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5
preventive and curative medicine, in order to ensure the smooth
working of the services, but it appears that, in view of the many
bodies concerned, this integration of the services must be dependent
to a very large degree on the efforts of the officers concerned.
It seems to me that Enfield's record of health service provision
should not pass unnoticed, as its record is one of no inconsiderable
achievement, and I have included in this report several graphs of
particular interest.
The first point of interest noted in the graphs is that Enfield
has grown since the beginning of the century from a district with
a population of 43,394 to an important town of 108,810, large
enough by all standards to have outgrown its Urban District status,
and surely of sufficient importance and achievement to be considered
worthy of more comprehensive local government responsibility.
The Birthrate which was 30.6 in 1902, steadily declined to
21.64 in 1915. In 1916 the figure rose slightly to 22.22, followed
by a fall in 1917 to 17.91 and in 1918 to 15.78. The next two
years saw a progressive rise to 22.87 in 1920, followed by a steady
fall until it reached 14.72 in 1933, this being the lowest Birthrate
recorded. A steady rise has since occurred with a remission in the
early years of the last war.
The deathrate shows a steady decline with frequent slight
fluctuations. Steady progress in the reduction of the maternal
mortality rate is also noted with particular emphasis on the last
few years. Perhaps the most striking progress has been made in the
case of the infant mortality rate which in the early part of the
century was as high as 158.3 and in 1944 was as low as 29.21.
In the province of infectious diseases some notable improvements
are observed. In the case of Tuberculosis, the incidence of
cases has shown on the whole a progressive reduction until 1929,
when the figures remained more or less stationary until the beginning
of the War, when there was a slight increase which has since shown
signs of abating. In the case of deaths from Tuberculosis, the
general trend has been a continual decrease.
The Enteric Fever group—cases and deaths—in the early part
of the century were at a steady level but have now reached the
stage where only occasional fluctuations in the incidence draw
comments.
The incidence of Scarlet Fever cases has shown no marked
reduction over the period under review, but the death rate from this
disease has fortunately shown progressively marked improvement.