Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
[Report of the Medical Officer of Health for London County Council]
Owing to the small figures upon which the London rates are calculated, it is
necessary to take London rates for a period of years in order to obtain a reliable
basis of comparison of maternal mortality in London with that of England and
Wales. In the following table, rates are shown for the last two decennial periods:—
|Area.||Deaths per 1,000 live births.||Percentage of live births in institutions, 1932.|
|England and Wales||1.70||2.58||4.28||24.0|
The table shows that the principal cause of the slight increase of maternal
mortality in England and Wales is the increase of deaths from puerperal sepsis.
The epidemiological factor to be taken into account in regard to this feature
was discussed in last year's report, and in regard to this an interesting discussion of
the seasonal variations of incidence in deaths from diseases of streptococcal origin
will be found in the annual report of the Registrar-General for 1932 (text, page 99).
A far more striking contrast, however, between the rates of England and Wales
and those of London is in regard to the maternal deaths from other causes than sepsis,
for while the sepsis mortality does not differ much in the two areas, the deaths
from other causes in England and Wales are 59 per cent, in excess of the London
figure in 1911-20 and 52 per cent, in excess for 1921-30. In the following
table similar figures are given for different parts of England and Wales:—
|Interval between delivery and death.||Cause of death.|
|Under 5 days||1||0||33||24|
|20 days and over||6||6||8||2|
It will be noted that the sepsis death-rate of Wales is above that in any other
area, while London compares favourably with the average as represented by England
and Wales as a whole. In London, where surgical skill is so much more readily available
in emergency, a greater proportion of complicated cases are referred to hospitals ;
and, with this higher proportion of emergency aid, a reduction of deaths from accidents
of childbirth would be expected. The figures, therefore, show the deficiency of
emergency aid in other areas, for the death-rate from accidents of childbirth, other
than sepsis, in London is much the lowest of those shown in the table.
In contrasting the mortality from sepsis with that from other causes, the duration
of the disease or condition causing death has to be considered. Deaths from sepsis
are infrequent within five days of labour, but the majority of deaths from other
causes occur within this time. The figures for deaths in which the information is
available for the years 1933 and 1934 in the Council's general hospitals are shown
in the following table :—
The Council's general hospitals.—Deaths among maternity cases. 1933 and 1934.
delivery and death.
Cause of death.
Under 5 days
20 days and over