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Thus deaths from prematurity, birth injury and congenital malformation
account for 64.7 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 6.31 in 1949, and this comparatively large advance is doubtless
associated with the contemporary emphasis on the care of premature infants. Birth
injuries will, it is hoped, be reduced as specialised obstetrical assistance become
more general. The average neonatal rate from this cause over the period 1936-40
was 2.20 per 1,000 live births but was 2.41 in 1949. The average neonatal death-rate
from congenital malformation was 2.84 per 1,000 life births over the period 1936-40
and in 1949 the rate was 2.34. In view of the more intractable nature of these three
causes compared with causes of an infective type it reflects credit on all workers
that in 1949 the neonatal mortality rate was only two-thirds of the average rate
for 1931-35. There is, however, no room for complacency and research organised
by the Department is being actively pursued to ascertain, with more precision, the
exact causes of neonatal death in order to improve preventive measures.
Puerperal
fever and
pyrexia,
maternal
mortality
A summary of maternal mortality statistics is 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 (p. 124).

Rates per 1,000 total births.
The maternal mortality rate (0.69) in 1949 constitutes a new low record. While
the downward trend of the total maternal mortality rate is unmistakable it should
be noted that owing to the small number of deaths the laws of chance applicable to
small numbers operate and the rates for component causes are liable to considerable
fluctuation without any significance necessarily being attached thereto.