BET 52 Metropolitan Borough of Bethnal Green Abridged Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1947 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 1947 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 Borough of Bethnal Green PUBLIC HEALTH COMMITTEE. (Which also acts as Maternity and Child Welfare Committee.) Councillor F. E. Sanders, Chairman. Councillor Mrs. M. E. Dyson, Vice-Chairman. Alderman M. Finlay. Councillor W. E. Hart. C. Sleigh. „ Mrs. M. E. Peaston. Councillor Mrs. N. R. Blackman. „ Mrs. A. M. Sivill. ,, R. W. Charlton. ,, Mrs. L. A. Stubbs. A. G. Clark. „ I. Sulkin. Ex-Officio Members: His Worship the Mayor (Councillor G. R. H. Hemsley, J.P.). Committee : Chairman : Baths Councillor A. E. McAuliffe. Electricity H. P. Wilson, J.P. Finance and Valuation H. J. Stubbs, J.P. Housing H. Hooke. Law and General Purposes H. E. Tate, J.P. Libraries and Street Trading Mrs. B. L. Tate. Staff and Establishment G. R. H. Hemsley, J.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. STAFF OF PUBLIC HEALTH DEPARTMENT, as at 31st December, 1947. 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, M.R.C.S., L.R.C.P. §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 Officer: 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: fJMiss E. M. Patrick Health Visitors: jMrs. F. Barden jMrs. A. W. Rosling IJrfMiss M. Playle |J*rfMiss D. L. Fraquct fJdMiss M. Irons ft^Miss B. E. Hale (2 vacancies) Clerk-Dispenser: Miss M. V. Hazell Clerk : 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: ti<2£mrs. j. Callow Sanitary Inspectorial Staff: Senior Sanitary Inspector: *mF. C. Sharpe " Food Inspectors: *mW. H. Heron *mG. E. Gould Workshop Inspector: *mS. R. B. Slater Housing Inspector: (vacant) District Inspectors: *G. S. Freeman *E. F. Swash *H. G. Avril *W. Johnson NURSERY STAFF. Columbia Market: Pritchards Road: University House: Matron Miss J. H. Bryce†f Miss E. V. Helyer† Miss M. s. Kirkhope† Deputy Matron Miss P. E. Keene†f Miss M. A. Godden† Miss M. Gray† Supervising Teacher — — Mrs. M. L. Vaughan-Jones Wardens 1 1 - Nursery Nurses 2 1 1 Nursery Assistants 3 3 2 Nursery Students 3 1 - Domestic Staff 4 4 3 OTHER EMPLOYEES. Welfare Centre: Storekeeper Caretaker 3 Cleaners (part time) General: 2 attendants Mortuary: (Attendant employed by Shoreditch Borough Council) Drainage: I Leading Labourer 4 Labourers Disinfection: Leading Disinfector Motor Driver 2 Disinfectors Personal Cleansing Station: Woman Attendant (part time) Other Associated Part-time Officers: Public Analyst: A. E. Parkes, F.R.I.C., F.C.S. Vaccination Officers: R. Berriff, Miss M. Peters. † Certificated Nurse. ‡ Certified Midwife. a Health Visitors Diploma. t Tuberculosis Certificate. * Certificated Sanitary Inspector, m Certified Meat, etc. Inspector. f Registered Fever Nurse. 5 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 1947 in an abridged form. The Vital Statistics of the Borough compare favourably with the national figures as set out in the table on page 9. The Infant Mortality rate of 45 is slightly up from last year but it is hoped that this slight rise will be ironed out in the future and that the downward trend of this rate in recent years will be continued. The Birth rate of 23 is slightly higher than last year and again stresses the need for more maternity bed accommodation than has in the past been available. The Death rate of 13.8 remains much the same and calls for no particular comment. During the year an epidemic of Poliomyelitis occurred in this country which fortunately was less prevalent in Bethnal Green than in many districts. I shall make special comment on this disease later in my report. Notifications of infectious disease numbered 1,003, a considerable reduction from last year. There was a reduction in cases of Diphtheria, Scarlet Fever and Measles but a slight increase in Whooping Cough and Tuberculosis. One death occurred from Diphtheria in a child who had not been immunised. Scarlet Fever, Measles and Whooping Cough continued, as in recent years, to be of a mild type and only in exceptional cases was it necessary to recommend removal to hospital. During the year the Diphtheria Immunisation Scheme was further extended and publicised with the result that a further clinic for this purpose will require to be established. Arrangements have been made to extend the Diphtheria Immunisation Scheme to Whooping Cough and, in suitable cases, to combine this protection with Diphtheria. It has been necessary to 7 tinue the treatment of most infectious diseases in the home owing to the acute shortage of hospital beds. The more serious of the infections, however, such as Diphtheria, Typhoid Fever and Poliomyelitis are admitted to hospital on notification. During the year a limited amount of new housing accommodation has been made available but with the present rate of progress in the provision of houses it will be a number of years before the needs in this respect will be adequately met. Owing to the presence of old, outmoded property in this district complaints by occupiers have continued to be particularly high. The staff of Sanitary Inspectors during the year was reduced in number owing to resignations but working under pressure 15,506 inspections and 8,846 re-inspections were carried out. As in previous years delays and disappointments occurred in the abatement of housing defects owing to the continued shortage of materials and of skilled labour. The Public Health Services and the Maternity and Child Welfare Service were maintained satisfactorily throughout the year. It is noteworthy that this will be the last complete year during which the Borough Council will be responsible for the personal health services in the Borough. The National Health Service Act of 1946 transfers these services to the care of the London County Council as from the 5th July, 1948, and these will be administered through the Divisional Health Committee in combination with the City of London and the Boroughs of Poplar and Stepney. Opportunity will still be available to the local council through their representatives on the Divisional Health Committee to voice their opinion on the form and development of these services in *heir locality in the future. It is hoped that the London County Council in their new-found responsibilities will be in a position to provide this area in the near future with a modern comprehensive health centre in which an efficient and complete health service will be available. The Day Nurseries have continued their work well throughout the year and by the use of part-time workers many more children have been admitted. The demand for places has not abated and there is still a waiting list of considerable size. The priority system of admission has worked satisfactorily throughout the year and no criticism 8 has been forthcoming as a result of its implementation. The London County Council will in future years be responsible for the provision and maintenance of Day Nurseries and should the present Columbia Market and Pritchard's Road Nurseries revert to their former use as Nursery Schools it will be necessary to provide new nurseries to take their place. There is no evidence that the demand for day nursery accommodation has decreased during the present year. Considerable difficulty has been experienced in maintaining an adequate and suitable staff particularly in the cases of Health Visitors, and Sanitary Inspectors. The shortage of Nursery Nurses, Students and Nursery Teachers has continued but it is hoped that with the adoption of the new salary scales this work will attract workers in the future in sufficient numbers to allow the present nursery accommodation to be used to its full. By the retirement this year of Dr. H. Tylford Howell, the Tuberculosis Officer, the Public Health Service and the Borough have lost a physician of outstanding merit and one who is held in high regard by the people of Bethnal Green. Dr. Howell came to this district over 30 years ago and his life has been devoted to the fight against tuberculosis. A man of great charm and attainments, he will indeed be difficult to replace. 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. 9 VITAL STATISTICS. The Vital Statistics for the year, calculated on the basis of the Registrar-General's estimate of the civilian population as 59,940, are as follow: Bethnal Green London England and Wales Bethnal Green 1940 Birth Rate 28.0 22.7 20.5 22.6 Death Rate 13.8 12.8 12.0 13.3 Infant Death Rate 45.0 37.0 41.0 41.3 Maternal Death Rate 0.7 — 1.17 1.4 Last year's high Birth Rate has been slightly increased but there are signs that it has reached its peak. In addition to the 1,378 live births, there were 36 stillbirths which formed 2.5% of the total births (live and dead). The Death Rate shows a slight increase over last year and is higher than the pre-war average, probably influenced by the altered age composition of the population. Two diseases mainly account for the increased deaths over 1946, Pulmonary Tuberculosis and Cancer. The Infant Death Rate is also higher than that for the preceding year, but is substantially lower than the pre-war average. As will be seen the Maternal Mortality Rate is not only lower than in 1946, but also compares very favourably with the rate for the country as a whole. The following table shows the causes of death and the age and sex composition of the people who died in the year:— 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. 2 — — — — — 2 F. — — — — — — — 3. Scarlet Fever M. — — — — — — — F. — — — — — — — 4. Whooping Cough m. 1 1 — — — — 2 F. 3 — — — — — 3 5. Diphtheria M. — 1 — — — 1 F. — — — — — — — C. Tuberculosis of respiratory system M. 2 — — 12 17 4 35 F. — — — 12 5 1 18 7. Other forms of tuberculosis M. — 1 — — — — 1 F. — — — — — — — 8. Syphilitic disease M. — — — 1 1 2 4 F. — — — — 2 — 2 9. Influenza M. 2 — — 1 — 1 4 F. — — — — — 1 1 10. Measles M. — — — — — — — F. — — — — — — — 11. Acute Poliomyelitis and polioencephalitis m. — — — — — — — F. — — — 1 — — 1 12. Acute infectious encephalitis M. — — — 1 — — 1 F. — — — — — — — 13. Cancer of mouth and oesophagus Cancer of uterus m. — — — 1 2 6 9 F. — — — — 3 1 4 14. Cancer of stomach and duodenum M. — — — — 7 4 11 F. — — — 2 4 12 18 15. Cancer of breast M. — — — — — — — F. — — — 1 4 9 14 16. Cancer of all other sites M. — — — 3 22 28 53 F. — — — — 24 23 47 17. Diabetes m. — — — — — 2 2 F. — — — — 2 2 18. Intra.-cra.nial vascular lesions M. — — — — 11 21 32 19. Heart Disease M. — — — 4 15 99 118 f. — — 1 4 18 92 115 20. Other diseases of circulatory system M. — — — 2 4 17 23 F. — — — — 4 20 24 21. Bronchitis M. 1 — 1 4 18 28 52 F. 1 — — — 3 11 15 22. Pneumonia M. 8 2 — — 8 14 32 F. 4 — — 1 3 8 16 23. Other respiratory diseases M. — — — — 5 4 9 F. — — — — 2 1 3 24. Ulcer of stomach or duodenum M. — — — — 1 4 5 F. — — — 1 3 1 5 25. Diarrhoea (under 2 years) M. 9 — — — — — 9 F. 3 — — — — — 3 26. Appendicitis M. — — — — — 1 1 F. — — — — 1 — 1 27. Other digestive diseases M. — — — — 1 2 3 F. — — — — 3 2 5 28. Nephritis M. — — 1 — 1 2 4 F. — — — — 2 1 3 29. Puerperal and post-abortive sepsis. F. — — — 1 — — 1 30. Other maternal causes F. — — — — — — — 31. Premature birth M. 4 — — — — — 4 F. 4 — — — — — 4 32. Congenital malformation, etc. M. 7 — — — — — 7 F. 4 — — — — — 4 33. Suicide M. — — — — — 3 3 F. — — — — 3 — 3 34. Road traffic accidents M. — — 1 2 1 1 5 F. — — — — — — — 35. Other violent causes M. 5 — 2 2 1 4 14 F. — — — — 1 2 3 36. All other causes M. 1 1 1 1 4 13 21 F. 1 — — 4 3 14 22 TOTAL ... 62 6 7 61 213 480 829 M 467 F 362 10 12 As in previous years, attention is drawn to the mortality from Cancer. Statistics with regard to Tuberculosis mortality will be found in the section of this report devoted to Infectious Disease. The following figures compare the incidence of Cancer in 1947 with that in 1946 and the pre-war years 1936-38: Death rate per 1,000 population 1947 1946 Average 1936-38 Cancer of: Mouth & oesophagus M .15 ... .12 ... .10 Uterus F .07 ... .09 ... .08 Stomach and M .18 ... .14 ... .26 duodenum F .30 ... .07 ... .12 Breast M — — — F .23 ... .22 ... .16 Other sites M .88 ... .86 ... .61 F .78 ... .40 ... .42 M 1.22 ... 1.12 ... .97 Total F 1.38 ... .79 ... .78 In considering these rates, the effect of the postwar higher age composition of the population should be borne in mind. 13 MATERNITY AND CHILD WELFARE. It is interesting to note that although the population of the borough is smaller than before the war and our facilities are more restricted, there has actually been a much larger attendance of expectant mothers at the Maternity Clinic. This is no doubt largely due to the use of the Welfare Centre as a registration centre for hospital accommodation for confinement. To illustrate the extent to which the Council's welfare facilities have been used in recent years, I give statistics of the pre-war average and the later war years as well as for the year under report. 14 Attendances at Welfare Centre. Babies (0-1) † Children (1-5) Mothers First Attendances Subsequent Attendances First Attendances Subsequent Attendances Ante-Natal Post-Natal First Subsequent First Subsequent Average * 1936-38 992 9339 178 6794 345 991 219 125 1942 682 4860 83 702 319 853 7 1 194 639 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 — 1947 1131 10,441 79 1283 737 3151 21 — * 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* † 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 Babies under 1 year. Children 1-5 years. Mothers Stillbirths, Infant deaths, Maternal deaths. Puerperal fever and pyrexia, Ophthalmia neonatorum Other infectious diseases. AnteNatal. PostNatal. 1936-38 12577 13880 1340 367 101 94 2339 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 1946 8245 7117 754 55 60 38 1457 1947 8843 5027 499 47 53 32 1386 I5 It should be noted that the Health Visiting- Staff was 11 before the war, but only 7 at the end of 1947. Notifications of Births.—Notices of 1,022 live births and 19 stillbirths were received, 466 of which were found to relate to other districts and were duly transferred to the appropriate Medical Officer of Health. Inward notifications relating to births to Bethnal Green mothers outside the borough amounted to 783 live births and 19 stillbirths, making the nett total of live births notified 1,345. Maternity Clinics.—The higher Birth Rate, existing housing conditions and probably the higher public standard with regard to midwifery have all contributed to a very substantial increase in the volume of work undertaken by the Council's Maternity Clinic which is actually greater than before the war despite the considerable fall in the population. It is interesting to compare some statistics of the position in 1938, the last normal pre-war vear, and in 1947: 1938 1947 Expectant mothers 230 ... 737 Attendances at Clinics 965 ... 3,888 The Clinic has always prided itself on its record for the early attendance of mothers for ante-natal care which has now been given an added fillip by the necessity for early booking for the confinement: First attendance in 1938 1947 2nd month of pregnancy 15 140 3rd „ „ ,, 20 257 4th „ ,, ,, 35 144 5th ,, „ ,, 32 83 6th „ „ ,, 51 44 7th ,, „ ,, 33 27 8th „ „ ,, 25 17 9th ,, ,, ,, 8 - 16 The results of the pregnancies so far as known at the time this report was compiled were as follow: (1938) Full term confinements 379 ... 150 Premature births — ... 6 Miscarriages 11 ... 5 Stillbirths 4 ... 6 Pregnancy terminated — ... 1 Not yet confined 281 ... 45 Left borough (results unknown) 41 ... 7 Premature Infants.—Of the births belonging to the Borough, in 76 cases the low birth weight brought the children within the definition of "Premature infants," 15 being born at home and 61 in a hospital or nursing home. One of the former group and 4 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.—67 of the live births which occurred during the year were illegitimate, the percentage being 4.8 which although higher than the pre-war rate, shows a reduction on 1946. 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. 17 During the year, the pre-war ancillary service of Physio-therapy was resumed at the Welfare Centre. Modern ultra-violet ray equipment was installed and a physio-therapist engaged for two sessions a week to give massage and light treatment. It was also found necessary to hold an extra Maternity Clinic session per week owing to increased attendances. Dental Treatment.—During the year, the Dental Clinic has been in active operation and the following figures summarise the treatment provided : New Cases Subsequent Attendances Mothers 133 333 Children 90 78 Extractions: Under Gas Local Anaesth. Mothers 304 (64) 105 Children 56 (17) 9 Fillings : Mothers 64 Children 93 Silver nitrate treatment: (Children only) 29 Stain removed: (Children) 17 Scaling: (Mothers only) 44 Gum treatment : (Mothers only) 16 Dentures supplied : (Mothers) 37 Dentures repaired 2 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 42 cases during the year. 18 Nursing Assistance.—The Shoreditch and Bethnal Green District Nursing Association continues to provide, at the Council's expense, nursing assistance in a variety of circumstances, mostly to expectant and nursing mothers and children under 5. During the year 154 new cases were dealt with and a total of 960 visits were paid. Convalescent Treatment.—Two mothers with their babies and two children under 5 were directly provided with convalescent treatment by the Council, and in addition, grants were made to the Invalid Children's Aid Association in respect of 12 children sent away by that body. NURSERIES. During the year, the previous difficulty in obtaining and retaining staff continued and it was not possible to use the nurseries to capacity. Towards the end of the year, however, the new salary scales and the employment of part time assistants effected some improvement 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. pr. Dec. qr. Columbia Market 36.1 49.5 53.4 56.0 Pritchards Road 33.4 37.7 38.6 45.1 University House 32.8 42.3 38.0 45.9 Although there is still a long list of children awaiting admission, some of them of mothers urgently needing employment for maintenance, the revised conditions laid down by the Public Health Committee for admission to, and retention in, the nurseries have enabled 19 much greater regard to be paid to social needs in the allocation of the accommodation. SCHOOL HEALTH SERVICE. The County Medical Officer has kindly furnished me with the following statistics giving the results of the medical inspection of 3,111 school children in the borough: Bethnal Green Per cent. London (average) Per cent. General condition: A—Good 1,379 44.3 42.0 B—Fair 1,646 52.9 54.3 C—Poor 86 2.8 3.7 Cleanliness of Head: Clean 3,052 98.1 98.8 Verminous 59 1.9 1.2 Cleanliness of Body: Clean 3,104 99.8 99.7 Dirty 6 0.2 0.3 Teeth: All sound 2,527 81.2 78.3 Defective 584 18.8 21.7 Vision: 6/6 in both eyes 1,605 72.2 78.8 6/9 in either or both 317 14.3 11.1 6/12 or worse in either or both 299 13.5 10.1 Prophylaxis: Vaccinated 617 19.8 52.7 Immunised against Diphtheria 2,512 80.7 82.7 20 The percentages of defects discovered upon medical inspection and their comparison with the London average are shown in the following table: Condition Bethnal Green London Malnutrition 2.9 1.6 Skin disease 2.7 1.2 Enlarged tonsils and adenoids 11.4 7.7 Enlarged cervical glands 2.0 1.0 Eye disease 1.1 0.7 Vision defect 15.2 10.2 Squint 1.4 1.3 Otitis media 0.8 0.5 Defective hearing 0.1 0.3 Speech defects 0.7 0.5 Heart and circulation 1.1 0.6 Anaemia 0.4 0.3 Lung defects (not T.B.) 2.1 1.2 Defects of nervous system 0.5 0.3 Orthopaedic defects 5.9 4.0 Psychological defects 0.9 0.4 21 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. There was a general reduction in cases of Diphtheria, Scarlet Fever and Measles, but an increase in Tuberculosis, Whooping Cough and Poliomyelitis, which is the subject of a special comment. 22 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 — 3 3 — Diphtheria (inc. Memb. Croup) 4 5 10 28 2 1 — — 50 50 1 Scarlet Fever 1 6 22 49 2 — — — 80 38 — Puerperal Fever — — — — 1 — — — 1 1 1 Puerperal Pyrexia — — — — 3 6 — — 9 9 Ophthal. Neonatorum 10 — — — — — — — 10 1 — Erysipelas — — — — 1 6 4 1 12 7 — Cerebro-spinal Fever 1 — 2 — — — — — 3 3 2 Acute poliomyelitis 3 1 4 7 4 2 2 — 23 22 1 Acute Encephalitis Lethargica — — — — — — — — — — 1 Acute Polioencephalitis — — — — — — — — — — — Acute Pneumonia 1 1 3 10 5 6 7 5 38 6 48 Dysentery 1 — 2 1 2 3 2 1 12 10 — Malaria — — — — — — — — — - — Continued Fever — — — — — — — — — - — Typhus Fever, Cholera, Plague, Relapsing Fever — — — — — — — — — — — Anthrax, Hydrophobia, Glanders — — — — — — — — — — — Measles 25 49 99 60 1 1 — — 235 31 — Whooping Cough 67 48 145 61 2 1 — — 324 39 5 Scabies 2 2 9 13 19 28 12 2 87 — — Pulmonary Tuberculosis 1 — 4 7 26 40 20 4 102 — 53 Other forms of Tuberculosis — — 3 4 3 2 2 — 14 — 1 Total 116 112 303 241 71 97 50 13 1,003 220 113 23 Poliomyelitis.—A widespread epidemic of this disease occurred in England and Wales during the year, although fortunately less prevalent in Bethnal Green than in many districts. Twenty-three case were notified, but only 12 were confirmed. Of these 5 recovered with no observed after-effects, 6 were left suffering from varying degrees of residual weakness, including 1 case of paralysis of both legs, while 1 patient died. Diphtheria.—As pointed out in previous reports, the recorded notifications of Diphtheria are not a completely reliable index to the actual incidence as in 24 of the cases (or 48%) the diagnosis was not confirmed in hospital. There was only 1 death from this disease. DIPHTHERIA IMMUNISATION. The clinic for the provision of immunisation against Diphtheria which was started in March 1946 continued in active operation during 1947. Immunisation is also carried out at the three nurseries. During the year, 791 immunisations were completed at the Welfare Centre and the nurseries, and 256 immunisations of Bethnal Green children were carried out by the London County Council. I estimate that approximately 50% of the children under 15 are now so protected. As the first inoculation in infancy loses some of its effect in the course of years, it is 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 24 of Diphtheria which may occur among immunised children. During the year 2 of the 8 cases of Diphtheria among children under 5 were found to be children who had been immunised, while 9 out of 15 cases among children between 5 and 15 were also immunised. The 1 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. 25 Registration Sub-Districts Number of Births registered from 1st January to 31st December, 1946 Number of Births entered in Vaccination Register 31st January. 1948 Col. I. Successfully Vaccinated Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Died unvacciuated Insusceptible of Vaccination Had Small Pox 1 2 3 4 5 6 7 North East 630 180 Nil Nil 263 21 South West 257 26 Nil Nil 138 10 TOTAL 887 206 Nil Nil 401 31 Number of Births not entered in "Vaccination Register" Number of these Births remaining on 31st Jan., 1948, 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 1947 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 1947 Registration Sub-Districts Postponement by Medical Certificate Removal to Districts the Vaccination Officers of which have been duly apprised 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 2 11 153 334 256 South West Nil Nil 3 80 108 167 TOTAL Nil 2 14 233 442 423 Children successfully vaccinated after declaration of conscientious objection: 1. The total number of copies of Certificates for the year 1947 sent to other Vaccination Officers was 126. 26 TUBERCULOSIS. During the year 116 new cases of Tuberculosis were notified and 725 patients were recorded on the register on the 31st December. The difficulty of placing patients in sanatoria has continued throughout the year and owing to the shortage of hospital staff there is no hope in the near future of an improvement in this position. It is vitally necessary that steps be taken to make the Tuberculosis Hospital Service attractive to new entrants if early and adequate treatment is to be made available to those unfortunate enough to contract this disease. The Tuberculosis Officer and his staff do all they can to ensure that the patients' conditions do not deteriorate as a result of delay in treatment by initiating and advising on sanatorium regime being carried out to some extent in the homes and in suitable cases commencing collapse therapy in lung disease which in other circumstances would only be carried out in hospital or sanatoria. The Tuberculosis Visitors paid 3,568 visits to patients. Three hundred and twelve grants of extra nourishment in the form of milk, Ovaltine or invalid meals were made to 59 necessitous patients. TUBERCULOSIS DISPENSARY. The work of the Tuberculosis Dispensary at the London Chest Hospital continued to increase and is revealed in the following figures:— 27 Diagnosis of New Cases. Adults Children under 15 Females Total Diagnosis -Males Females Males Pulmonary tuberculosis 51 38 5 3 97 Non-pulmonary tuberculosis 4 6 3 3 16 N on-Tuberculous 195 285 85 86 651 Doubtful 5 4 3 5 17 255 333 96 97 781 Diagnosis of Contact Cases. Pulmonary tuberculosis 4 Non-pulmonary tuberculosis 1 Non-tuberculous 233 Doubtful — Total 238 Other Figures. Total number of Attendances 3,130 Number of Patients sent to hospital or sanatoria by the L.C.C. 52 Number of visits to patients at their homes 75 Number of attendances at: X-ray Department 1,698 Artificial Pneumothorax Clinic 1,034 Other Departments 26 Sputum Examinations 694 Tuberculosis Allowances Scheme. The following table sets out the allowances approved by the Tuberculosis Officer during the year:— 28 Grants made under Tuberculosis Allowances Scheme: Ordinary Maintenance Grants Discretionary (Supplementary) Grants Special † Grants Total On 1st Jan. 1947 22 3 . — ... 25 New cases 43 7 2 52 65 10 2 77 Ceased during 1947 39 3 . — ... 42 Carried forward to 1948 26 7 2 35 + covering such small matters as pocket money and tares I understand from the Borough Treasurer that the amount paid out in these grants was £2,339 12s. lOd. Mass Radiography.—The L.C.C. Mass Radiography unit was made available to workers in the Borough during the year, with the following results: Persons Examined Refd. for large films No Abnormality Refd. to Gen. Practitioner (Prob. Tuber.)[/### Men 200 14 2 5 Women 148 4 1 2 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, 42 of Measles and 94 Whooping Cough. 132 cases of Chicken pox, 63 of Mumps, 5 of German measles, 201 of Scabies, and 56 of Gastro-enteritis were also reported in this way. All were visited. Disinfection.—Although reduced in volume compared with pre-war experience, a substantial amount 29 of disinfection was carried out: 835 rooms and 10,627 articles, while 177 articles were destroyed by request. The Personal Cleansing Station provided facilities for the treatment of Scabies for 68 men, 102 women and 99 children, accounting for a total of 587 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 Diphtheria 495 9 Sputum Tuberculosis 20 1 Faeces Typhoid, Dysentery, etc. 1 — 30 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. Article. Samples taken formally Samples taken informally Total number of samples taken. No. taken Genuine Adulterated No. taken Genuine Adulterated Milk 78 77 1 29 29 — 107 Dried Milk — — — 2 2 — 2 Sterilised Milk 5 5 — 2 2 — 7 Butter 3 — 4 4 — 7 Margarine — — — 2 9 — 2 Cheese 1 1 — — — — 1 Cooking Fat — — — 1 1 — 1 Mustard — — — 3 3 — 3 Pepper — — — 3 3 3 Vinegar 28 2G 2 99 21 1 50 Acetic Acid 5 — 5 5 1 4 10 Salad Oil 1 1 — — — — 1 Salad Cream — — — 1 1 — 1 Sauce — — — 2 2 — 2 Curry Powder — — — 2 9 2 Spices — — — 1 1 — 1 Sage — — — 1 1 — 1 Sage and Onion Stuffing — — — 1 1 — 1 Essences — — — 2 2 — 2 Pea Flour — — — 1 1 — 1 Cereals — — 2 2 — 2 Baking Powder 1 — 1 3 2 1 4 Egg Powder ' — — — 1 1 — 1 Table Jellies — — — 3 3 — 3 Jam — — — 3 3 — 3 Fruit Pie — — — 1 1 — 1 Mixed Fruits in Svrup — — — 1 1 — 1 Cocoa — — — 1 1 — 1 Coffee — — — 1 1 — 1 Coffee and Chicory — — — 1 1 — 1 Chocolate Powder — — — 1 1 — 1 Chocolate Spread 1 1 — 1 1 — 2 Malted Sova Cream — — — 1 1 — 1 Cordials 6 6 — 4 4 — 10 Sherbet — — — 4 4 — 4 Ice Cream — — — 1 1 — 1 Mincemeat — — — 1 1 _— 1 Sausages 8 7 1 13 12 1 21 Sausage Rolls — — — 1 1 — 1 Cooked Meats 1 1 — — — — 1 Meat Roll — — — 1 1 — 1 Meat Paste — — — 1 1 — 1 Meat Extract — — 1 1 — 1 Canned Foods — — — 6 6 — 6 Frying Oil i 1 — — — — 1 Gelatine — — — 1 1 — 1 Wines and Spirits 8 8 — 1 1 — 9 Drugs 2 2 — 28 28 — 30 totals 149 139 10 167 160 7 316 31 SPECIAL EXAMINATIONS OF FOOD, &c. During the year, 5 bacteriological or special chemical examinations were made as follows:— Ice Cream 2 Dinner 1 Water from deep well 2 UNSOUND FOOD. The number of occasions on which unsound food was condemned by the Food Inspectors was 307. INSPECTION OF FOOD PREMISES. The following premises in which food is prepared or deposited for sale were supervised and inspected by the sanitary staff : Milkshops 153 Poultry slaughterhouses 171 Butchers 182 Fish shops 97 Restaurants 205 Bakehouses 86 Ice Cream Vendors 141 Other premises 24 Total number of inspections 1,059 32 SANITARY CONDITIONS. While the remedying of sanitary defects still remains as difficult, if not more complicated, the actual volume of sanitary work was less in 1947 than in the preceding year, there being fewer complaints and drainage inspections. Owing to the shortage of district inspectors, infectious disease enquiries were for a period undertaken by the Health Visitors, and the Food and Sanitary Inspectors were largely diverted from their normal duties to deal with district work, with consequent reduction in the visits to food and factory premises. Housing enquiries, on the other hand, showed an increase. 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 243 Complaints as to sanitary conditions 4,805 Inspections of: Factories 183 Outworkers' houses 25 Tenement houses 14 Drainage work 4,184 Enquiries with regard to Housing 1,250 Other inspections 4,802 Re-inspections 8,846 33 Nuisances were abated at 1,906 premises, as compared with 3,408 in 1946. The clerical staff prepared 3,704 Preliminary notices and 1,029 Nuisance notices. The sanitary defects which gave rise to the foregoing action covered the following matters: Dirty rooms 3,295 Defective drains and choked w.c's 624 Defective and dirty w.c's 1,711 Defective water supply 823 Defective paving 135 Defective gutters and rain water pipes 767 Defective roofs 1,714 Dampness 1,053 Defective dustbins 238 Other defects 5,709 Total 16,069 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 : 28. Water 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 it does not call for special comment. It is, however, interesting to report that there are 7 wells in the 34 borough. Two of them have not been used for some years: samples from the remainder have proved satisfactory except that in 1 case there was evidence of past pollution. Two of the wells are used as a supplementary supply for industrial purposes, 2 are attached to the Council's Public Baths, and the other 1 is attached to a local hospital and is used for all purposes. Nine certificates were issued in respect of the satisfactory supply of water to 132 new houses. Notice was sent to the Metropolitan Water Board of observed waste of water in 779 cases. Rent Restriction Acts.—As a result of applications by tenants and following inspections of their houses, 26 certificates of disrepair were issued under the above Acts. Rats and Mice.—Investigations were made into 175 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 413 premises with highly satisfactory results. Baiting of the sewers was undertaken during April and again in December. In all 1,378 sewer manholes were baited with positive results in 691 cases and it is estimated that at least 2,000 rats were killed. 35 Housing Enquiries.—A considerable amount of labour continues to be occupied both by the sanitary inspectors and the office staff in dealing with housing enquiries, especially where overcrowding or ill-health is concerned. This involved 1,250 visits by the inspectors and the recommendation to the L.C.C. for preferential consideration of 453 cases on account of overcrowding and 76 on grounds of health. Overcrowding is widely prevalent, 2,113 dwellings being recorded as being in this state, 453 of them coming to light during the year. Factories.—Inspections and re-inspections of factory premises numbered 636 and led to 123 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 378 bodies were received there and 374 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 living, but only in one case was it necessary to take legal action to ensure removal to hospital. LEGAL PROCEEDINGS. During the year, it was found necessary to take out 9 summonses to enforce compliance with nuisance notices, with the following results: 36 Withdrawn, upon payment of costs, (£1 lis. 6d. (3); £3 3s.Od. (2)) 5 Adjourned sine die 1 Nuisance orders made (with fines and costs amounting to £5 10s. 6d.) 3 Other summonses may be summarised as follow: Fines Costs £ s. d. £ s. d. 1 Selling milk containing added water - - - 3 3 0 5 Selling vinegar or solution of acetic acid deficient in acetic acid 19 0 0 27 6 0 1 Selling bread unfit for consumption 1 0 0 3 3 0 An order was also obtained for the removal to hospital of an aged and infirm person.