Infant mortality provides society with the first major index of the reaction of a new human life to its surroundings. It is a measure of human beings’ ability and willingness to control their environment. The characteristics of a community begin to impress themselves as soon as the child starts its separate existence apart from its mother. This existence begins with explosive force. At no period in after-life does there occur any shock like that accompanying birth. For in the great systems of the body, in the physiological processes of respiration, circulation, heat regulation and digestion, there is an instantaneous and drastic change, and the failure of the child to meet these new demands or of the community to provide adequate protection can only result in death. Infant mortality is indeed the price of adaptation paid by each generation when entering life and the toll of infant deaths is a broad reflection of the degree of civilisation attained by any given community. “Health”, declared René Sand (1935), “is purchasable.… Each country, within certain limits, decides its own death rates.” In British Gambia in West Africa, life for the native is both brutal and brief, with infant deaths at the rate of 370 to every 1,000 births. At the other extreme, there are districts of New Zealand where the rate has fallen to below 20. Or we may compare Glasgow and its rate of 109 in 1936 with pre-1939 Amsterdam and a rate of only 30. These wide differences in the risk of death bear out Sir Arthur Newsholme’s view (1909-10) that “Infant mortality is the most sensitive index we possess of social welfare and of sanitary administration, especially under urban conditions”.

“Progress”, wrote Herbert Spencer, “is not an accident” and it is no accident that the infant death rate for England and Wales fell from over 150 to around 50 in one hundred years. It was not, however, until about 1900 that the rate began to fall rapidly and the ensuing thirty years witnessed the greatest decline. It is instructive to note that public attention, as seen in the flow of commissions and inquiries after 1900, was directed to high infant mortality chiefly by the disclosures of physical ill-health and inefficiency during and after the Boer War; the first detailed statement of infant mortality in the Registrar-General’s reports appeared in 1905.