BEX 6 Health Department, 14 Brampton Road, Bexleyheath, Kent. My Ref. (please quote) You Ref 27th June , 1941. G. F. B R A M LEV. M.D.,D.P.H . MEDICAL OFFICER OF HEALTH. TELEPHONE, BEXLEYH EATH 2 2 4-4-/5 . ANNUAL REPORT OP THE MEDICAL OFFICER OF HEALTH FOR 1940. The report this year is again confined to essential and urgent matters in accordance with Ministry of Health Circular 2314 of the 26th March, 1941. A summary of vital statistics is appended, from which it will be seen that the general health of the Borough has been maintained at a high standard despite the conditions of overcrowding when the majority of the population spent many of the night hours in air raid shelters in the last four months of the year. Some evidence was forthcoming, however, that some persons were not bathing and changing their underclothes as frequently as before, and this was seen "by an increased number of cases of scabies. This, I understand, has been fairly general throughout the country. The Registrar General's estimate of population for midyear is 77,670 compared with 80,110 for 1939. There has been a slight fall in the birth rate which is only to be expected in view of the several conditions brought about by the war. There has been an increase in the death rate, largely due to deaths due to war operations, but even after the application of the comparability factor the death rate compares favourably with the rest of the country. The Corporation Maternity Home has been fully occupied throughout the year and maternity and child welfare clinic sessions held regularly, although smaller attendances have been encouraged especially at the child welfare sessions. There has been no curtailing of health visiting, in fact there has been an increase in the number of home visits made, and the only restriction in the whole of the maternity and child welfare services throughout the year was the discontinuation of special classes in cookery and sewing. The bye-laws affecting sanitation, as with other bye-laws, lapsed in October 1940, three years after the Incorporation of the Borough as required in the Borough Charter. Application was made to the Ministry of Health for the renewal of certain of the lapsing bye-laws which it was deemed necessary to have in effect, but in view of the war the Minister refused to sanction the proposed bye-laws put forward. So far it has been possible to continue sanitary work without these bye-laws, but if a difficult offender is met it is not possible to forecast how the remedy for the nuisance or defect can be obtained where such is not covered in the general legislation. The water supply, despite temporary dislocation due to was damage, has been maintained and a pure and wholesome water has been forthcoming after a few hours on practically all occasions. Regular weekly collections of house refuse have been seriously interfered with owing to the call-up of workmen and the difficulty in replacing them and owing to dislocations in traffic movements from time to time. The longest period between 2. collections has not, however, exceeded fourteen days. The incidence of scarlet fever and diphtheria was lower in 1940 than in any previous recorded year in this district. Immunisation against diphtheria was pushed vigorously throughout the year and by the end. of the year the percentage of the peace time child population inoculated under the age of 11 was about 38. Many more children require to be immunised and all the publicity that can, should be given to this vital procedure. Of 4,6ll children immunised in this Borough from the commencement of the scheme up to the end of 1940 not one has developed diphtheria. During the second and third weeks of June nine cases of Para-typhoid B Fever came to my notice. This was at a time When there was a prevalence of this disease in other parts of the country, and, although many investigations were made, the cause was not found. It must be assumed, however, that there had been some infection of some foodstuff at this time, and with the increased handling of unwrapped foods and the employment of more women in shops, with frequent changes in staff, such outbreaks can only be prevented by all persons who are handling food frequently washing their hands both before and during the period they are working. The increased duties placed upon the staff with the many dislocations which occurred during the year, including the necessary vacation of the Health Department Offices for several weeks,placed a severe strain on everyone concerned, but the work of the health services was not discontinued, and I am indebted to members of the Council and to the whole of the members of my staff and the officers of other departments for their assistance and co-operation. GEO. P. BRAMLEY, M.D. , Ch.B. , D.P.H, , Medical Officer of Health, BEX 6 SUMMARY OP VITAL STATISTICS. 1940. England and Wales. 126 C.Bs and Great Towns including London 148 Smaller Towns (Resident Populations 25,000 - 50,000 at 1931 Census) London Administrative County. Borough of Bexley.  Births - *Rates per 1,000 Civilian Population. 14.6 16.0 15.7 13.7 16.46 Live Still 0.55 0.64 0.55 0.44 0.41 Deaths - All Causes 14.3 15.8 12.8 17.8 10.40 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.00 0.00 Diphtheria 0.06 0.07 0.05 0.01 0.05 Influenza 0.32 0. 29 0.30 0.18 0.03 Smallpox — — — — — Measles 0.02 0.02 0,02 0.01 0.00 Notifications - Cerehro Spinal Fever 0.32 0.33 0.29 0. 28 0.15 Enteric Fever 0.07 0.06 0.10 0.06 0.12 Scarlet Fever 1.63 1.53 1.57 0.82 0.80 Whooping Cough 1.34 1.29 1.35 0. 22 0.11 Diphtheria 1.16 1.29 1.21 0.61 0.30 Erysipelas 0.33 0.36 0.30 0.35 0.16 Smallpox 0.00 - - - — Measles 10.24 9.23 9.99 1.78 0.30 Pneumonia 1.20 1.37 1.00 0.87 0.46 Rates per 1,000 Live Births. Deaths under one year of age 55 61 54 50 45.5 Deaths from Diarrhœ a & Enteritis under two years of age 4.6 5.9 4.4 5.8 4.05 Rates per 1,000 Total Births (i.e. Live and Still) Maternal Mortality - Puerperal Infection (No.147) 0.52 Others 1.64 Not available 0.79 Total 2.16 0.79 Notifications - Puerperal Fever 11.96 13.90 9.73 3.34 13.30 7.13 Puerperal Pyrexia including Puerperal Fever. *A dash ('-) signifies that there were no deaths.