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turity; congenital malformations have risen from fourth to third, displacing birth
injury; and pneumonia has risen from sixth to fifth displacing other diseases of early
infancy. Despite these fluctuations deaths from immaturity, injury at birth and congenital
malformations consistently account for some 55 per cent. of neo-natal deaths and it is
in these fields that any drastic reduction must be sought.
In London, deaths in the first four weeks of life from immaturity per 1,000 live births,
which had fallen comparatively slowly to 11.6 in 1938, rose temporarily during the
war and, after regaining the pre-war level of 11.6 in 1944, have continued to fall to
3.6 in 1954. This comparatively large reduction in the rate is doubtless associated with
the contemporary emphasis on the care of immature infants. Birth injuries offer less
ground for satisfaction—the average neo-natal rate from this cause over the period
1936-40 was 2.2 per 1,000 live births which compares with 2.3 in 1954 and which is, however,
a definite reduction from the figure of 2.7 for both 1953 and 1952. The birth
injury death-rate has been under-stated in the past but now more post-mortem examinations
are performed and more injuries thus detected. The result is that deaths, which
would formerly have been assigned to other causes, are now assigned to birth injury,
and the death-rate has thus increased, without any real increase in the risk necessarily
being implied. It would appear, therefore, safe to say that in fact the pre-war figure
has been regained if allowance is made for the increased precision of diagnosis. The
average neo-natal death-rate from congenital malformations was 2.8 per 1,000 live
births over the nerind 1936-40. and in 1954 the rate was 2.4

Maternal
mortality
Rales per 1,000 total births, except for deaths following abortion where the rales are expressed per 1,000females (15-44)
The maternal mortality rate (excluding post-abortion deaths) in 1954 was 0.54, as
compared with 0.40 in the previous year. The total number of maternal deaths in the
County during a year has now fallen to such a low level that purely chance fluctuations
will affect them considerably, and there is little value in discussing the rates for component
causes in individual years. The following analysis has, therefore, been made on
the basis of numbers and not rates.
Cause of death Post-abortion Other pregnancy and child birth Total
1951 1952 1953 1954 1951 1952 1953 1954 1951 1952 1953 1954
Sepsis 13 10 8 5 3 8 1 3 16 18 9 8
Other causes 5 5 8 1 21 27 20 25 26 32 28 26
Total maternal deaths 18 15 16 6 24 35 21 28 42 50 37 34
It is interesting to note that the total number of maternal deaths has in fact fallen
in 1954 and that the rise in mortality (excluding abortion) has been offset by a reduction
in the post-abortion deaths. In England and Wales there were 480 maternal deaths—
the lowest figure so far recorded: 76 of them were post-abortion. The maternal
mortality rate for the country as a whole was thus 0.70 (0.10 due to sepsis; 0.49 due to
other causes; and 0.11 post-abortion): the corresponding London figures were 0.66
(0.06; 0.48; and 0.12).
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