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Thus nearly 60 percent. of these deaths occurred before the babies were one week old. The majority of
these deaths were due to prematurity, conditions associated with prematurity and congenital defects.
The search for the causes of prematurity and the best methods of treatment continues and therein lies the
main hope of further appreciable reduction in the infant mortality rate.
Maternal Mortality.—The number of deaths due to causes associated with pregnancy and childbirth
was nil. This gives a maternal mortality rate per 1,000 total (live and still) births of nil as compared
with 0.7 for England and Wales. Maternal deaths are usually divided into those due to septic infection
and those due to diseases and other conditions associated with pregnancy and labour, and the local trend
of deaths from these two causes is shown below:—

Here, as throughout the country, advances in the prevention and treatment of septic infections can
be measured by the considerable reduction in deaths from septic abortion, puerperal fever, etc. Fluctuations
in the number of maternal deaths due to causes other than sepsis serve to remind us of the need for
improving ante-natal and obstetric care.
INFECTIOUS DISEASE
Notification to the Medical Officer of Health is the essential preliminary to the control of infectious
disease. It has been so useful that it has been suggested that it might be adopted in investigations into
other diseases such as gastric ulcer, rhematism, etc. and into the causes and prevention of accidents.
The diseases notifiable under the Public Health Act, 1936, are smallpox, cholera, diphtheria, membranous
croup, erysipelas, scarlet fever, typhus fever, typhoid fever, enteric fever, and relapsing fever.
Under Regulations issued by the Minister of Health the following diseases are also notifiable:—plague,
poliomyelitis, tuberculosis, malaria, dysentery, puerperal pyrexia, ophthalmia neonatorum, acute primary
pneumonia, acute influenzal pneumonia, whooping cough, measles, acute encephalitis and meningococcal
infection. Food poisoning is notifiable under the provisions of the Food and Drugs Act, 1938. A medical
practitioner, " as soon as he becomes aware that the patient is suffering from a notifiable disease " should
send a notification to the Medical Officer of Health and all practitioners are supplied with forms for this
purpose. If consideration of any action to discover the source of or prevent the spread of infectious disease
is to be effective notification should reach the Medical Officer of Health as soon as possible but this does not
happen always. In some cases this may be due to delay by the patient in seeking medical advice but more
often it is an omission by the practitioner.
The exclusion from work of adult contacts is now only recommended in exceptional cases where
the type of disease and the nature of the contact's employment present a special risk of the spread of
infection. The exclusion from school of contacts has been curtailed considerably and generally is restricted
now to contacts of smallpox, poliomyelitis, diphtheria and scarlet fever. In actual practice the
contribution of school exclusion of contacts to the prevention of the spread of infection has not justified the
loss of schooling arising therefrom.
The two common sites in the human body where disease producing bacteria and viruses may be
found are the bowels and the nose and throat. The diarrhoeal diseases are spread by contamination of
food by vermin, flies or failure to wash the hands thoroughly after the toilet. The remedy here is a higher
standard of personal and food hygiene. The diseases affecting the nose and throat are spread by droplets
sprayed out in talking, coughing, sneezing, etc. As " coughs and sneezes spread diseases " the handkerchief
is a useful weapon in preventing spread, but it should be changed frequently during the acute stage of the
illness. Insect and water borne diseases are now, due to the great improvement in sanitation and water
supplies, of comparatively minor importance in this country.
The virtual abolition of diphtheria resulting from immunisation, the continuing mild type of scarlet
fever, improved sanitation and hygiene and the availability of powerful curative agents such as the
sulphonamides and antibiotics for use in other bacterial diseases have produced a great change in the
picture of infectious diseases and as the bacterial diseases fade into the background the virus diseases come
into prominence. Nature is adaptable and bacteria and viruses continue their struggle for existence.
They have already shown a capacity to develop resistance to drugs and antibiotics and their behaviour
must be the subject of constant study if we are to maintain or extend the ground already won.
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