REPORT ON INVESTIGATION IN THE COALFIELD OF SOUTH WALES AND MONMOUTH .sx To the Rt .sx Hon .sx THE MINISTER of HEALTH .sx SIR , .sx We have the honour to present to you our Report upon the investigation which you instructed us to make into the conditions of the inhabitants of the coal mining districts in South Wales and Monmouthshire .sx Pending the completion of our enquiries we have on two occasions reported to you the impressions which we had gathered , and as further experience has not led us materially to modify the views we then expressed it may be convenient if we repeat them in the course of this Report .sx We have not found it possible without unduly delaying the presentation of our Report to visit every mining centre in the Coalfield , and our knowledge of the conditions of some even of the towns and villages where the number of miners unemployed is very large is dependent upon the information of ethers .sx We have , however , made an intensive examination personally of the conditions in several areas , in the course of which we have visited not only schools , institutions , clinics and training establishments , but also a number of the houses of miners employed and unemployed .sx For the rest of our information , local and general , we are indebted to a host of witnesses .sx including ministers of religion , medical men holding official positions and in private practice , members and officers of public authorities , persons conversant with the mining industry and individuals engaged in charitable activities .sx It would take too long to enumerate the names of those whom we have interviewed and an official Report is hardly the place in which to express the thanks we owe to them for their assistance , but it may not be inappropriate to record the unfailing courtesy and good will with which we were received by the miners and their wives into whose houses we made our way with the express object of intruding into the secrets of their domestic affairs .sx In the domestic part of our investigation our procedure was undoubtedly facilitated by the experience gained in visiting the households in the Bedwellty Union expressly brought to your notice after the deputation received by you on the 31st October .sx The primary object of our visit , we understood , was to ascertain whether a result of unemployment in the coalfield the physical condition in any section of the population was such as to call for , .sx special action to enable the Public Health and Poor Law Authorities to take the appropriate remedial steps .sx With this object in view we were enabled through the good offices of the Welsh Board of Health to confer with the Medical Officers of Health of the Counties of Glamorgan and Monmouth and the County Borough of Merthyr Tydfil and of all the districts in the two Counties which contain mines .sx We also had the advantage of a conference with all the Regional Medical Officers of the Board of Health who act for the area concerned .sx Naturally , we found these conferences of the greatest assistance to us , not only from what we gained by learning the facts noted by skilled observers in their own neighbourhood and the opinions which they based upon those facts , but also from the guidance we obtained as to the directions in which personal investigation by us might profitably be pursued .sx The first question to which it was obvious that we ought to direct our attention was that of .sx any variation to be observed in the rates of mortality in South Wales and Monmouth .sx indicaling new conditions exceptionally injurious to health .sx No such indications are .sx forth- .sx coming from the general death rates .sx Further , there has been no unusual mortality from epidemic diseases .sx The infant mortality rate and the death rate from tuberculosis are generally regarded as reflecting economic conditions , and to these the following observations .sx apply .sx The infant mortality rates since 1920 in the administrative counties of Glamorgan an Monmouth and the County Borough of Merthyr Tydfil are shown in the following table :sx - .sx It will be seen that in each instance there was an increase in 1927 over 1920 , but that with the exception of Merthyr , the figures compared not unfavourably with those for the years before 1926 .sx Complete figures for 1923 are not yet available , but an examination of Figures supplied to us shows that the rates for the first nine months of 1927 and 1928 were , in Glamorgan , respectively , 86.5 and 71.0 .sx in Monmouth , 82.3 and 65.9 ; in Merthyr C.B. , 103.0 and 96.9 - in each instance a decline .sx On the criterion of infant mortality , therefore , there are no figures showing that the health of this region is suffering or need give rise to anxiety .sx The next consideration was the incidence of tuberculosis .sx W have been supplied by the Welsh National Memorial Association .sx with information as to the death rate from tuberculosis in Wales since 1922 , and the following figures are abstracted :sx Though the pulmonary figures show some increase in 1927 as compared with 1926 , the variation is not so great as to demand an exceptional explanation , and in Monmouth and Merthyr the comparison of 1927 with years before 1926 is favourable .sx The non- .sx pulmonary figures show a marked decline when compared with the earlier years .sx Until the complete figures are available it is not , of course , possible to say whether the death rates from tuberculosis have changed for the better or worse in 1928 , but the figures available for the first eleven months of the year do not indicate any substantial variation .sx There has been no obvious growth in the prevalence of .sx the disease which has impressed itself upon the District Medical .sx Officers of Health or upon these responsible for tuberculosis administration .sx Except for a statement that in one of the hospitals under the King Edward VII Memorial Fund there has been an increase in the number admitted of young people , especially women , suffering from an acute type of tuberculosis , there is no indication of any material change in the position .sx ' The importance of tuberculosis in this connection is that it is a disease to which resistance is decreased by insufficient or improper feeding .sx As regards what are specially termed " deficiency diseases , " there was no evidence of the existence of scurvy , and the only form belonging to this category which appeared to have shown signs of increase was rickets .sx This disease , according to the evidence which we could obtain , has until recent years not been common in South Wales and Monmouth .sx We thought it of importance , for two reasons , to explore with some care the question whether there has been a recent increase .sx In the first place , apart from the deformity which may result from the disease , it indicates directly a low health standard among children affected and therefore of the rising generation .sx In the second place , an extended prevalence of the disease may be regarded as a warning of a lowering of the standard of nutri- .sx tion generally .sx From the investigations we have made , it is clear to us that in some districts , but not uniformly , there is an increase in the occurrence of rickets .sx The increase nowhere affects a large .sx proportion of the child population , but the children it affects are children in the early years of life .sx It is not so much the extent of the prevalence we regard as important as the fact of its occurrence as a fresh development which we think carries the definite significance of the existence of a deficiency in the quality , if not the quantity , of the diet of the child population .sx Although apart from rickets we could find nothing to indicate an increase in any particular disease , and although there is no evidence of obvious and widespread deterioration of physique , there could be no question that in some areas women , especially the mothers of young children , suffer to an unusual extent from languor and anaemia .sx We were also not infrequently told that there is loss of tone and persistence of debility after illness in the older men , and that men long unemployed who have not been actually ill find resumption of work difficult as a mere physical effort .sx Malnutrition is , of course , difficult to assess as a separate factor apart from the incidence of definite disease .sx The personal equation of the observer must always come in and there are all degrees of failure of nutrition and no definite standard .sx From the observations which we made per- sonally in the houses we visited , observations which were confirmed by what has been told us by various informants .sx the diet in the households of the unemployed men comprised little .sx beyond white bread , butter or margarine , potatoes , sugar , jam , .sx tea and bacon in limited quantity .sx Meat was seldom eaten except .sx in very small amounts on Sundays , very often not more than a shillingsworth for the whole family .sx Fresh milk was not seen by us except when supplied from a welfare clinic , the usual milk being skimmed condensed .sx Fresh vegetables other than potatoes were seldom eaten , and it was noticeable that almost invariably the bread was not baked at home .sx This diet lacks a sufficient proportion of protein , mineral salts and vitamins .sx It could be much improved if greater use were made of wholemeal bread , of the pulses and of the cheaper varieties of fish .sx It may , perhaps , contain a sufficiency of calories , but according to accepted canons of diet , it is unsuitable for the maintenance of health over any prolonged period and especially for young children and nursing mothers .sx Notwithstanding this fact , it has to be recorded that our observations did not disclose any widespread manifestation of impaired health which could be attributed to insufficiency of nourishment .sx In this view we are confirmed by the opinions of the medical practitioners who have the best opportunities of watching the physical condition of families .sx Expression of such an opinion has , however , often been accompanied by reservations indicating surprise at the absence of ill-effects and apprehension that the inevitable sequel of the prolongation of such conditions must be a deterioration of physique .sx The prevalence of rickets which we have mentioned is in our opinion the first manifestation of such a deterioration ; and we are glad to record that to a great extent the disease is controlled and cured by means of the Maternity and Child Welfare Centres .sx When mothers take their babies to these Centres , as they do to a large and increasing extent , the first signs of rickets are observed and can be arrested by efficient treatment .sx Similarly , we think the dangers to be apprehended from the continued use of a diet such as we have described can be obviated without serious difficulty .sx A better selection of the articles of food bought out of the limited money available to a household would do much , but where on adequate grounds it might appear , necessary to supplement the provision made at home , arrangements for the supply of extra nourishment to children and their mothers might be organised at no very great expense .sx Apart from diet , another factor which must tend to impair the physical condition of the poorest of the population is the insufficiency of proper clothing and footwear .sx The existence of this .sx deficiency is more immediately obvious than that of insufficient food , and shabby outer garments and worn-out boots were often to be seen in public .sx In the houses we visited we frequently found the bed clothing and under-clothing far from adequate , and the boots not enough for the school children , to say nothing of the adults and infants .sx So far as clothing is concerned , several agencies were in existence for its collection and distribution besides the Lord Mayor's Fund but it was clear to us that up to December the means did not exist to supply all that was needed .sx Since our investigation began measures have been taken to increase substantially the funds designed to meet these needs and to supplement the supply of food .sx In the areas we have visited the ratio of unemployment has varied from something over 60 per cent .sx to something under 25 per cent .sx