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London and the country as a whole. In the later years of the war, however, despite
the manifold difficulties, the mortality in London was gradually brought down to
pre-war level, and it has continued to fall.
It is important, however, to remember that the reduction in infant mortality in
the past fifty years as a result both of rising social standards and the energetic
intervention of public health authorities has mainly been effective against the causes
of death (principally infectious) which do not operate until after the first few weeks
of life and that deaths within the first four weeks of life have not been reduced to the
some extent. The following figures for London illustrate this point:—

The reason for this is that while in the first weeks of life mortality from infection
has been much reduced (as at later ages) there has remained an apparently intractable
core of mortality from prematurity, congenital malformations and birth injury,
i.e., conditions which represent a fatal handicap to the infant on entry into the world.

Thus deaths from prematurity, birth injury and congenital malformation account
for 64 per cent. of all neonatal deaths. Many prematurities could, no doubt, be
prevented by greater attention to the general health of the mother and by improved
ante-partum medical care; and where prevention fails and premature births do occur,
many of the subsequent deaths are preventable by specialised treatment of the
infant. In London, deaths in the first four weeks from prematurity per 1,000 live
births fell from 16.1 in 1911 to 11.6 in 1938, a comparatively slow rate of progress
but after a temporary rise due to war-time difficulties, the rate has been further
reduced from 11.6 in 1944 to 6.6 in 1948, and this comparatively large advance is
doubtless associated with the contemporary emphasis on the care of premature
infants. Many birth injuries would not occur if specialised obstetrical assistance were
more general. The average neonatal rate from this cause over the period 1936-40
was 2.20 per 1,000 live births and was still 2.13 in 1948. The average neonatal death
rate from congenital malformation was 2.84 per 1,000 live births over the period
1936.40 and in 1948 the rate was 2.51.
Puerperal
fever and
pyrexia;
maternal
mortality
The basic figures in respect of the hazards of childbirth are as given below.
Detailed figures for the metropolitan boroughs are shown in Tables 2 and 9 and
comparative figures for England and Wales in recent years are shown in Table 8,
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