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of adaptation on the part of the infant to its new surroundings
and mode of life. The effect of these two influences is most marked
shortly after birth, with the result that there is a very high
mortality amongst infants within the first 24 hours, and a still
very high rate for the remainder of the first week. After this,
these influences become less powerful, but are replaced by environmental
conditions, particularly due to the infections. The neo-natal
death rate, therefore, which is the rate of mortality of infants
under one month of age expressed as a ratio to the total number
of births, is an index of the extent of ante-natal and natal influences.
Deaths after this time, however, are part and parcel of the
mortalities of early childhood.
The rate of the earlier deaths is common to all classes of the
community, and can be influenced to any extent only by ante-natal
care and hygiene, apart from the secondary effects of nourishment
on the development of the growing female affecting the pelvic
measurements. The deaths in the later months, however, are very
susceptible to surroundings. It is amongst these age groups that
the tremendous reduction has taken place which has resulted in
a halving of the infant mortality rate in a generation. It is in
this group that the most striking differences are found in good
surroundings as compared with poor ones, in the children subject
to good as compared with feckless mothering.
The chief causes of death of those infants dying shortly after
birth are either congenital malformations such as hydrocephalus,
spina bifida or malformations of the heart; congenital debility;
premature birth and injury at birth. Some of these are distinct
entities, and are diagnosable as such, as instance congenital spina
bifida. The cause of death of many infants alleged to have died
of congenital heart, however, in all probability should more
more correctly be allocated to the other groups, some being due to
difficulty in delivery, and others to the infant not having reached
a state of development, or not possessing that minimum of vitality,
to enable it to survive. Atelectasis or a failure on the part of the
infant to expand its lungs fully is a commonly ascribed cause.
This and other causes of death might well be described, as many
are, as being due to deficient inherent vitality. These are nature's
failures—in some cases the developing foetus dies in utero and
subsequent labour results in a stillbirth; in other cases the infant
has survived to term but has not the stamina to adapt itself.
Another large group includes the premature infants. While in
some instances the suspected cause of the premature onset of
labour can be conjectured, in most there appears to be no
reason.
Twenty (12 male and eight female) infants died within 24
hours of birth. Prematurity was the cause in 13, of whom two
were twins born after 6A months' gestation, and a third was one
of twins born at the thirty-sixth week. Premature onset of labour