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The underlying causes of prematurity, congenital malformations, etc., seem to be closely associated
with those of stillbirths and the trend of the stillbirth rate (Figure I) is like that of the neo-natal
mortality rate. " In many cases it is merely a matter of chance whether the foetus dies within the
womb, in the birth passages or immediately following birth." If the infant mortality, neo-natal mortality
and stillbirth rates are studied in the social groups into which the population is divided by the RegistrarGeneral,
it is found that all these rates are lowest in social class 1, professional, managerial, etc.) and
highest in social ciass V (unskilled workers) and these differences have remained unchanged over the
last 30 years. This shows that there are factors other than nutrition, housing, income, etc., and research
is tending to concentrate on"the mother and child during pregnancy and labour.
If the loss of life from stillbirths and early death of babies is to be reduced, local health
authorities, general practitioners and hospitals have a part to play in trying to improve mothercraft,
ante-natal carc and the management of birth.
Maternal Mortality.—No death occurred due to causes associated with pregnancy and childbirth.
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. The diseases required by statute to be notified are:—smallpox, cholera, diphtheria,
membranous croup, erysipelas, scarlet fever, typhus fever, typhoid fever, paratyphoid fever, relapsing
fever, plague, poliomyelitis, tuberculosis, malaria, dysentery, puerperal pyrexia, ophthalmia neonatorum,
acute primary pneumonia, acute influenzal pneumonia, whooping cough, measles, acute encephalitis,
meningococcal infection, and food poisoning. It is known that all cases are not notified, but there are
no grounds for suspecting that the level of notification varies to any great extent from year to year.
Persons travelling overseas may require to produce evidence of recent vaccination against smallpox or
inoculation against yellow fever, cholera and typhoid fever. Such certificates require to be endorsed by
the Medical Officer of Health, and during the year 323 were so endorsed.

The age distribution of notifiable disease during 1954 is shown in Table V.
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