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its position as the most serious mortality risk of pregnancy and has been displaced
by toxaemia, haemorrhage and other accidents (trauma of pelvic organs, etc.) which
now contribute the greater part of the total mortality. The effect of war conditions
in temporarily arresting the decline in maternal mortality in London is shown by
the following diagram, which indicates the movement of the rates in both London
and over the country as a whole. The sharp rise in London in 1941 was not shared
by the country as a whole, and can be attributed to the effect of the bombardment,
which reached its peak intensity in that year and the consequent evacuation. These
factors rendered it difficult to maintain the normal high standards of maternal care.
Infectious
diseases
The attack-rates and death-rates of the principal infectious diseases in London
during 1946 and earlier years, and for the constituent metropolitan boroughs in
1946, are shown in tables 3, 4 and 13. A comparison of the death-rates in London
and England and Wales is given in table 12, page 25.
Anthrax
No case of anthrax was notified during the year. London has now been free
from this disease since 1943.
Cerebrospinal
fever
Prior to the war, the attack-rate had fluctuated, rarely falling below 0.020 per
1,000 and rarely exceeding 0-050 per 1,000. Not unexpectedly, the rate rose during
1940-41 to 0.3 per 1,000, reflecting the poor conditions of ventilation then obtaining.
Subsequently, the rate fell, and in 1946 was only 0.081 per 1,000. In 1921, 80 per
cent, of notified cases were fatal. In 1946 the case-mortality had been reduced to
24 per cent.
Dysentery
The dysentery notifications are not at present an indication of the trend of incidence
of the disease. In the March, 1947, issue of the Bulletin of the Ministry of Health
and the Public Health Laboratory Service, Dr. J. A. Glover points out that the notification
figures show capricious movement from year to year. In England and
Wales as a whole, the ratio of notifications to death has risen from 4-6 in 1919 to
98-6 in 1945. Dr. Glover says "a partial explanation of this outstanding change is,
of course, to be found in the influence of bacteriology on medical terminology, and
the real answer to the enigma of notified dysentery lies in the recognition of the