AC4366 BET 46 Public Health Department, Town Hall, Patriot Square, Bethnal Green,E.2. May, 1942. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, Appropriately to the circumstances of the time, I furnish an interim report on the health of the borough and the work of the Public Health Department, which is brief in extent, and only deals with a few salient features, leaving a full account to follow after the War. As, however, we are now in the third year of war, it has appeared desirable to furnish a few comparative figures for recent years so that the Council may note the extent of some of the changes which are taking place. VITAL STATISTICS. Comparing the 3 years, during the whole or part of which the war has been raging, with the average of the 3 preceding years, we have the following figures 1936 - 8 (average) 1939 1940 1941 Death Rate 12.2 11.5 20.1 20.5 Infant Death Rate 70 + 51 50 62 Birth Rate 13.7 12.8 15.1 17.0 Meternal Mortality Rate 1.9 1.7 Nil 1.5 + Greatly influenced by abnormally high rate of 98 for 1936. It should be borne in mind that the continual shifting of population which has taken place during recent years makes it difficult to interpret differences in the rates. The Registrar-General has given 47,480 as his estimate of the civilian population for the year 1941. MATERNITY AND AND CHILD WELFARE. With a much depleted staff, the essential work of this branch of the health service has been continued without break. It has been necessary to suspend the operation of such adjuncts as light and inhalation treatment and massage. The Dental Clinic was closed in 1940, but it has recently (1942) been found necessary to arrange with the Shoreditch Dental Clinic for our cases to be dealt with there. Evacuation, and to a less extent, the disturbance of normal family routine, are responsible for the very considerable falling off in attendances of mothers and children at the Welfare Centre, as shown in the figures below. The work of the health visitors shows similar reduction. - 2 - Attendances at Welfare Centres. 1936-38 (average) 1939 1940 1941 Babies (0 - 1) 10,332 9851 5745 3599 Children (l - 5) 7,427 6832 3551 883 Mothers: Ante-natal 1,337 1247 813 687 " Post-natal 345 185 7 - Visits of Health Visitors. 1936-38 1939 1940 1941 Babies (0 - 1) 12,577 8,993. 9,757 4,109 Children (l - 5) 13,88O 10,044. 13,317 7,580 Mothers: Ante-natal 1,374 1,157. 674 256 " Post-natal 367 128. 75 37 Total visits & revisits: 31,242 21,476. 23,356 13,841 These figures must, of course, also be read in the light of the considerable reduction of staff, both medical and health visiting, which has taken place. Before the War, in addition to Dr. Purce, there were 4 part-time doctors engaged in the work of the two Welfare Centres, and there were 11 health visitors. At the end of 1941, there was only one centre, one medical officer and 5 health visitors. DISEASE. The low incidence of infectious disease noted in the last two interim reports continued generally in 1941,although as shown below, there was an unwelcome substantial increase in Measles and Whooping Cough; and Cerebro-Spinal Fever also showed a further increase from 22 to 31 cases as compared with the 1936-1938 average of 5 per annum. Equally unsatisfactory is the greater number of cases of Tuberculosis coming to light. There is little to add to what has been said in the two previous reports with regard to the very considerable reduction in the occurrence of Diphtheria and Scarlet Fever. The main facts with regard to the trend of infectious disease may be seen from the following figures: Measles Whooping Cough Tuberculosis Other infectious disease. 1936-38 (average) (254) + (1143) (410) + (250) 134 951 1939 23 312 101 566 1240 187 10 82 272 1941 489 345 96 309 + In view of the biennial incidence of these diseases, separate figures for 1937 & 1938 are given instead of the triennial average. - 3 - FOOD. The war has thrown up into greater prominence the part played by our food supply in the maintenance of health, and the importance of efficient local administration to insure its purity and soundness. Ihe following figures illustrate only a few of these aspects : Unsound food Seizures Surrenders Samples of Food taken. % of adulteration (all samples) % of adulteration (milk samples) 1936-38 average 2 19 724 3.9 2.6 1939 16 690 3.9 2.7 1940 1 41 559 3.2 3.8 1941 3 45 557 6.5 5.3 Some of the prosecutions taken under the Food and Drugs Act during the year present features of public interest. In April a food trader was fined £10 with £5. 5. 0. costs for allowing refuse and filth to accumulate in a shop where food for human consumption was exposed for sale. The case was a particularly bad one, of long continued neglect of elementary measures of cleanliness, despite warning. Anothe vendor was charged with having in his possession a quantity of tinned food which was unfit for human consumption, but in view of his previous good record the case was dismissed upon payment of £10. 10. 0. costs. Ihe increase of rationing and other food restrictions has led to the production of alleged substitutes for foods in short supply and the use of misleading descriptions for the defrauding of the public. A firm was charged in October for selling as egg powder a substance which did not contain anything in the nature of egg. Ihe case was dealt with more as a warning and the magistrate dismissed the summons upon payment by the defendant of £5. 3. 0. costs. SANITATION. Despite the difficulties created by the war and the additionel duties falling upon them therefrom, the sanitary inspecting staff have maintained all the essential work of sanitary supervision of the borough during the.past 5 years as may be seen from the following figures: 1936-38 1939 1940 1941 Infectious disease and food poisoning 2074 865 404 663 Complaints 4756 4293 3625 3305 House-to-house insp. 672 451 - 4 Total visits 44,608 44,954 32,627 31,277 Premises where nuisances abated. 5657 4658 3592 3172 Preliminary notices 5575 6254 4312 3585 Nuisance notices 2474 3109 1878 1647 « _ 4 DISINFECTION. The Disinfecting service is a branch of Public Health, which seldom gets the attention and thanks it deserves for its unobtrusive, but necessary work. To a large extent the title is now a misnomer. With the abandonment of some of the earlier ideas about the sacred rite of room disinfection after every case of scarlet fever, the work of the disinfecting staff is now concerned mainly with the destruction of pests much larger than bacteria (although quite likely to be their hosts). Recent years have shown a rising public standard with regard to the destruction of domestic vermin, and there is greater readiness to make use of public resources to secure and maintain a higher level of hygiene in the home. War circumstances have naturally hindered this process, but by accentuating some of orr problems (e.g., increasing incidence of sbabies and bug infestation through greater personal contact in sleeping and washing arrangements) they have rendered more necessary than ever the most efficient provision of public facilities for personal cleanliness and freedom from insect parasites. It is regrettable that this was not more clearly foreseen at the outbreak of war, if not before, when so many cleansing institutions were taken over for First Aid, Decontamination and other civil deferce purposes, which, although equally, if not more, important for the time being, would have been much better conducted from premises specially devised for those purposes. Ihe closing of the Council's.Personal Cleansing Station in September, 1959, and the long delay in securing first sanction to and then the actual building of a much less efficient temporary alternative had the unfortunate consequence of leaving large numbers of cases of scabies either untreated or ineffectively treated, so that when public treatment was once more available, there had accumulated a large reservoir of scabies infestation in the district. Apart from the destruction of insect vermin, the disinfecting staff have also rendered useful, service in the drying of bedding, etc., which had become damp through exposure to the weather in war-damaged houses or through dampness in air raid shelters. HOUSING. Ihe standstill in housing improvement imposed by the war continues. It is, however, useful to take stock of the situation created by the war. In 1939, the housing of the Borough might have been divided into 4 categories (1) That which was included in the redevelopment or other insanitary areas in process of being dealt with by the London County Council or the Borough Council. (2) Other housing in the Borough which was eligible for similar treatment. (3) Housing of a modern type erected by the London County Council, Borough Council and Public Utility Societies in recent years. (4) Ihe remaining housing in the Borough which, although structurally sound end free from serious sanitary defects was ageing, lacking in domestic convenience and amenity, and definitely below modern standards of planning. - 5 - During 1940 and the early part of 1941, air raid damage was done to houses of all 4 types. In addition, there has been the extra wear and tear or neglect resulting from evacuation, billeting and other disturbances of occupation, as well as from the necessities of air raid precautions,such as strutting, blackout, etc. All these circumstances have accentuated the natural deterioration of age which has affected not only categories (l) and (2), but also (4). It is, therefore, clear now that for any satisfactory solution of the housing problems of the borough, the whole borough should be regarded as a Redevelopment Area, in order that it may be replanned as a whole. With the exception of category (3), there is little housing which is worth preserving, except that probably, as a transitional measure it may be necessary to defer the clearance of some houses in category (4) while the replanning and rebuilding of the borough is in progress, so that they may serve for temporary accommodation. Having regard to the conditions which have been endured by the people of Bethnal Green, in common with those in other parts of London and the country, we are justified in expecting that the reconstruction of the borough shall not be marred when it is complete by isolated streets or houses of a standard far below that of the remainder of the district. Even from a practical point of view, the obvious consequences of such a policy would be reluctant occupation of such houses by families unable to obtain better accommodation, and the rapid further deterioration of this property. Having decided, as one may reasonably hope, to have done with slums once and for all, it would be folly to countenance a situation in which fresh slums must inevitably develop. While our principal energies are concentrated on all essential measures for victory in the war, it is not too soon to think of the great tasks of reconstruction which will confront us immediately it is attained. It must be remembered that for some years before the war, it was recognised that not only did the housing of the borough require drastic changes but also that the Health services, notably Maternity and Child Welfare, required considerable improvement end extension. Ihe years of war have greatly increased the urgency of these tasks. Reconstruction is not, however, summed up in the mere replacement of new houses for old but, if it is to produce results worthy of a new page in our history, must involve some rational relationship between health, education and the other social services and industry and amenity and the resettling of the population in communities and areas that will allow of a fuller social life. This naturally means planning on a vast scale and will probably require larger areas of local government than those with which we are now familiar, although it will no doubt be necessary to retain a great deal of local democratic sharing in the control of the administration. With these considerations in mind, I venture to express the hope that it will be possible at an early date for Bethnal Green to make its own particular contribution to these plans for the future. Medical Officer of Health.