Accidents in childhood.

DURING the last 100 years there has been a remarkable fall in child mortality rates. Before 1860, 4 per cent of children who survived their first year died before attaining the age of fifteen, while in the slums the figure was as high as 20 per cent (Office of Health Economics, 1962). The term "The Survival of the Fittest" was more than an aspect of Darwin's new theory of Evolution: it was a hard fact of life. The reasons for the improvement in the picture are not difficult to find. Improved Public Health services and possibly superior resistance to infectious diseases transmitted by surviving parents probably account for the earlier, slow but steady fall in the child mortality rate; the rapid increase in tempo since the 1930's is undoubtedly mainly the result of the development of effective antibacterial agents and vaccines. The control of the five infectious diseases--pneumonia, tuberculosis, diphtheria, measles and whooping cough-and their complications accounts for over half the reduction in mortality since 1931 (Office of Health Economics, 1962); only pneumonia remains as an important cause of death to-day (Fig 1). Deaths attributed to accidents in childhood have also decreased in number during this period, including, surprisingly enough, a 50 per cent fall in the number of deaths from road accidents, but this decline has been much less marked than the fall in deaths from infectious disease, so that accidents have assumed greater relative importance and now account for nearly 30 per cent of all childhood mortality. Indeed, a Lancet annotation in 1961 declared that accidents were the largest single cause of death between the ages of 1 and 9 years in the United Kingdom, while in some countries more persons between 5 and 19 years of age die from accidents than from all other causes combined. It is convenient to consider accidents in two categories-those inside and those outside the home.