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4
Births
There was a slight increase in the birth rate for 1956, and it appears to be becoming stabilised at about
15 per 1,000, a little below that of England and Wales.
Deaths
There was a slight increase in the death rate for 1956, and it appears to be becoming stabilised
at about 10 per 1,000, a little below that of England and Wales, which is about 11 per 1,000. The causes of
death are shown in Table 1.
Infant Mortality
The infant mortality for 1956 was slightly above that for 1955 but still below that for England and
Wales (table 2).
(a) By Wards
A much lower figure was attained in the better wards, but in the worst wards (Kensal Rise and Kilburn)
it was more than three times as high as Manor, the best ward; Carlton, Stonebridge, Roundwood and
Willesden Green also show high rates. It is clear that an improvement in the social conditions in these wards
would help to reduce the mortality (table 3).
(b) By Social Class
The number of deaths by social class gives a further illustration of the effects of environment on infant
mortality (table 4).
The greatest reduction in infant mortality in the past few years has been for infants aged 1-12 months.
The neonatal period (0-1 month) now accounts for more than two-thirds of the total infant mortality (table 5).
An even better picture is obtained if one considers the perinatal mortality which includes stillbirths
and deaths occurring during the first week of life, the causes for which are similar. The perinatal mortality
for 1956 was slightly less than that for last year (table 2).
Causes of death
A further substantial reduction in infant mortality could be made if causes of prematurity and of congenital
malformations could be eliminated.
(a) Prematurity
Prematurity is a major cause of infant death contributing 20% to the total; and it was associated
with atelectasis as a cause of death in another 15% (tables 6, 7).
Premature babies have a relatively high death rate; ten percent. of the premature infants died during
the first week of life; in addition half the stillbirths were premature.
The causes of prematurity are not fully understood, but unsatisfactory living conditions, pood maternal
health and illegitimacy accounted for some, and complications of pregnancy (maternal toxaemia, placenta
praevia and birth injury) for some of the others (table 8).
(b) Congenital malformations (table 9).
Most of the deaths from this cause occurred in the neonatal period. Now that there has been a
general reduction in infant mortality there has been a proportionate increase in the number who die from congenital
malformations. Preventive measures are taken to remove one of the causes of congenital malformation :
arrangements are made to prevent expectant mothers, especially in the first three months of pregnancy,
coming in contact with cases of German measles and other virus infections.
(c) Respiratory, diarrhoea and enteritis, and other infections
In the past years there has been a general reduction in the number of deaths from infections, but
there are still a few preventable deaths most of which come from the lower Social Classes (table 10). With
better health education, maternal care, and living conditions many of these deaths could have been prevented.
(d) Other causes
Ninety per cent. of the deaths classified under other causes occurred in the neonatal period, and lifty
per cent. of these were attributed to atelectasis, most of them associated with prematurity.
1 infant died from accidental suffocation in a pillow. The health visitors are continually giving
advice on how to avoid such unfortunate incidents.
Conclusions
There is no doubt that a general improvement in living standards and better maternal care would help
to reduce infant mortality still further, but more research is still required in the causes of congenital malformations
and prematurity.
GENERAL PROVISION OF HEALTH SERVICES
Public Health Laboratory Service (see table 11)
Bacteriological specimens (swabs from sore throats, faeces from intestinal infections, cough plates
and post-nasal swabs from whooping cough cases, etc.) are examined by the Public Health Laboratory Service
at the Central Public Health Laboratory, Colindale, and at the branch laboratory in Neasden Hospital.