London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1950

[Report of the Medical Officer of Health for London County Council]

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15
The reduction in infant mortality in the past fifty years is a result of many
factors and they have mainly been effective against the causes of death (principally
infections, diarrhoeal or respiratory) which do not operate until after the first few
weeks of life. Deaths within the first four weeks of life, which result mainly from
prematurity, congenital malformations and birth injury, have been more resistant
to reduction.

The distribution of causes of death in the first four weeks of life in 1950 was as ollows:—

CauseNo. of deathsPer cent. Total
Prematurity24527.2
Post-natal asphyxia and atelectasis19521.6
Birth injury12914.3
Congenital malformations13615.1
Other diseases of early infancy9410.4
Pneumonia of newborn586.4
Diarrhoea and Enteritis40.4
All other causes414.6
Total902100.0

Thus, deaths from prematurity, birth injury and congenital malformation account
for 57 per cent, of all neo-natal 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 4.6 in 1950, 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
becomes more general. The average neo-natal rate from this cause over the period
1936-40 was 2.20 per 1,000 live births, but was 2.42 in 1950. The birth injury deathrate
has in the past been understated. Now more post-mortem examinations are
performed and more injuries are detected. The result is that deaths which would
formerly be assigned to other causes are now assigned to birth injury and the death
rate has increased without any real increase in the risk necessarily being implied.
The average neo-natal death-rate from congenital malformation was 2.84 per 1,000
live births over the period 1936-40 and in 1950 the rate was 2.55. 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 1950 the neo-natal mortality rate was less
than two-thirds of the average rate for 1931-35.
Puerperal
fever and
pyrexia,
maternal
mortality

A summary of maternal mortality statistics is given below. Detailed figures for the metropolitan boroughs are shown in Table 2 and comparative figures for England and Wales in recent years are shown in Table 8 (page 143).

YearLive and still-birthsDeaths in pregnancy or childbirth excluding abortionPost-abortion deathsNotifications of Puerperal pyrexia
No.RateNo.RateNo.Rate
194957,679230.40170.0234337.51
195054,33529* 0.5390.0123716.83

Rates per 1,000 total births except for deaths following abortion where the rates are expressed
per 1,000 females 15-44.
The maternal mortality rate in 1950 was officially 0.53 but it is necessary to
point out that the Registrar-General assigned (under international rule of classification)
two deaths to maternal causes because the death certificates mentioned earlier
pregnancies as the origin of hypertensive disease. One of these pregnancies was
* See text for correction to this rate.