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(c) Overcrowding.—Less number of persons to the acre may have been
a factor. During the years 1901-1921 the population of the Borough decreased
by nearly 50,000.
(d) Clean milk and dried milk.—Milk is certainly less contaminated than
it used to be. The shops and the milk receptables are cleaner than formerly.
Milk is no longer sold in shops where coal and paraffin, etc., are also sold
which was the case until 1909. Previous to that year paraffin and other
objectionable materials were sold, in 420 registered milk-shops, and in 42 of
them coal was sold as well. They were either struck off the register, or they
gave up the sale of coal and paraffin, and improved the condition of the
premises generally.
Dried milk undoubtedly plays an important part in the reduction of
infantile mortality, especially with regard to summer diarrhoea. Dried milk
is recommended and distributed at the infant welfare centres during the hot
weather, because it not only provides a nourishing food, but is in a form
which limits the probabilities of pollution in homes which have unsatisfactory
means of storage. The free supply of dried milk and of fresh milk have been
a great factor in the reduction of the mortality during the last few years.
(e) Ante-natal inspection may have some influence on the infantile
mortality, but it has more effect in reducing the maternal mortality.
(f) Decrease of alcoholic intemperance has been a beneficial factor. The
restricted hours in the opening of public-houses have no doubt had an effect
in reducing the harmful effects resulting from the domestic neglect due to
alcoholic over-indulgence.
(g) Climatic conditions.—The effect of a hot summer used to be considered
the greatest factor in causing a high infantile mortality by causing
epidemics of summer diarrhoea. The summer of 1921 was very hot and dry,
and yet the infantile mortality was only 89 per 1,000 births. The year 1921
was hotter and drier than in the previous years, and resembled 1911 in this
respect, when the infantile mortality was 149 per 1,000.
(h) Reduction in the birth-rate.—It is considered by many authorities
that the reduction in the birth-rate causes a reduction in the infantile mortality.
In our Borough there has been a great reduction in the birth-rate in all districts,
with the exception of the Limehouse district, where the birth-rate has
been nearly stationary, and is only slightly lower than it was 25 years ago,
whereas in St. George's and Whitechapel it is less than one-half what it was
then. Yet the reduction in the infantile mortality has been greater in the
Limehouse district than in any other part of the Borough.
(i) The National Health Insurance Acts is another important, if indirect
factor in the decrease of maternal mortality.