BET 51 Metropolitan Borough of Bethnal Green Abridged Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1946 BY MURDOCH MacGREGOR, M.D.,ch.B.,D.p.H.,D.L.o. Barrister-at-law. Medical Officer of Health and Administrative Tuberculosis and Maternity and Child Welfare Officer for the Metropolitan Borough of Bethnal Green LONDON: Printed by J.S. Forsaith & Son, Ltd. (t.u.), 319 Bethnal Green Rd.,E.2 Metropolitan Borough of Bethnal Green Abridged Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1946 BY MURDOCH MacGREGOR, M.D.,Ch.B.,D.p.H..D.L.o. Barrister-at-law. Medical Officer of Health and Administrative Tuberculosis and Maternity and Child Welfare Officer for the Metropolitan Borough of Bethnal Green Metropolitan aough of Bethnal Green PUBLIC HEALTH COMMITTEE. (Which also acts as Maternity and Child Welfare Commitee.) Councillor F. E. Sanders, Chairman. Councillor Mrs. M. E. Dyson, Vice-Chairman. Alderman J. Hewer. Councillor Mrs. M. E. Peaston. Councillor Mrs. M. E. Cousins. ,, Mrs. A. M. Sivill. W. E. Hart. ,, H. J. Stubbs, J.P. „ A. E. McAuliffe. ,, I. Sulkin. Mrs. B. L. Tate. Ex-Officio Members: His Worship the Mayor (Councillor H. Hooke, J.P.). Committee : Chairman : Baths Councillor H. J. Stubbs, J.P. Electricity A. E. McAuliffe. Finance and Valuation ,, A. V. Howes. Housing ,, H. P. Wilson, J.P. Law and General Purposes ,, H. E. Tate, J.P. Libraries and Street Trading ,, Mrs. B. L. Tate. Staff and Establishment „ G. R. H. Hemsley, T P Works and Stores ,, A. E. Turpin. Council Representatives on Joint (Tuberculosis) Dispensary Committee and Care Committee: Councillors Mrs. M. E. Dyson and Mrs. A. M. Sivill and the Medical Officer of Health. 4 STAFF OF PUBLIC HEALTH DEPARTMENT, as at 31st December, 1946. Medical Officer of Health and Admin. Officer for Maternity and Child Welfare and Tuberculosis: Murdoch MacGregor, M.D., Ch.B., D.P.H., D.L.O., Barrister-at-Law. Unestablished Associated Medical Officers: § Maternity and Child Welfare: Sophia A. P. Allen, MRCS LRCP § Dental Surgeon: F. R. Bate, L.D.S. (R.C.S.) § Dental Anaesthetist: Alison R. Kerridge, M.R.C.S., L.R.C.P., D.A. §Diphtheria Immunisation: D. Bielenky, B.M., B.S., M.R.C.S., L.R.C.P. Clinical Tuberculosis Officers: H. T. Howell, M.R.C.S., L.R.C.P. M. Caplin, M.R.C.S., L.R.C.P. §Public Vaccinators : B. S. Kaushal, M.B., B.S., M.R.C.S., L.R.C.P. M. Rockfelt, M.B., B.S., M.R.C.S., L.R.C.P. § Part Time. Maternity and Child Welfare: Superintendent Health Visitor : ‡†Miss E. M. Patrick Health Visitors: † Mrs. F. Barden † Mrs. A. W. Rosling † ‡dMiss M. Playle † ‡ *dMiss D. L. Fraquet † ‡dMiss A. B. Davis (2 vacancies) Clerk-Dispenser: Miss M. V. Hazell Clerk: Miss D. M. Hare Chief Administrative Assistant: *J. Henry Lloyd, F.S.S. Clerical Staff: Chief Clerk: L. A. Taylor, A.C.I.S Senior Clerk : *R. W. Slyfield Clerks: S. P. Hansen J. E. Pestell J. P. Mackenzie R. F. Marshall S. A. Wright L. Harley C. W. Foxton Junior Clerk: (Vacant) Tuberculosis Visitors: † ‡dtMrs. J. Callow † tMiss M. L. Grant Nursery staff Sanitary Inspectorial Staff: Senior Sanitary Inspector: *W. Billings Food Inspectors: * mW. H. Heron * mG. E. Gould Workshop Inspector: ‡mS. R. B. Slater Housing Inspector: F. C. Sharpe District Inspectors: *G. S. Freeman *nE. F. Swash *C. J. Cooley *C. Day *J. Collier *J. W. Dale 5 Nursery staff Columbia Market: Pritchards Road: University House: Matron Miss J. H. BRYCE† f Miss E. V. helyer† Miss M. s. KlRKHOPE† Deputy Matron Miss D. G. Beeny Mrs. G. M. House Miss h. M. Cattermole Supervising Teacher – – Miss A. G. Innes, M.A. Wardens 1 1 — Nursery Nurses 2 3 1 Nursery Assistants 5 3 4 Nursery Students 2 2 1 Domestic Staff 4 4 3 Welfare Centre: Storekeeper Caretaker 3 Cleaners (part time) OTHER EMPLOYEES. General: 2 attendants Mortuary: (Attendant employed by Shoreditch Borough Council) Drainage: 1 Leading Labourer 4 Labourers Other Associated Part-time Officers: Public Analyst: A. E. Parkes, F.R.I.C., F.C.S. \accinntion Officers : R. Berriff, Miss M. Peters. Disinfection : Leading Disinfector Motor Driver 2 Disinfectors Personal Cleansing Station : Woman Attendant (part time) † Certificated Nurse. ‡ Certified Midwife. d Health Visitors Diploma. t Tuberculosis Certificate. * Certificated Sanitary Inspector. m Certified Meat, etc. Inspector n On National Service. f Registered Fever Nurse. 6 The Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Your Worship, Ladies and Gentlemen, I have the honour to submit my Annual Report on the state of the Public Health in the Borough for the year 1946 in an abridged form. In spite of continued rationing of food and inadequate housing, the standard of health generally has remained satisfactory. In many women, however, who have the responsibilities of the care of large families, there is evidence of a lack of well-being which is no doubt associated with the the worries of catering and the lack of a reasonable standard of housing. The vital statistics compare favourably with the national figures and are shown in the table on page 11. In a district such as Bethnal Green the Infant Mortality rate of 41.3 is remarkably low compared with the pre-war years and an interesting graph showing the fall from 150.0 in the early part of the century to the present level has been prepared and is shown on page 10. It is to be hoped that with improved environmental conditions, a higher educational standard of parental teaching and earlier treatment that further improvement in future years will take place. The Birth rate of 22.6 is the highest since 1924 and has accentuated the acute shortage of midwives and of maternity bed accommodation. Unsatisfactory homes, due mainly to overcrowding and the lack of amenities, has resulted in a a further call for hospital beds by women for their confinements, which in times of reasonable facilities would have been conducted in the patients' own homes. 7 No serious major epidemics occurred in the district and the influenza epidemic anticipated in the post-war years has not materialised. Notifications of Infectious Disease numbered 1405. One death occurred from Diphtheria, a disease which is to a great extent preventable. During the year the Diphtheria Immunisation Scheme was extended and publicised and although the proportion of children protected in this way is not as high as one would wish, it is reasonable to look forward in future years to a greater use being made of the facilities and to a further improvement in the incidence of this serious disease. Scarlet Fever, Measles and Whooping Cough have been mild in type and only where the home conditions were unsuitable were cases removed to hospital for treatment. This unavoidable measure of treating infectious disease in the home, owing to the acute shortage of hospital beds, has apparently had no adverse effect on the spread of infection. The incidence rate in Tuberculosis, which in the war years 1941-44 showed a rise compared with the gradual fall recorded in the years prior to the war, has again fallen and the table on page 27 shows the trend for both the primary notification rate and the death rate. Inadequate housing both in quantity and quality is the most urgent problem which needs to be dealt with in the field of public health in the immediate future. The long and short term policies of both the Borough Council and of the London County Council, when completed, will reap rich rewards in mental and physical well-being, and an opportunity will then arise to rid the district of much slum property which in other circumstances would not have been tolerated. It is fortunate that during the year the staff of Sanitary Inspectors was not affected by the general shortage of these officers. Complaints have greatly increased and 19,823 inspections and 15,486 re-inspections were carried out. A rigorous policy of enforcing abatement of nuisances was pursued but unavoidable delays and disappointments occurred as a result of the shortage of materials and skilled labour. The Public Health Services and the work of the Maternity and Child Welfare Services were gradually 8 tended but these were necessarily limited by the inadequate accommodation at the Cornwall Avenue Welfare Centre which worked to full capacity. The Council's urgent needs in this respect have been formulated and the approval of the Ministry of Health is awaited to a scheme for a modern comprehensive Health Centre on the vacant site adjoining the present Town Hall. The form of this Health Centre will be dependent on the proposals of the National Heath Service Act, 1946, which will become operative in 1948. Apart from functions connected with environmental hygiene, the direct control of these services may not be permitted to the Borough Council and will be the responsibility of the London County Council. Consultations have proceeded with officers of the County Council and your Council's proposals and intentions have received sympathetic consideration. It is to be hoped that these early consultations will expedite matters and Health Centres of modern design and equipment, which even in pre-war years were considered to be urgently necessary, will materialise as soon as conditions permit. On the 1st April, 1946, the entire responsibility for the provision and management of Day Nurseries passed from the Ministry of Health to the Borough Council. The demand for places continued throughout the year to be greatly in excess of the supply and this has been accentuated by difficulties in obtaining staff, resulting in the restricted use of the available accommodation. It is to be hoped that fuller use of the present facilities will be made in the near future by the introduction of part time workers. A review of the present users was made in the latter part of the year and the Council decided that a priority scheme should be instituted which had some relationship to the social needs of the applicants: these priorities have been set out on page 20 of this report, and it is with satisfaction that I record the elimination of many hardships since the scheme was implemented. It is unlikely that the demand for day nursery accommodation will decrease in the near future as there is an industrial need for woman-power and it will be necessary for the Council to give consideration to the provision of 9 permanent nurseries for children under three years of age when two of the present nurseries revert to their former use as Nursery Schools. I place on record my appreciation of the loyal and wholehearted co-operation of the staff of the Public Health Department, and of the courtesy and help which I have received from the Chief Officers and Staff of other departments of the Council. To the members of the Council generally and, in particular, to the Chairman and Members of the Committees with which the work of the Public Health Department is especially concerned, may I offer my grateful thanks for their co-operation, encouragement and courtesy at all times. I have the honour to be, Your Worship, Ladies and Gentlemen, Your obedient Servant, Murdoch MacGregor. 10 11 VITAL STATISTICS. The Vital Statistics for the year, calculated on the basis of the Registrar-General's estimate of the civilian population as 57,800, are as follow: Per 1,000 of the population Bethnal Green London England & Wales Bethnal Green 1945 Birth Rate 22.6 21.5 19.1 17.9 Death Rate 13.3 12.7 11.5 14.1 Infant Death Rate 41.3 41 43 29.2 Maternal Death Rate 1.5 1.43 — 1.1 Taking these in turn, the most striking is the increased Birth Rate which is the highest reached in the borough since 1924 and is a natural consequence of the large scale demobilisation of the armed forces which took place in the latter part of 1945 and beginning of 1946. In addition to the 1,306 live births, there were 36 stillbirths which formed 2.7% of the total births (live and dead). The Death Rate although lower than that of recent years is higher than the pre-war average, probably due to the altered age composition of the population. While the Infant Death Rate is higher than that for the preceding year, which was a record low one, it is on the whole satisfactory, being little more than half the pre-war average. Similar remarks apply to the Maternal Mortality Rate. Owing to the very abridged character of the Annual Report during the war years, the mortality in the borough has not been shown in detail but in view of its importance I have deemed it advisable to include the following table this year: 12 13 Causes of Death. Cause of Death. 0-1 year. 1-5 years. 5-15 years. 15-45 years. 45-65 years. 65 years. Total. 1. Typhoid and paratyphoid fevers m. – – – – – – – F. – – – – – – – 2. Cerebro-spinal fever m. – – – – – – – F. – – – – – – – 3. Scarlet Fever m. – – – – – – – F. – – – – – – – 4. Whooping Cough m. – – – – – – – F. 1 – – – – – 1 5. Diphtheria m. – – – – – – – F. – 1 – – – – 1 6. Tuberculosis of respiratory system m. – – – 12 5 5 22 F. – – 1 7 4 1 13 7. Other forms of tuberculosis m. – – – 1 – – 1 F. – – 3 – – – 3 8. Syphilitic disease m. – – – 1 5 1 7 F. – – – – 1 – 1 9. Influenza m. 1 1 – – – 1 3 F. – 1 – – 1 2 4 10. Measles M. – – – – – – – F. – 1 – – – – 1 11. Acute Poliomyelitis and polioencephalitis M. – – – – 1 – 1 F. – – – – – – – 12. Acute infectious encephalitis M. – – – – – – – F. – – – – – – – 13. Cancer of mouth and oesophagus m. – – – – 1 6 7 F. – – – – 3 2 5 14. Cancer of stomach and duodenum m. – – – – 6 2 8 F. – – – – – 4 4 15. Cancer of breast m. – – – – – – – F. – – – 2 5 6 13 16. Cancer of all other sites m. – – 1 4 21 24 50 F. – – 1 – 8 14 23 17. Diabetes m. – – – – – – – F. – – – – 2 4 6 18. Intra-cranial vascular lesions m. – – – – 9 28 37 – – – – – – – 19. Heart Disease M. – 2 23 73 98 F. – – – 6 25 94 125 20. Other diseases of circulatory system M. – – – 6 7 13 F. – – 1 2 14 17 21. Bronchitis M. 4 1 – – 9 26 40 F. – – 1 – 21 22 22. Pneumonia M. 7 – – 2 6 12 27 F. 5 – – 1 5 7 18 23. Other respiratory diseases m. – – 1 1 – 2 F. – – – – 3 1 4 24. Ulcer of stomach or duodenum M. – – 1 9 3 13 F. – – – 2 3 5 25. Diarrhœa (under 2 years) M. 2 – – – – – 2 F 1 – – – – – 1 26. Appendicitis M. – – – – – – F. – 1 – – – 1 2 27. Other digestive diseases M. 1 – 1 1 1 4 F. – – 1 ' 2 9 28. Nephritis M. – – 2 4 4 11 F – – 2 10 29. Puerperal and post-abortive sepsis F. – – 1 – – 1 30. Other maternal causes F. – – – 1 –– – 1 31. Premature birth M. 9 – – – – 9 F. 5 – – – – 5 32. Congenital malformation, etc. M. 8 – – – – 8 F. 6 – – – – 6 33. Suicide M. – – – – 2 4 F. – – 2 – – 2 34. Road traffic accidents M. – – 1 2 – 1 4 F. – – 1 – – 1 2 35. Other violent causes M. – – – 3 4 2 9 F. 1 – – 1 1 3 6 36. All other causes M. 2 – 1 4 7 8 22 F. 2 – 1 6 4 12 25 TOTAL 54 7 10 70 199 432 772 M F 402 370 ' 14 It was the practice of my predecessor to draw attention to the mortality from certain diseases such as Tuberculosis and Cancer, as well as from street accidents. Statistics with regard to the first mentioned will be found in the section of this report devoted to Infectious Disease. The following figures compare the incidence of Cancer in 1946 with that in 1945 and the pre-war years 1936-38: Death rate per 1,000 population Cancer of: 1946 1945 Average 1936-38 Mouth & oesophagus M .12 .16 .10 Uterus F .09 .14 .08 Stomach and M .14 .24 .26 duodenum F .07 .16 .12 Breast M – .02 – F .22 .24 .16 Other sites M .86 1.05 .61 F .40 .68 .42 total M 1.12 1.47 .97 F .79 1.22 .78 In considering these rates, the effect of the higher age composition of the population should be borne in mind. With regard to deaths from motor traffic in the streets there is a satisfactory improvement on the pre-war average of 14 deaths per year, there being only six in 1946. 15 MATERNITY AND CHILD WELFARE. Notwithstanding the smaller population of the borough and the restriction of our facilities, the volume of work at the Welfare Centre and of the Health Visitors in the homes is very little short of its pre-war level. The attendance of mothers at. the Ante-Natal Clinic is actually several times greater than before the war and it has been necessary to increase the weekly session from 3 to 4. In accordance with the practice in the reports of recent years, I give statistics of the immediate pre-war period, the war years and the year under report, for purposes of comparison. These show not only the war-time fluctuations (due to evacuation and return) but the new post-war level which has been reached in this work: 16 Attendances at Welfare Centre. fChildren (1-5) Mothers First Subsequent First Subsequent Ante-Natal Post-Natal Attendances Attendances First Subsequent First Subsequent 992 9339 178 6794 345 991 219 125 1939 913 8938 154 6678 312 935 121 64 1940 687 5058 146 3405 277 536 7 — 1941 466 3133 50 833 215 472 — 1942 682 4860 83 702 319 853 7 1 1943 639 5733 53 705 413 1321 12 4 1944 562 3556 34 565 338 1120 9 1945 694 5426 54 810 401 1428 11 — 1946 926 7780 84 1057 855 3159 14 * During this period and part of 1939 three sessions a week were held at a Branch Centre, in addition to those at the Main Centre, t With regard to the children in this age group, it should be pointed out that since 1942 some 200 have been under daily close health supervision in the nurseries. Home Visits by Health Visitors. Average 1936-38 Babies under 1 year. 12577 Children 1-5 years. 13880 Mothers Stillbirths, Infant deaths. Maternal deaths. 101 Puerperal fever and pyrexia, Ophthalmia neonatorum 94 Other infectious diseases. 2339 AnteNatal. 1340 PostNatal. 367 1939 8993 10044 1157 128 60 104 834 1940 8757 12317 674 75 68 52 301 1941 4109 7580 256 37 58 13 1721 1942 4764 4826 317 49 49 38 1074 1943 7646 6730 830 98 63 12 1351 1944 6912 6428 802 36 45 25 833 1945 7389 7142 581 34 59 16 1275 i i r.'7 17 It should be noted that the Health Visiting Staff was 11 before the war, but only 7 in 1946. Premature Infants.—Of the births belonging to the Borough, in 65 cases the low birth weight brought the children within the definition of Premature infants," 13 being born at home and 52 in a hospital or nursing home. One of the former group and 14 of the latter died before the end of one month but the majority of the remainder not only survived but eventually gained normal weight and development. Illegitimate Infants.—74 of the live births which occurred during the year were illegitimate, the percentage being 5.6 which is rather higher than the pre-war rate. The Council makes a grant through the Metropolitan Boroughs' Standing Joint Committee to a local association who provide the services of an experienced social worker for the welfare of the illegitimate child and unmarried mother. Infant Life Protection.—Only one foster mother, with one child, was on the register at the end of the year. For some years, there has been disinclination on the part of women to undertake this work. To some extent, the need has been met by the nurseries. Extensions of Work.—During the year, in addition to providing extra sessions to cope with the increasing work of the Maternity Clinic and the Infant Consultations, it was also found necessary to resume the Dental Clinic, which had been suspended during the war, and to introduce a Diphtheria Immunisation Clinic. Statistics with regard to these activites follow. 18 Dental Treatment.— During the first half of the year, the arrangement by which the Shoreditch Dental Clinic undertook the dental care of our mothers and children was in operation, but in July the Council's own Dental Clinic was reopened at the Welfare Centre. The following figures summarise the treatment provided: (Jan.-June) Cases dealt with at Shoreditch (July-Dec.) Dental Clinic (24 Sessions, incl. 5 for gas) New Cases Subsequent Attendances Mothers 72 78 125 Children 17 42 19 Extractions: Gas Admins. Under Gas Local Anaesth. Mothers 222 (43) 161 33 Children 33 (11) 18 2 Fillings: Mothers 44 74 Children — 12 Silver nitrate treatment: (Children only) 43 38 Scaling: (Mothers only)18 41 Gum treatment : (Mothers only) — 20 Dentures supplied : (Mothers) 22 7 Dentures repaired 2 1 Home Helps.— Owing to our inability to obtain the necessary staff it has been impossible to put into operation the extended system of Home Helps for domestic emergencies, recommended by the Ministry of Health. The Maternity Home Help service was, however, maintained with difficulty and provided for 57 cases during the year. Nursing Assistance.— The Shoreditch and Bethnal Green District Nursing Association continues to provide, at the Council's expense, nursing 19 assistance in a variety of circumstances, mostly to expectant and nursing mothers and children under 5. During the year 182. new cases were dealt with and a total of 2,037 visits were paid, very little fewer than the pre-war figure. Convalescent Treatment.—It had not been found practicable to resume the Council's pre-war convalescent arrangements but grants were made to the Invalid Children's Aid Association in respect of 7 children sent away by that body. NURSERIES. On the 1st April, 1946, under the scheme approved by the Ministry of Health with the concurrence of the London County Council, arrangements were made for the transfer to the responsible control of the Borough Council of the former war-time day nurseries at Columbia Market, Pritchards Road and University House. Owing to the increasing difficulty in obtaining- and retaining adequate staff it was found impossible to use the nurseries to capacity, as will be seen from the following statistics as to average attendance of children in the four quarters of the year. March qr. June qr. Sept. qr, Dec. qr. Columbia Market 51.4 54.8 48.9 48.3 Pritchards Road 42.5 43.2 41.1 43.7 University House 38.4 31.8 39.8 35.4 This situation was particularly anomalous as throughout the year there was a long list of children awaiting admission, many of them of mothers urgently needing employment for maintenance. In the circumstances, the Public Health Committee 20 found it necessary to revise the conditions of entry to the nurseries. During the war period, only two criteria had been adopted: the fact of the mother's employment and the date of her application. As a consequence, a large part of the accommodation was occupied by the children of mothers whose husbands were also in full-time employment. At the same time there tended to be an increasing proportion of war widows, separated or deserted wives and unmarried mothers on the waiting list. It was therefore resolved to adopt a definite order of priority, one that would take into consideration the social circumstances of the applicant. The implementation of the scheme necessitated the removal from the nurseries of a number of children whose parents had no prior claims in order to provide vacancies for those on the waiting list with such claims. This procedure which naturally aroused a little feeling was initiated at the end of 1946 and satisfactorily completed early in 1947. The categories entitling to preference in the allocation of nursery vacancies are as follow:— Separated or deserted wives. Widows. Unmarried mothers. Married women whose husbands are unemployed, or frequently ill and unable to work full time. Married women with husbands in the forces. Applications from married women whose husbands are in full-time employment are dealt with on their merits (the husband's earnings being one of the factors considered) when vacancies not required by the 21 priority groups are available. Accommodation is also made available when mothers have to undergo medical treatment in hospital or in cases of urgent domestic difficulties. SCHOOL HEALTH SERVICE. The County Medical Officer has kindly furnished me with the following statistics giving the results of the medical inspection of school children in the borough: Children examined 3,272 Bethnal Green. Per cent London (Average) Per cent. Clothing and Boots: Good 2,105 64.33 69.99 Fair 1,163 35.54 29.75 Poor 4 0.12 0.26 N utrition: Excellent 459 14.03 17.98 Normal 2,565 78.39 76.19 Slightly subnormal 247 7.55 5.78 Malnutrition 1 0.03 0.05 Cleanliness of Head: Clean 3,183 97.28 98.59 Nits 68 2.08 1.14 Verminous 21 0.64 0.27 Cleanliness of Body: Clean 3,266 99.28 99.65 Dirty 6 0.18 0.34 Verminous — — 0.01 Teeth: All sound 2,452 74.94 73.38 Less than 4 decayed 674 20.60 22.45 Four or more decayec 146 4.46 4.17 22 It will be seen that Bethnal Green children do not differ materially from the London average. The conditions which were discovered upon medical inspection are shown in the following- table, the defects serious enough to require treatment being shown in the second column: Condition Cases of defect. Cases requiring treatment. Defects of Nutrition 153 140 Skin disease 99 55 Defective teeth 820 742 Enlarged tonsils 304 110 Adenoids 25 15 Enlarged tonsils and adenoids 57 37 Other nose and throat defects 31 19 Enlarged glands 56 13 Eye disease 90 53 Vision defect 449 257 Otorrhoea 13 6 Other ear disease 27 20 Defective hearing 31 2 Speech defects 8 4 Heart defects 31 4 Anaemia 4 3 Lung defects (not T.B.) 64 20 Nervous defects 45 24 Spinal deformities 6 8 Other deformities 127 80 Rheumatism 17 10 Other defects 36 23 23 PREVENTION AND CONTROL OF DISEASE. The accompanying table shows the number of cases of various diseases notified during the year, also the number removed to hospital. Compared with the previous year there was an increase in the cases of Scarlet fever, Diphtheria, Pneumonia. Measles and Whooping Cough, and a decrease in Erysipelas, Dysentery, Tuberculosis and Scabies. 24 Infectious Disease. Disease. 0-1 year. 1-2 years. 2-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65years. Total Removed to Hospital. Deaths. Smallpox — — — — — — — — — Enteric Fever — — — 1 — — — — 1 1 — Diphtheria (inc. Memb. Croup) 1 6 19 20 10 5 61 61 1 Scarlet Fever 5 6 29 87 3 2 1 — 133 86 — Puerperal Fever — — — — 1 2 — — 3 3 1 Puerperal Pyrexia — — — — 3 2 — — 5 5 — Ophthal. Neonatorum 5 — — — — — — — 5 5 — Erysipelas — — — 1 — 2 3 2 8 2 — Cerebro-spinal Fever — — 1 3 1 — — — 5 5 — Acute poliomyelitis — — — 2 — — — — 2 2 — Acute Encephalitis Lethargica — — — — — — — — Acute Polioencephalitis — — — — — — — — — — 1 Acute Pneumonia 2 3 7 5 3 6 6 4 36 7 14 Dysentery 3 3 8 4 2 1 3 1 25 20 — Malaria — — — — — 1 — — 1 — — Continued Fever — — — — — — — — — — — Typhus Fever, Cholera, Plague, Relapsing Fever — — — — — — — — — — — Anthrax, Hydrophobia, Glanders — — — — — — — Measles 40 103 307 197 3 — — — 650 78 1 Whooping Cough 27 25 59 27 — — — — 138 26 1 Scabies 5 4 34 47 43 80 25 4 242 — — Pulmonary Tuberculosis — — 1 3 31 30 12 6 83 35 Other forms of Tuberculosis — — — 3 1 2 — 1 7 — 4 Total 88 150 465 400 101 133 50 18 1,405 301 8058 25 Diphtheria.—I think I should draw attention to the fact that the recorded notifications of Diphtheria are not a completely reliable index to the actual incidence as in 32 of the cases (or 52%) the diagnosis was not confirmed in hospital. There was only one death from this disease. DIPHTHERIA IMMUNISATION. A clinic for the provision of immunisation against Diphtheria was opened at the Welfare Centre in March and 588 children were treated thereat by the end of the year. In 372 cases, the immunisation was checked by the Schick test and a certificate of immunisation was issued. From information with regard to the immunisation of Bethnal Green children by the London County Council and other agencies, it would appear that approximately 38% of the children under 15 are now so protected. The effect of the first inoculation in infancy wears off in the course of years and it is accordingly necessary, in order to maintain the protection, for additional inoculations to be carried out at the age of 5 and again during school life. This fact should be borne in mind in assessing the value of this protective measure in cases of Diphtheria which may occur among immunised children. During the year one of the seven cases of Diphtheria among children under five was found to be a child who had been immunised, while six out of 14 cases among children between 5 and 15 were also immunised. The one death during the year occurred in a child who had not been immunised. VACCINATION. The following return of the Vaccination Officers gives the figures with regard to vaccination during the year. 26 Registration Sub-Districts Number of Births registered from 1st January to 31st December, 1945 Number of Births entered in Vaccination Register 31st January, 1947 Col. I. Col. II. Col. IV. Number in respect of whom Col. V. Successfully Vaccinated Insusceptible ot Vaccination Had Small Pox Statutory Declarations of Conscientious Objection have been received. Died unvaccinated 1 2 3 4 5 6 7 North East 137 7 Nil Nil 88 1 South West 141 14 Nil Nil 83 2 TOTAL 278 21 Nil Nil 171 3 Number of Births not entered in "Vaccination Register'' Number of these Births remaining on 31st Jan., 1947, neither duly entered in the " Vaccination Register " nor temporarily accounted for Total number of Certificates and copies of Certificates of Successful Primary Vaccination of Children under 14 received during the Calendar Year 1946 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate, during the Calendar Year 1946 Registration Sub-Districts Postponement by Medical Certificate Removal to Districts the Vaccination Officers of which have been duly appraised Removal to places unknown or which cannot be reached; and Cases not having been found 1 8 9 10 11 12 13 North East Nil 6 Nil 35 171 212 South West Nil Nil 4 38 110 127 TOTAL Nil 6 4 73 281 339 27 TUBERCULOSIS. During the year 90 new cases of Tuberculosis were notified and 725 patients were recorded on the register. In the accompanying graph it is interesting to note that the incidence rate during the war years 1941-45 rose to 2.6, but that in 1945-46 it appears to have fallen again, but has not reached the incidence level of the late 1930's. Although it is recognised that an increase in this disease has occurred generally throughout the country, it has, to some extent, been influenced by the introduction of Mass Radiography and the use of service examinations which have brought to light cases which, in the years prior to the war, would have remained undetected. With the return to peacetime and to improved living conditions generally, a further fall in the incidence rate can be accomplished. The death rate during the years referred to above did not rise to quite the same degree and the figure of .7 is much the same as in previous years except for the rise in 1940-41. TUBERCULOSIS CASE AND DEATH RATES 23 The Tuberculosis Visitors paid 3,138 visits to patients. Grants of extra nourishment in the form of milk, Ovaltine or invalid meals were made in 280 cases. TUBERCULOSIS DISPENSARY. The work of the Tuberculosis Dispensary at the London Chest Hospital continued to increase and is revealed in the following- figures:— Diagnosis of New Cases. Adults Children under 15 Diagnosis Males Females Males Females Total Pulmonary tuberculosis 47 41 2 4 94 Non-pulmonary tuberculosis 5 2 1 4 12 Non-Tuberculous 195 800 64 73 632 Doubtful 3 4 1 — 8 250 347 68 81 746 Diagnosis of Contact Cases. Pulmonary tuberculosis 2 Non-pulmonary tuberculosis — Non-tuberculous 177 Doubtful — Total 179 Other Figures. Total number of Attendances 2,909 Number of Patients sent to hospital or sanatoria by the L.C.C. 48 Number of visits to patients at their homes 96 Number of attendances at: X-ray Department 1,356 Artificial Pneumothorax Clinic 816 Other Departments 23 Sputum Examinations 435 29 The advantages of having the Dispensary attached to a hospital such as the London Chest Hospital, with all its resources for diagnosis, consultation and treatment, are greatly appreciated by the staff and it is undoubtedly the ideal arrangement for this work. A distressing fact in recent years is the inadequate provision of beds in hospital and sanatorium which shows no sign of improvement in the near future. An early case of pulmonary tuberculosis has a period of waiting of from two to three months for admission and likewise cases requiring special surgical treatment are subject to a similar delay. It is to the credit of the London County Council that their arrangements for institutional treatment are good when compared with the six to eight months waiting period in various parts of the country. This delay in treatment undoubtedly diminishes the prospects of ultimate recovery in early cases and the lack of institutional accommodation for advanced cases, particularly in these times of overcrowding and inadequate housing, is a serious problem from the public health standpoint. Many are required to remain in overcrowded homes with inadequate provision for their care for many months and the consequent exposure to infection of other members of the household cannot fail in time to affect adversely the incidence rate. Tuberculosis Allowances Scheme. The following table sets out the allowances approved by the Tuberculosis Officer during the year:- 30 Grants made under Tuberculosis Allowances Scheme: Ordinary Maintenance Grants Discretionary (Supplementary) Grants Special Grants Total On 1st Jan. 1946 26 l 3 30 New cases 30 5 3 38 Old cases reapplying 5 — — 5 61 6 6 73 Ceased during 1946 39 3 6 48 Carried forward to 1947 22 3 — 25 + covering such small matters as pocket money and fares I understand from the Borough Treasurer that the amount paid out in these grants was £1,437. After three and a half years experience of the scheme there is little doubt that it has done much to attain the primary objective of attracting patients to have early treatment which they might have otherwise refused on economic considerations, but there are, however, certain defects in the scheme. It is limited in scope and does not include the chronic, advanced and non-pulmonary cases. Incapacity for work and not probable future capacity might be made the criterion for eligibility. The present system of dispensing financial assistance through the Government scheme or through the Social Welfare organisation, depending on prognosis, is undesirable on psychological grounds. If one body were responsible for all the forms of financial assistance this would be obviated. Mass Radiography. The L.C.C. Mass Radiography unit was not available in the Borough during the year. 31 Measles, Whooping Cough, &c.—In addition to the formal notifications from doctors included in the foregoing table, other cases came to light from other information, 91 of Measles and 40 Whooping Cough. 162 cases of Chicken pox and 6 of German Measles were also reported in this way. All were visited. Disinfection.—Although reduced in volume compared with pre-war experience, a substantial amount of disinfection was carried out: 541 rooms and 15,054 articles, while 164 articles were destroyed by request. The Personal Cleansing Station provided facilities for the treatment of Scabies for 132 men, 279 women and 225 children, accounting for a total of 1,400 treatments. Bacteriological Examinations.—The arrangements with the Clinical Research Association for bacteriological examinations in connection with suspected infectious disease were continued and the following is a statement of the work done. Disease Suspected Examined Found Positive Throat and nasal swabs Sputum Diphtheria 407 22 Tuberculosis Typhoid, 22 5 Faeces Dysentery, etc. 3 32 PROTECTION OF FOOD SUPPLY. The following table shows the number and nature of the samples of food taken and analysed during the year:— Summary of Analyst's Reports Samples taken formally Samples taken informally Article. No. taken - Genuine Adulterated No. taken Genuine Adulterated Total number mples/ taken. Milk 123 119 4 48 48 — 171 Sterilised Milk 19 19 — 2 2 21 Condensed Milk — — — 1 1 1 Butter 10 10 — 4 4 — 14 Margarine — — — 3 3 — 3 Cheese 1 1 — 2 2 — 3 Cooking Fat 2 2 — 2 2 — 4 Mustard 1 1 16 13 3 17 Pepper 1 1 — — — 1 Vinegar 77 68 9 24 24 101 Acetic Acid — 2 2 2 Sauce 3 3 3 Curry Powder — — — 3 3 3 Spices and Herbs — — — 9 9 — 9 Sage and Onion Stuffing — — — 1 1 — 1 Essences and Flavourings — — — 10 10 — 10 Salad Dressing — — — 4 4 — 4 Cornflour — — 1 1 1 — 1 Cake — 3 3 — 3 Cake Mixture 5 5 — 5 Baking Powder 2 1 1 15 13 2 17 Dessert Powders — — — 3 3 — 3 Table Jellies 1 1 — 4 4 — 5 Jam 6 6 — 2 2 — 8 Honey — — — 1 1 — 1 Lemon Curd 1 1 — — — — 1 Cocoa 1 1 — 1 1 2 Coffee 2 2 2 Coffee and Chicory — — — 1 1 — 1 Drinking Chocolate — 2 2 2 Malto Bar — — — 2 2 — 2 Sandwich Spread — — — 4 4 — 4 Icing Sugar 1 1 1 Cordials 9 9 4 4 — 13 Effervescent Drink — — — 1 1 — 1 Cocktails 3 3 — 1 1 — 4 Mincemeat — — — 1 1 — 1 Sausages & Sausage Meat. 9 9 — 19 19 — 28 Liver Sausage 2 2 — — — 2 Forcemeat — — — 1 1 — 1 Meat Pies — — — 6 6 — 6 Meat Paste 3 3 — 3 Fish Paste — — — 1 1 — 1 Fish Dressing — — — 1 1 — 1 Canned Soup — 1 1 1 Desiccated Soup — — — 1 1 1 Saccharin Powder — — — 1 1 1 Gee Tabs — 1 1 — 1 Gelatine — 3 3 3 Wines and Spirits 14 14 — 2 2 — 16 Drugs 2 — 2 59 55 4 61 TOTALS 284 267 17 287 278 9 571 38 SPECIAL EXAMINATIONS OF FOOD, &c. During the year, 17 bacteriological or special chemical examinations were made as follows:— Pasteurised Milk 2 Ice Cream 9 Camembert Cheese 2 Pork 1 Water from Swimming Bath 2 Scrapings from sink 1 UNSOUND FOOD. The number of occasions on which unsound food was condemned by the Food Inspectors was the same as in the previous year, 259. This figure is considerably higher than the pre-war level, due to the fact that the Ministry of Food control system requires all unsaleable food to be inspected and officially condemned prior to disposal. Vegetables, fruit and tinned food of various kinds constituted the bulk of the food condemned. The following premises in which food is prepared r deposited for sale were supervised and inspected y the sanitary staff : Milkshops ... 216 Poultry slaughterhouses ... 201 Butchers 219 Fish shops 135 Restaurants 222 Bakehouses 93 Ice Cream Vendors 138 Other premises 15 Total number of inspections 1,239. 34 SANITARY CONDITIONS. It might be said that the number of complaints received is a reliable index to sanitary standards, both as they exist in the minds of citizens and in actual fact. On this assumption it is interesting to mention that following a steady decline during the war years, when more serious dangers occupied attention, and reaching the lowest level in 1941, complaints have since fluctuated until in 1945 they reached pre-war level and in 1946 exceeded it. Taking into account the extensive war damage, the arrears and difficulties of ordinary maintenance for seven years, and the age and sub-standard quality of most of the pre-war housing in the borough, it is not surprising that sanitary conditions to-day should be extremely unsatisfactory and the task of the sanitary inspecting staff particularly onerous. The main items in the work of the sanitary inspectors, apart from food, which is separately reported, during the year were: Visits to houses arising from : Infectious disease 711 Complaints as to sanitary conditions 5,146 Inspections of: Factories 1,310 Outworkers' houses 79 Tenement houses 52 Drainage work 5,708 Enquiries with regard to Housing 1,003 Other inspections 5,814 Re-inspections 15,486 35 Nuisances were abated at 3,408 premises, as compared with 2,831 in 1945. The clerical staff prepared 4,852 Preliminary notices and 1.907 Nuisance notices. The sanitary defects which gave rise to the loregoing action covered the following matters: Dirty rooms 4,188 Defective drains and choked w.c's 789 Defective and dirty w.c's 1,743 Defective water supply 641 Defective paving 199 Defective gutters and rain water pipes 1,108 Defective roofs 2,222 Dampness 791 Defective dustbins 410 Other defects 5,136 Total 17,227 As will be seen from the appended list of legal proceedings, it was necessary to take such measures to enforce compliance with some notices. Drainage.—Plans submitted and approved: 57. Dangerous Structures. — The Superintending Architect of the L.C.C. was notified of possible dangerous structures in 102 cases. W ater Supply.—As the great bulk of the water used in the borough comes from the mains of the Metropolitan Water Board and is frequently tested 36 it does not call for special comment. It is, however, interesting to report that there are seven wells in the borough. Two of them have not been used for some years: samples from the remainder have proved satisfactory except that in one case there was evidence of past pollution. Two of the wells are used as a supplementary supply for industrial purposes, two are attached to the Council's Public Baths, and the other one is attached to a local hospital and is used for all purposes. 28 certificates were issued in respect of the satisfactory supply of water to 144 new houses. Notice was sent to the Metropolitan Water Board of observed waste of water in 676 cases. Rent Restriction Acts.—As a result of applications by tenants and following inspections of their houses, 25 certificates of disrepair were issued under the above Acts. Rats and Mice.—Investigations were made into 223 complaints of rat infestation received during the year and in most cases tests of the drainage of the premises affected were carried out by the drainage staff under the supervision of the sanitary inspectors. The two rodent operatives were fully employed during the year and baiting and poisoning were carried out on 445 premises with highly satisfactory results. Baiting of the sewers was undertaken during April and again in December. In all 1,079 sewer manholes were baited with positive results in 634 cases and it is estimated that at least 2,000 rats were killed. 37 Housing Enquiries.—In addition to the pressure on the sanitary staff arising from the worn out condition of the greater part of the housing in the borough, it is perhaps not always sufficiently realised what a great volume of work is also cast upon them arising from complaints from families living under unsatisfactory housing conditions. Of the 1,054 complaints of this kind received during the year, more than half were referred from the London County Council. To deal with them involved 1,003 visits by the sanitary inspectors, arising from which 518 families were recommended to the London County Council for preferential consideration on account of overcrowding and 139 on grounds of health. Overcrowding is widely prevalent, 2,040 dwellings being recorded as being in this state, 518 of them coming to light during the year. \ Factories.— Inspections of factory premises numbered 2,820 and led to 414 notices being served for sanitary defects. Mortuary.—The Council's Mortuary is now occupied and staffed by the Shoreditch Borough Council and serves both boroughs. During the year 353 bodies were received there and 343 post mortem examinations were made. Aged and Infirm Persons.—A number of enquiries were made by the sanitary inspectors into the conditions under which aged and infirm persons were Jiving, but only in one case was it necessary to take legal action to ensure removal to hospital. 38 LEGAL PROCEEDINGS. During the year, it was found necessary to take out 29 summonses to enforce compliance with nuisance notices, with the following results: Withdrawn, upon payment of costs, in all but one case. (£1 lis. 6d. to £3 3s. Od.) 17 Dismissed upon payment of cost: (£4 4s. Od.) 1 Order made for costs (£5 5s. Od.) 1 Nuisance orders made (with fines anc costs amounting to £51 17s. Od.) 1 10 Other summonses may be summarised as follow: Fines Costs £ s. d. £ s. d. 1 Dirty bottle offence under Milk & Dairies Order 1926 10 0 0 7 7 0 1 Selling milk unfit for consumption Conviction on previous summons. 1 Selling milk containing added water 3 3 0 7 Selling vinegar deficient in acetic acid 13 3 0 15 ] 15 0 1 Selling cakes unfit for consumption 2 0 0 5 5 0 An order was also obtained for the removal to hospital of an aged and infirm person.