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30
Infections accounted for most of the 18 deaths of those between 3
and 12 months, of which respiratory complaints were the cause in 6,
gastro-enteritis in 4, and meningitis in 1.
Deaths in infants over one month old are largely due to the infections.
Much of the reduction in the infant mortality rate which has occurred in
this century is due to the improvement in hygiene, either outside or more
particularly inside the home. On the other hand, those deaths occurring
under one month are due to a variety of causes, some arising from some
failure of intra-uterine development, some due to difficulties arising
from the birth itself and others due to a failure of adaptation to the
new surroundings. The underlying causes for the first group are probably
related to and associated with those unknown factors which are
responsible for premature delivery, or, in still earlier stages for miscarriages,
and may be found to be due to such influences as endocrine imbalance
or vitamin deficiency. The reduction in the next group can be achieved
by better midwifery, including in this not only the standard of midwifery
and nursing care but sound ante-natal hygiene and the conduct of the
confinement in good surroundings. Many deaths, though, occur amongst
those who have survived the shock of birth itself but fail to live for one
week, and a similar number fail to survive the rest of the month. Under
existing practice the mother confined at home has the attention of the
midwife for some 14 days which is a comparatively recent extension on
the previous period of ten days. If a home help is available she attends
for the same period, after which time these helps are withdrawn and the
mother so soon after her ordeal is expected to manage, as before, her
household together with the added burden of affording the extra care
and attention to the very young baby. It is just at this time that
difficulties in the feeding of the baby arise. There is much to be said for
provision being made for the services of the home help to be available
for one month after the birth of the baby so as to smooth the difficulties
with which the mother has to contend, probably with beneficial results
in the matter of breast feeding of the infant, and to enable her to devote
more of her time to the child in those most critical days. In the same way
it would probably be of advantage if a change in attendants were deferred.
It is customary for the health visitor to call as soon as possible
after the midwife has ceased her visits to the mother. Even where her
visit can be paid at the earliest date it is rarely possible for the health
visitor as a routine to pay many more early calls, having to limit such
visits to such special cases as need her attention. It would be of advantage
for the midwife to undertake these earlier duties of the health visitor,
at least in regard to her own patients, continuing to attend them for a
month, by which time their supervision would pass into the hands of the
health visitor. Such practice probably would not seriously reduce the
number of cases which the midwife would be enabled to attend.
Not so many years ago when the infant mortality rate was in the
region of 120, the irreducible minimum was assumed to be a figure of
about 40. To-day, when figures of under 30 have been reached it is not
accepted that there is any limit and what remains is referred to rather
as the hard core of resistance. Undoubtedly though the law of diminishing
returns will operate and any future successes will be far more difficult