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8
The crude death rate was 12.47 per thousand population (against 12.81 per
thousand in 1936) and here again this figure appears to represent a fairly stabilised
rate. The crude death rate is of course not a good criterion of the health of a
community as it varies with many factors, such, for example, as the average age of
the population or the ratio of the sexes—factors which may differ widely in different
communities.
The infant mortality rate for 1937 was 54 per thousand births. This showed a
welcome drop from the previous year when it was 75 per thousand births and which
in itself was considerably higher than in 1935 when it was 52 per thousand births.
As I have pointed out however in the body of the report, the infant mortality rate
will vary considerably from year to year and this is especially due to a group of
diseases, the enteritis group, which is always more prevalent and causes far more
mortality in a poor, heavily congested district than it does in districts which are
economically better off and which are less crowded. Most of the other causes of
deaths in infants are due to prematurity or inborn faults, and over these causes
there is at present little control. The infectious illnesses (which include the enteritis
group) can however to some extent be controlled and when this is done the infant
mortality rate should be both lower and more stabilised. The difficulties are great
but are being tackled so far as the Department is able.
The toddlers' clinic was commenced in May, 1937. This clinic, which was set
up to make routine inspections and arrange for the proper treatment of children
between the ages of 1 and 5 years, has already met with a fair amount of success.
I am hopeful that with some slight alterations of administrative technique, it will
continue to advance and fill the very real gap which has heretofore been present
in the medical supervision of children at this period of their life. The idea, shortly,
is to detect by means of routine inspections at the ages of 18 months and at or near
subsequent anniversaries of the toddler's birthday any deviation from the normal.
Treatment, if necessary, will then be given, and will be started at a stage when it
can be most effective and when it will be relatively painless.
The increased call on the services of the municipal midwife, which had previously
necessitated the appointment of a temporary part-time additional midwife, continued
to increase during the year, and in July the part-time midwife was put on the
permanent staff. At the end of the year negotiations had opened and were still
being continued with the London County Council with regard to their scheme for a
service of midwives under the Midwives Act, 1936. Only two boroughs in London
have municipal midwives but as the London County Council scheme includes only
47 whole-time midwives in the service of the County Council it is obvious that
nothing approaching a comprehensive domiciliary midwifery service can be provided
by the County Council itself. It certainly seems more rational that where a borough
has established an extensive maternity and child welfare service this important
link between the ante-natal and post-natal branches of the service and the equally
important link between the ante-natal life of a child and its individual existence