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Public Health Department,
Town Hall,
Fulham, S.W. 6.
July, 1938.
To the Mayor, Aldermen and Councillors
of the Metropolitan Borough of Fulham.
Mr. Mayor, Ladies and Gentlemen,
I have the honour to submit the Annual Report on the health and sanitary conditions of the
Borough for the year 1937.
"The Mortality still is, as it always was, greater in towns than in the country. But
the difference has diminished in an extraordinary degree. There is the best reason to believe
that the annual mortality of Manchester, about the middle of the last century, was one in
twenty-eight. It is now reckoned at one in forty-five. In Glasgow and Leeds a similar
improvement has taken place. Nay, the rate of mortality in those three great capitals of
the manufacturing districts is now considerably less than it was, fifty years ago, over England
and Wales, taken together, open country and all. We might with some plausibility maintain
that the people live longer because they are better fed, better lodged, better clothed, and
better attended in sickness. ..."
Despite the modern ring of these sentiments, Macaulay wrote them in 1830,* and whilst the
passage of one hundred years has modified the slightly self-satisfied attitude underlying them, it
has not diminished their validity. The annual mortality of Manchester and the other great towns
to which he refers is now about one in eighty, but further improvements in housing, nutrition and
medical science have rather revealed further deficiencies to be met than pointed to the achievement
of perfection. (Incidentally, not the least of these deficiencies is the ugliness produced by industrialisation,
on which Southey's criticisms led to Macaulay's thunder.)
Nutrition and housing remain the basic public health problems and in the former field much
significant work is being undertaken. That of the National Birthday Trust and the Research Committee
of the Joint Committee of Midwifery Organisations deserves special mention.
It was devoted, in particular, to the problem of maternal mortality, and commenced in the
Rhondda Valley in 1934, being subsequently extended to other distressed areas in South Wales and
on the North East coast. The early work concentrated on providing improved midwifery facilities,
both personal and environmental, and insofar as the maternal mortality rate was an index of its
effect, was without result. The provision, however, of certain forms of nourishment rich in vitamin
content, in addition to the milk supply and supervision already given, reduced the maternal mortality
rate to one quarter, not only of the earlier figures, but of the concurrent figures in non-assisted women
in the same area. It also produced a 50 per cent. reduction in the still-birth and neo-natal death
rates. Puerperal sepsis, which usually causes as many deaths as other puerperal causes, practically
disappeared from the 'fed' group.
This work, baldly summarised here from the accounts given of it by Lady Williams in "Public
Health," is still continuing, and the Medical Research Council are observing it officially. It was
undertaken in a group whose income per head per week, after rent, etc. was met, was less than four
shillings; it is not yet possible to evaluate its statistical significance; but it clearly calls for repetition
on a very wide scale and pari passu it is probably applicable to groups whose income is higher. Equally,
it may affect local authority policy on maternity homes. However socially desirable these may be,
they may prove a poor alternative to the provision of adequate nourishment with the additional
disadvantage of being a more expensive one. Should choice be necessary, good food and poor housing
may be, in maternity as in life generally, superior to bad food and good housing, though there is no
intrinsic reason why both should not be good.
* Essay on Southey's Colloquies on Society.