AC4366 BET 45 MEIROPOLIIAN BOROUGH OF BETHNAL GREEN INTERIM ANNUAL REPORT o n the health of the Borough and the work of the Public Health Department during 1940 by VYNNE BORLAND, M.B., Ch.B., B.Sc., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Bethnal Green, E.2. 4th September, 1941. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, In accordance with the suggestion of the Ministry of Health, I am furnishing a brief interim report on the health of the Borough and the work of the Public Health Department during 1940, leaving a fuller account of these matters until after the war. VITAL STATISTICS. Following the comparatively satisfactory general mortality figure for 1959, the death rate for 1940 was very high, rising from 11.5 per thousand population to 20.1 per thousand. On the other hand, the infant death rate was maintained at its previous low level, and was 49.5 per 1,000 births, actually the lowest on record in the Borough. The reasons for this contrast seem to be bound up with the facts that the majority of the babies concerned, although belonging to Bethnal Green, were mostly born in country districts where a large number of them remained, while the adult civilian population, raised in age level by the enlistment of large numbers of young men in the armed forces, was subjected to intensive air raids, as well as other unfavourable circumstances, e.g., severe winter. It is of specially tragic interest to report that 145 of these deaths were due to air raid injuries, 72 males and 73 females, including 12 children under 15 and 25 persons over 65. The birth rate rose from 12.8 to 15.1 per 1,000 population. There were no maternal deaths. The Registrar-General's estimate of the civilian population for the year was 66,620, and the birth and death rates have been calculated on this basis. MATERNITY AND CHILD WELFARE. Attendances at the Welfare Centra have been affected by the flow and ebb of evacuation, which has in turn been profoundly influenced by the frequency or apparent suspension of air raids. Three of the health visitors continue to act as nurses in charge of First Aid Posts or Mobile Units, while the places of two who retired during the year were not filled. Notwithstanding these adverse circumstances, the remaining health visitors paid 1,662 visits and 21,694 revisits during the year, which compares favourably pro rata to staff with pre-war figures. Special attention has been paid to the visiting of toddlers. The attendances of mothers at the Maternity Clinic has also shown less than the reduction which might reasonably have been expected, being 813, as compared with 965 in 1938, but there is a great falling off in the post-natal attendances. It is in the attendsjnces of the children at the Welfare Centres that the effect of the war is most obvious, there being only 9,296 as compared with the pre-war level of 19,506. The fall in the children's consultations with a doctor shows this even more strikingly, having dropped from 11,004 in 1938 to 1,048 in 1940. The ancillary services, although greatly reduced in volume, have been continued: dental treatment, nursing assistance, home helps, maternity outfits, milk grants. There were no maternal deaths, and a much reduced incidence of puerperal fever, puerperal pyrexia and ophthalmia neonatorum. INFECTIOUS DISEASE. The continued fall in the incidence of infectious disease since the war began is no doubt mainly attributable to the evacuation of the children to less vulnerable areas, as the diseases affecting adults show nothing like the same reduction. Diphtheria fell further from 138 to 57 cases, Scarlet fever 219 to 82, Erysipelas from 54 to 37, and Pneumonia from 90 to 59. The only diseases showing any increase were Cerebro Spinal Fever from 2 to 22 cases and Measles rising from 16 to 187 cases. Measles (187) and Whooping cough (10) have changed places again in their respective number of cases, but these figures, even allowing for the smaller population of children, are low compared with pre-war experience. It is less satisfactory to record that 82 new cases of Tuberculosis were notified during the year. This underlines the sound remarks of Dr. H.T. Howell, the Clinical Tuberculosis Officer, in his report, with regard to the special difficulties of the tuberculous during wartime arising from defective blackout ventilation, inadequate or unsuitable diet, insufficient and disturbed rest and worry. FOOD. Fewer than the usual number of samples were taken during the year, as was indeed inevitable, having regard to the extra duties put upon the Food Inspectors. Nevertheless, the substantial total of 557 samples was obtained, and the amount of adulteration was slightly less than the pre-war average. The inspection of food premises continued, with a view to the maintenance of cleanly and wholesome conditions, with the same efficiency as before the war, and only slightly less in the volume of visits. Owing to the Government control of the meat trade, the remaining slaughterhouse in the Borough was not used. SANITATION AND HOUSING. Representative figures of work by the Sanitary Inspectors may be quoted as follows 1938 Infectious disease investigations 395 (2338) Investigating sanitary complaints 3625 (4654 Housing inspections 667 (1511) Factory " 1029 (2325) Drainage " 3159 (3830) War damage " 1159 ( -- ) Shelter " 878 ( -- ) Total visits: 32,627 (42,573) Premises where nuisances abated 3592 (5311) Every branch of sanitary administration has been maintained and, having regard to the Civil Defence duties also performed by the inspectors, the figures are very creditable. The housing situation arising from air raid destruction and damage, and the evacuation and return of residents is too complex and unstable to enable much useful comment to be made at the present juncture. Cynical as it may sound, it is nevertheless true that it has taken the horrors of war to compel us to face the necessity for the prompt and wholesale renewal of bad and worn-out housing that would have taken generations to accomplish by the slow and piecemeal methods of pre-war days. THE FUTURE. Concentrated as must be most of our energies on the task of the immediate present, it is not too early to give some small consideration to the even greater task that peace and reconstruction will place upon us. Most of these matters involve national planning, and questions of policy outside my jurisdiction, but there are nevertheless many important matters in which local health administration will have its part to play, whatever the actual shape of the new social order. This particularly applies, for example,' to the Maternity and Child Welfare service which, before the war, was recognised to be in need of much more adequate premises and is now most seriously cramped for working space. The warning about health conditions which I ventured to include in my interim report for 1939 has been justified by the figures which it has been my duty to submit in the earlier part of this report. Notwithstanding the claims of the war effort, indeed because of that effort, we must not only maintain our health services at the highest possible standard of adequacy, and efficiency, but plan for their extension after the war. The shortage of medical personnel in relation to present and prospective needs renders it urgently desirable . that these resources shall be organised in the most effectivemanner in the public interest. I am, Ladies and Gentlemen, Your obedient servant, Medical Officer of Health.