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areas. In considering this table, it must be borne in mind that the figures
of maternal deaths are far from expressing the amount of disability and
of invalidism, stopping short of a fatal issue, resulting from faulty conduct
of pregnancy', of labour, and of the lying-in period.

The following comments may be made on the table given above:—
(a) Croydon has less than the average incidence of fatal puerperal sepsis
found in the larger towns. This suggests, on the one hand, a relatively
high standard of professional practice in Croydon, among other factors; it
may also mean, though evidence is not directly obtainable, that there is
relatively infrequent resort to instrumental delivery and to operative manipulation,
which are important ingredients in the production of puerperal sepsis.
No definite conclusions can be drawn from comparison of the proportion
of cases attended by midwives and the maternal mortality rate. The fact is,
therefore, merely recorded here that the proportion of births attended by
midwives in Croydon is somewhat below the average for the whole country
(about 45 per cent. in Croydon, 50 to 60 per cent. in England and Wales),
while the percentage of calls for medical help by midwives appears to be
considerably below the proportion in a number of other large towns (9 per
cent. of the total confinements attended by midwives, while this figure rises
to 15, 20, and 30 per cent. in various large towns).
(b) Croydon appears to have slightly more than the average maternal
mortality from complications other than puerperal sepsis for other county
boroughs, while it has markedly more than in the metropolitan boroughs. A
review of the causes of these deaths during the years 1919-22 suggests that
in one-third of the cases death could probably have been avoided by early
and regular ante-natal examination and supervision; and that, in a further
considerable proportion—perhaps one-third--admission, or admission at an
earlier stage, to a maternity bed in a hospital might have saved the mother's
life.
It is not possible to draw dogmatic conclusions from these data as to
the reason for Croydon's unsatisfactory contrast in this group of cases with
the metropolitan boroughs. It is unlikely that the degree of ante-natal
supervision is materially less than in the London boroughs, except In so far
as the greater hospital facilities in London automatically give increased
chances of ante-natal care; on the other hand, it is accepted that London,
with its large general and maternity hospitals is exceptionally well equipped
for dealing with complicated cases of labour, and the relatively poor facilities
in Croydon for the serious complicated case need attention.