4412(1) BECKEMTAM BEC 12 BOROUGH OF BECKENHAM REPORT ON THE HEALTH OF THE DISTRICT DURING 1945 BY T. PHILIPS COLE, M.B., D.P.H. Medical Officer of Health t<aCo\ BOROUGH OF BECKENHAM REPORT ON THE HEALTH OF THE DISTRICT DURING 1945 BY T. PHILIPS COLE, M.B., D.P.H. Medical Officer of Health REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1945 TABLE OF CONTENTS 1. Staff of the Department. 2. Introduction. 3. Vital Statistics: (a) For Years 1920 to 1944. (.b) For 1945. 4. Natural and Social Conditions. 5. Sanitary Circumstances of the Area. 6. Housing. 7. General Provision of Health Services in the Area : (a) Hospitals provided by Public Authorities. (b) Local Services provided by Voluntary Organisations. (c) Ambulance Service. (id) Clinic Services provided by Public Authorities. 8. Maternity and Child Welfare : (a) Ante-Natal Scheme. (b) Welfare Centres and Home Visiting. (c) Unmarried Mothers. (d) Adoption Act. (e) Premature Infants. (f) Boarded-out Children. (g) Obstetric Consultant's Service. (h) Special Treatments. (i) War-time Nurseries. 9. Maternity Hospital Accommodation. 10. Infectious Disease : (a) Table of Cases. (b) Comments on Major Infectious Diseases. (c) Tuberculosis—Incidence and Deaths. (d) Diphtheria Immunisation. 11. Sanitary Inspection of the District—Report by Mr. G. A. Webber, Chief Sanitary Inspector : (a) Nuisances found and remedied. (b) Complaints. (c) Abatement of Nuisances. (d) Milk Sampling. (e) Food Sampling. (/) Meat Inspection. (g) Shops Act Inspections. (h) Rats and Mice (Destruction) Act. STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health and. School Medical Officer T. Philips Cole, M.B., D.P.H. Assistant Medical Officer Miss Sheila Thomson, M.B., D.P.H. Chief Sanitary Inspector G. A. Webber, Cert. R.San.I. and Sanitary Inspectors' Examn. Joint Board. Certificated Food Inspector. Sanitary Inspectors ... H. G. Richards, Cert. R.S.I., Cert. Food Inspector. E. U. Williams, Cert. R.San.I., and S. I.E. J.B. Food Inspector (Returned from Military Service, Feb. 1946). R. C. Rogers, Cert. R.San.I. and S.l.E.J.B. (Returned from Military Service, Feb. 1946). W. Newman, Cert. R.San.I. Health Visitors Miss E. F. Smith, S.R.N., S.C.M., H.V.'s Cert. Miss M. G. Kendall, S.R.N., S.C.M., H.V.'s Cert. Mrs. M. Walmsley, S.R.N., S.C.M., H.V.'s Cert. Miss B. N. Chandler, S.R.N., S.C.M., H.V.'s Cert. (Resigned 30/11/45). Matron of Maternity Hospital Miss D. Beard, S.R.N., S.C.M. Assistant Matron Miss H. Lomax, S.R.N., S.C.M. Matron of Springfield Nursery Miss I. Williams, S.R.N. Matron of Beckenham Rd. Nursery Miss E. Taylor-Smith, S.R.N. Chief Clerk S. W. Collett, Cert. R.San.I., Cert. Food Inspector. Assistant J. Dungay (On Military Service from 13/2/42). Temporary Staff Mrs. J. Harris, Miss J. Sparling, Miss E. Hocking, Mrs. MacInnes, Mr. J. Haining, Miss J. Fenn, Miss V. Forbes. 3 ANNUAL REPORT, 1945 INTRODUCTION. The termination of hostilities, first in the West and then in the East, brought certain changes—some for the better, some for the worse. The changes for the better were associated solely with the natural anxieties about death and injury which had been a part of daily life for so many years. There was the knowledge that friends and relatives in the Fighting Forces were safe and would come home again; that friends and relatives in areas exposed to enemy attack were no longer in danger ; that families could be united again; and that no more houses and homes would be destroyed. The changes for the worse were most noticeable in the rapid deterioration of an already desperately serious Housing Situation. Peace had come to a battered world ; the process of repair was still going on but its completion was not yet in sight; the output and erection of prefabricated houses was very slow; labour and materials for new construction were still limited; and the men and women were coming home—coming home very often to houses shared with others, to accommodation which in so many cases was totally inadequate. The food situation remained almost unaltered; the difficulties of mothers and housewives were not relieved. Many hospitals were still unable to use all of their beds owing to the shortage of staff; many nurses were doing the work of ward maids; cases of tuberculosis had to wait many weeks for admission to sanatorium; and the care of those sick persons, for whom hospital beds were not available, became a serious problem —a problem which could not be dealt with adequately in Beckenham, largely because the response to appeals made for " Home Helps " was negligible. In short, the scarcities and restrictions of war were merely thrown into stronger relief by the coming of Peace. It is too early to assess the effects of the war on the Public Health: much will depend on how quickly and smoothly the difficulties of the immediate post-war period can be solved. The strain has been severe and prolonged, and rest of mind and body are essential if recovery is to be speedy and complete. The various Public Health Services were conducted throughout the year on a scale approximating to that of the years before the war. The Maternity Hospital was working to full capacity during the last six months of the year. The Infant Welfare Centre attendances increased steadily after the cessation of hostilities. The incidence of Infectious Disease was light. In spite of constant traffic to and from the devastated areas of Europe, no cases of the dangerous infectious diseases occurring in many parts of the Continent were imported. A limited amount of building labour became available for the repair of dilapidated houses, and a considerable amount of work was done to houses which had suffered from years of unavoidable neglect. 4 The Council decided to help residents and occupiers of business premises to discharge their duties under the Rats and Mice Destruction Act, and additional staff was engaged for the purpose. Much detailed inspection of the Borough was carried out, the work to be done was considered and appraised, and the preparation of a plan for carrying it out was put in hand. All of the staff of the Department worked efficiently and very willingly; and all are looking forward to the time when the removal of restrictions inevitably imposed by a great National emergency will enable arrears to be made good and steady and thoughtful progress to be resumed. VITAL STATISTICS. Before recording the vital statistics for 1945 I am presenting tables showing the statistics covering the 25 years from 1920 to ,1944—the period between the end of the first war and the closing of the war just ended. In addition to being a record of the Public Health in Beckenham in recent years, these tables provide a standard with which the various rates for the year under review can be compared. The twenty-five years have been divided into five 5-year periods and the rates shown are the rates for the whole of each such period. These 5-year periods correspond fairly closely with phases in the development of the Borough. Thus, 1920—1924 was the period of re-settlement and reconstruction after the first war ; 1925—1929 was a relatively stable period with little growth and only a gradual increase in the population; 1930—1934 saw a great development particularly in the Eden Park and Short lands areas; 1935—1939 was the period between the amalgamation of Beckenham and West Wickham and the outbreak of war; and 1940—1944 was the war period. Unless otherwise stated, the rates are expressed as a rate per 1,000 of the population. Period Live Birth Rate Still Birth Rate Percentage of births which were illegitimate per 1,000 population per 1,000 births 1920-1924 15.70 0.35 21.92 3.57 1925-1929 13.46 0.29 21.07 3.23 1930-1934 12.46 0.35 27.56 2.70 1935-1939 13.12 0.45 33.43 2.15 1940-1944 14.34 0.55 37.32 4.45 LIVE BIRTH RATE. The table shows the rise following the end of the first war followed by a steady decline; the slight increase after the inclusion of West Wickham within the Borough and definite increase during the war. 5 STILL BIRTH RATE. This rate has shown a steady rise throughout the whole period, and is difficult to account for. The question of Still Birth is discussed in the body of this report. ILLEGITIMACY. The only note-worthy point is the rise during the war years. indicated to the Health and Welfare Committee earlier in the year that though the percentage of illegitimate births had increased greatly all over the country, certain facts suggested that the premarital conception rate was not very different from the rate in the years before the war. It may be noted that the percentage of Illegitimate births in Beckenham during the last two years of the last War (1918-1919) was between seven and eight per cent. VARIOUS DEATH RATES. Period Death Rate Cancer Death Rate Tuberculosis. Notifications and Death Rate Infantile Mortality Rate per 1,000 live births Maternal Mortality Rate per 1,000 births Violence Pulmonary NonPulmonary N. D.R. N. D.R. 1920-1924 9.96 1.43 1.08 0.60 0.41 0.09 53.19 2.23 0.30 1925-1929 10.61 1.52 0.96 0.56 0.37 0.13 48.09 3.24 0.32 1930-1934 9.29 1.50 0.79 0.44 0.25 0.04 35.51 2.53 0.32 1935-1939 8.89 1.43 0.77 0.39 0.19 0.06 33.04 1.49 0.38 1940-1944 11.31 1.93 1.06 0.43 0.16 0.06 30.04 0.70 0.16 The outstanding point in this table is that for the first four of the five-year periods, every rate except the Cancer rate and Deaths from violent causes declined more or less steadily. During the last period (the war period) the general Death rate and the Death rates from Cancer and from Pulmonary Tuberculosis rose ; Infantile Mortality and Maternal Mortality continued to decline, and there was a sharp fall in the Deaths from Violence. (Deaths from enemy action are not included in the table.) The General Death Rate and the Cancer Rate were no doubt affected by the evacuation of mothers and children to other areas; the reduced population of the war years, on which the rates are based, contained a greater proportion of middle aged and elderly people, and this in itself would cause a rise in the death rates. Pulmonary Tuberculosis increased in incidence during the earlier years of the war ; in this disease increased incidence is quickly reflected in an increased fatality rate. The fact that the war years did not interrupt the steady decline in the Infantile Mortality and Maternal Mortality rates is a cause for satisfaction. 6 The sharp fall in the number of deaths from Violence coincides vrith the marked reduction in the vehicular traffic on the roads. The last table shows the death rates from the principal groups of diseases; for the sake of clarity these rates are shown as rates per 100,000 of the population. DEATH RATES PER 100,000 OF THE POPULATION. 1920-24 1925-29 1930-34 1935-39 1940-44 Diseases of the Heart 1 and Circulation 246 332 355 348 485 Cancer 143 152 150 143 193 tuberculosis 69 69 48 45 49 Pneumonia 58 49 43 39 47 All other Infectious Diseases 83 76 39 28 34 Diseases of the Digestive Organs 36 21 56 50 60 Respiratory Diseases 77 77 34 30 72 Kidney Diseases 29 24 30 25 26 Pregnancy and Child Birth (mother and child) 45 40 33 31 30 Deaths from Violence 30 32 32 38 16 This table merits careful study. If we ignore, for the moment, the last five-year period (the war years) certain trends are evident. Some diseases are causing an increasing number of deaths, others diminishing in fatality. It is interesting to note that the diseases which are declining in fatality are those which are conveyed by infection, either through food or directly from person to person— diseases such as Tuberculosis, Pneumonia, other lung diseases, Puerperal Sepsis and the ordinary Infectious Diseases. Two diseases show little change through these first four periods —Cancer and Kidney Diseases. Diseases of the Heart and Circulation and Diseases of the Digestive Organs (of which the commonest is Peptic Ulcer) show a decided increase. Diseases of the Heart* and Circulation are for the most part the results of degenerative changes in the heart and blood vessels ; these changes seem to be inevitable with advancing age. Death must come to all, but in time we may reach the position when the vast majority of deaths are due simply to the degenerative changes which come with age. Science and Medicine (Curative, Preventive and Social) have assisted in reducing greatly the fatalities due to disease of which the cause is known. If further large-scale progress is to be made and the span of life is to be further and further extended, it can only come with the discovery of the causes of diseases, the origin of which is at the present obscure—Cancer and Peptic Ulcer are good instances—and as a result of prolonged and intensive study of the degenerative changes in the tissue of the body. The approach to this subject is certainly very difficult. There is a popular impression that Research requires specially trained workers with elaborate equipment and to a considerable extent this 7 is true; but it does not seem to be sufficiently appreciated that a tremendous amount of valuable work can be done " in the field " by all medical men and women. It is true that there have been instances of startling discoveries made by the intervention of pure chance in the work of one who had the genius to grasp the full implications of what had occurred ; Penicillin was such a discovery. But, in the main, research is a long process and the torch must be passed from hand to hand. Accumulation of a large mass of observations, records and evidence is essential, and in this collection of evidence the medical practitioner can take a large part. Patient observation, enquiry and recording of facts may in time supply the very evidence which is missing from other investigations. It is to be hoped that the Medical Services of the future will allow all workers, whether independent practitioners or men and women in the National or Local Government Services, time and opportunity to contribute, as they will certainly be well able to do, to the task of elucidating the origins of many of the conditions about which we are in ignorance. Turning to the last five-year period in the table, we find that excluding Kidney Disease—which remained stationary—and Violence which as noted above declined sharply, every group of diseases shows an increase in mortality. I have already remarked on the increase in mortality from Cancer and Tuberculosis. The increased mortality from Pneumonia and Respiratory Diseases generally occurred mainly in 1940 and 1941, and the winter air-raids which compelled so many people of all ages to spend night after night in out-door shelters no doubt contributed to this result. War-time diet and war-time conditions and anxieties may have influenced the mortality from diseases of the Digestive System. The increase in the number of deaths from other infectious diseases was entirely due to outbreaks of Influenza in 1940; and 1943. DIPHTHERIA IN BECKENHAM OVER A PERIOD OF FIFTY YEARS. The infectious disease records of Beckenham in the possession of the Public Health Department go back to 1895. The record of the incidence and mortality from Diphtheria over this period will no doubt be of interest. Five-year period Attack rate per 1,000 population Death rate per 1,000 population Case Mortality rate Deaths per 100 cases 1895-1899 1.24 0.19 15.8 1900-1904 1.27 0.17 13.9 1905-1909 1.92 0.14 7.4 1910-1914 2.32 0.15 6.6 1915-1919 0.93 0.03 3.4 1920-1924 0.88 0.07 8.2 1925-1929 1.07 0.09 8.3 1930-1934 0.40 0.008 2.0 1935-1939 0.22 0.014 6.6 1940-1944 0.24 0.017 7.1 8 The marked and sustained decline in both incidence and mortality since Diphtheria Immunisation was begun in the Autumn of 1928 are quite evident. That the decline in mortality cannot be attributed to a natural decline in the severity of the disease is shown by the column which gives the case mortality, i.e., the percentage of cases which proved fatal. The case mortality rate was halved in the first decade of this century, due in part perhaps to a decline in severity, but certainly attributable in part to the routine use of an efficient antitoxin : since then, although there have been periods when fatality was low, the general case mortality has remained much the same. INFANTILE MORTALITY. The number of deaths of infants under the age of twelve months was 22 as compared with 24 in 1944. The Infantile Mortality Rate for the year was 24.943 per 1,000 live births. The following table shews the causes ot death in ZZ cases tor which full records exist. Under 1 week 1—2 wks. 2—3 wks. 3—4 wks. Total under one mth. 1—3 mths. 4—6 mths. 7—9 mths. 10—12 mths. Total under one year A. Congenital Deforities. 1. Atresia of the small intestine — 1 — — 1 — — — — 1 2. Imperforate anus — — — — 1 — — — — 1 3. Meningo— encephalocele — — — 1 1 — — — — 1 B. Due to Ante—natal or Intra—natal Conditions 1. Prematurity 7 1 — — 8 1 — — — 9 2. Atelectasis 1 — — — 1 — — — — 1 3. Cerebral Haemorrhage 1 — — — 1 — — — — 1 C. Due to Infections. 1. Gastro—enteritis — — — 1 1 — — — — 1 2. Pneumococcal Meningitis — — — — — — — 1 — 1 3. Bronchopneumonia — — _ 1 1 2 — — — 3 4. Acute Laryngitis — — — — — 1 — — — 1 D. Other Causes. 1. Lack of attention at birth 1 — — — 1 — — — — 1 2. Icterus Gravis Neonatorum 1 — — — 1 — — — — 1 11 2 — 4 17 4 — 1 — 22 9 Half of the deaths occurred in the first week of life and most of these were due to prematurity. Only six of the deaths were certified as being due to infection. STILL BIRTHS. As stated in the opening pages of this Report the Still Birth rate in the Borough has been steadily rising. The Still Birth rate for 1945 was 30.63 per 1,000 births, compared with an average of 37.32 for the five years 1940-1944. The most convenient way of examining the question of Still Births is to study the records of the Beckenham and Penge Joint Maternity Hospital. In the six years since the new hospital in Stone Park Avenue was opened there have been 2,791 births in the hospital of which number 74 were still births. This gives a still birth rate over the whole period of 26.51 per 1,000 births. The causes of many of the still births were not known. Of the 74 registered, 10 were attributed to the Toxaemias of Pregnancy, 20 were due to abnormal conditions developing during labour and 15 of the infants had congenital malformations which were incompatible with life. There remain therefore 29 still births for which no definitely recognisable cause could be found, the records show that 24 of these infants were dead before the onset of labour. The records have been examined from two particular aspects tp see if either of these aspects had any recognisable effect on the question of Still Birth. These aspects are :— 1. Age and number of pregnancies. 2. Family income. (1) Age and Number of Pregnancies. Of the total number of 2,791 births :— In 55.78% it was the first pregnancy. In 28.16% there had been one previous pregnancy. In 10.32% there had been two previous pregnancies. In 5.72% there had been three or more previous pregnancies. The Still Birth rate for each of these groups was as follows :— First pregnancies ... 30.82 per 1,000 births. Second „ 8.90 „ „ „ Third „ 34.72 „ Fourth and subsequent pregnancies 56.25 ,, ,, „ The table shows very striking differences, though it is probable that in a larger series of cases the divergencies between the various rates would not be quite so wide. It is well recognised that the risks of pregnancy ending in a still birth are greater in first pregnancies, but it is surprising to find the rate rising so sharply in pregnancies after the second, but as mentioned above, the number 10 of cases in this series with more than two pregnancies is not large (about 450 cases). If we take into account age as well as parity we get the following figures:— Age Under 30 years. 30 years and over. First pregnancy 22.35 55.83 Second „ 4.74 13.73 Third „ 22.47 40.20 Fourth and subsequent pregnancies — 56.33 Risks appear to increase quite definitely with age. (2) Family Income. Many observers believe that under-nourishment during pregnancy greatly increases the risks of abortion, still birth and premature birth. For the purposes of this enquiry the cases are grouped according to the fees payable for accommodation : these fees are based strictly on family income. Still births according to the fees charged are shown in the following table:— Still birth rate Fees per 1,000 births Under £2 a week 23.3 £2 and under £3 28.0 £3 and under £4 17.0 Over £4 a week 35.3 No reliable conclusions can be reached from these figures. There is one condition which undoubtedly is responsible for some still births and which has received a lot of attention during recent years. Most people now-a-days know that for the purpose of blood transfusion the donor must belong to the same blood group as the recipient, because bloods of different groups contain elements which are incompatible and mutually destructive. The new factor which has been discovered in the blood in recent years is known as the Rhesus factor. In about fifteen per cent, of individuals the blood is Rhesus negative and in the rest it is Rhesus positive. If a mother is Rhesus negative and her developing child is Rhesus positive, the positive factor in the child's blood will cause the production of antibodies in the maternal blood : in time these antibodies develop to such an extent that they bring about the destruction of the child's blood cells and cause premature intra-uterine death. The Rhesus factor is inherited from both parents, but if the positive factor is present it is the dominant factor: individuals therefore may be double positive (Rh.Rh.) 11 single positive (Rh.rh.) or negative (rh.rh.). If the husband of a Rhesus negative woman is double positive every child conceived will be Rhesus positive ; if the husband is single positive there is an even chance that a child conceived may be positive or negative. The antibodies developed in the blood of a Rhesus negative mother may not affect the first child conceived, but if each succeeding child conceived is Rhesus positive practically all the later pregnancies will terminate in still births. Obviously, in marriages where the mothers are Rhesus positive, or the fathers are Rhesus negative this particular danger does not occur. This phenomenon may explain in part the sharp increase in the still birth rate as the number of pregnancies increases. One can ascertain whether an individual is Rhesus positive or Rhesus negative, but the knowledge obtained will be of no practical value in trying to prevent still births, because there is no way of preventing or arresting this destructive process if the conditions for its development exist. Of course the condition would be prevented if women who were Rhesus negative refrained from marrying men who were Rhesus positive. Toxaemias of Pregnancy and difficulties arising during labour are, in theory, preventable. Nothing can be done in the present state of our knowledge to prevent the occurrence of malformations in the infant in the course of development. For the rest, it would appear that the prevention of many still births is a social matter and not a purely medical one—earlier marriage, with an earlier age for child bearing, adequate income for the purposes of nutrition, and previously ascertained compatibility of the respective blood groups concerned. SUMMARY OF VITAL STATISTICS, 1945 Area of District in acres 5,935 Civilian Population as estimated by Registrar-General at 30th June, 1945 58,850 Civilian Population per acre 9.9 Rateable Value at 1.10.45 £806,973 Births Registered : Male Female Legitimate 457 379 Illegitimate 28 22 Total 886 Birth Rate per 1,000 of Civilian Population 15.055 Deaths Registered: Male Female 322 328 Total 650 Death Rate per 1,000 population 11.045 Infant Mortality Rate per 1,000 births 24.943 22 Deaths of Infants under 1 year of age: Male Female Legitimate 11 7 Illegitimate 4 — Total 22 12 Deaths from Enteritis under 2 years of age—1 death. Rate per 1,000 births 1.128 Still Births-Rate per 1,000 population 0.476 Male Female Legitimate 13 13 Illegitimate — 2 Total 28 Death Rate from Lancer (109 deaths) 1.852 Death Rate from Pulmonary Tuberculosis (31 Deaths) 0.520 Table A. Birth rates, Civilian Death rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the Year 1945. Provisional figures based on Weekly and Quarterly Returns. England and Wales 126 C.Bs. and Great Towns including London 148 Smaller Towns Resident Pop. 25,000—50,000 at 1931 Census London Adm. County Beckenham *Rates per 1,000 Civilian Population : Births— Live 16.1‡ 19.1 19.2 15.7 15.055 Still 0.46‡ 0.58 0.53 0.40 0.476 Deaths— All Causes 11.4‡ 13.5 12.3 13.8 11.045 Typhoid and Paratyph'd 0.00 0.00 0.00 0.00 0.01 Scarlet fever 0.00 0.00 0.00 0.00 — Whooping cough 0.02 0.02 0.01 0.02 Diphtheria 0.02 0.02 0.02 0.01 0.017 Influenza 0.08 0.07 0.07 0.07 0.034 Smallpox — — — — — Measles 0.02 0.02 0.02 0.01 — Rates per 1,000 Live Births : Deaths under 1 Year of Age 46.0† 54.0 43.0 53.0 24.943 Deaths from Diarrhoea and Enteritis under 2 Yrs. of Age 5.6 7.8 4.5 7.6 1.128 *A dash (—) signifies that there were no deaths. †Per 1,000 related births. ‡ Rates per 1,000 Total population. 13 NATURAL AND SOCIAL CONDITIONS Beckenham is a residential suburb situated in the County of Kent, in the extreme North-West corner of the County, and just outside the Metropolitan area ; it has only two well defined industrial areas, one at Elmers End and the other at Lower Sydenham. It is about eight miles from Charing Cross. On its North and West borders it touches the Metropolitan Boroughs of Lewisham, Camberwell and Lambeth ; on its West and South sides the Urban District of Penge and the County Borough of Croydon; on its East and South-East sides the Borough of Bromley and the Urban District of Orpington. The total area of the district, which was enlarged in 1935, including all land and inland water, is 5,935 acres. Its elevation varies from 100 to 300 feet above sea-level. The district generally is flat with rising ground on the West towards the site of the Crystal Palace and Sydenham, and again on the east towards Lewisham and Bromley. With regard to the geological formation of the district, about half the area consists of " Blackheath Pebble Beds," and the remaining half of "London Clay" with beds of "Valley Gravel" following the course of the streams known as Chaffinch Brook and the Ravensbourne River. The climate is comparatively mild and the annual rainfall is low, averaging 35.62 inches in the last year of which records are available. The Council have purchased about 170 acres of land for public open spaces and also about 90 acres for use as allotments. Several large open spaces are held by Business houses and Sports Clubs as Playing Fields and these have helped to preserve the pleasant character of the district. In the Wickham area, there is a large tract of open country which forms part of the "Green Belt." SANITARY CIRCUMSTANCES OF THE AREA SEWERAGE AND DRAINAGE. The sewerage and excreta of the district are removed by the Water Carriage System. The sewers are on the " separate system," that is to say, there is one set of pipes for sewerage and another for surface and storm water. For the purposes of sewage removal, Beckenham is divided into two districts, namely, the Metropolitan Sewerage Area and the West Kent Area. The former district comprises the Kent House and Lawrie Park Wards (area 567 acres), and the latter the remainder of the district (area 5,368 acres). The dividing line between the two areas is the Crystal Palace branch of the Southern Railway and the Poole River. The drainage of the Beckenham Sewerage Area discharges 14 into the Penge and Bell Green Sewer, which latter sewer (taking also the sewerage from Penge) connects to the Metropolitan Sewer at Lewisham, the main outfall of which Metropolitan Sewer is situate at Crossness on the River Thames. The sewers of the West Kent Area discharge at several points into the two main sewers of the West Kent Sewerage Board, the sewage being eventually collected at Dartford, where, after purification, it is discharged into the Thames. The sewers are ventilated by means of man-holes opening on the surface of the streets and by shafts carried above roof level. CESSPOOLS. In the year 1882 and the subsequent years the sewering of the district was carried out, and the old system of house drainage to cesspools was practically abandoned. Isolated houses which were too far from the sewer continued to be drained to a cesspool, but as the district extended and new roads and sewers were laid, these gradually were connected up to the sewers. At the present time there are seven houses in the district connected to a cesspit, and these are in every instance beyond the legal distance within which the owners can be called upon to connect them with the district sewers. All cesspools are properly constructed and cleansed when necessary. SCAVENGING. Every occupied house in the district is provided with a galvanised iron dustbin for the reception of house refuse in accordance with the Beckenham Urban District Council Act, 1903. Special arrangements exist for the frequent removal of trade refuse. The Destructor is situated at the Electricity Works in Churchfields Road, but owing to a breakdown of the Destructor Plant it was necessary to institute " Controlled Tipping " of refuse, and a site South of the Borough has been used. HOUSING Extracts from a Memorandum submitted to the Chairman and Members of the Health and Welfare Committee on January 16th, 1946. The housing situation is deplorable, and the difficulties increase each week as men and women leave the Services and return home. The original estimate of post-war housing needs, reported to the Council in May, 1943, by the Housing Committee, was that houses would be needed for 1,000 families : present information indicates that this was an under-estimate. It was recognised by the Housing Committee at the time that some of this need could be met by private enterprise, but it was evident that a very substantial number of houses would have to be provided by the Local Authority. 15 The suggested programme for the first year following the end of hostilities was the provision of houses for 200 families: at the time when this programme was put forward, the enormous expenditure of time and labour on the repair of houses damaged by flying bombs" could not be foreseen; still, by the later months of 1946, 270 new homes will, we hope, be erected. The large number of small houses completely destroyed by the flying bombs has changed the situation. Another thing of outstanding importance is the large number of new families, young people who married during the war, many of whom now have children. At present many of these young families are living in the homes of their parents, and as demobilisation proceeds they are being joined by their husbands with great and increasing inconvenience and distress to old and young; in a number of cases there is actually statutory overcrowding. The re-housing problem is still a large one: it can be nothing but a temporary expedient to accommodate "bombed out " families in requisitioned houses: sooner or later they will have to be accommodated in houses of their own. A house is more than a shelter from the elements : it is, or should be, a home. Minds, no less than bodies, need rest. Real rest and relaxation cannot be obtained without adequate living space: and by living space we surely must mean more than minimum standards of floor space and cubic capacity. It would appear that if these are sufficient to prevent actual physical ill-health we are asked to agree that they constitute a home. In no other way is it possible to explain a legal standard of over-crowding which decrees that every room in a house—except the bathroom, water-closet and scullery—are to be used as sleeping rooms. The family is often, and rightly, regarded as the unit in our social life ; but a family is made up of individuals, and some degree of privacy for individuals is essential for a healthy family life. If space for living is inadequate, family life is distorted; children are apt to be a nuisance: trivial annoyances, which under such conditions are of almost daily occurrence, achieve exaggerated importance ; harmony is disturbed and things fester in the mind. One does not have to be a doctor for very long to know that body, mind and spirit are indeed inseparable and interdependent, and that unrest or disease in any one re-acts harmfully on the whole. However difficult and trying the circumstances may be, most people can preserve their balance and their mental health if they can have any real hope that they will get adequate homes in the not too distant future, but that is a hope which is denied to the large majority of those who are at present in need of homes. It is a hope which I, for one, do not dare to encourage, since the present Housing programme in Beckenham cannot possibly provide for more than a fraction of those in need. I must refer again to what I said in the introduction to my Annual Report for the year 1944: that there are many small houses 16 in the Borough which, during the next year or two, will have to be condemned as being unfit for habitation : when that happens the occupants of those houses will have to be provided with other accommodation. By the middle of next year I hope to have precise information on this point, but I shall be surprised if there are found to be less than a hundred of such houses. The Department made special enquiries and submitted reports to the Housing Committee on 24 cases during the year. Statutory overcrowding was recorded as existing in five of these cases. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA A. HOSPITALS PROVIDED BY PUBLIC AUTHORITIES. 1. Fever Hospitals. The West Kent Joint Hospital Board provides Fever Hospital accommodation for Beckenham and a number of other districts. The Board has two Hospitals, one for Smallpox cases, and the other for specified infectious diseases. 2. Maternity Hospital. The Beckenham Borough Council and the Penge Urban District Council maintain a Joint Hospital at Stone Park Avenue, Beckenham. This building was specially built as a Maternity Hospital with 34 beds, and was opened in December, 1939. Details of the work in 1945 appear later in the Report. 3. General Hospital. The County Council provide General Hospitals at Farnborough and at Orpington for acute cases and the chronic sick. The Hospital at Farnborough includes a Maternity Block with 50 beds. These Hospitals serve that part of the County in which Beckenham is situated. Old and infirm cases are dealt with as far as possible by the County Public Assistance Committee. 4. Tuberculosis. The Kent County Council are responsible for the provision of Sanatoria and Hospitals for Tubercular patients, and for the provision of Chest Clinics for diagnosis and treatment. The Chest Clinic for Beckenham and Penge is at 1, Westbury Road, Penge, and for Wickham at 2, Park Roacf, Bromley. 5. Day Nurseries. To meet war-time developments the Council opened two Nurseries, with places for 85 children in all. Details appear later in the Report. B. LOCAL CLINIC SERVICES PROVIDED BY THE LOCAL AUTHORITIES. The table on page 21 shows the Centres and Clinics in operation at the end of December, 1945. 17 C. LOCAL SERVICES PROVIDED BY VOLUNTARY ORGANISATIONS. 1. Beckenhatn Hospital. This Voluntary Hospital has accommodation for 78 patients. It is the General Hospital for the district for the treatment of acute medical and surgical cases and is supported by voluntary contributions and charges made to patients. A rebuilding scheme estimated to cost £250,000 is now under consideration. The Hospital is staffed by General Practitioners of the District acting in an honorary capacity. The services of Consultants are available to any practitioner on the staff who desires a specialist opinion on any case. A few years ago the Hospital greatly extended its sphere of usefulness to the community by instituting a series of Consultant's Out-Patient Clinics at which patients can receive the advice of a specialist. Appointments for the Clinics must be made through the patients' own doctors. The following types of cases are dealt with by the Consultants :— Monday. Dental Gynaecological Genito-Urinary Fortnightly Tuesday Skin Diseases Orthopaedic . Wednesday Ophthalmic Surgical Friday Ear, Nose and Throat Weekly Children Psychological Saturday — Medical During the war, the Beckenham Hospital was the Emergency Hospital for Beckenham and Penge, and the majority of the severe air raid casualties were admitted to this Hospital for initial treatment. The Honorary Medical Staff, and the Nursing Staff did a magnificent job in dealing with these cases. 2. The South-Eastern Hospital for Children. This is situated just outside the Borough, but takes a great many cases from the northern part of the area. 3. Heartsease Hospital, Woodland Way, West Wickham. This is a special Hospital for children with Heart Disease, and is provided by the Invalid Children's Aid Association. D. HOMELESS CHILDREN. There are several voluntary institutions in the district which provide excellent care for orphans and homeless children. These all moved away during the war, but are now returning. At the end of 1945 the following were open or about to re-open:— 1. St. Hilda's Home, Crescent Road, Beckenham. Originally a home for girls, but now to be a home for babies. Organised 18 and maintained by the Waifs & Strays Society. 2. The Home of Compassion, Bromley Road. 3. Miss Sharman's Home for Girls, Newlands Park. 4. The Salvation Army Home for Girls, " Willoughby," Crystal Palace Park Road. 5. The Aberdare Memorial Home for Boys, Woodland Way, West Wickham. 6. Dr. Barnardo's Home for Girls, 16, Park Road, Beckenham. E. HOMES FOR THE AGED. The arrangements made by the County Council for the care of old people in institutions have been severely curtailed by war-time difficulties, and it is now extremely difficult to obtain accommodation in any of the County Hospitals, even when advancing years and chronic illness make it essential that these old folk should have more care than it is possible to receive from relatives or those with whom they live. It is to be hoped that this problem will be dealt with before long. Experience during air-raids shows that there are a large number of old people living alone, far from any relatives who can give them a helping hand. The S.O.S. Society opened a Hostel for old people at 71, Bromley Road, Beckenham, in 1944, and this has met a real need. The Beckenham Old People's Committee has helped in many ways to provide extra comforts and furnishings for the occupants of this Hostel. F. PRIVATE NURSING HOMES. Most of the premises used for this purpose were damaged by bombing and had to be closed. At the end of 1945 there were five private homes registered in the Borough and these provided a total of 52 beds. These premises were inspected under the Nursing Homes (Registration) Act, and 12 visits were made to the premises by the Assistant Medical Officer of Health. G. NURSING ARRANGEMENTS. Professional Nursing in the Home. (a) Midwifery. The County Council remains the supervising authority under the Midwives Acts, and repeated applications by the Borough Council for delegation of powers have been refused. The Kent County Council provide 3 midwives for this area, and in 1945 they attended 135 confinements. (b) General. For all general Nursing in the Home the services of the Queens Nurses are available. This service is organised by the Beckenham & Shortlands District Nursing Association and the West Wickham & Hayes District Nursing Association. These Associations employ 5 nurses. A small fee is 19 able according to the circumstances of the patient, or families can join as Annual Contributors. The number of visits made in 1945, by these Nurses was 10,124 and every type of case was undertaken with skill and kindness. H. AMBULANCE FACILITIES. 1. For Infectious Diseases. The West Kent Joint Hospital Board provide Motor Ambulances for the removal of Fever cases to Hospital and return cases to their homes when discharged. 2. For Non-Infectious and Accident Cases. On the 1st April, 1942, the Ambulance Service was transferred from the control of the N.F.S. to the C.D. Casualty Service and when the C.D. Service was disbanded on the 20th June, 1945, it was decided to set up a joint service with Penge to serve the two areas. After consultation it was decided that the Beckenham and Penge Councils should collaborate in forming a Joint Service to be administered by Beckenham, and this came into operation on 1st July, 1945. Facilities were arranged for the vehicles to be stationed at the Beckenham and Penge Fire Stations and for all calls to be received over the N.F.S. telephone system. The following table shows the calls dealt with by the Casualty Service and from the 1st July to 31st December by the Joint Service. (a) Calls Dealt with During War Years. Period Total Calls Accidents Removals to Hospitals Maternity Cases Calls Transferred to adjoining areas Mileage covered 1.4.42— 31.3.43 1,084 195 459 430 46 9,266 1.4.43— 31.3.44 1,476 231 740 505 65 13,026 1.4.44— 31.3.45 993 168 537 288 155 8,689 1.4.45— 30.6.45 298 54 148 96 5 2,428 3,851 648 2,184 1,319 271 33,809 (b) Calls Dealt with by Joint Service. 1.7.45— 31.12.45 1,143 212 593 279 57 9,545 20 LOCAL CLINIC SERVICES Arrangements in force at 31st December, 1945. Service Days and Times Premises in Use Ante-Natal Fridays, 2—4 (weekly) Clinic Block, Town Hall. Fridays, 2-—4 (once a month) Clinic Block, Hawes Lane, West Fridays, 10—12 (weekly) Wickham. R.M.O. Maternity Hospital — Thursdays, 10—12 (weekly) Practitioners' Mon., Tues., Wed., 10—12 Matron's Clinic. Obstetric Consultant Mondays (fortnightly) 2—4 Maternity Hospital Child Welfare Monday, 2—4.30 Clinic Block, Hawes Lane,West Wickham. Tuesday, 2—4.30 a) Baths Annexe, Beckenham Road. b) Coney Hall Club, West Wickham. Wednesday, 2—4.30 a) Church Hall, Langley Road, Elmers End. b) Church Hall, Valley Road, Shortlands. Thursday, 2—4.30 a) Clinic Block, Town Hall. b) Church Hall, Lennard Road. c) Clinic Block, Hawes Lane,West Wickham. Friday, 2—4.30 Church Hall, Langley Road, Elmers End. School Inspection Tuesday, 10—12.30 Clinic Block, Town Hall. Wednesday, 10—12.30 Do. Thursday, 10—12.30 Clinic Block, Hawes Lane,West Wickham. Minor Ailments Tuesday, 2—3 Alexandra Schools. Thursday, 10—11 Churchfields School. Thursday, 2—3 Stewart Fleming School. Tuesday, 9—10 Marian Vian School. Monday, 9—10 Hawes Down School. Monday, 9—10 Wickham Common School. Thursday, 9—10 (Balgowan and Bromley Rd. Schools) Clinic Block, Town Hall. Dental Daily—By appointment Clinic Block, Town Hall. Wednesdays—all day Clinic Block, Hawes Lane,West Wickham. Ophthalmic Wednesday, 1.20—4.30 Clinic Block, Town Hall. Wednesday (once a month) 1.30—4.30 Clinic Block, Hawes Lane, West Wickham. Aural Fridays, 2—4 (monthly) Clinic Block, Town Hall. Orthopaedic Surgeon : Mondays (fortnightly) Clinic Block, Town Hall. Massage : Mondays (all day} Do. Wednesday (all day) Do. Thursday, 2—4 Do. Fiday, 10—12 Do. Chest Clinic Friday, 10.30—12.30 1, Westbvry Road, Penge. 21 Venereal Disease. Place For Day and Time Held K.C.C. Clinic, 37, Westhill, Dartford. Men Tuesday, 4—6 p.m. Women Tuesday, 2—4 p.m. L.C.C. Clinic, King's College Hospital, Denmark Hill, s.e.5. Men Monday, Tuesday, Thursday, Friday, 5 p.m. Wednesday, 11 a.m. Thursday, 2 p.m. Women Monday, 6 p.m. Wednesday, 4 p.m. Friday, 2 p.m. Croydon C.B.C. Clinic, Croydon General Hospital. Men Tuesday, 7 p.m. Saturday, 2.30 p.m. Wednesday, 2.30 p.m. Women Thursday, 11 a.m. Friday, 3 p.m. and 5.30 p.m. L.C.C. Clinic, St. John's Hospital, Lewisham. Men Tuesday, 5.30 p.m. Thursday, 9.30 a.m. Women Monday, 3 p.m. Thursday, 6.15 p.m. L.C.C. Clinic, St. Thomas' Hospital. Men Daily, 10 a.m.—8 p.m., including Saturdays. Women Daily, 10 a.m.—8 p.m., including Saturdays. MATERNITY AND CHILD WELFARE This service is concerned with the care of the mother throughout her pregnancy and confinement and the supervision of nursing mothers and of children up to the age of five years. The provision made for this work thus falls into three sections: 1. Care of the expectant mother. 2. Arrangements for the confinement and lying-in period. 3. Supervision of mothers and infants. 1. CARE OF THE EXPECTANT MOTHER. (a) Observation of the progress of pregnancy, detection of abnormalities, and discovery and correction of any other physical defects which may exert a harmful effect on the process of gestation. This work is carried out by the routine attention of the medical practitioner or midwife who has been engaged for the confinement. In cases where a midwife only has been engaged it is necessary that the expectant mother should be examined at least twice during pregnancy by a medical practitioner. It is for this purpose that Ante-natal Clinics are established. The Ante-natal Clinics are conducted by a panel of medical 22 practitioners practising in the Borough. Expectant mothers are invited to select from the names on the panel the practitioner whom they would wish to attend them in the event of the services of a doctor being needed at the confinement. Appointments for the necessary examinations at the Clinics by the doctor selected are then made by the Public Health Department. Ante-natal examinations of those mothers who have arranged to have their confinements in Institutions outside the Borough are carried out by the Assistant Medical Officer of Health. All attendances at the Ante-natal Clinics are by appointment, by which means periods of waiting are reduced. Ante-natal Clinics for those mothers attending the Beckenham and Penge Joint Maternity Hospital are held at the Maternity Hospital: for all other mothers they are held at the Borough Clinics at the Town Hall and in Hawes Lane, West Wickham. During 1945, 135 births were attended by Midwives, and 95 of these mothers attended at the Clinics. Ante-natal Assistant Medical Panel Officer Sessions held 61 48 Number of expectant mothers attending 465 166 Number of attendances made 751 289 (b) Inspection of home conditions; advice as to general hygiene, securing extra nourishment, provision of extra clothing, etc. The Health Visitors pay visits to the homes of expectant mothers and assist in all these matters—except in the cases of those mothers who have engaged the services of a medical practitioner. During 1945 the Health Visitors made 990 visits for these purposes. 2. ARRANGEMENTS FOR THE CONFINEMENT. (a) Institutions. (b) Mothers' own homes. (a) Institutions. The Institutions within the Borough are:— The Beckenham & Penge Joint Maternity Hospital. Two private Nursing Homes, registered under the Public Health Act, 1936. The Beckenham Hospital which takes a few maternity cases but only under certain special conditions. The demand for institutional accommodation for confinements has been steadily increasing for a number of years. This is shown by the following figures:— 1935 56% of the births took place in Institutions. 1938 67% of the births took place in Institutions. 1945 79% of the births took place in Institutions. The existing housing situation and the difficulty in securing adequate help in the home undoubtedly contributed to the high percentage of institutional births in 1945, but as stated above this 23 tendency was steadily increasing in the years before the war. In the Ministry of Health's Hospital Survey published in 1945 the following paragraph appears:— "There has been for some years an increasing tendency for women whose confinement is likely to be normal to seek institutional accommodation rather than to be confined at home. This tendency has been strengthened during the war when it has become even more difficult to get help in the home. It seems clear that a habit has become firmly established which will make it essential in the future to provide maternity beds, not only for the comparatively small number of women whose confinement may be difficult or whose home circumstances are unsuitable, but also for the much larger number who desire institutional confinement as a matter of convenience. Our enquiries suggest that it would be unwise to budget for less than half the number of births to take place in institutions in the immediate future (in London the proportion is already 60 per cent.) and that this proportion may continue to increase." In 1935 the Beckenham & Penge Joint Maternity Hospital was at 80, Croydon Road, Beckenham, and contained fourteen beds. In that year the distribution of the Institutional births was as follows:— Total Institutional In B. & P. In Other In Institutions Births J.M.H. Institutions outside the in the Borough District 56% 25.4% 11.8% 18.8% In 1945 the new Hospital in Stone Park Avenue (34 beds) was in full use for the last nine months of the year and the figures were:— Total Institutional In B. & P. In Other In Institutions Births J.M.H. Institutions outside the in the District District 79% 49.1% 15.7% 14.2% The Hospital, in a full year, could accommodate a larger number of cases, but it could not accept more than 55—60% of the births in Beckenham in any one year. It is noteworthy that Beckenham residents during 1945 used no less than thirty-two Institutions outside the Borough, but the County Hospital at Farnborough, and two private Maternity Homes in Bromley dealt with over 60% of these cases. It must be recognised that if the demand for Institutional accommodation increases, or even remains at its present level, the Beckenham & Penge Joint Maternity Hospital will not be able to accept all of those who apply for admission. (b) Mothers' Own Homes. Mothers wishing to have their confinements in their own homes can engage the services of a medical practitioner and/or a midwife. The domiciliary midwifery service in Beckenham is provided and administered by the Kent County Council. The midwives in the Borough may act in two capacities: either as midwives in complete charge of the case, or as maternity nurses acting under the direction of a medical practitioner. 24 During 1945 the County midwives attended 104 cases as Midwives and 31 as Maternity Nurses. Home Helps. The Council is empowered to engage suitable women to assist in the housekeeping and domestic work of homes where the mother is confined in her own home; in certain cases the Council pays all or part of the fees for this attendance. It has been difficult to obtain the services of women for this work, but 10 confinement cases were assisted. 3. SUPERVISION OF MOTHERS AND INFANTS. (a) Post-Natal Clinics. Arrangements are made for the examination of mothers after their confinements. These examinations are carried out by the medical practitioners on the panel or by the Assistant Medical Officer, as the case may be. During 1945, 299 of these examinations were carried out. In addition, all mothers who engaged midwives for their confinements are invited to attend the Obstetric Consultant's Clinic for final examination and the correction of any abnormality caused by pregnancy and childbirth. Details of this work appear in the report of the Obstetric Consultant. (b) Nursing Mothers and Infants. Supervision is carried out at the Infant Welfare Centres and by visits to the homes made by the Health Visitors. There are seven Infant Welfare Centres in the Borough and during the year nine sessions were held each week. With the exception of the Centre at Shortlands a Medical Officer attended each centre each week. The situations and other particulars of the centres appear in the Table of Local Clinic Services on page 21. The work of the Centres is summarised in the following table. Infant Welfare Centre Attendances, 1945. Town Hall Alexandra Elmers End Wickham Coney Hall Baths Shortlands Total 1945 Total 1944 Total 1943 Total Attendances 2,643 3,593 6,662 5,519 2,742 4,232 1,354 26,745 21,675 33,674 New Cases 184 149 218 267 92 196 108 1,214 926 1,062 Sessions Held 51 49 100 96 50 77 48 471 474 462 Aver. per Session 51 73 66 57 54 54 28 57 35 72 Doctors Session 51 48 49 48 50 47 - 293 294 307 Cases seen by Doctors 520 938 870 847 384 1,122 - 4,681 3,744 5,448 Aver. per Session by Doctors 10 19 17 17 7 23 - 15 13 17 3,619 children made 26,745 attendances—an average of 7.4. 25 The following figures shew the attendances of children in age-groups. Infant Welfare Centre Attendances. Year of Attendances Birth made 1940 343 1941 1,082 1942 2,013 1943 3,832 1944 10,959 1945 8,516 Total 26,745 Four Health Visitors were engaged in Home Visiting and at the Infant Welfare Centres during the year 910 new cases were placed on the Health Visitors registers. Particulars of the visits made are shewn in the following table. Health Visitors' Home Visits. New Cases Routine Visits to Children under one Routine Visits Aged 1-5 Special Visits for Illness Expectant Mothers Other Visits No Reply Total Visit Miss Smith 247 798 814 237 305 25 514 2,94 Miss Kendall 341 612 899 158 348 103 212 2,67 Mrs. Walmesley 206 405 842 405 157 24 453 2,49 Miss Chandler 243 202 268 269 180 23 353 1,53 Total 1,037 2,017 2,823 1,069 990 175 1,532 9,64 Comparison 1944 910 1,819 2,804 1,174 842 476 2,404 9,75 In December, 1945, a report on the Infant Welfare Services was presented to the Health and Welfare Committee; after considering this report the Committee recommended that an additional Health Visitor be appointed to commence duty on 1st April, 1946, and that additional sessions should be held at two of the Infant Welfare Centres. UNMARRIED MOTHERS. During the year the cases of 18 unmarried mothers were brought to the notice of the Department. Of these 12 were reported by the Social Worker of the Rochester Diocesan Moral Welfare Council, 3 by Midwives or Health Visitors, 2 by Forces Welfare Societies and 1 by the Surrey County Council. Arrangements were made for 10 of these cases to enter special Hostels maintained by the Rochester Diocesan and other Moral Welfare Societies, the remaining 8 making their own arrangements. Of the 15 babies born, 1 died shortly after birth, 5 remained in the care of their mothers, 6 were adopted under the Adoption of 26 Children Act, and 1 was boarded out with a foster mother under the Infant Life Protection Act. 2 left the area. In addition there were 31 other illegitimate births not reported until the notification of birth was received. These were all followed up and the information obtained showed that 2 were stillborn, 2 died before reaching the age of three months, 18 remained in the care of their mothers, 5 were adopted and 4 left the area. These cases create a considerable social problem and the present resources are not adequate to deal with them all. More Hostel accommodation is urgently required, where the mothers can remain long enough to have time to arrange for their future in the best interests of themselves and the children. ADOPTION ACT, 1939. The Health Department receives notification under this Act for the proposed adoption of children. The Registered Adoption Societies ask the Department for a report on the home before placing any child and this is a very useful procedure. Any person who acts as a third party in arranging an adoption is required to give notice to the Health Department but in many cases arrangements are made direct between the parent and the adopter. The whole procedure for Adoption is now under consideration by a Government Committee and new legislation will doubtless be enacted. It is to be hoped that the responsibility for giving notice will be placed upon both the parties to the arrangement. Information was received from 9 registered Adoption Societies and 5 other bodies during the year relating to 35 children and all the homes visited regularly. Adoption orders were made by the Courts in 24 cases; in three cases the applications were withdrawn, and 7 were still under consideration at the end of 1945. Close liaison is maintained with the Education Officer in cases coming under the provision of this Act. PROVISION OF MILK, MILK FOODS, ETC. A stock of dried milks and other foods is kept at the Centres and sold to the mothers at cost price. During the year foods to the value of approximately £3,000 were sold. During the year the issue of Fruit Juices and Cod Liver Oil to children up to 5 years of age was continued at Welfare Centres and First Aid Posts at the request of the Ministry of Food. A very high proportion of the children in the area had these regular additions to their diet. FREE MILK TO NECESSITOUS CASES. The supply of milk for children under 5 has been taken over by the Ministry of Food, and the Council retain only the option of supplementing supplies in special cases. The Milk Officer reports that since the Scheme came into operation, a very large number of permits have been issued. 27 VOLUNTARY HELPERS. We are much indebted to the many ladies who give most valuable assistance at the Beckenham Welfare Centres. At all Centres there is a band of volunteers who attend regularly and undertake a great deal of work which makes it possible for the nurses to concentrate on giving advice and instruction to mothers. PREMATURE INFANTS. During the year 23 infants were born in the Borough weighing less than five and a half pounds. Weight at birth cannot be regarded as the sole criterion of prematurity, but the Ministry of Health's Circular regarding the care of premature infants suggests that infants whose weight at birth is less than five and a half pounds should be regarded as premature and in need of the special methods of care recommended. Of these 23 infants, 2 were born at home and 21 in Institutions. Born at home 2 Nursed entirely at home 2 Died during the first 24 hours Nil Alive at the end of one month 2 Born in institutions 21 Died during the first 24 hours 5 Alive at the end of one month 16 Results shown according to the duration of pregnancy:— Duration Number Alive Died during first 24 hours Died after the end of one month 38 weeks 6 6 - - 36 weeks 7 6 - 1 35 weeks 1 1 - - 34 weeks 3 2 - 1 33 weeks 2 - 2 - 32 weeks 2 1 1 - 31 weeks 1 - 1 - Results shown according to weight at birth:— Weight at birth Number Alive Died during the first 24 hours Died after the end of one month 5lbs. to 5½lbs. 7 7 - - 4½lbs. to 5lbs. 3 3 - - 4½lbs. to 4½lbs. 4 2 1 1 3½lbs. to 4lbs. 2 2 - - 3lbs. to 3½lbs. 5 2 2 1 Under 3 lbs. 1 — 1 - From this is would appear that, with skilled attention, infants who are not more than six weeks premature and whose weight at birth is not below three and a half pounds have an excellent chance of survival. 28 The Council have approved arrangements for the care of these cases. Special equipment has been provided and arrangements made for the admission to the Maternity Hospital of any premature infant requiring medical attention. SPECIAL TREATMENT. Arrangements have been made for children from 1 to 5 years of age to participate in the special services available for school children and the use made is shewn by the following attendances :— Eye Clinic U.V. Ray Clinic Orthopaedic Clinic Aural Clinic 1945, Infants 92 721 406 27 BOARDED-OUT CHILDREN. At the commencement of the year there were 11 registered foster mothers having charge of 16 children. At the end of the year there were only 9 names still on the register with 12 children. The Health Visitors and the Assistant Medical Officer are Infant Life Protection Visitors and made 47 visits to the homes. OBSTETRIC CONSULTANT'S SERVICE. The consultants clinics were held at the Maternity Hospital. Eighteen sessions were held; 22 ante-natal cases and 121 post-natal cases were examined. The total number of attendances at the Clinics was 166. Mr. Douglas Lindsay saw 41 cases at the request of local medical practitioners. Thirty-nine of these were seen at the Maternity Hospital and 2 in their own homes. The conditions are summarised below:— 1. Ante-Partum Haemorrhage. Placenta praevia, normal delivery 4 do. Caesarean section 1 5 2. Toxaemias of Pregnancy. Induction of labour 6 Spontaneous delivery 3 9 3. Contracted Pelvis. Caesarean section 7 Natural delivery 2 9 4. Difficult Labour. Malpresentation, non-rotation of head 3 do. persistent, occipito-posterior 1 do. transverse lie 1 Prolonged labour, non-descent of head 1 8 do. delay in birth, second of twins 1 Hydrocephalus, disproportion and perforation 1 , 5. Caesarean section for avoidance of excessive damage to soft parts (recently reconstructed) 1 6. Adherent placenta 4 7. Extensive perineal repair 1 8. Puerperal Pyrexia. Subinvolution—sapraemia 2 Bacillus coliinfection 1 Mammary abscess 1 4 29 MATERNITY AND CHILD WELFARE—DENTAL REPORT. Sessions were held each Friday afternoon and at such other times as circumstances demanded. The estimated number of sessions was 72. The attendances were 547 compared with 448 in 1944. Summary of treatment:— Adults Infants Attendance 391 156 Number treated 161 94 Extractions 406 94 Fillings 72 52 Dressings 95 65 Silver Nitrate — 27 Scalings 22 — Nitrous Oxide 80 29 Ethyl Chloride — 9 Local Injections 28 3 Impressions, etc 86 — Dentures 44 — Repairs to Dentures 3 — Robert A. Waters, L.D.S. Eng. 30 WAR-TIME NURSERIES. The third Day Nursery at Coney Hall was never opened, and attendances at the original two Nurseries were much reduced, particularly at Beckenham Road, during the time when the district was suffering from the results of enemy action. At the end of the year the numbers on the roll had increased to capacity, and there have been waiting lists for admission, particularly for children under two years of age. Considerable difficulty has been experienced in keeping domestic staff, and the Matrons and the Nurses are to be congratulated on the way they have overcome these difficulties and the high standard of care and welfare they have maintained. When Measles was widespread in the area, both Nurseries experienced a number of cases, and this accounts for the small attendances in April and May. Dr. S. Thomson has supervised the health of the children in attendance and has carried out immunisation against Diphtheria and Whooping Cough. Month Summary of Attendances SPRINGFIELD (45 Places) BECKENHAM RD. (40 Places) Number on Register Average Attendance Days open Number on Register Average Attendance Days open Total 0-2 2-5 0-2 2-5 Total 0-2 2-5 0-2 2-5 January 45 14 31 8.0 15.7 27 28 10 18 5.0 9.9 27 February 42 14 28 11.3 23.5 20 29 11 18 6.0 14.1 20 March 48 15 33 12.4 22.3 21 33 11 21 6.6 17.0 22 April 43 11 32 11.6 26.0 20 35 9 26 8.4 11.3 20 May 41 12 29 5.8 20.7 20 45 11 34 3.7 17.0 20 June 49 14 35 7.3 29.7 21 47 12 35 5.4 23.8 21 July 44 12 32 12.2 33.0 22 46 12 34 8.5 23.7 22 August 49 13 36 10.5 26.2 20 47 9 38 5.3 25.7 20 September 54 14 40 10.5 30.5 20 47 9 39 5.3 28.2 20 October 53 13 40 12.2 32.5 23 51 10 41 5.3 31.1 23 November 55 14 41 11.5 32.4 22 51 10 41 7.3 34.3 22 December 51 13 38 9.7 29.1 18 43 9 34 7.4 28.4 18 These figures do not include Saturdays; the Springfield Nursery is open all day on Saturday, but the Beckenham Road Nursery closes at mid-day. The hours of opening were reduced in August to relieve somewhat the demands on the Staff, and both Nurseries now open at 7.45 a.m. and close at 6.30 p.m. A CASE OF SONNE DYSENTERY AT A DAY NURSERY. At this Day Nursery children are admitted between the ages of 6 months and 5 years. They are divided into two groups: those from 6 months to 2 years and those from 2 to 5 years. The groups have separate lavatories and playrooms but use the same room, though at different times, for meals. 31 One of the younger group, a child of ten months, developed diarrhoea and vomiting. She was at once excluded from the Nursery and bacteriological examination of her faeces showed B. Dvsenterae Sonné present. It was then decided to carrv out a bacteriological examination of the faeces of all contacts—12 staff (nursing and domestic) and 20 children with the result shown in the following table:— Age of Contact 6 months -1 year 1-2 years 2-5 years Total Children Adults No. examined 3 3 14 20 12 No. with B. Dysenteriae Sonné 1 3 9 13 1 No. with B. Dysenteriae Sonné after 2 weeks 1 3 3 7 0 Those who showed no B. Dysenteriae Sonné had two further examinations at 2-3 day intervals. Those who showed B. Dysenteriae Sonné were examined again at weekly intervals. At least three negative results were required before these latter contacts were regarded as free from infection. Seven children remained positive after two weeks and these were treated with sulpha guanidine. There were some relapses and the nursery was not completely clear of infection for six weeks. During the investigation no new admissions to the nursery were made and strict precautions were taken to prevent the spread of infection. As none of the contacts whose faeces showed B. Dysenteriae Sonne present, was ill they were allowed to attend the nursery and were isolated from the other children. The staff looking after these children had no contact with the other children. The investigation showed clearly the high percentage (65%) of child contacts who were carriers of B. Dysenteriae Sonné and the persistence of this condition in more than half of these positives. 32 BECKENHAM AND PENGE JOINT MATERNITY HOSPITAL This Hospital is provided jointly by the Borough of Beckenham and the Urban District of Penge and is administered by a Joint Committee of members from the two authorities. ACCOMMODATION PROVIDED. The Hospital commenced admitting patients in December, 1939. The ground floor of the building contains:— 1. The admission section. 2. A four-bed ward for ante-natal patients. 3. Out-patient Department. 4. Kitchen, domestic offices (including a small laundry) and Staff dining room. 5. Office accommodation. 6. Room for sterilising dressings and the Dispensary. The first and second floors each provide accommodation for fifteen patients, with babies' nursery and bathrooms, ward kitchens, sluice rooms and patients' bathrooms. The fifteen beds on each floor are contained in:— 1. Two four-bed wards. 2. Two two-bed wards. 3. Three single-bed wards. A complete labour and operating unit is provided in a wing on the first floor. The second floor of this wing contains the living quarters of the domestic staff. The Nurses' Home is in a wing at the west end of the building. There is a detached Isolation Block in the grounds and this block contains four single-bed wards, a duty room for the staff, and an operating theatre. Between the main building and the Isolation Block is a boiler house. STAFF. The Nursing Staff at the 31st December consisted of:— Matron. Deputy Matron. Sister Tutor. Five Ward Sisters. Seventeen Pupil Midwives. ADMISSIONS The number of admissions in 1945 was 601 compared with 373 in 1944, and 581 in 1943. ANTE-NATAL SUPERVISION. The Matron holds a Clinic on three days a week and saw 405 cases who made 3,591 attendances. 33 DISTRICT CASES. Cases who do not wish to enter the Maternity Hospital for confinement and cannot afford the services of a private doctor, can have the attendance of a County Midwife who may refer her patient to the Clinic under the Ante-Natal Scheme. TRAINING OF PUPIL MIDWIVES. In 1944 the Hospital was recognised by the Central Midwives Board as a training institution for Pupil Midwives, and during the year 27 pupils were in training. During the year 4 passed the Part I examination of the C.M.B. CONSULTING STAFF. Dr. N. M. Jacoby, is Consulting Paediatrician to the Hospital: his advice is especially welcome on the care of premature infants. ANNUAL STATISTICS FOR 1945 Relating to the Beckenham and Penge Joint Maternity Hospital Information Required Particulars 1. Name and Address of Institution Beckenham and Penge Joint Maternity Hospital, Stone Park Avenue, Beckenham. 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds) 34 2a. Number of such beds used for Ante-Natal cases 4 3. Number of Maternity cases admitted during the year Beckenham 419 601 Penge 182 4. Average duration of stay 14.0 days 5. Number of cases delivered by: (a) Midwives 462 (b) Doctors 129 3 Born before admission. 2 Abortions. 2 Transferred to 1946 2 Left before delivery 6. Number of cases in which medical assistance was sought by a midwife in emergency 252 34 Information Required Particulars 7. Number of cases notified as: (a) Puerperal Fever Nil (b) Puerperal Pyrexia 30 8. Number of cases of Pemphigus Neonatorum Nil 9. Number of infants not entirely breast-fed while in Institution, exclusive of those given supplementary feeding whilst breast feeding was being established) 25 10. (a) Number of cases notified as Ophthalmia Neonatoum Nil (b) Result of treatment in each case 11. Number of Maternal Deaths Nil 12. Number of Foetal Deaths: (i) Stillborn 19 (ii) Within 10 days of birth 8 35 36 INFECTIOUS DISEASE The following table gives the number of cases notified during the year, the number removed to Hospital and the number of deaths. Cases of Tuberculosis are shown in a separate table. Disease Total Beckenham West Wickham Male Female 0 to 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 Over 65 Removed to Hospital Deaths Diphtheria 5 2 3 1 4 - - - 2 - 1 1 - - 1 - - 5 1 Scarlet Fever 41 31 10 20 21 — — 3 4 3 15 7 5 3 — 1 — 17 - Typhoid Fever 1 1 — 1 - - - - - - - - - - - 1 — 1 1 Puerperal Pyrexia 34 34 — — 34 — — — — — — — 1 28 5 — — 11 — Pneumonia 28 24 4 12 16 1 — 2 1 — 3 — 1 2 4 9 5 4 — Erysipelas 9 6 3 4 5 - - - - - - - - 1 1 4 3 1 — Encephalitis Lethargica 1 1 — 1 — — — — — — — — — — — — 1 — — Poliomyelitis 1 1 — 1 - - - - - - - - - - - 1 — 1 1 Dysentery (Amoebic) 1 1 — 1 — — — — — — — — — — — 1 — 1 — ,, (Sonne) 12 9 3 5 7 — — — — — 1 — 2 — 4 3 2 1 — Gastro-enteritis (Under 2 years of age) 1 1 - - 1 - 1 — — — — - - - - - - 1 - Measles 222 198 24 117 105 3 17 19 Ib 18 126 15 4 4 — — — 4 - Food Poisoning 1 1 — 1 — — — — — — — — — — 1 — — — - German Measles 4 4 — — 4 — — — 1 — 2 1 — — — — — — - Whooping Cough 21 20 1 13 8 2 2 3 1 1 12 - - - - - - - - Chicken Pox 26 26 — 13 13 - - - - - 18 4 3 1 — — — — - Mumps 9 9 — 4 5 — — — — — — 8 — — — — 1 — - DIPHTHERIA. Only five cases were notified during the year. In only one year 1936) since the notification of infectious diseases was instituted has here been as small a number of cases. One of the cases proved fatal—a little girl aged 3 years ; she lad not received any protective inoculations. Two of the other cases had received protective inoculations : the attacks developed even years and three and a half years after the completion of the courses of injections: in both cases tests carried out six months after the injections were satisfactory. SCARLET FEVER. The incidence was low all over the district in 1945. As indicated in previous reports, Scarlet Fever incidence in Beckenham has had a fairly regular rhythm—years of high incidence being separated by periods of low incidence. During recent years the rhythm has become less regular, partly no doubt because there have been more extensive movements of population. The infection was mild in all cases. TYPHOID FEVER. One case was notified during the year and it ended fatally, Investigation failed to reveal the source of the infection. No other cases occurred at the time in Beckenham or in neighbouring areas. Such sporadic cases are usually caused by the chance surface contamination of food by undetected carriers of the disease. DYSENTERY. (a) Amoebic. The one case notified was a recrudescence of an infection contracted abroad a good many years ago. b) Bacillary. (Type Sonn6). Only twelve cases were notified but there is no doubt that many more occurred during the year. There is reason to believe that this type of infection has been widely prevalent all over the country for a number of years. The large majority of the cases is extremely mild—a gastro-intestinal upset which clears up in about two or three days—and it is only in a few cases that the services of a doctor are sought. It is only the occasional case which presents the classical symptoms of the disease. It is this mildness which assists the spread of the infection. Even a mild unrecognised case will go on harbouring the infecting bacilli in the bowel for a few weeks and unless scrupulous personal cleanliness is practised all such cases are ready sources of infection for those who are in close personal contact with them. In June there was an extensive outbreak of this disease in a Secondary School in the Borough. Only one case was actually notified—for the reasons advanced above—but from reports received from the school authorities in the course of the investigations it was clear that there were at least 70 or 80 cases. Investigations soon revealed the source of the infection in a worker in the school canteen. A week before the outbreak occurred this worker was absent with an attack of gastro-enteritis : the source of the infection 37 was confirmed by bacteriological examination. Suspension from duty of the worker, until positive proof of freedom from infection was obtained, quickly brought the outbreak to an end. PUERPERAL PYREXIA. Thirty-four cases were notified: of these, 29 occurred in the Beckenham and Penge Joint Maternity Hospital, 2 in a private nursing home in the Borough, 1 in King's College Hospital and one in the patient's own home. Under the Puerperal Pyrexia Regulations, 1939, puerperal pyrexia means any febrile condition occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100.4° F. or more has been sustained during a period of 24 hours or has recurred during that period. The causes to which the pyrexia in the cases notified were attributed were as follows:— INFECTIONS. Urinary infectious (Bacillus Coli) 8 Mastitis 7 Toxaemias of Pregnancy 5 Local Sepsis of pelvic organs and tissues 5 Septicaemias 1 Phlebitis (post-operative) 1 Acute otitis media 1 Pneumonia 1 Bronchitis 1 No discoverable cause 4 MEASLES. The cases notified in Beckenham were 198 and 34 in West Wickham. As mentioned in previous Annual Reports, Measles has departed from its very regular biennial cycle during the war ; it will be interesting to observe if it returns to its regular rhythm when large-scale fluctuations in the child population have ceased. It is as vet too soon to draw anv conclusions. BACTERIOLOGICAL WORK. The number and results of the examinations made at the Public Health Department Laboratory during 1945 was:— Disease suspected Total 1945 Results Comparative Total for 1944 Positive Negative Diphtheria 133 6 127 299 Tuberculosis 33 — 33 55 Other Diseases - - - 5 Total 166 6 160 359 OPHTHALMIA NEONATORUM. No cases were notified. 38 39 Tuberculosis—Table of Notifications and Deaths, 1945. Sex Ages Wards M. F. Total 0 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 Over 65 L. PR. K.H. M.H. C.C. E.P. PR. L. Short W.W. Notifications (New Cases only) Pulmonary 23 33 56 2 4 2 4 14 12 11 5 1 1 1 8 5 2 10 8 4 18 Non-Pulmonary 4 4 8 1 — 2 1 — 2 — 1 — 1 1 1 1 — 2 1 1 1 Totals 27 37 64 3 4 4 5 14 14 11 6 1 2 2 9 6 2 12 9 5 19 Deaths Pulmonary 16 16 32 1 — — 1 — 11 11 4 2 2 3 5 5 2 4 3 1 9 Non-Pulmonary 4 1 5 1 2 — — — — — 1 1 — 1 — 1 — 1 — 1 1 Totals 20 17 37 2 2 — 1 11 11 5 3 2 4 5 6 2 5 3 2 10 TUBERCULOSIS. The total of 64 cases compares with 79, 71, 76, 58 and 65 in the preceding five years. In addition to the new cases there were 12 definite cases transferred from other areas, and 6 old cases restored to the register. 9 cases were not notified until after death. At the end of the year the number of notified cases in the area was:— 190 Pulmonary Males, 190 Pulmonary Females, 39 nonPulmonary Males and 30 non-Pulmonary Females; a total of 449 cases, which compares with 419 last year. 61 cases were placed off the register for the following reasons: Died, 37; Cured, 6; Left area, 17. 1 Withdrawn (not Tuberculous). Notification.—In 9 cases notification was not made until after death. Follow-up of Contacts.—91 contacts from Beckenham were examined at the Chest Clinic during 1945 and 2 were found positive. TUBERCULOSIS CARE COMMITTEE. The Voluntary Tuberculosis Care Committee which was formed in 1938 has continued to operate throughout the war years and despite great difficulties has raised considerable sums of money and used them for the benefit of local patients. This voluntary fund gives assistance to patients in ways which supplement the official schemes, and I feel that a word of congratulation is due to the Hon. Secretary and Committee for their continued good work for the benefit of the Tuberculosis patient. I understand that since the Committee was formed an amount of over £1,000 has been raised from local sources, and a special activity of the Committee has been the boarding out of child contacts to minimise the risk of infecting young children. DIPHTHERIA IMMUNISATION. Annual Return for Year Ended 31st December, 1945.—This return is required from every Local Authority whether or not it is itself the Authority responsible for the carrying out of immunisation. 1. IMMUNISATION IN RELATION TO CHILD POPULATION. Number of Children who had completed a full course of Immunisation at any time up to 31st December, 1945. Age at 31.12.45 i.e.— Under 1 1 2 3 4 5 to 9 10 to 14 Total Under Born in year 1945 1944 1943 1942 1941 1936 to 1940 1931 to 1935 Number Immunised 3 446 426 612 475 1,698 2,337 5,997 Estimated mid-year population, 1945 4,290 7,700 11,990 During 1945 a special effort was made to protect children between the ages of one and two years, and also to give reinforcing 40 doses to children on reaching the age of 5 years. 800 new cases completed treatment and 250 old cases had extra doses. The following figures shew the number of new cases in age groups:— 1931 10 1936 9 1941 18 1932 3 1937 8 1942 62 1933 10 1938 13 1943 174 1934 7 1939 24 1944 446 1935 5 1940 11 Total 800 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No occasion has arisen during the year to exercise the powers conferred by these Regulations of prohibiting any person engaged in the milk trade from continuing his employment. PUBLIC HEALTH ACT, 1936 (SECTION 169). It has not been necessary to apply for an Order under this Section for the removal of a patient to hospital. WHOOPING COUGH. 21 cases were notified during the year by the doctors in attendance. CHICKENPOX. 26 cases were notified by doctors. MUMPS. 9 cases of Mumps were brought to the notice of the Department during the year. EPIDEMIC DIARRHOEA. This disease becomes notifiable annually during the period 15th July to 15th October. No cases were notified. SMALLPOX. No cases were notified during the year. 643 children were vaccinated by the Public Vaccinator during the year. SCABIES. During the war years there has been a considerable increase in the cases of scabies requiring treatment. Arrangements were made for the treatment to be given at the Baths First Aid Post by the Staff on duty there, and the following statement shews the number of cases dealt with; there were very few cases of reinfestation. After the closure of the F.A.P., arrangements were made to hold 4 sessions a week as required. 41 The staff of the Aid Post are to be congratulated on the excellent results of the treatment and the way they have dealt with this task. Treatment of Scabies at Baths Cleansing Station. Attendances Persons Treated Males Females Re-infested 30 days interval Under 14 yrs. Over 14 yrs. Under 14 yrs. Over 14 yrs. 1942 556 357 74 46 102 135 4 1943 733 429 98 50 115 166 32 1944 606 314 65 77 49 123 27 1945 413 199 41 40 49 69 3 OVERSEAS CONTACTS. Information was received from Ports and Air Ports of the arrival'of eight persons from areas where Smallpox and or Typhus Fever existed. These cases were visited daily until we were satisfied that no infection existed. This necessitated 37 visits by the Sanitary Inspectors and by the M.O.H. 42 REPORT ON THE SANITARY INSPECTION OF THE DISTRICT FOR THE YEAR 1945. By G. A. Webber, Chief Sanitary Inspector. The total number of visits of inspection made by the Inspectors uring 1945 was as follows:— Initial Visits 2,703 Revisits 3,008 A summarv of nuisances, found and remedied, is appended. Found Remedied Structural defects—external 125 124 „ „ —internal 216 217 Verminous conditions 13 13 Smoke nuisances 1 1 Choked drains 372 367 Other drainage defects 171 175 Defective sanitary appliances 121 136 Insufficient and/or unsuitable water supply 50 52 Absence of dustbin 45 49 Offensive accumulations 25 26 Unclassified defects 29 34 Total 1,168 1,194 The routine examination of properties was reduced to a minimum during the year, owing to the extra duties necessitated by war, plus the unavoidable reduction of staff. In the early part of the year a great deal of time was spent on the salvage of war-damaged foods, and it is pleasing to be able to report that it was found necessary to condemn only a small proportion of the scores of tons of food sorted after exposure to enemy action. COMPLAINTS—ABATEMENT OF NUISANCES. Particular attention has been paid to complaints considered by members of the public to be matters affecting public health. The Public Health Act, 1936, states that any person aggrieved may make complaint of a statutory nuisance before a Justice of the Peace. Orders for abatement, and penalties for the disobedience of Orders, may be made. Complaint, however, is usually made to the Public Health Department of a local authority, whose duty it is to investigate the matter. In almost all cases, the Sanitary Inspector undertakes this work on behalf of his Authority. The public, quite properly, is quick to grasp its right to lay a complaint, but is, perhaps, slower to realise that the information given forms only one part of the structure which may have to be built before abatement of a statutory nuisance is secured. A complaint, possibly outlined vehemently to an impartial Officer, falls into its first category as an alleged nuisance. Personal investigation by the Sanitary Inspector either results in its establishment as a confirmed complaint of a statutory nuisance, or its discard as not being of that 43 character. In the former case, unless informal action by the Inspector results in abatement, procedure follows, by statute, a set pattern. The Sanitary Inspector must report the facts brought to light by his investigation to the Local Authority, in order to obtain approval for the service of an Abatement Notice, and, if necessary the institution of legal proceedings. This Notice is served on the person or persons identified as being responsible for the nuisance arising or continuing, and describes the nuisance, stating the remedy required; it must not specify the actual method of remedy and, in the majority of cases, must not identify the materials to be used. Sufficient time for abatement, having regard to the nature of the nuisance, and its remedy, must be allowed by the Notice. Noncompliance is followed by the laying of information before a Justice of the Peace, who may, at a subsequent hearing, order the work to be done within a period stated by the Court. The time taken to reach this latter phase can be considerable. It is unavoidable This fact is not always appreciated by an irate complainant, who wonders when the Council are "going to do something." The machinery of the law is slow, and when a member of the public seeks to right a wrong by complaint to a local authority, he or she very definitely " goes to law." It reflects great credit upon those who are responsible, ofter without knowledge, for the occurrence or continuance of a nuisance, that this lengthy and tedious procedure is not necessary in the majority of cases. Entirely informal intimation, without statutory background, given by the Sanitary Inspector, frequently results in the remedy of the nuisance without further ado. The work arising from the lodging of complaints occupies a large proportion of the Sanitary Inspector's time, and is now made more difficult by the shortage of labour and materials. During 1945, in Beckenham, 1,440 complaints of one sort or another were reported to the Public Health Department. The majority proved to be of a justifiable character. Some complaints are made anonymously, and it is well to know that these receive the same full investigation applied to others. Nuisances of a similar character are a constant source of com plaint throughout the year. CHOKED DRAINS. 352 complaints were received of choked drains. Choked drain are cleared by Council employees in most instances, and, where necessary, a charge is made for the service. STRUCTURAL DEFECTS. 315 complaints related to various external and internal structural defects, giving rise to instances of statutory nuisances in dwelling houses. DRY ROT. 39 instances of dry rot were reported—an increase on previous 44 years. The Ministry of Health directed attention, in a Circula dated June, 1944, to the effect that the amount of dry rot in domestic buildings is greatly on the increase. The reasons for the increase include:— (1) Alterations of buildings for A.R.P. precautions, such as sandbagging, which caused walls to become damp. Closing of sub-floor ventilators because of the danger of gas, and the introduction of timber strutting into damp basements. (2) General neglect of upkeep, owing to shortage of labour and materials. (3) War damage, admitting damp into buildings. (4) The absence of owners and tenants of properties. Dry rot means the decay of timber in buildings, caused by ertain fungi. The growth of the fungus is rapid, and the results are requently alarming. Local Authorities are asked to pay particular ttention to this nuisance. Remedial action was speedily introduced in all cases coming to our notice. INSECT PESTS. 24 complaints were received relating to Insect Pests. These were received during the warmer months of the year, and, in many cases, ants were the insects responsible. An invasion by ants does not constitute a statutory nuisance, but nevertheless, helpful advice is given where possible. It cannot be doubted how great is the effect of such an invasion upon the nerves of the housewife, a fact which makes it the more remarkable to record that no single instance of a specific complaint of a fly nuisance was received during the year, that this pest flourished in ever-increasing numbers during the warmer seasons was very evident. With the release of the Insecticide D.D.T. for general use, special attention will be paid in the coming months to its effect in fly-infested restaurant kitchens, and places used for food preparation. ANIMALS KEPT SO AS TO BE A NUISANCE. 9 instances were reported of animals kept so as to be a nuisance. These complaints were in all cases justified, and in the main arose through the over-zealous animal lover whose home becomes a harbourage for any number of creatures falling into the category of domestic pets. Tactful approach to these kindly souls was usually successful, although in one or two instances, where sterner action was necessary, the Inspector was accused of being a person cruel to animals. MILK BOTTLES. 2 complaints were received of the presence of foreign bodies in bottles of milk. In one case it was found that a margarine wrapper, tightly folded, was floating in the milk. It had obviously been placed there by a previous user of the bottle, and the bottle-washing machine had failed to dislodge the wrapper. In the second case, the foreign bodies appeared to be a form of insect. Specimens sent to the British Museum for identification, brought the following reply:— 45 Department of Entomology British Museum (Natural History) Cromwell Road, London, SAV.7. G. A. Webber, Esq., Town Hall, March 1st, 194; Beckenham, Kent. Dear Sir, The specimens you sent with your letter of yesterday, an which were found in a milk-bottle are the empty chrysalid (known technically as "puparia") of a two-winged fly belong ing to the Phoridae and known as Paraspiniphora berger stammi; it has no common name, unfortunately. The fly has a rather interesting life-history, as it is parasit in its grub, or maggot stage, on certain snails. At times a parently the full-fed maggots, instead of pupating within this shells of the snails, may crawl out and pupate elsewhere; from the number of cases we have seen, empty milk-bottles, no doub lying by the sides of hedges, etc., or in gardens, are frequently chosen. The chrysalids are so securely glued to the sides of the bottle by the dried milk that when the latter passes through the washing-machine the jets and detergent fail to dislodge then The bottles, are, of course, inspected before being passed to the filler, but here the human element at present comes in, though it is hoped that after the war a mechanical "spotter" may be introduced. Anyway, these puparia show up well against the white milk which also acts as a solvent of the "glue" by whih the cases adhered to the glass and may float free through the milk. Such "foreign bodies" are generally spotted by customer. Yours faithfully, (Sgd.) Frederick Lain It will be noted that no opinion is expressed as to whether the milk was rendered unfit for human consumption. It so happens in this case that very little of the milk was consumed, and no effects were reported by the user. MILK SAMPLING; SUPERVISION OF DISTRIBUTION. During the year 87 formal samples of milk were taken in the course of sale in the district, for chemical analysis. When a sample of milk contains less than 3% of milk fat, and/or less than 8.5°/ of milk solids other than milk fat, it is presumed for the purposes of the Food & Drugs Act, 1938, until the contrary is proved, that the milk is not genuine, by reason of the abstraction therefrom of mi fat or milk solids other than milk fat, or the addition thereto of water. In one case the Public Analyst returned a certificate the the sample submitted showed the following analysis:— Milk Fat 2.64% Solids, not Fat 7.17% 46 The presumption was that the sample contained at least 15.6% of added water. Prosecution of the vendor followed. The defendant pleaded that a leaking cooler was responsible. This defence was accepted, and the Magistrates dismissed the summons on payment of £3 7s. 0d. costs. MILK—HEAT TREATMENT. In order to encourage the heat-treatment of milk, and after discussion with the trade, the Ministry of Food decided, subject to compliance with certain conditions, to pay milk retailers an allowance of £d. per gallon in respect of milk heat-treated by them, from the 1st November, 1944. Local Authorities were asked to assist by the taking of samples of this heat-treated milk, for subjection to prescribed tests. 13 such samples were taken; 12, passed the prescribed tests for adequate heat-treatment, whilst only 8 satisfied the tests for keeping quality. Notification of failure was, in accordance with the instructions of the Ministry of Food, immediately sent to the Area Milk Officer. MILK—SPECIAL DESIGNATIONS. 19 samples of Specially Designated Milks were taken. 5 failed to satisfy the prescribed tests. In these five cases, the milk was obtained from producers licensed by the Kent County Council, at whose request the samples were taken. The County Council ac:epted responsibility for whatever action was considered necessary, following submission of unsatisfactory samples. MILK—TUBERCULOSIS. 2 samples from dealers in the Borough were submitted for special examination for tubercle bacilli. In both cases the milks vere satisfactory, and showed no evidence of tuberculosis. FOOD SAMPLING. 69 samples of food (not including milk) were taken during the year, and were found to be genuine. MEAT INSPECTION. Except for "emergency killing" slaughterhouses in the district are closed. On 10 occasions animals were dressed for food, when 14 pigs and 1 calf were slaughtered. No diseased conditions were found. SPECIAL PREMISES LEGISLATION. shops Acts 1912-1936, Factories Act 1937, Food & Drugs Act 1938. 78 Shops Acts inspections were made, and 37 visits of inspection to factories in the area. The following nuisances discovered in factories were remedied following the service of informal notices :— Insufficient ventilation 1 Insufficient sanitary accommodation 2 47 361 visits were paid to Food Shops in the Borough. These visits were mainly concerned with specific items, e.g., the surrender of unsound food, and the sale of ice-cream. LANDLORD & TENANT (WAR DAMAGE) (AMENDMENT) ACT, 1941. The functions of a Local Authority under Sub-section 4 of Section 1 of the above Act, may be exercised on their behalf by such Officer as may be authorised in writing by the Authority. The Council at its meeting held on the 30th October, 1944, authorised me to exercise the functions accorded to the Local Authority by Section 1 of the Act. The Act provides that where for any period any land let on a short tenancy is unfit by reason of war damage, and is not occupied either in whole or in part by the tenant whilst it is unfit by reason of war damage, there shall be payable by the tenant in respect of the period of such occupation, such rent as may be agreed between him and the landlord, or in default of agreement, as may be fixed by the Court. In order to settle disputes between landlord and tenant, this Council may be asked to issue a certificate relating to the condition of the house. 12 applications for certificates under the Act were received during the year. 11 certificates were issued, and in one case a certificate to an owner of property was refused. RATS & MICE (DESTRUCTION) ACT, 1919. 351 complaints of infestation were received. The unsatis factory conditions prevailing in the area formed the subject of a special report to the Health & Welfare Committee. The Council decided that a service for disinfestation should be instituted, the service to be free to private householders, with charges made the business premises. This service commenced in November, 1945, and has proved very satisfactory. It is intended to submit a detailed report on the working of the scheme at a future date. MOVEABLE DWELLINGS. Persons occupying licensed moveable dwellings in the area were visited frequently throughout the year. On one occasion it was found necessary to serve informal notices for the removal of unnecessary accumulations. Freame, Manning A Co., Ltd. 12a, Let High Road S.B. 13 48