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14
from the severe conditions, but this setback was soon recovered at the end of the
war. 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 injury at birth, have been more resistant
to reduction.

It is seen that deaths from prematurity, injury at birth and congenital malformations
account for 56 per cent. of 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 could be reduced by specialised
treatment of the infant. An analysis of the 296 premature babies born at home
will be found on page 53.
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 during the war the rate has been further reduced from 11.6
in 1944 to 4.6 in 1951, 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 1936-10 was
2.20 per 1,000 live births, but was 2.94 in 1951. The birth injury death-rate has,
in the past, been understated. Now more post-mortem examinations are performed
and more injuries are thus detected. The result is that deaths which would formerly
have been assigned to other causes are now assigned to birth injury, and the deathrate
has thus increased, without any real increase in the risk necessarily being
implied. The average neo-natal death-rate from congenital malformations was
2.84 per 1,000 live births over the period 1936-40, and in 1951 the rate was 2.14.
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 1951 the neo-natal
mortality rate was about two-thirds of the average rate for 1931-35.
Puerperal
fever and
pyrexia—
Maternal
mortality

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 1951 was officially 0.45 as compared with 0.53 in
the previous year. It is, however, necessary to point out that in three cases assigned