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population is due to a birth-rate of 19.3, as compared with 13.6 in 1933 and is, in fact, the
highest rate since 1923. I think this is due to the many marriages that have occurred with the
return of men and women from the Forces, and also to the fact that many married couples who
did not have children during the war period have since determined that it was time to raise a
family. For this reason I doubt whether the present birth-rate will be continued over a period
of many years.
The infantile mortality rate for the year, which is considered as an index of the health
of the population, was 38, the lowest ever recorded in St. Pancras, comparing with 44 per thousand
births in 1945, which even then was a record. The rate for the country as a whole in 1946 was
43, and for London 41. Ninety-six children died before they reached the age of one year. Of
these 15 died of bronchitis and pneumonia, 24 due to premature birth, 12 injury at birth, 13
enteritis, 11 atelectasis, and 8 congenital malformations.
These figures of death from individual causes enable us to assess our efforts and determine
what further improvements can be obtained. Children should not contract bronchitis, pneumonia
or enteritis, and injury at birth should be preventable with expert obstetric care and optimum
environment in all cases. Atelectasis is a condition in which the lungs fail to expand at birth.
The cause of this and possibly prematurity may be associated with inherited factors. So far we
make a dividing line between deaths due to prematurity and children born dead; but it is very
possible that the causes are allied and may be associated with blood reactions of the parents.
We know that under certain circumstances mating couples may produce children likely to die
of haemorrhage soon after birth, and this factor may also be responsible for the birth of a dead
child. So far our knowledge is not sufficient to prevent congenital malformations, but there is
reason to believe that research may make even this possible as well as the prevention of stillbirths
and hæmorrhagic disease of the new born in the near future. An infantile mortality
rate, however, of 38 in St. Pancras is good, and is an indication of what can be achieved by
determination, even under adverse housing and environmental conditions; for I have already
pointed out that a large percentage of our houses have sanitary defects and that at least a fifth
of our residents need rehousing, many of them urgently. Much of this low infantile mortality
is, in my opinion, due to the constant attention which our health visitors give to the individual
children under one year in the borough. It is easy to forget that the primary duty of a
health visitor is to visit homes where there are children under five. It is these visits to the
homes and concentration on special cases that, in my opinion achieve most in child health. No
less than 32,000 visits were made by our health visitors during the year.
Infectious Disease.
There were 66 notifications of diphtheria during the year, and two deaths. Neither of
the two children who died had been immunised, and of the 45 under 15 years of age who contracted
the disease we have records that only seven were immunised.
Whooping cough accounted for the death of one child out of the 497 cases notified.
Intense research is now being carried out to ascertain the effect of immunisation, and the results
which have been achieved give at least cause for encouragement. It is not generally considered
wise to commence a scheme of mass immunisation against this disease, but comparative experimental
work between districts and schools is considered advisable, and in due course the results
achieved may indicate the lines on which we should proceed in order to eradicate, or at least
mitigate, the effects of this distressing condition.
In the body of this report will be found figures concerning the incidence and death rate
from measles for the past 20 years. The number of cases have varied considerably. There