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4
Births
There was an increase in the birth rate for 1957, and it is now a little above that of England and
Wales.
Deaths
There was a slight decrease in the death rate for 1957, 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 1957 was less than that for England and Wales and for the previous year
(Table 2). Compared with before the war the lives of at least one hundred babies are saved annually.
A much lower figure was attained in the better wards; the rates in the three worst wards,
Kilburn, Kensal Rise and Roundwood, were more than double those of the three best wards, Brentwater,
Brondesbury Park and Church End. Improvements in the social conditions in the worst wards would
help to reduce the mortality (Table 3).
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 4).
An even better picture for comparison 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 1957 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 malformation could be eliminated.
(a) Prematurity
There has been a marked decline in the number of deaths from prematurity (Table 5), but it still
contributed 10% to the total and with atelectasis was associated as a cause of death in another 17% (Table
4): it also was responsible for half the stillbirths.
The causes of prematurity are not fully understood, but unsatisfactory living conditions, poor
maternal health and illegitimacy accounted for some, and complications of pregnancy (maternal toxaemia,
placenta praevia and birth injury) for some of the others.
There were many more premature births in the worst wards than in the best wards (Table 6).
(b) Congenital malformations (Tables 4 and 7)
There were fewer deaths from congenital malformations. There is still a proportionately high
number who die from this cause because of the further reduction in the general infant mortality.
Radioactivity in the form of ingestion of radioactive dust or exposure to excessive X-rays are thought
to contribute to the development of malformations. Preventive measures are taken to remove another cause
of congenital malformation: arrangements are made to reduce the contact made by expectant mothers in
the first three months of pregnancy 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 marked 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 8). Overcrowding
is responsible for most of the infant deaths from respiratory infections.
One infant, not immunised, died of whooping cough; this illustrates the need for all children to be
immunised against whooping cough as well as diphtheria as early as possible.
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
50% of these were attributable to atelectasis, most of them associated with prematurity.
One infant died from inhalation of vomit. The health visitors are continually giving advice on
how to avoid such unfortunate incidents. One infant died from neglect at birth and was found in the street
unidentified.
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. The National Birthday Trust Fund are conducting a survey into the causes
of perinatal mortality.