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important contribution to human welfare, and points the way to the
urgent need for even greater effort in this vital field. An even more
welcome feature of the infant mortality figures is a drop in the neonatal
rate, i.e., deaths of children in the first month of life. It is
now generally agreed that most progress can be expected during these
four vital weeks, when the influence of ante-natal care and home
conditions are exerting their maximum effect. It is here that the
value of mothercraft makes itself apparent; indeed, at no other
time does the mother exert such an enormous influence on the child.
Now that admissions to hospital for confinements are more than ever
restricted, and early discharge from hospital an accepted procedure,
this home influence gains added weight. When we remember the
conditions under which mothers are having their babies at home,
and under which children are being reared during the first few weeks
of life, the importance of home environment takes on an even more
significant pattern. Ante-natal care in Southgate can justly be
claimed to be of a high standard; the standard of midwifery is
equally good. A glance at the numbers of mothers attending our
clinics shows that this aspect of our work is also satisfactory. When,
however, we consider the amount of time being devoted by our
Health Visitors to visits in the home, especially just after confinement
has taken place, the picture is by no means so happy. We should be
able to reduce the number of children dying in the first four weeks of
life still further than has been possible in the past, but to do this we
must provide a home visiting service on a much more generous scale
than has yet been practicable.
Every life lost during the first twelve months is a tragedy; in
approximately 50 per cent, of cases an avoidable tragedy. And that
is only the beginning of the story. We know perfectly well that
many children survive the first twelve months of life, only to be
left with unfortunate sequelae which cloud and stultifythe remainder
•of their existence. It is just as important that these tragedies
should be avoided, as that we should save actual life. Any other
criterion would be quite illogical. The practical minimum to which
the infantile mortality rate can be reduced is said to be in the
neighbourhood of twenty per thousand, but we should not rest
content to achieve this figure. Zero may be a Utopian dream, but
who, fifty years ago, would have contemplated a reduction in infant
mortality approaching the figure to which we are so accustomed
to-day ? Our present difficulties are many, yet we must not allow
that fact to discourage our efforts. We have won great triumphs in
the past few decades; there is no reason why greater triumphs should
not lie ahead. Practically, our most immediate methods of approach
to the problem would appear to lie:
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