AC 4363 SHOR 48 LIBRARY 5 ABRIDGED REPORT ON THE HEALTH AND SANITARY CONDITION OF THE METROPOLITAN BOROUGH OF SHOREDITCH IN THE COUNTY OF LONDON FOR THE YEAR 1943 BY E. H. R. SMITHARD, M.D., D.P.H., Medical Officer of Health AVERAGED TABULATED STATISTICS IN FIVE YEAR PERIODS Years Population Density per acre Persons per hereditament Births Birthrate (per 1,000 pop.) Deaths Death rate (per 1,000 pop.) Infant mortality rate (perl ,000 live births) T.B. notification rate (all forms) (per l ,000 pop.) T.B. death rate (all forms) (perl,000 pop.) 1893-1897 121,749 188 - 4,266 35.0 2,744 22.5 185 - 2.9 1898-1902 118,835 185 - 4,029 33.8 2,646 22.3 196 - 2.8 1903-1907 115,549 180 - 3,810 32.1 2,324 20.1 170 - 3.0 1908-1912 112,305 167 - 3,594 32.0 2,070 18.5 144 - 2.4 1913-1917 101,341 156 - 3,032 29.9 2,002 19.8 145 6.3 2.9 1918-1922 98,913 153 - 2,727 27.6 1,667 16.9 117 3.8 2.0 1923-1927 105,640 164 - 2,538 24.0 1,372 13.0 79 2.5 1.4 1928-1932 98,336 149 - 1,888 19.2 1,318 13.4 76 2.2 1.1 1933-1937 88,044 133 6.6 1,347 15.3 1,104 12.5 68 1.7 0.9 1938-1942 57,198 86 4.7 897 15.7 933 16.5* 52 1.8* 1.2* 1941 36,360 55 3.6 634 17.4 879 24.2 63 3.0 2.2 1942 34,900 53 3.6 642 18.4 611 17.5 51 2.2 1.4 1943 35,460 54 3.7 671 18.9 566 15.7 46 2.7 1.5 * These rates are based on an average population figure for deaths of 56,324 *T.S. 8/44 150 2 To the MAYOR, ALDERMEN and COUNCILLORS Sir, Ladies and Gentlemen, The report of the health department for 1943 is again an interim statement recording only the basic facts of the work done. The vital statistics show that the number of births classified as belonging to the borough again increased, and were 671 as against 642. The Registrar-General estimated that there was at the same time a slight increase in the population, but in spite of this the birth rate, i.e., the number of births per thousand population, went up from 18.39 to 18.92, which is the highest rate since 1930. The infant mortality rate for the year again decreased, this time from 51 to 46, which is pleasingly low for a borough of this type, but which, being based on relatively small figures, is not likely to be stable. It is no less than 12 per thousand below the figure for London as a whole. The biggest cause of deaths of infants under one year of age was premature birth, with the high total of 13. cases. Deaths from diarrhoea and enteritis remained relatively low, only four occurring under one year of age in spite of an epidemic of enteritis in the latter part of the year. Some further remarks on the infant mortality rate occur later in this introduction and are illustrated by a new table placed on the last page of the report. The general death rate, which for 1943 was 15.7, although still above the average for the last 10 years, shows a decrease on 1942 and a considerable decrease on 1941. With regard to infectious disease, points of interest are that the pneumonia group again showed a considerable decrease in mortality, while dysentery showed a large increase in incidence, although there were no deaths from it. The type of dysentery was that due to an organism called Sonne's bacillus and it began spreading about July, 1943. In September, possibly as a result of the warm weather and increase in flies, two of the nurseries were affected. It was of a very mild type but gave rise to considerable administrative trouble and expense in the detection of carriers and to inconvenience in the exclusion of children from the nurseries, one of which was closed for a few weeks. There was also a considerable increase in the number of cases of scarlet fever, but here again the disease was mild and no death was registered from it. Measles remained fairly prevalent, and, much more serious, the notifications of pulmonary tuberculosis increased by nearly one-third. During June a new scheme of tuberculosis allowances came into existence as part of a wider scheme for diagnosis and treatment of the disease. The intention is to help keep the home going while necessary treatment is being carried out. The wartime official purpose is the restoration of the patient to working capacity, and for that reason cases unlikely to be so restored are excluded. The scheme only applies to pulmonary cases. The allowances are " maintenance," and also possibly "discretionary" (for high rents, mortgages, education, etc.), or " special " (for example, travelling, domestic help). Figures to the end of the year are given in the table on page 6. The borough's nursery scheme was completed during the year. Mayfield continued to fill a real need as a short-stay holiday or convalescent home for toddlers, and at the end of the year it was decided to renew the lease for a further five years. Copthorne was open throughout the year but owing to a mild but persistent streptococcal infection it was deliberately not filled to capacity. During the year the third war-time nursery, at Vince Street, was opened and this had accommodation for 62 children between the ages of 0 and 5. Apart from the diarrhoea and dysentery cases referred to above there is little to report in the nursery work. The benefit to the childrens' conduct, appearance and mental development is clearly seen, and probably easily outweighs the extra risk of picking up infectious disease. 3 Certain other decisions and work require to be mentioned in connection with the year 1943. Included are the following items:— In January I was authorised to supply insulin to poor inhabitants of the borough suffering from diabetes. In the same month it was decided to appoint two full-time home helps in addition to any part time homo helps remaining on the panel. In April it was agreed to institute an evening antenatal clinic. In May I was authorised to enter into negotiations with voluntary hospitals for the provision of extra beds for maternity cases, any agreements to contain a clause stating that no woman be refused admission for reason only that she is unmarried. (This problem of extra beds was later in the year settled by the L.C.C. arranging to set aside up to five beds for us at St. Bartholomew's.) In May the scale for dinners for mothers and toddlers was modified by being made more generous. An additional foot clinic session was instituted and it was decided to appoint a whole-time chiropodist in addition to one of the part-time workers. In that month also the committee recommended for adoption some standards submitted for reconditioning selected houses. In August the compulsory notification of scabies came into force. In that month too the health committee and the housing committee decided to set up a joint committee to deal with the requisitioning and reconditioning of houses to mitigate housing difficulties. In September the health shelter in Reeves Place was closed, arrangements having been made with Bethnal Green for the use of their health shelter if required. In November a Rodent Officer was appointed and shortly afterwards started work with a small staff ; by the end of the year the first of two intensive treatments had been applied to the whole sewer system. In the matter of civil defence only a few incidents occurred during the year and the medical services showed commendable keenness in all their work and exercises. Disinfection and disinfestation of bedding used by firewatchers and other A.R.P. workers continued and the mobile hot-air disinfector was of great assistance. Altogether during the year nearly 88,000 articles were treated by this means. A word should be added about the new table included on the back page of this report and described as Reproductive Wastage. This table demonstrates some interesting points. The reproductive wastage rate attempts to show the number of pregnancies per thousand live births which do not result in the birth of a child who lives beyond the age of one year. It includes therefore the number of still births and the number of babies dying within the first year of life. It should also strictly include the number of abortions, but as these are not notifiable and as the vast majority of them occur within the first month or two of pregnancy they may be regarded as of less account than children dying any time between the sixth month of pregnancy and the end of the first year of life. The total reproductive wastage rate, as can be seen, is gradually diminishing, but is still too high. It remained up last year owing to the increase in still-births, and in neo-natal deaths—a serious statement in itself as possibly, among other things, indicating lowered nutrition in the mother. Further interesting points are the neo-natal death rate, that is, the number of babies dying in the first month of life per thousand live births, and the rate of deaths during the rest of the first year of life. It will be seen that the neo-natal rate has fallen from 36 in the years 1905-9 to 22 in the years 1940-43, that is, a drop of 39 per cent., whereas the rest of the first year rate has fallen from 117 to 36 in the same period, which is equivalent to a drop of no less than 70 per cent. The figures for 1943 alone are striking, although too small to be reliable. They show that for the second time on record (1943 and 1942) the rate of deaths from the first month to the end of the first year was less than the rate of deaths during the first month. 4 CAUSES OF DEATH WITH AGE DISTRIBUTION CAUSES OF DEATH AGES SEX Total deaths due to each cause Under 1 1 to 2 2 to 5 5 to 10 10 to 15 IS to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and Upwards Male Female 1 Typhoid and paratyphoid fevers - - - - - - - - - - - - 1 - - 1 1 2 Cerebro-spinal fever 1 - - - - - - - - - - - - - 1 - 1 3 Scarlet fever - - - - - - - - - - - - - - - - - 4 Whooping cough - - 1 - - - - - - - - - - - 1 - 1 5 Diphtheria - - - - - - - - - - - - - - - - - 6 Tuberculosis of respiratory system - - - - - 3 9 10 8 7 7 2 - - 30 16 46 7 Other tuberculosis 1 1 1 - 1 1 - - - 1 - - - - 1 5 6 8 Syphilitic diseases 1 - - - - - - - - 1 3 5 - - 8 2 10 9 Influenza - - - - - - - - - 2 2 1 2 - 3 4 7 10 Measles - 1 1 - - - - - - - - - - - 2 - 2 11 Ac. poliomyelitis and polioencephalitis - - - - - - - - - - - - - - - - - 12 Ac. inf. encephalitis (lethargic) - - - - - - - - - - - - - - - - - 13 Cancer of buccal cavity and oesophagus (M.) uterus (F.) - - - - - - - - - 1 2 3 - - 5 1 6 14 Cancer stomach and duodenum - - - - - - - - - - 3 6 2 - 7 4 11 15 Cancer breast - - - - - - - - 1 3 1 3 1 - - 9 9 16 Cancer, all other sites - - - - - - 1 1 5 6 10 15 8 1 30 17 47 17 Diabetes - - - - - - - - - - - 1 - - 1 - 1 18 Intra-cranial vascular lesions - - - - - - - - - 1 5 16 9 2 18 15 33 19 Heart diseases - - - - - 1 - 1 4 6 15 35 45 11 58 60 118 20 Other circulatory diseases - - - - - - - - 1 2 5 10 5 2 12 13 25 21 Bronchitis 1 - - - - - - 1 — 2 18 14 17 6 38 21 59 22 Pneumonia (all forms) 4 1 - - - - - 2 — 2 6 12 7 1 24 11 35 23 Other respiratory diseases - - - - - - - 1 - - 1 2 4 - 7 1 8 24 Ulcer, stomach and duodenum - - - - - - - - - - - 3 - 1 3 1 4 25 Diarrhoea (under 2 yrs.) 4 1 - - - - - - - - - - - - 3 2 5 26 Appendicitis - - - - - - - - - 1 - 2 - - 2 1 3 27 Other digestive diseases - - - 1 - - - 1 - 1 4 3 3 1 3 11 14 28 Nephritis - - - - - - - 2 2 - 1 1 1 - 4 3 7 29 Puerperal and postabortive sepsis - - - - - - - 1 1 - - - - - - 2 2 30 Other maternal causes - - - - - - - - - - - - - - - - - 31 Premature birth 13 - - - - - - - - - - - - - 7 6 13 32 Congenital malformations, birth inj., inf. dis. 5 - - - - - - - - - - - - - 3 2 5 33 Suicide - - - - - - - - - - 1 1 - - 2 - 2 34 Road traffic accidents - - - 2 - - - - - 2 - 1 2 - 6 1 7 35 Other violent causes - - 2 1 - - - - 5 1 2 1 1 1 10 4 14 36 All other causes 1 - - - - - 1 1 2 7 7 11 22 2 25 29 54 Total deaths (all causes) 31 4 5 4 1 5 11 21 29 46 93 148 130 28 314 242 556 5 GENERAL DATA Area of Borough 662 acres Average height above sea-level 60 feet Estimated number of houses (including separately-rated flats) 9,500 Number of families (1931 census) 25,156 Rateable value £685,000 Sum represented by a penny rate £2,254 SHOREDITCH LONDON 1943 Average 1933-1942 1943 Average 1933-1942 Birth rate (rate per 1,000 living) 18.92 15.45 15.8 13.10 Still births (rate per 1,000 total births) 35.92 31.67 -† -† Death rate (deaths per 1,000 living) 15.68 14.11 15.0 13.28 Marriage rate (persons married per 1,000 living) 23.74 23.39 -† -† Infantile mortality rate— (deaths under 1 year per 1,000 births) 46 62 58 59 Maternal mortality rate (deaths per 1,000 live births) 2.98 2.23 -† -† Death rate from pneumonia and bronchitis 2.65 1.9 -† -† „ ,, „ cancer 206 1.77 -† -† ,, „ ,, diarrhoea and enteritis (under 2 years) per 1,000 births 7.45 14.53 10.4 10.55 ,, „ ,, pulmonary tuberculosis 1.3 0.97 -† -† Notifications of tuberculosis (per 1,000 population) 2.7 1.72 -† -† † Figures not available. PUBLIC HEALTH STATISTICAL INFORMATION VITAL STATISTICS Population, estimated at midsummer, 1943 35,460 Number of births registered 671 Birth rate (per 1,000 population) 18.92 „ „ still births registered 25 Still birth rate (per 1,000 live births) 37.25 „ „ infant deaths registered 31 Infant mortality rate (per 1,000 births) 46 „ ,, deaths registered 556* Death rate (per 1,000 population) 15.68 „ „ maternal deaths registered 2 Maternal mortality rate (per 1,000 live births) 2.98 * Includes 14 due to "other violent causes." INFECTIOUS DISEASE (1) Infectious diseases (2) Cases notified (3) Removed to hospital (4) Deaths registered (1) Infectious diseases (2) Cases notified (3) Removed to hospital (4) Deaths registered Scarlet fever 194 186 - Measles 411 181 2 Diphtheria, membranous croup 62 62 — Whooping cough 116 45 1 Enteric (including paratyphoid) - - - Ophthalmia neonatorum 8 2 - Acute primary or influenzal pneumonia 27 9 6 Puerperal fever 4 3 - Puerperal pyrexia 8 7 - Erysipelas 27 20 1 Cerebro spinal fever 11 11 1 Acute poliomyelitis 1 1 — Continued fever 1 1 — Dysentery 92 87 — Scabies—first case in housed 231 — — Tuberculosis—pulmonary 82 — 46 „ other forms 14 - 6 ‡Notiftable from 1.8.43 6 DISINFECTION Steam : no. of houses dealt with 1,125 Number of rats destroyed (estimated) 6,582 no. of rooms dealt with 1,121 „ ,, persons (excluding school children) no. of articles disinfected 15,306 cleansed : for vermin 6 Hot air : no. of articles treated 87,881 for scabies 899 Phenol vapourisers : no. of treatments 387 Shelters : no. of special sprayings 3,660 no. of articles treated 30,470 no. of HCN treatments 1 Number of articles destroyed 3 VACCINATION Number of names received in birth lists 268 Certificates of insusceptibility received - Certificates of successful vaccination received 118 Statutory declarations of objections received 135 „ „ postponement received 11 TUBERCULOSIS DISPENSARY TUBERCULOSIS CARE WORK No. of cases on Borough register on 1-1-43 383 New cases and re-registrations 97 ,, ,, ,, added in 1943 104 Cases receiving extra nourishment 598 ,, ,, ,, deleted in 1943 73 ,, given monetary help 140 ,, „ „ on Borough register on 31-12-43 414 ,, given other help 82 „ „ new cases (excluding contacts) 187 ,, referred elsewhere for help 48 ,, ,, contacts 167 TUBERCULOSIS ALLOWANCES Total attendances 2,857 Patients admitted to institutions 82 Applies, for maintenance allowances 43 Specimens of sputum examined 380 Maintenance allowances granted 40 X-ray examinations 604 do. existing at end of year 20 Domiciliary visits by medical officer 185 Discretionary allowinces made 4 „ „ ,, T.B. visitors 3,425 Special allowances made 18 MEDICAL AND DENTAL TREATMENT (1) Service (2) No. of sessions held New Cases (7) Revisits (8) Total attendances (3) 0-5 (4) 5-15 (5) 15+ (6) Total General medical clinic 26 - - 87 87 265 352 Gynaecological clinic 52 - - 242 242 467 709 Foot clinic 640 6 26 691 723 5,304 6,027 Diphtheria immunization clinic 152 651 330 81 1,062 3,265 4,327 Dental hospital 557 57 257 1,179 1,493 4,627 6,120 FOOD, SHOPS, FACTORIES, ETC. Samples of food taken for investigation 589 Inspections of mechanical factories 714 Initial and routine inspections of shops under Shops Acts 245 ,, „ non-mechanical factories 69 ,, ,, workplaces 78 Re-inspections of shops under Shops Acts 46 ,, outworkers' premises 161 Inspections under Pharmacy and Poisons Act 89 Other Factories Act inspections 1 „ of food premises and milk shops 1,105 Factories Act—intimation notices served 8 SANITARY INSPECTION AND HOUSING 1 lumber of complaints received 924 Number of house-to-house inspections made - ,, intimation notices served 1,855 ,, „ re-inspections 12,232 ,, nuisance notices served 292 ,, notices served under section 9 — ,, premises under sanitary notice 1,590 Total visits of all inspections 20,703 Letters written to owners and others 1,078 Samples taken under the Rag Flock Act 5 7 MATERNITY AND CHILD WELFARE STATISTICAL INFORMATION HEALTH VISITING (1) (2) 1st Visits (3) Total (1) (2) 1st Visits (3) Total Expectant mothers 554 1,622 Ophthalmia neonatorum, etc. 21 82 Infants 695 4,526 Children aged 1-5 356 7,174 Puerperal fever 4 6 Interviews — 1,231 Puerperal pyrexia 7 8 Futile visits — 2,316 Child life protection — 35 Still birth visits 16 16 CLINIC ATTENDANCES (1) Centre (2) No. of Sessions Children (7) Antenatal (8) Miscellaneous (9) Total (10) H. V.'s Attendances 0—1 1—5 (3) Seen by Dr. (4) Total (5) Seen by Dr. (6) Total Model Welfare Centre 340 1,496 3,242 635 1,169 1,373 3,390 9,174 562 Herbert Grove 211 1,268 2,418 807 1,352 937 376 5,083 365 Total 551 2,764 5,660 1,442 2,521 2,310 3,766 14,257 927 MISCELLANEOUS ATTENDANCES (INCLUDED ABOVE EXCEPT NURSERIES) (1) (2) First (3) Total (1) (2) First (3) Total Toddlers' clinic 387 621 Housewifery classes - 1,049 Post-natal clinic 76 76 Sun Babies War Nursery 102 12,309 Mothers without children - 990 Brunswick ,, ,, 92 11,935 Artificial sunlight—mothers 1 1 Vince St. ,, ,, 61 2,550 „ ,, children 90 1,043 DINING CENTRE, 210, KINGSLAND ROAD (1) (2) (1) (2) Ordinary dinners served to mothers 961 Mothers on register at end of period 3 „ ,, ,, lying-in mothers — Toddlers on register at end of period 10 Dinners served to toddlers 2,024 MISCELLANEOUS Mayfield : admissions 170 Minimum free milk allowances (M.C.W.) 6 ,, discharges and transfers 170 Maximum free milk allowances 16 Admissions to other convalescent homes 18 Free milk recipients (C.M.S.)— Visits under otorrhœa scheme 159 end of 1st Quarter 337 Home help cases 38 end of 2nd Quarter 496 Midwifery cases: Council 118 end of 3rd Quarter 410 .. ,, St. Bart's — end of 4th Quarter 472 .. ,, ante-natal visits 823 Reduced cost milk recipients (C.M.S.)— Maternity dressings 143 end of 1st Quarter 1,854 Copthorne : admissions 28 end of 2nd Quarter ‡ „ „ discharges and transfers 22 end of 3rd Quarter „ „ no. resident at end of year 16 end of 4th Quarter † Opened 11.8.43. ‡ Figures not obtainable. 8 GENERAL STATISTICAL INFORMATION District nursing association:— cases visited 126 Number of common lodging houses 1 Public mortuary—bodies received 302 total visits 1,569 „ „ post-mortem examinations 291 Child life protection:— Food and Drugs Acts:— children received 4 Number of informal samples taken 488 cases on register 1 „ „ ,, ,, adulterated 27 total visits 47 „ ,, formal samples taken 112 Total bacteriological and pathological examinations made 2,915 „ „ „ „ adulterated 24 Legal proceedings taken 6 Persons receiving domiciliary relief:— Total legal proceedings taken (Four dismissed) 18 at end of 1st quarter 414 „ „ 2nd „ 383 „ „ 3rd „ 341 „ „ 4th „ 389 TUBERCULOSIS (1) Year (2) Pop. (nearest '000) (3) Total notifications (4) Notification rate Pulmonary notifications (5) 0—5 (6) 5—15 (7) 15—25 (8) 25—35 (9) 35 + (10) Total (II) Percentage of M & F in col. (7) M. F. M. F. M. F. 1913 109 905 8.3 28 88 109 494 719 1914 108 604 5.6 18 46 55 359 478 1915 102 559 5.5 17 38 61 313 429 1916 99 538 5.4 15 38 52 265 370 1917 88 577 6.6 10 47 46 38 57 221 454 55 45 *19181922 99 368 3.7 6 32 31 28 34 31 148 311 52 48 * 19231927 106 271 2.5 3 14 22 28 21 19 110 219 44 56 *19281932 98 215 2.2 2 14 25 30 17 17 72 176 45 55 *19331937 88 147 1.7 2 8 15 20 12 II 53 121 43 57 1938 80 118 1.5 3 4 15 18 4 6 46 96 45 55 1939 77 91 1.2 1 3 18 17 6 6 22 73 51 49 1940 57 109 1.9 2 6 15 22 12 6 30 93 40 60 1941 36 110 3.0 3 4 13 70 8 7 42 97 39 61 1942 35 78 2.2 2 7 8 14 7 5 19 62 36 64 1943 35 96 2.7 4 6 10 22 2 5 33 82 31 69 * Averaged. REPRODUCTIVE WASTAGE IN 5-YEAR PERIODS (1) Period (2) Still-birth rate (3) Neo-natal death rate (4) Rest of 1 st year death rate (5) Total infant mortality rate = (3)+ (4) (6) Total wastage rate = (2)+ (3)+ (4) 1895-99 - - - 197 - 1900-04 - - - 187 - 1905-09 - 36 117 153 - 1910-14 - 39 110 149 - 1915-19 — 41 98 139 - 1920-24 22 33 63 96 118 1925-29 25 25 53 78 103 1930 34 31 23 52 75 106 1935-39 35 19 36 55 90 *1940-43 30 22 36 58 88 1943 37 28 18 46 83 * — 4 years. A blank indicates that figures are not recorded. I am, Sir, Ladies and Gentlemen, your obedient servant HEALTH DEPARTMENT E. H. R. SMITHARD, Medical Officer of Health. TOWN HALL, OLD STREET, E.C.I. 25 August 1944.