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to achieve and will be that much the less spectacular. Success, too, will
probably follow only the results of efforts aimed specifically at the object.
While no doubt much of the reduction of the infant mortality rate already
achieved in this century is due to the efforts of local authorities and their
staffs in the operation of the extensive maternity and child welfare
services, part of the decline is undoubtedly part and parcel of the general
improvement in the health standards of the community. It is an interesting
speculation as to what extent these improvements would have
occurred without the operation of specific measures. In the case of
what is now left of infant mortality, though, anything from one-half
to three-quarters of the loss of infants is due to prematurity. Premature
expulsion of the foetus may be brought about by a variety of causes,
some accidental, others purposive in that the uterus is expelling a waste
product. That, no doubt, is what occurs in a number of instances when
the infant is deformed. Feeding experiments indicate that nutrition
may be a factor of importance, though probably, because of the parasitic
state of the foetus, not one of major importance, and probably whatever
influence there is is due to a shortage of some specific factor or factors
rather than to a general shortage of calorie value. If all these lives
could be saved, though, it would effect in itself nothing like the reduction
in mortality or, conversely, the saving of life as remains possible in
another field. The average figure of the incidence of stillbirths is one of
3 per cent of the viable births. It has been calculated that there are
four abortions for every stillbirth, this giving a figure of 12 abortions
per 100 viable births or a total ante-natal mortality of 150 per 1,000
live births. The factors causing these losses may prove to be those
which account later on for premature births and there is a vast field here
for exploration as to the causative factors. To-day at last the nation is
waking up to an appreciation of the significance of the declining birth
rate. Many are the reasons proffered as the explanation of the falling
rate and widely differing remedies have been suggested for improving
the condition. There are, however, many instances where pregnancy
has already been achieved but has not resulted in a viable infant. Possibly
related in some cases is the subject of sterility, more particularly where
the reason for the failure to produce an infant is not the failure to achieve
pregnancy but is the result of a very early expulsion of the developing
foetus. Absence or shortage of Vitamin E. appears to have some relation
to the sterility of rats. It may be that some such factor might be
found to be one of importance in the expulsion from the uterus of the
products of conception at any stage of development.
MORTALITY AMONGST CHILDREN of 1 to 5 years of age.
Infections caused 10 of the 13 deaths amongst children of one year
of age, pneumonia being responsible for six and specific infections the
other four. Two deaths were accidental, as was also the single death
amongst children of two years of age, and two of the 5 deaths of those of
three years of age. Specific infections were responsible for two of the
other deaths of this age, and for two of the 3 fatalities amongst those of
four years of age. Diphtheria was the cause of death of one child aged
one, one aged 3 and one aged 4. Tuberculosis this year was responsible
for none.