of the 12 Erith babies
on whom the infant mortality rate is based, no less than 8
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 improvement in the infant
mortality rate depends 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 21 as against 17 in 1956 and 18 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 carcinogenic substances
in tobacco and I believe that some progress is being made in
this respect. Further research is also required into the causes
of heavy cigarette smoking. I have given a number of talks
on this subject to senior schoolchildren in a neighbouring
district and have been impressed by the grasp shown by
mem 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 in point of time tended to reduce
its impact for, to a boy or girl of 15, to talk of what may