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4
Births
There was an increase in the birth rate for 1958, and it is now above that of England and Wales.
Deaths
There was a slight increase in the death rate for 1958, and it appears to be becoming stabilised at
about 10 per 1,000. a little below that of England and Wales, which is about 12 per 1,000. The causes of
death are shown in Table 1.
Infant mortality
The infant mortality rate rose from 17 to 22 per thousand, but it remained slightly below the infant
death rate for England and Wales (23 per thousand). The stillbirth rate, however, fell from 21 to 17 per
thousand: nevertheless there was a slight rise in the perinatal rate (table 2).
Sixty-nine infants under one year died in Willesden in 1958, 53 died in the first month and 49 of
these within the first three days.
By wards and social class
The worst wards, Carlton, Kilburn and Kensal Rise, showed a high rate of infant mortality of about
30 (table 3) which was three times as high as that in the best wards of Brentwater and Brondesbury Park.
Improvement of social conditions could certainly reduce the mortality in the worst wards to equal
that of the best.
The number of infant deaths by social class indicates in the same way the influence of environment on
mortality. There was only one infant death recorded in classes I and II (table 4).
Causes of death
Prematurity, the greatest single factor in neonatal mortality, increased. Twenty-five of the neonatal
deaths (47 per cent) occurred in premature babies associated with atelectasis in seven. There is evidence that
poverty plays an important part in producing prematurity.
The percentage of premature births is the highest in the worst wards (table 7). Four premature births
were associated with placenta praevia and one with toxaemia.
Congenital malformations caused the death of 12 babies (17 per cent of the total infant deaths.)
(Table 8.) No antenatal cause for these malformations could be discovered, and there was no history of virus
disease or pelvic irradiation during pregnancy. Much more research is needed to deal with this problem.
Respiratory, diarrhoea, enteritis and other infections. Respiratory infection caused all the deaths
(only three were neonatal) except one, where Sonne dysentery was a contributing factor. No child died from
gastro-enteritis (table 5).
Most of these deaths could have been prevented by improved social conditions ; overcrowding was
mainly responsible.
Four babies were not under the sole care of their own mother; two had been with a foster mother
and one had been well until she was placed with a daily-minder. They suffered from acute virulent infections
where antibiotics have no effect; two of them developed capillary bronchitis and bronchopneumonia due to
inhaled vomit.
Other causes. Ninety per cent of these deaths occurred in the neonatal period; 41 per cent due to
atelectasis associated with prematurity (table 5). Three babies died of blood incompatability despite good
antenatal supervision. One baby died because of neglect at birth; there was no doctor or midwife present.
There was only one death associated with eclampsia or toxaemia of pregnancy.
Conclusions
General improvement in living standards would certainly reduce infant mortality still further. Overcrowding
is one of the most important factors producing respiratory infections. Research into the causes of
prematurity, stillbirths and congenital malformations is still required.
GENERAL PROVISION OF HEALTH SERVICES
Public Health Laboratory Service (Table 9)
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.
Specimens delivered by doctors to the Health Department, the Health Clinics (or the branch laboratories
in Neasden Hospital) are collected and taken to the Central Public Health Laboratory. A report by
telephone is given to the doctor next morning followed by a written report.
Samples of milk, ice cream, and water are sent by Public Health Inspectors.
The two Grade 4 ice cream samples were manufactured in the borough from a cold mix. The
methods of manufacture were investigated and suggestions were made for improvement. Three subsequent
samples were Grade 1.