H.—3l

Stage 11.

For some weeks after birth the child is generally mare or less entrusted, to others. There is divided care, contraband responsibility. For the most part the mother does as she is told to do by the nurse in attendance, and the issue is largely in the hands of the nurse and. the medical attendant. Stage 111. After a few weeks the mother is generally in sole charge, and everything depends on her. Is she ignorant, or has she been well prepared in body, mind, and habits to do the best for her child ? If not, is she, at the eleventh hour, sensible enough to seek sound reliable guidance and advice from a competent doctor or nurse, and. to act on the advice and help offered ? The records already given show that the New Zealand mother does avail herself, sooner or later, of her opportunities, otherwise the death-rate from infantile diarrhoea could not have been, brought down nearly to zero, nor would the total infantile mortality have been reduced to 4 per cent. SECTION INFANTILE MORTALITY IN FIRST MONTH OF LIFE. In spite of the more than encouraging reduction in the total infantile-death rate after one month, and in the death-rate due to what was formerly the one great scourge of early life, in. New Zealand, as elsewhere —viz., infantile diarrhoea —we still have to face the painful fact that our loss of mothers and babies within a few weeks of childbirth (the natal and early post-natal stages referred to above) is still quite unjustifiably high, and utterly out of proportion to the singularly low infantile-death rate from the end of the first to the twelfth month. More than half our total infantile mortality actually occurs within eight days of birth —say, 620 deaths out of a total of 1,200 deaths in the course of a year. Nothingcould possibly be more significant and suggestive than this fact, coupled with our disproportionately high maternal-death rate. Mother and child are indeed one and indivisible at the start: anything that injures the mother injures and imperils her child. Indeed, our attention has just been forcibly drawn to our anomalous statistics in this connection by Dr. C. J. Brenkman, Chief of the Medical Statistical Department of Amsterdam, who, on investigating the relative figures for the Dutch capital, and New Zealand, found that while our total infantile-mortality rate was not much lower than theirs, our death-rate among babies after a month was less than half the Amsterdam rate ; and yet before a month of age the very reverse was true —their deaths in the first month showing less than half the New Zealand rate, their maternal mortality being only two-fifths, or possibly only a third of ours. (See footnote farther on.) He naturally seeks an explanation. The following are extracts from. Dr. Brenkman's letter to the Department of Health, New Zealand, dated Amsterdam, 9th February, 1924 : — " Your Reports on Public Health we have read with much interest : those bearing on child welfare are specially interesting for us here in Amsterdam. I myself made a comparison between infant mortality in New Zealand and. in Amsterdam, and I wrote an article on that subject in the monthly Tydschrift voor Sociale Geneeskunde. I send you a copy of the journal and a translation of my article, thinking it may be of interest to yourself and your co-workers. I also enclose copies of graphs we have made. " C. J. Brenkman, " Chief of the Medical Statistical Department of the Municipal Health Service of Amsterdam." Condensed Extracts ebom Dk. Bkenkjvian's Article. The Annual Report on Child Welfare for New Zealand (1920-21) contains two graphs dealing with infantile mortality. " The first graph," so tho report says, " was prepared for lecturing purposes, in order to impress on nurses, midwives, and others the urgent need for reducing the deaths of infants in the first month after birth. . . ." It seemed interesting to make a graph, on the same subject for Amsterdam, and this work was done by our Medical Statistical Department (see Graph No. II). ... In New Zealand 29,006 babies were born in 1922, and 1,215 died (i.e., 4-2 per cent., or 42 per 1,000). In Amsterdam 14,143 children were born in 1922, and in the same year 676 infants died {i.e., 4-7 per cent., or 47 per 1,000). Our population is 700,000. The New Zealand graphs show that tho fall in their infantile-mortality rate during the last fifteen years has been due solely to the saving of lives after the first month : the mortality of infants in their first month did not fall throughout this period, and has remained high— i.e., 30 per 1,000 births. In Amsterdam the mortality of infants in their first year, after reaching one month of age, is more than twice that of New Zealand. For New Zealand it is under 2 per cent, [actually only 1-5 per cent, for last two years], while for Amsterdam it is nearly 4 per cent. In New Zealand the mortality of very young infants . . . under tho ago of ono month . . . was formerly 3 per cent., or 30 per 1,000, and now it is practically the same'; in Amsterdam, on the other hand, it was 2-3 per cent., or 23 per 1,000, in 1905, and now it is only 1-3 per cent., or 13 per 1,000. These data and this fall we notify with some pride; but while our data for tho older infants are such that we may say that we are on the right track, yet, comparing our data and results with those of New Zealand, it is clear we can work with much more success. We agree with Dr. Truby King, Director of Child Welfare for Now Zealand, when ho says, "There is every ground for confidence that with the further growth of knowledge on the part of mothers, nurses, and midwives, the deaths of babies after the first month of age will be brought down in New Zealand another third in the near future, and that a much greater reduction will be effected in the inordinately high death-rate in the first month." For Amsterdam our midwives should be highly satisfied with the result of this comparison ; their advice to the young mothers is of very great importance, and they generally have the first opportunity to promote and spread breast-feeding. The following graphic chart is based on the Amsterdam statistics for 1922, supplied by Dr. Brenkman, contrasted with the New Zealand figures for the same year.

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