BEX9 (pleas e quote) G. F. B R A M LEY. m.d.;d.p.h. Your Ref.. Medical officer of health. TELEPHON E, BEXLEYHEATH 224-4-/5. 22nd June 1944 ANNUAL REPORT 0? THE MEDICAL OFFICER OF HEALTH FOR 1943 The report is again restricted in accordance with the Ministry of Health Circular 10/44 of the 15th February 1944. A Summary of vital statistics is appended. Compared with the rest of the country, and with previous reports, the health of the inhabitants of the Borough has been maintained at a high standard. The low infantile mortality rate (26.01) is an outstanding fact and most gratifying. It is 6.59 below that of last year which was up to then the lowest ever recorded in this Borough. It has been stated recently that a goal of 25 for the infantile mortality rate of greater London might well be aimed at in the next ten years, so that to stabilise or reduce the 1943 record in 3exley there can be no relaxation and indeed only intensification of the activities of maternity and Child Welfare. The low infantile mortality rate is accompanied by a low stillbirth rate. An equally outstanding and gratifying fact is that there was no death from diphtheria in 1943, when by December 31st, 70% of children under the age of 15 were immunised and to this must be given the credit. With varying phases of human resistance and bacterial infectivity there may be a change in this relationship, but so far as present evidence goes a high immunisation rate will mean a low diphtheria rate. Immunisation is a continuous process and the parents of children approaching one year old should take advantage of the facilities offered, as although diphtheria is now becoming an uncommon disease relaxation of the immunisation campaign would only lead to the old conditions with the disease taking a big toll of child life as the diphtheria germ is still with us. Scarlet fever was common during the year, but did not reach the levels of the previous epidemic cycles in 1920-22, 1926 and 1933. The disease was, however, very mild with no deaths. From home isolated cases there were less than 2% of return cases, as against over 5% from Hospital isolated cases. Inoculation against Whooping Cough was continued and appears to be justifying the campaign as only 9 children of the 2891 inoculated since the scheme began in July 1942 have contracted the disease. The influenza epidemic at the end of the year was mild and Bexley appeared to come off very lightly so far as deaths were concerned. The assistance of Voluntary Organisations was freely given in a scheme organised to give domestic and nursing assistance and to assist with shopping where the adults of a household were incapacitated. The Ministry of Health gave stimulus to the Home Help Scheme during the year and the scheme suggested was substantially the same as had been in operation in the Borough since 1936, but with a 50% increase in applications and the inability of the Ministry of Labour to find suitable persons to act as Home Helps, the local service has not been easy to maintain. The scheme is restricted by legislation to homes in which there is a nursing or expectant mother or child under the age of five, but there are many homes where domestic assistance is urgently required outside the restriction, but we are unable to help. With the increase in illegitimate births the suggestions of the Ministry of Health to make provision for the mother and her child BEX9 have "been put into operation so far as they arc applicable, and arrangements sought with the County Council whore joint efforts would be more applicable and economical, for example, in residential nursery accommodation not only for the illegitimate child but for children whose mothers need to be admitted to hospital; the only accommodate on in this part of the county is very limited and supplied by the public Assistance Committee. The services of the Rochester Diocesan Council in the provision of hostels has been appreciated and arrangements made for contributions per case. The rise in illegitimacy should not necessarily bv attributed to a lowering of moral standards, but it must be appreciate. that opportunity for marriage to legitimise an expected birth is very often impossible in war time. In peace time in England and wales 20% of first births were legitimised by marriage after conceoption. By the end of the year four days nurseries were in operation in the Borough, and one 24 hour nursery, There was a waiting list of 75 children for admission. The Okehampton Nursery for 60 children was in course of erection and a nursery in Bellsgrove Road, Welling, proposed, as the Ministry of Labour required provision for children of mothers in part time employment During the year there and no accommodation available for children whose mothers were in part-time . employment The nurseries hove continued to serve an essential purpose with obvious benefit physically and mentally to the children in them. With nursing supervision the physical side of children in nurseries has always been well catered for and with further development during the year of the educational side the role of the nursery is assuming its proper proportions. The continued high birth rate with large clinic attendances has necessitated increased ante-natal and child welfare sessions and the Council agreed to the use of adaptable premises in Wrotham Road and Falconwcod. The provision of clinic accommodation in these areas was held up by the outbreak of war but could not be postponed any longer. This additional service is appreciated as judged by attendances. It was also necessary to increase the dental sessions as the waiting list was becoming alarmingly big. The housing position becomes more acute but as new houses cannot be provided before the end of the war, the Council have before them schemes for post-war housing. I estimate that at least 500 new house -are required in the Borough for the rehousing of families living in houses net fit for habitation or overcrowded as judged by the Housing Act Standards in addition to 618 houses required for rehousing of families still living in areas .scheduled under Slum Clearance before the war. With the addition of houses required for married couples living with parents and new marriages a big programme lies, ahead. The number of new cases of scabies coming to my notice did not diminish during the year and many contacts were not being treated as the disease was not notifiable in the Borough. The necessary power was obtained therefore for the disease to be notifiable as from the 1st November.' Since then all notified cases and contacts have been, followed up to see that they obtained treatment either at the Cleansing Station, or at homo under the patient's own doctor. 129 cases were notified in the two months and during the year 728 cases and contacts attended for treatment at the Cleansing Station. The bathing and treatment is given by Civil Defence personnel and for this and help in other activities of the Health Department we are deeply indebted to them. An event of Public Health importance in the Borough during the year was the setting up of the Tuberculosis After Care Committee. A band, of very energetic voluntary workers has commenced work on a very large test. As Tuberculosis is as much an economic calamity in the average household as a medical problem the wok of the After Care Committee will go far to mitigate its evils and thereby prevent its spread. I have to thank the members of the Council and officers of other departments for their helpful consideration and express my indebtedness to all members of the Health Department. GEO. P. BRAMLSY, M.D., Ch.B., D.P.H., Medical Officer of Health SUMMARY OP VITAL STATISTICS 1943 England and Wales. 126 C.Bs and Great Towns including London. 148 Smaller Towns Resi_ dent tions 25,000 - 50,000 1911 London Administrative County. Borough of Bexley ≠Rates per 1,000 Civilison Population. Births Live 16.5≠ 18.6 19.4 15.8 18.03 Still 0.51≠ 0. 63 0.6l 0.45 0.37 Deaths - All causes 12.1≠ 14.2 12.7 15.0 9. 21 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 - Scarlet Fever 0.00 0.00 0.00 0.00 - Whooping Cough 0.03 0.03 0.03 0.03 0.01 Diphtheria 0.03 0.04 0.04 0.02 - Influenza 0.37 0.36 0.37 0.27 0.15 Smallpox - — - - — Measles 0.02 0.02 0.02 0.02 0.01 Notifications Typhoid Fever 0.01 0.01 0.02 0.01 0.01 Paratyphoid Fever 0.01 0.01 0.01 0.01 - Cerebro Spinal Fever 0.08 0.10 0.05 0.09 0.03 Scarlet Fever 3.01 3.29 3.54 3.80 4.78 Whooping Cough 2.54 2. 82 2. 25 2. 68 1.42 Diphtheria 0.85 1.12 0.77 0.74 0.29 Erysipelas 0.31 0.35 0.27 0.42 0. 26 Smallpox - - - - - Measles 9.88 9.23 9.77 9.17 10.90 Pneumonia 1.34 1. 62 1.16 1.27 1.00 Rates per 1,000 Live Births Deaths under one year of age. 49 ≠ 58 46 58 26.01 Deaths from rrhoea & ibis under two years of age. 5.3 7.9 4.4 10.4 2.1 Rates per 1,000 Total Births (i.e. Live and Still) Maternal Mortality - Abortion with aepsions 0.34 0.70 Abortion without sepsis 0.11 Puerperal Infection. 0.39 Others 1.45 0.70 Total 2. 29 1.41 Not ific ations perpera1 Pyrexi all. 11.68 15.11 9.26 15.23 12.73 Puerperal Fever 3.05 ж A dash (-) signifies that there were no deaths. ≠ per 1000 related births ≠ These rates are those published in the Quarterly returns.