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9
a whole, is a pleasing statistical fact to all those active in the
field of preventive medicine. In the last twenty years in
Bromley the infant mortality rate from a five yearly average
has fallen from 44 per 1,000 live births to 28. In my first annual
report to you, when the infant mortality rate was 57 per 1,000
births, I stated that " no less than 50 per cent, of the baby deaths
occurring were during the first month of life, 26 per cent, of
baby deaths were under one week of age, and if we are to save
a needless waste of life, intensive ante-natal work is essential."
"We know that an infantile mortality rate of 30 is not an unachievable
objective." Let us take, after twenty years, these
two statements and compare with conditions as they exist today.
Taking the last first, the objective has been attained, and
in fact has been in some years surpassed : but the first remains
much as it was, and this in spite of intensive ante-natal work
and efficient midwifery service. The rate of deaths under one
week of age has remained very much the same, while there has
been an actual increase in the percentage dying in the first
month of life It means that the present saving of life operates
after the second week of life—a period of the life of a baby when
it comes into active association with the child welfare services.
These are statistical facts applicable not only to Bromley but
to the whole country. Is there anything the matter with the
maternity services, the care of the mother during pregnancy,
the care of the mother and baby during confinement? The
reduction in maternal mortality is proof that the midwifery
service has improved and the provision for her care during the
critical period at least adequate and complete. It follows,
therefore, that it is mainly during the pregnancy that we fail.
Is the mother adequately nourished, or what is it that devitalizes
the unborn baby or interferes with a natural function of child
bearing? Under our present state of knowledge there is no
direct panacea to our troubles. Everything is done for the
mother who shows evidence of abnormality during pregnancy,
and until we know the actual causes of the accidents of pregnancy,
or prematurity and of stillbirths, we shall not be able
to reduce the stillbirth rate, or baby mortality in the first week
of life. A post-mortem on all such deaths might bring to light
something unknown to us at present.