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in 3 birth diseases. Infections accounted for 8, of which 7 were cases of
pneumonia. Of the 14 deaths amongst those of 1 to 3 months, 7 were due
to respiratory complaints, and 2 each of gastro-enteritis and pyloric
stenosis. Eighteen survived 3 months, but died before the 12 months,
infections again accounting for practically all of these deaths, the majority
being respiratory complaints, gastro-enteritis accounting for most of the
remainder.
In 1900, the infant mortality rate for the country was 156. By
1939, it had fallen to 50. Last year's figure for England and Wales was
43—a low record. Harrow's figure was 31—a figure for an area not
with a mere handful, but with nearly 4,000 births in the year. An
achievement and to what is it attributable ?
Firstly it should be pointed out that it is not a mere flash in the pan,
because on many occasions the figure has been in the low 30's. In fact,
apart from the disastrous years of 1940 and 1941 the rate has been less
than 40, often considerably less, since 1937.
To be even part of the way to answering the question it must be
realised that, although the infant mortality rate has been so often referred
to and has been accepted as an index of the sanitary state of a community,
yet it is composed of two quite different factors. So different are these
that it might be better to discontinue considering the rate for the year
as a whole. A child's greatest risk of dying is at or shortly after birth.
When the infant mortality rate was 60, which means that 60 out of every
1,000 babies born died before reaching the first birthday, 10 of those
deaths would occur before the infants were 24 hours old, another 10
roughly before the end of the first week, another 10 before the end of
the first month, yet another 10 before the end of the third month, and the
remainder spread out over the rest of the year. The earliest deaths
were the result of damage during delivery, of lack of sufficient vitality
to survive in the new surroundings (just as many failed to survive long
enough to reach the full stage of gestation), and to their suffering from
congenital abnormalities or defects inconsistent with their survival.
Such deaths are constant in all social groups. There has been relatively
little decline in them since the early part of the century. As the child
gets older other quite different factors operate to prevent its survival,
more especially the infections, whether specific or non-specific, respiratory
or gastro-intestinal. It is at these ages that the very marked differences
in the mortalities amongst those of the various social classes are seen,
and it is deaths from these causes which have been saved during this
century, and which account for to-day's rate being so much lower than
that in the early 1900's.
The difference between a high rate and a low rate was largely the
result of an altered standard of maternal care, and as a background to
this ignorance, poverty, fecklessness, employment of women, illegitimacy
and domestic insanitation. Investigations into the infant mortality
rates in different parts of the country showed that it is higher amongst
males than females, higher in the summer months, in urban as opposed
to rural communities, and higher in the north than in the south.
As an explanation of Harrow's favourable rate, then, must be placed
first the fact that Harrow is in the south and not the north of the country,
and it is not an industrial area producing much smoke to deprive the