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15
This large increase in notifications since 1950 is misleading and is due to the Puerperal
Pyrexia Regulations of 1951 which now require the inclusion of cases notified in the
hospitals. Many of these relate to maternity patients residing outside the County.
The trend of maternal mortality in the Administrative County of London from 1896
is shown in Table 3 (page 146). It will be observed from this Table that maternal
mortality fell very slowly until the introduction of the sulphonamides in the middle
'30's, resulting in a substantial decline in the mortality from puerperal infection. In recent
years puerperal sepsis has lost its position as the most serious mortality risk in pregnancy
and has been displaced by toxaemia, haemorrhage and other accidents (trauma of the
pelvic organs, etc.), which now contribute the greater part of the total mortality, though
the risk of death from this cause has also been falling rapidly. It will be noted that if
abortion is excluded there were, as in 1950, no cases of maternal mortality from this cause
in 1953. The effect of war conditions in arresting temporarily the decline in maternal
mortality in London is shown by the following 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 this can be attributed to the effect
of the air bombardment, which reached its peak intensity in that year, and the subsequent
evacuation. These factors rendered it difficult to maintain the normal high standards of
maternal care. Since the war further considerable progress has been made.
MATERNAL MORTALITY (EXCLUDING ABORTION)
MORTALITY PER 1,000 TOTAL BIRTHS
ENGLAND &. WALES LONDON

* Excluding pneumonia of the new born (under 4 weeks) which is included in Diseases of early infancy
B