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To the Mayor, Aldermen and Councillors of the Metropolitan Borough
of Lewisham.
Mr. Mayor, Ladies and Gentlemen,
I submit herewith my report on the work of the health department
for the year 1948.
The Registrar-General's estimate of the population in mid-year
1948 at 226,100 was some 5,000 more than the estimate for the previous
year and compares with the pre-war estimate in June 1939 of 231,000.
The birth rate for the year at 18.9 shows a drop from the high figure
of 21.9 in 1947, but is still above the pre-war years. The death rate
also dropped, from 11.9 to 9.9, and this is a lower figure than for many
years past. Factors in the death rate, however, are too complex to allow
any simple reason to be given for the drop. The infant mortality rate
fell to 28, which is a record low for the borough. It remains less than
the average for London as a whole (31) and for England and Wales (34),
but the difference has been decreasing over the years. The death rate of
illegitimate infants was 26 and this is no doubt the first time that the
illegitimate rate has been less than the legitimate rate ; it has usually been
considerably higher. Two maternal deaths occurred during the year ;
this gives a maternal mortality rate of 0.46, which is a very low figure
— but still unfortunately means two deaths.
In connection with the work carried out during the year 1948
special mention may be made of the following :—
Tuberculosis
The number of new notifications increased considerably — from
426 to 502. At the same time the death rate from pulmonary tuberculosis
(the main form of the disease) decreased from 0.55 per thousand
population to 0.48. This may say something for advances in treatment
but the fact that there is an increased number of notifications is of
potentially serious importance. The notification rate in fact (per
thousand population) has only twice been exceeded in the last 15 years
or more, both times during the late war years. To some extent this
present high rate may be due to more exact ascertainment through
improved methods of diagnosis, including the mass miniature X-ray,
but while housing conditions remain bad, more particularly with regard
to overcrowding, the incidence of tuberculosis must be regarded as a
major public health problem. It is too often forgotten that tuberculosis
is in fact an infectious disease, but a disease where the infectivity may last
for many years instead of for merely a few weeks or days. In the past
numerous measures on a national scale have been taken with regard to
prevention of tuberculosis, and this work, together with treatment of
the disease, has become a specialised branch of medicine and public
health. The present proposals therefore to join up tuberculosis work
with other work involving other organs of the body, to do away with
what has always been known as the TB Dispensary and attach it to a
general hospital as part of the chest department, and to replace the