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the middle thirties, resulted in a substantial decline in the mortality from puerperal
infection. Indeed, but for the war-time increase in abortions with their relatively
higher risk of infection, the sepsis mortality in 1941-45 would be an even smaller
proportion of the total than is indicated by the table. In recent years puerperal sepsis
has lost 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, though the risk of
death from these causes has also been falling rapidly. The effect of war conditions
in temporarily arresting the decline in maternal mortality in London is shown by
the above 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 1948 and earlier years, and for the constituent metropolitan boroughs in
1948, are shown in Tables 2, 3 and 11. A comparison of the death-rates in London
and England and Wales is given in Table 10, page 121. In order to preserve uniformity
with national statistics the notification figures used in this section of the report have
been corrected as far as possible to take account of changes of diagnosis made after
the original notifications had been received. See footnote to Table 11.
Anthrax
One case of anthrax was notified during the year and it was confirmed bactenologically.
The disease was contracted by a fur dresser and the infection was traced
to two bales of hides from South Africa which were immediately destroyed.
Cerebrospinalfever
Prior to the war, the attack-rate tor cerebro -spinal lever had fluctuated, rarely
falling below 0.02 per 1,000 and rarely exceeding 0.05 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 1948 was only 0.03 per
1,000 (110 cases). In 1948 the case-mortality was 33 per cent. Two-thirds of the
cases are in infants under the age of five.
Dysentery
The dysentery notifications are not at present an indication of the trend of incidence
of the disease. The notification figures show capricious movement from year to year.
The fact that many cases of comparatively mild disease without any of the classical
signs and symptoms are due to the same infection as bacillary dysentery has become
increasingly recognised.

Diphtheria
It would appear that apart from increased incidence during the two wars, the
real incidence of dysentery remained fairly stationary up to 1947. In 1948 there were
however only three deaths compared with 11 in 1947.
The campaign to encourage immunisation against diphtheria began in 1941 and
the results have been very encouraging. The fall in the incidence of diphtheria since
then has been far in excess of any downward fluctuation observed in the previous
50 years. In 1948 there were only 335 cases or 0.100 per 1,000 living, compared with
a rate of 0.136 in 1947. The effects of the immunisation campaign are illustrated by