AC 4412(1) BECKENHAM BEC13 BOROUGH OF BECKENHAM REPORT ON THE HEALTH OF THE DISTRICT DURING 1946 BY T. PHILIPS COLE, M.B., D.P.H. Medical Officer of Health borough of beckenham. annual report op medical officer of health for 1946. ERRATA. Please insert this in your copy. Health Section. Page No. 6. The Infantile Mortality rate of 28.571 should be 27.715. 7. The Civilian population per acre of 9.9 should be 11.6. 8. The comma in the figure for the Death rate should be a decimal point, giving a rate of 10.763. The comma In the figures for Cancer death rate should be a decimal point, giving a figure of 2.190. 9. Para. B. The pages referred to should be 11/12. 23. The heading to the Table relating to Infectious disease mentions deaths. Only one death was recorded, and that was due to Whooping Cough. 36. The heading in the last column of the Table - "Deaths of Infants under one year" has a sub-heading "Rate per 1,000 of population". This should read "Rate per 1,000 live births." p.t.o. - 2 - School Health Services. Page . 4. The date of resignation of Miss Sutton should read 24/3/47 10. The word "Orthondontist" should read "Orthodontist". Public Health Dept. , 28. 7. 47. m BOROUGH OF BECKENHAM REPORT ON THE HEALTH OF THE DISTRICT DURING 1946 BY T. PHILIPS COLE, M.B., D.P.H. Medical Officer of Health Freame, Manning & Co., Printers (T.U.)» 12a, Lee High Road, Lewisham, S.E.13 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1946 TABLE OF CONTENTS 1. Members of Health & Welfare Committee. 2. Staff of the Department. 3. Introduction. 4. Vital Statistics. 5. Natural and Social Conditions. 6. Sanitary Circumstances of the Area. 7. Housing. 8. General Provision of Health Services in the Area : (a) Hospitals provided by Public Authorities. (b) Local Services provided by Voluntary Organisations. (c) Ambulance Service. (d) Clinic Services provided by Public Authorities. 9. 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) Day Nurseries. 10. Maternity Hospital Accommodation. 11. Infectious Disease: (a) Table of Cases. (b) Comments on Major Infectious Diseases. (c) Tuberculosis—Incidence and Deaths. (d) Diphtheria Immunisation. 12. 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. (f) Meat Inspection. (g) Shops Act Inspections. (h) Rats and Mice (Destruction) Act. 2 LIST OF MEMBERS OF HEALTH & WELFARE COMMITTEE FOR THE YEAR 1946/47. Councillor Christie (Chairman) Councillor Mrs. Constable-Gray (Deputy Chairman). Aldermen Brook, Mrs. Campbell, C. A. Campbell and Dr. Edden. Councillors Dowdall, Hall, Jackson, Keen, Price and Took. Ex-officio—The Mayor and Deputy Mayor. 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. (Resigned 31/3/47). Mrs. M. H. Mack, M.B., Ch.B. (Appointed 1/5/47). 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.I.E.J.B. (Resigned 31/12/46). W. Newman, Cert. R..San.I. W. T. G. Woodard, Cert. R.San.I. and S.I.E.J.B. (Appointed 24/2/47). Health Visitors Miss E. F. Smith, S.R.N., S.C.M., H.V.'s Cert. (Retired 31/8/46). Miss M: G. Kendall, S.R.N., S.C.M., H.V.'s Cert. Miss D. Furse (1/5/46—24/2/47). Mrs. M. Walmsley, S.R.N., S.C.M., H.V.'s Cert. (Resigned 16/8/46). Miss G. Baker (3/6/46—28/2/47). Miss D. Dawson (2/1/46—30/6/46). 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. Senior Assistant J. Dungay. Clerical Staff K. Wood, M. Graham-Williams, Miss E. Hocking, Miss J. Sparling, Mrs. E. Best, Miss J. Roberts, Miss J. Fenn. 3 ANNUAL REPORT, 1946 INTRODUCTION. Social conditions shewed no real improvement during the year. The Housing situation in Beckenham, as in the rest of the country, remained just as serious in spite of the fact that considerable' progress was made with the programme adopted by the Council. The general food situation remained about the same, extra supplies of some foods being counterbalanced by a shortage of others ; the rationing of bread was a heavy blow to many households in which bread has always been the principal article of food. The most noticeable effect of the various shortages and restrictions was a loss of reserve power: resistance to infections was impaired and the period of recovery was prolonged. I do not think that this was entirely the result of physical causes: general tiredness, monotony of food, hope deferred and a fairly general resentment at the continuation of restrictions and the.short supply of those goods, which, though not actual necessities, make so much difference to the general comfort, have all been contributory causes. If a clearer indication could be given of how long this state of affairs was likely to continue, existing circumstances would be accepted with more equanimity: continued uncertainty is both irritating and debilitating. For several reasons the children have largely escaped this particular disability: on the one hand they are not so conscious of restrictions because most of them have known no other conditions during their short lives: on the other hand, special arrangements have been made to safeguard their nutrition and development. With the grave shortage of houses and the absence of any definite programme for the future, it has become essential to maintain existing houses in a habitable condition, and to call for extensive work to render fit houses which have become dilapidated through neglect or damage, and which, in less difficult times, would un" doubtedly have been condemned and demolished. It is not sufficient merely to patch up the worse defects in such houses: such a policy might suffice if there were any reasonable prospect of obtaining more houses in the near future: but, since it is certain that these houses will be needed for a good many years to come, they must be rendered fit in every respect for habitation. It is for this reason that action is now being taken under the Housing Acts as well as under the Public Health Acts. Every house which can be saved now and kept fit for habitation is a positive contribution towards the solution of a very grave problem. The inspection and repair of houses has occupied much of the time of the Sanitary Inspector's Department, and a great deal of useful work has been done. The incidence of infectious disease was again very light and no special problem was presented. The Maternity and Child Welfare Services were greatly handicapped by the shortage of staff. Advertisements for Health Visitors 4 produced no suitable applicants; the Council therefore decided to offer bursaries to two nurses who were anxious to train as Health Visitors : the selected candidates have signed undertakings that after qualifying, they will give at least two years' service in the Borough. The Maternity Hospital was fully booked throughout the year. The appointment of a Resident Medical Officer made itpossible to extend the services given to the patients. At the request of the Ministry of Health and with the concurrence of the Central Midwives Board, the stay of patients in the Hospital was reduced from 14 days to 10 days after confinement. This is admittedly an emergency measure to deal with a difficult situation: the unsatisfactory housing situation and the difficulty of getting help in the homes make it most necessary that maternity beds in institutions should be used to their highest possible capacity. Under this new arrangement, from 80—90 patients were given accommodation each month during the latter part of the year. The chief difficulty at the Hospital has been the shortage of domestic staff; this need has never been met adequately since the Hospital was opened, and the condition is getting worse. The Nursing Staff of a Maternity Hospital cannot be allowed to scrub floors. It should be realised that if this extreme shortage of domestic staff persists, it will threaten the very existence of the Hospital. Although wages of domestic workers in institutions have been greatly increased, they still compare unfavourably with the wages which can be earned in private establishments: they also compare unfavourably with what can be earned in industry, and with the present appeal to women to return to industry, the outlook is very serious. The attention of the public was drawn during the year to two important matters: one affecting children and the other affecting old people. The Curtis Report indicates clearly that there is room for considerable improvement in the care and supervision of "boardedout" children, both in institutions and in private homes. The institutions in the Borough for the care of children are conducted by voluntary organisations; they are visited frequently and the children are all very well cared for. The welfare of the aged presents a more difficult problem ; and this problem is becoming and will become more urgent as the proportion of elderly people in the population increases. Civilisations may be judged by the way they look after their old people. Primitive races solved the question by exterminating all those who were too old to be useful: inhuman no doubt, but at any rate there was no pretence about it. More advanced civilisations kept their old people alive and ultimately acknowledged a responsibility towards them—a responsibility which was discharged officially on a strictly impersonal and institutional basis. This century has seen considerable advances, of which the most important was the Old Age Pension with its implied recognition of the natural desire of all old people to spend their closing years in homes of their own, no matter how humble, with their personal possessions around them. 5 In formulating plans for the care of old people, the over-riding consideration must be for the old people themselves—not for their relatives. Plans must consider old people in health and in sickness In health, old people want their own homes; they want to be free to come and go as they will and to be able to receive their friends Accommodation is perhaps best provided by including a proportion of homes for old people in every housing estate. This principle was adopted by the Council in 1938: the housing development of that year was small, but six out of thirty-four houses built were designed for old people. I have not been able to find out the number of old people living independently in the Borough, but personal experience suggests that it is considerable. In sickness we have to rely on the hospitals. Nursing in the home is not nearly adequate at present for old people living alone. Acute cases of illness present no difficulty; they can be admitted to hospital and discharged when cured. But most of the sickness in old people is due to degenerative changes in the body and its organs, and for these patients there are only the "chronic wards" of municipal hospitals. One has only to visit old people to discover how great is their dislike at the idea of leaving their homes and entering these institutions: they feel, rightly or wrongly, that once admitted, they will not see their homes again. Chronic wards are rather sad places: often overcrowded, often understaffed, and though kindness is shewn to the patients, the atmosphere is not a hopeful one. Many cases are admittedly incurable, but with encouragement, others could often make enough temporary improvement to be able to return home. The point is of practical importance, because at the present time, the demand for beds for old people and the chronic sick in this part of Kent far exceeds the supply. Sick people are forced to wait in their own homes without adequate help or attention, and often in great discomfort and pain. More beds for old people are urgently needed, and with the beds is needed a wicer and more hopeful outlook The most difficult matter of all is how to help those who, though not actually bedridden, yet by the infirmities of age, are unable entirely to look after themselves. Perhaps the domiciliary nursing services to be created under the National Health Act, with the assistance of a more adequate system of " home helps " will be able to assist in this problem. I should like to express my thanks to the members of the Health and Welfare Committee for the couitesy and help they have extended to me, and to record my appreciation of the loyal and efficient service given by every member of the staff of the Public Health Department. INFANTILE MORTALITY. The number of deaths of infants under the age of twelve months was 37 as compared with 22 in 1945. The Infantile Mortality Rate for the year was 28.571 per 1,000 live births. The following table shews the causes of death in 37 cases for which full records exist. 6 Table of Causes of Infant Deaths in Beckenham. Cases in 1946. Age in Weeks Total under 4\veeks Age in Months Total under 1 year 0-1 1-2 2-3 3-4 1-3 4-6 7-9 10-12 A. * Congenital Defects Hyppertrophy of Pylorus - - - - - - 1 - - 1 Hydronephrosis 1 - - - 1 - - - - 1 Defect of Oesophagus - - - - - 1 - - - 1 Congenital heart disease 2 - - - 2 1 1 - - 4 Hydrocephalus - - - - - 1 - - - 1 Intestinal obstruction 1 - - - 1 - - - - 1 B. Ante-Natal or Intra-Natal Conditions Prematuiity 7 2 - - 9 1 1 _ _ 11 Atelectasis 3 - - - 3 — - - - 3 Congenital debility 1 - - - 1 - - - - 1 Erythroblastosis 2 - - - 2 - - - - 2 Irtra-cranial haemorrhage 1 - - - 1 - - - - 1 C. Infections Pneuinonia - 1 - - 1 2 2 - - 5 Whooping Cough - - - - - 1 - - - 1 Gastro-Enteritis - - - - - - 1 - - 1 D. Other Causes Asphyxia- Misadventure - - - - - 1 - - - 1 Intestinal Obstruction - - - - - - - 1 - 1 Duodenal Ileus - - - - - 1 - - - 1 Totals 18 3 - - 21 9 6 1 - 37 SUMMARY OF VITAL STATISTICS, 1946 Area of District in acres 5,935 Civilian Population as estimated by Registrar-General at 30th June, 1946 70,330 Civilian Population per acre 9.9 Rateable Value at 1.10.46 £826,038 Births Registered: Male Female Legitimate 630 643 Illegitimate 38 24 Total 1,335 Birth Rate per 1,000 of Civilian Population 18.413 7 Deaths Registered: Male. Female 364 393 Total 757 Death Rate per 1,000 population 10,763 Infant Mortality Rate per 1,000 births 27.715 37 Deaths of Infants under 1 year of age: Male Female Legitimate 19 15 Illegitimate 3 — Total 37 Deaths from Enteritis under 2 years of age—1 death. Rate per 1,000 births 0.749 Still Births—Rate per 1,000 population 0.399 Male Female Legitimate 17 11 Illegitimate Total 28 , Death Rate from Cancer (152 deaths) 2,190 Death Rate from Pulmonary Tuberculosis (22 Deaths) 0.314 Table A. Birth rates, Civilian Death rates, Analysis of Mortality, Maternal Mortality in the Year 1946. 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 19.1 22.2 21.3 21.5 18. 413 Still 0.53 0.67 0.59 0.54 0 399 Rates per 1,000 Live Births: Deaths under 1 Year of Age 43 45 37 41 28.571 Deaths from Diarrhoea and Enteritis under 2 Yrs. of Age 4.4 6.1 2.8 4.2 0.749 NATURAL AND SOCIAL CONDITIONS No change has taken place from the details printed in previous reports. SANITARY CIRCUMSTANCES OF THE AREA SEWERAGE AND DRAINAGE. No major alterations or amendments require report. 8 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. 2. Maternity Hospital. The Beckenham Borough Council and the Penge Urban District Council maintain a Joint Hospital at Stone Park Avenue, Beckenham. 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. 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 Road, 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 00 shows the Centres and Clinics in operation at the end of December, 1946. C. LOCAL SERVICES PROVIDED BY VOLUNTARY ORGANISATIONS. 1. Beckenham 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. The Hospital provides Consultant's Out-Patient Clinics at which patients can receive the advice of a specialist by appointments which must be made through the patients' own doctors. 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. Heartease Hospital, Woodland Way, West Wickham. This 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. 9 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. The S.O.S. Society opened a Hostel for old people at 75, 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 1946 there were seven private homes registered in the Borough and these provided a total of 97 beds. These premises were inspected under the Nursing Homes (Registration) Act, and 15 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 5 midwives for this area, and in 1946 they attended 266 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 payable according to the circumstances of the patient, or familiescan join as Annual Contributors. The number of visits made annually by these Nurses is about 10,000 and every type of case is 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. 10 2. For Non-Infectious and. Accident Cases. The Beckenham and Penge Councils collaborate in a Joint Service administered by Beckenham, and this came into operation on 1st July, 1945. Facilities have been 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 Joint Service in the twelve months 1.4.46—31.3.47. Calls operated Accidents Removals to Hospitals Maternity Cases Calls Transferred to adjoining areas Mileage covered Day 2,075 318 1,229 299 212 23,951 Night 506 63 175 497 Total 2,581 381 1,404 796 212 23,951 LOCAL CLINIC SERVICES Arrangements in force at 31st December, 1946. 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 Wickham. Fridays, 10—12 (we.ekly) 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. 11 Service Days and Times Premises in Use Minor Allments Tuesday, 2—3 Alexandra Schools. Thursday, 10—11 Church fields 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. Tuesdays, 2—4.30 Do. Ophthalmic Wednesday, 1 30—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. Friday, 10—12 Do. Chest Clinic Friday, 10.30—12.30 1, West bury Road, Penge. 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 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 12 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 1946, 266 births were attended by Midwives, and 147 of these mothers attended at the Clinics. Ante-natal Assistant Medical Panel Officer Sessions held 51 55 Number of expectant mothers attending 315 214 Number of attendances made 632 668 (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 1946 the Health Visitors made 559 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. 1946 81% of the births took place in Institutions. 13 The existing housing situation and the difficulty in securing adequate help in the home undoubtedly contributed to the high percentage of institutional births in recent years. During 1946 the County midwives attended 266 cases as Midwives and 7 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. A total of 161 applications were recorded for enquiry, many more were refused because it was impossible to get sufficient women to undertake domestic work. Advertisements and posters were used to get staff and the engagement of full-time "Helpers" was found to be unsatisfactory because it was difficult to use the afternoons. Help was given in 57 confinement cases and 15 cases of illness for from 6—18 hours a week for 2—4 weeks according to the need. It is evident that there is a real need for this service, but it is difficult to organise and in many cases the applicant only " wants someone ,to do the rough work." This is not the function of the " Home Help "—her job is to keep the home running whilst the mother is unfit, to do essential work, shopping and sometimes cooking. It is an important job—well worth doing—and every woman who does this work can be assured of the satisfaction which comes from giving help in cases where it is urgently needed. 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 1946, 182 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. (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. A Medical Officer attended each centre weekly. The situations and other particulars of the centres appear in the Table of Local Clinic Services. The work of the Centres is summarised in the following table which shows that the attendances have again reached the 30,000 figure. 14 Infant Welfare Centre Attendances, 1946. Town Hall Alexandra Elmers End Wickham Coney Hall Baths Shortlands Total 1946 Total 1945 Total 1944 Total Attendances 3,368 5,058 6,926 5,380 2,598 4,873 1,942 30,145 26,745 21,675 New Cases 246 190 251 234 126 215 105 1,367 1,214 926 Sessions Held 51 51 102 99 53 53 51 460 471 474 Aver. per Session 66 99 67 54 49 91 38 65 57 35 Doctors Sessions 51 51 51 49 53 53 16 324 293 294 Cases seen by Doctors 804 1,339 881 550 345 1,142 187 5,248 4,681 3,744 Aver. per Session by Doctors 15 26 17 11 6 21 11 16 15 13 3,117 children made 30,145 attendances—an average of 9.3. Infant Welfare Centre Attendances, 1946. The following figures shew the attendances of children in age-groups. Infant Welfare Centre Attendances. Year of Birth No. of Children attendances made 1941 56 498 1942 351 1,258 1943 439 1,789 1944 637 3,917 1945 801 10,706 1946 833 11,977 3,117 30,145 Four Health Visitors were engaged in Home Visiting and at the Infant Welfare Centres and during the year 1,305 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 Visits Miss Smith 42 139 142 26 46 1 67 463 Miss Furse 265 619 675 240 53 12 432 2,296 Miss Kendall 418 789 880 150 226 18 163 2,644 Miss Baker 274 514 734 107 58 12 487 2,246 Mrs. Walmsley 165 312 667 316 84 16 261 1,821 Miss Dawson 141 149 334 199 92 8 127 1,050 Total 1,305 2,582 3,432 1,038 559 67 1,537 10,520 Comparison 1945 1,037 2,017 2,823 1,069 990 175 1,582 9,643 In December, 1946, 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, 1947, and that additional sessions should be held at two of the Infant Welfare Centres. It has not been found possible to secure this additional help up to the present. UNMARRIED MOTHERS. During the year the cases of 16 unmarried mothers were brought to the notice of the Department. Of these 13 were reported by the Social Worker of the Rochester Diocesan Moral Welfare Council, 2 by Midwives or Health Visitors, and 1 by the Catholic Rescue Society. Arrangements were made for 9 of these cases to enter special Hostels maintained by the Rochester Diocesan and other Moral Welfare Societies, the remaining 7 making their own arrangements. Of the 13 babies born, 1 died aged 3 months, 1 aged 7 months, 6 remained in the care of their mothers, 3 were adopted under the Adoption of Children Act, and 1 was boarded out with a foster mother under the Infant Life Protection Act. 1 left the area. In addition there were 27 other illegitimate births not reported until the notification of birth was received. 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. Information was received from 4 registered Adoption Societies and 9 other bodies during the year relating to 41 children and all the homes visited regularly. Adoption orders were made by, the Courts in 27 cases; in three cases the applications were withdraw n and 11 were still under consideration at the end of 1946. Close liaison is maintained with the Education Officer in cases coming under the provisions 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. 16 The scheme organized by the Ministry of Food for the provision of Cod Liver Oil, Vitamin Tablets and Orange Juice to expectant mothers and children, has been steadily developed since its inception and it now entails a very large weekly distribution. The Local Food Office have made arrangements for volunteers to be in attendance at 20 distribution points in addition to the Corporation's Infant Welfare Centres. The "take-up" of these issues varies very much in different districts, but the periodical statistics furnished by the Ministry of Food shew quite conclusively that Beckenham is among those areas with the highest percentage. The figures for the month of December, 1946, shew that the issues were:— Cod Liver Oil 494 bottles representing 54.35% of the possible issues. Vitamin Tablets 106 packets representing 71.62% of the possible issues. Orange Juice 2,061 bottles representing 63.24% of the possible issues. The volunteers who undertake this work are to be congratulated on their public spirit as all medical opinion is agreed upon the importance of these additions to our present dietary. FREE MILK TO NECESSTIOUS 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. 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 20 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 20 infants, 3 were bom at home and 17 in Institutions. Born at home 3 Nursed entirely at home 2 Died during the first 24 hours Nil Alive at the end of one month 1 Born in institutions 17 Died during the first 24 hours 1 Alive at the end of one month 10 17 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 U.V. Ray Orthopaedic Aural Clinic Clinic Clinic Clinic 1946, Infants 101 675 441 45 BOARDED-OUT CHILDREN. At the commencement of the year there were 9 registered foster mothers having charge of 12 children. At the end of the year there were 9 names still on the register with 14 children. The Health Visitors and the Assistant Medical Officer are Infant Life Protection Visitors and made 97 visits to the homes PUBLIC HEALTH ACT, 1936-SECTIONS 226-220. Under these Sections the Council may grant exemption Certificates from provisions covering the necessity for notification of admission and discharge of children from residential homes and schools. All the premises in the area were circulated and after investigation exceptions were granted in eight cases. In one of these the owners were asked to carry out certain improvements in the sanitary accommodation before the exemption was granted. In two, the Societies concerned did not wish to take advantage of the provisions, and notifications of admissions and discharges are duly received. In all cases, the Council still retain the right of inspection. OBSTETRIC CONSULTANT'S SERVICE. The consultants clinics were held at the Maternity Hospital. Eighteen sessions were held ; 70 ante-natal cases and 320 post-natal cases were examined. The total number of attendances at the Clinics was 428. Mr. D. M. Lindsay, F.R.C.O.G., was asked to see 62 cases during the year. Professor Fleming deputised in 8 cases. The following summary indicates the reasons for the consultations. 1. Ante-Partum Haemorrhage: Placenta Praevia 6 Abortion 1 - 7 18 2. Toxaemia of Pregnancy: Albuminuria 4 Eclampsia 1 Induction of labour 1 Spontaneous delivery 2 8 3. Contracted Pelvis: Spontaneous delivery 5 Induction of labour 1 6 4. Difficult Labour: Malpresentation—extended breech 3 „ persistent occipito-posterior 1 „ transverse lie 1 Deformity of Pelvis 1 Uterine Inertia 2 Disproportion—craniotomy 1 10 5. Caesarean Operation for: Contracted Pelvis 11 Extended Breech 3 Rigidity of Soft Parts 3 Placenta Praevia 2 Toxaemia 1 Multiple Fibroids 1 Anxiety Neurosis 1 22 6. Adherent Placenta 3 7. Puerperal Pyrexia: Cystitis 1 Sapraemia 1 Salpingitis 1 Mammary Abscess 1 Unspecified 1 5 8. Other conditions: Suspected post-maturity 1 Total 62 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 523, compared with 547 in 1945. 19 Summary of Treatments:— Adults Infants Attendances 348 175 N umber treated 136 99 Extractions 336 89 Fillings 79 99 Dressings 92 66 Silver Nitrate — 6 Scalings 20 — Nitrous Oxide 71 23 Ethyl Chloride — 10 Local Injections 21 1 Impressions, etc. 107 — Dentures 38 — Repairs to Denture 1 — Robert A. Waters, L.D.S. Eng. DAY NURSERIES Both Nurseries have been booked 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. The attendances have been affected from time to time by minor illnesses. Dr. S. Thomson has supervised the health of the children in attendance and has carried out immunisation against Diphtheria and Whooping Cough. Month SPRINGFIELD BECKFNHAM RD. Under 2 2—5 Total Days Open, Sats. inc. Under 2 2—5 Total Days Open, Sats. inc. January 171 574 745 27 144 643 797 27 February 155 612 767 24 135 570 705 24 March 185 696 881 26 213 667 880 26 April 169 688 857 23 170 532 702 23 May 234 726 960 27 232 760 992 27 June 194 601 795 22 173 595 768 22 July 268 714 982 27 136 660 796 27 August 235 569 804 26 122 477 599 25 September 179 632 811 24 188 671 859 24 October 221 904 1,125 28 230 762 992 28 November 211 799 1,010 28 186 641 827 26 December 171 601 772 20 106 476 582 20 Total 2,393 8,1196 10,509 302 2,035 7,454 9,499 299 *These figures include Saturdays when the attendances are small; the Springfield Nursery is open all day on Saturday, but the Beckenham Road Nursery closes at mid-day. 20 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. ADMISSIONS The number of admissions in 1946 was 882 compared with 601 in 1945, and 373 in 1944. ANTE-NATAL SUPERVISION The Matron held a Clinic on three days a week and saw 680 cases who made 5,246 attendances. 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 22 pupils were in training. During the year 12 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 1946 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 Penge 641 882 241 3a. Number treated in Ante-Natal Beds 58 21 Information Required Particulars 3b. Average duration of Ante-Natal Stay 8.06 days 4. Average duration of stay 13.8 days 5. Number of cases delivered by: (a) Midwives 691 (b) Doctors 191 6. Number of cases in which medical assistance was sought by a midwife in emergency 129 7. Number admitted after delivery (included in 3.) 2 8. Number of cases notified as: (a) Puerperal Fever Nil (b) Puerperal Pyrexia 19 9. Number of cases of Pemphigus Neonatorum Nil 10. (a) Number of Infants who have at any time received a supplementary feed while in the Hospital (excluding the first 3 or 4 days). 135 (b) Number of Infants wholly Breast fed on leaving the Hospital 720 11. (a) Number of cases notified as Ophthalmia Neonatorum ■Nil (b) Result of treatment in each case 12. Number of Maternal Deaths Nil 13. Number of Still Births 20 14. Number of Infant Deaths 6 22 23 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 Beckenham West Wickham Total 0 to 1 1 to 5 5 to 10 10 to 15 15 to 25 25 to 45 45 to 65 Over 65 Age Unknown Admitted to Hospital Measles 261 23 284 5 97 164 7 4 4 - - 3 - Whooping Cough 67 15 82 4 34 31 4 1 3 - - 5 - Chicken Pox 11 6 17 - 1 13 3 - - - - - - Mumps 4 2 6 - 1 2 2 - 1 - - - - German Measles 3 1 4 - - 3 1 - - - - - - *Diphtheria 7 2 .9 - 2 2 1 1 2 1 - - 9 Scarlet Fever 34 11 45 - 4 23 5 11 1 1 - — 25 Poliomyelitis 1 - 1 - - - - - 1 - - - 1 Paratyphoid 3 - 3 - - 2 - - 1 - - - - C.S.M 2 - 2 — - 2 - - - - - — 2 Malaria 1 1 2 - - - - 1 1 - - - 2 Dysentery 4 7 11 - 2 1 - 3 4 1 - - 4 Erysipelas 10 - 10 - - - - - 2 6 2 - 1 Gastro-Enteritis - 1 1 1 - - - - - - - - - Pneumonia 30 5 35 - 2 3 - 2 6 11 11 - 1 P. Pyrexia 19 4 23 - - - - 12 10 - - 1 All Hospital Confinements *Seven cases withdrawn. DIPHTHERIA. Only two definite cases were notified during the year, and one of these developed the disease during a lengthy stay in a London hospital. In no previous year since the disease was notifiable has the number of cases notified been so few. SCARLET FEVER. The incidence was low, the number of cases notified being 42 compared with 41 in 1945. The infection was mild in all cases. PARATYPHOID FEVER. Three cases were notified. Two cases definitely contracted the disease abroad and were already ill when they returned to this country. The source of infection in the third case was not discovered. OTHER DISEASES NOTIFIED. Measles (257 cases) was prevalent in Central Beckenham during the last two months of the year. There is still no sign of a reappearance of the pre-war regular periodicity. Whooping Cough (82 cases) occurred mostly in the Kent House, Manor House and Eden Park Wards during the first half of the year. PUERPERAL PYREXIA. Twenty-three cases were notified. Of these, nineteen occurred in the Beckenham & Penge Joint Maternity Hospital, and four in other institutions. Detailed reports were received of fifteen of the cases. The conditions to which the pyrexia was attributed were:— Urinary Infections 4 Mastitis 4 Mammary Abscess 1 Phlebitis 1 Lymphatic infection—white leg 1 Sapraemia 1 Pleurisy 1 No cause discovered 2 BACTERIOLOGICAL WORK. The number and results of the examinations made at the Public Health Department Laboratory during 1946 was:— Disease suspected Total 1946 Results Comparative Total for 1945 Positive Negative Diphtheria 117 1 116 133 Tuberculosis 41 1 40 33 Other Diseases 6 - 6 - Total 164 2 162 166 OPHTHALMIA NEONATORUM. No cases were notified. 24 25 Tuberculosis—Table of Notifications and Deaths, 1946, from Local Records Sex Total Ages Wards M. F. 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 39 30 69 — 2 2 9 9 16 13 9 3 6 4 11 9 5 16 6 7 11 Non-Pulmonary 6 3 9 — 2 - 1 1 1 1 1 2 — 1 — 2 — 3 1 1 1 Totals 45 33 78 — 4 2 10 10 17 14 10 5 6 5 11 11 5 19 7 8 12 Deaths Pulmonary 14 12 26 — 1 — — 4 6 4 3 4 4 2 4 6 — 5 2 2 5 Non-Pulmonary 1 — 1 — — — 1 — — — — — — — — 1 — - — — - Totals 15 12 27 — 1 — 1 4 6 4 3 4 4 2 4 7 — 5 2 2 5 TUBERCULOSIS. The total of 78 cases compares with 64, 79, 71, 76 and 58 in the preceding five years. In addition to the new cases there were 44 definite cases transferred from other areas, and 8 old cases restored to the register. 5 cases were not notified until after death. At the end of the year the number of notified cases in the area was:— 234 Pulmonary Males, 220 Pulmonary Females, 44 nonPulmonary Males and 34 non-Pulmonary Females; a total of 532 cases, which compares with 449 last year. 52 cases were placed off the register for the following reasons: Died, 27; Cured, 10; Left area, 13. 2 Withdrawn (not Tuberculous). Notification.—In 5 cases notification was not made until after death. Follow-up of Contacts.—106 contacts from Beckenham were examined at the Chest Clinic during 1946 and 3 were found positive. TUBERCULOSIS CARE COMMITTEE. The Voluntary Tuberculosis Care Committee which was formed in 1938 has continued to raise 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, 1946.—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, 1946. Age at 31.12.46 Under 1 1 2 3 4 5 to 9 10 to 14 Totle Under i.e.— Born in year 1946 1945 1944 1943 1942 1937 to 1941 1932 to 1936 Number Immunised 1 536 625 469 644 2,521 2,818 7,614 Estimated mid-year population, 1946 5,170 8,560 13,730 26 During 1946 a further effort was made to protect children between the ages of one and two years, and also to give reinforcing doses to children on reaching the age of 5 years. 922 new cases completed treatment and 493 old cases had extra doses, compared with 800 and 250 for 1945. The following figures shew the number of new cases in age groups:— 1932 3 1937 11 1942 32 1933 5 1938 12 1943 43 1934 4 1939 20 1944 179 1935 5 1940 35 1945 534 1936 8 1941 31 Total 922 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. EPIDEMIC DIARRHOEA. This disease becomes notifiable annually during the period 15th July to 15th October. One case was notified. SMALLPOX. No cases were notified during the year. 1,081 children were vaccinated by the Public Vaccinator during the year. SCABIES. It has not been found necessary to continue the war-time arrangements for the treatment of scabies. Instructions and material are issued to any cases referred to the Department. OVERSEAS CONTACTS. Information was received from Ports and Air Ports of the arrival of 112 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 618 visits by the Sanitary Inspectors and by the M.O.H. 27 REPORT ON THE SANITARY INSPECTION OF THE DISTRICT FOR THE YEAR 1946. By G. A. Webber, Chief Sanitary Inspector. The total number of visits of inspection made by the Inspectors| during 1946 was as follows:— Initial Visits 4,803 Revisits 8,074 A summary of nuisances, found and remedied, is appended. Found. Remedied Structural defects—external 494 342 „ „ —internal 669 515 Insanitary conditions—other than vermin 83 60 Verminous conditions 12 12 Choked drains 416 410 Other drainage defects 309 340 Defective sanitary appliances 265 281 Insufficient and/or unsuitable water supply 19 23 Absence of dustbin 55 50 Offensive accumulations 33 29 Unclassified defects 21 13 2,376 2,075 The commencement of the year brought the return of Mr. E. U. Williams and Mr. R. C. Rogers from H.M. Forces to their preenlistment duties as District Sanitary Inspectors. In March, 1946, the Council appointed to the permanent staff Mr. W. Newman, bringing the total number of District Sanitary Inspectors to four, Further increases in the personnel of the Department were made by the appointment of three rodent operators and a part-lira employee to assist the whole-time Disinfector Handyman. It has been possible with this much-needed added assistance to prepare to build an organisation which will enable us to deal more fully with the innumerable statutes, the enforcement of which form the basis of the Sanitary Inspector's duties. It was a matter of regret to me when, in December, 1946, Mr. Rogers resigned his appointment to take up duties elsewhere. During 1946, 1,718 complaints were received from members of the public, alleging the existence of conditions prejudicial to health or a nuisance. This number exceeded the 1945 figure by 278. In the majority of cases the complaints were justified, and appropriate action was taken in accordance with statute. As in previous years, nuisances of a similar character were the subject of complaint, and generally related to (a) external and internal structural defects, (b) insanitary conditions by reasons of choked or defective drainage. The investigations and administrative work, necessitated by the lodging of complaints, form the major part of the Inspectors' work. 910 Intimation Notices and 163 Statutory Notices were served in respect of nuisances discovered 28 It is not the practice to serve Statutory Notices until it is plain that the informal notification of the existence of nuisances, given by the intimation notice (which is not a legal requirement), has failed to bring about the remedy required by the responsible person. The figures already quoted, therefore, indicate that informal approach was, in the majority of cases, completely successful. This pointer to the worthiness of the vast majority of property owners is pleasing to record, yet serves to focus attention upon those few who either deliberately evade their responsibilities, using cleverly every loophole the slow-moving machinery of the law provides, to the detriment of their tenants, or who fail to realise that the ownership of property must carry with it certain liabilities, for which they omit to cater in assessing the value of their investment; nor would it be correct in discussing the calculating or irresponsible property owner to leave out reference to the bad tenants who allow their dwellings to become places of squalor, where the structural and decorative deterioration is often a matter of wilful neglect. The "owner," in such cases, deserves the greatest support from the public health official, as do the neighbouring families who are forced to share the distressing conditions produced by those who fail in their duties as members of a community. Fortunately, such instances are rare in Beckenham, but they do exist. Perhaps the greatest difficulty of all in the year under review has been the scarcity of building materials for use in existing properties. Whilst one must keep in mind that authoritative action, which has restricted their use, has been introduced with the National problem in view, the advisability of maintaining in habitable condition the houses we have must be emphasised. The issuing of notices to act as "permits" for this or that article of building maintenance repair has increased greatly the administrative work of the Department. HOUSING—INSPECTION OF DWELLING HOUSES DURING THE YEAR. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,181 Number of inspections made for the purpose 3,521 Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 25 Number of inspections made for the purpose 117 Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not be in all respects reasonably fit for human habitation 910 Number of dwelling houses in respect of which Informal Notices were served 910 Number of dwelling houses in which defects were remedied after service of Informal Notices 747 29 FORMAL ACTION UNDER PUBLIC HEALTH ACTS. Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 163 Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) by owners 128 (b) by Local Authority in default of owners Nil LEGAL PROCEEDINGS. Legal proceedings were taken against an owner of property for failure to comply with an Abatement Notice requiring the remedy of defective gutters. The magistrates ordered the owner to abate the nuisance within a specified period of time, and pay a fine of one pound. The owner complied with the Nuisance Order made by the Court. SCHOOLS. Special attention was paid during the year to the sanitation of the schools in the area. It was found necessary to call for greater attention to the cleanliness of sanitary conveniences provided, and in one instance a serious insufficiency of sanitary accommodation was discovered. Remedial action has now been taken in these matters. VERMINOUS CONDITIONS. Twelve houses were found to be in a verminous condition, due either to bug or flea infestation. No case was suffiicently serious to warrant extermination by gas, and the Council's Staff were able to cope with the conditions by the use of disinfectant solutions special'y prepared for the purpose. FOOD & DRUGS ADMINISTRATION. Formal and informal sampling of milk, food and drugs was carried on as a routine measure throughout the year. Samples were taken as follows:— Formally Informally Milk 58 28 Food 9 53 Drugs — 4 67 85 One of the formal milk samples was returned by the Public Analyst as adulterated with 11.4% added water. There were, however, circumstances in the taking of the sample, noted at the time, which the Analyst agreed might have produced this result. The Health & Welfare Committee, after considering all the facts, concluded that no formal action was necessary. All other formal milk samples were returned as genuine. The informal milk samples were taken at the request of the Kent County Council or the Ministry of Food (Milk Division), and relate to specially designated milks, i.e., Tuberculin Tested, 30 credited or Heat-treated. Any sample failing in the tests prescribed is notified to the appropriate body for whatever action they consider necessary. None of the food or drug samples were found to be adulterated Visits of inspection and supervision were paid to the two dairies in the area having milk processing plants for heat treatment; to food shops of all descriptions, and to the six dairy farms in the area. FACTORIES ACT, 1937. 195 visits of inspection were made to Factories in the area. The following nuisances discovered were remedied following the service of informal notices:— Absence of proper lighting of water closet 9 Insanitary condition of water closet 8 Insufficient sanitary accommodation 3 Insanitary condition of factory 2 Broken water closet pan 1 Absence of water supply to water closet 1 Water closet compartments not labelled for the sexes 3 SHOPS ACTS. 324 visits were paid in connection with the Shops Acts. 26 contraventions discovered were remedied following the issue of informal or statutory notices. WATER SUPPLY. The water supply of the area has been satisfactory in quality and quantity, all properties being supplied by the mains of the Metropolitan Water Board. Bacteriological examination of the supply has been regular. 36 samples have been taken during the year, 35 being reported by the Public Analyst to be "good waters." One sample was reported as contaminated. This supply, which was to a lavatory basin, and an intermittent supply in that it passed through a storage tank, was not a normal drinking supply, but could possibly have been used for such purpose. The defective storage tank was removed and a further sample, taken after the installation of a new properly covered tank, proved to be satisfactory. A semipermanent encampment of caravan dwellers obtain their water from a stand pipe taken direct from the Metropolitan Water Board mains. MEAT INSPECTION. On 5 occasions animals were dressed for food when 11 pigs were slaughtered. Two pigs' heads and one pluck were found to be diseased, and condemned as unfit for human consumption. 31 RAT REPRESSION In 1945 the Beckenham Council instituted an organised free service to assist householders in the extermination of rats and mice. At the same time there was introduced a scheme for business premises, but a charge was, and is, made for the service provided. These schemes necessitated the appointment of two whole-time employees. The cost of the employment of the "private dwelling s" operator was to be borne entirely by the Council, and that of the "business premises" operator to be recovered, partly by the charges made, and partly by grant from the Ministry of Food. At a later date the "private dwellings" staff was increased to two, mainly to comply with grant requirements of the Ministry of Food, arising from the general private dwellings scheme which that Ministry wished to be instituted. Further reference will be made to this matter later in the report. In order properly to appreciate the better position created by the operation of the present schemes-, we must fully understand the circumstances existing before their inception, and the real nature of the problem which caused these circumstances; and, in addition, the various difficulties of procedure, which were then found to provide an insurmountable barrier to any effort to control the vermin. In one respect the Borough has, so far, been fortunate. Infestation is confined, so far as rats are concerned, to one specie—the common Brown or Sewer rat. Fairly near neighbours in the Metropolis have, in addition, moderate infestations of Black rat, whilst, in Central London, this latter specie predominates. Of the two, Black rat lives in closer relation to mankind, and for that reason must be considered more dangerous as a menace to health. Regard must be paid to the rapid breeding of the vermin. The period of gestation is twenty-one days, each litter may number up to fifteen, and one female will produce from six to nine litters in a year. At the age of three months the rat is sexually mature. All the young do not survive. Rats are cannibalistic, and the size to which a colony will grow depends largely on the food supply and harbourage facilities readily available. It may be apparent from these few brief facts that apathetic, unskilled, and unorganised control, which results only in creaming the surface of an infestation, will assist the continued existence of a colony. The complete extermination of rats causing an infestation is therefore essential. All rats must be regarded as a potential danger to health, and it is suggested that the responsible public health administrat or should have this aspect uppermost in mind. The conservation of food is of great importance, and even if we in Beckenham cannot agree that, locally, this aspect is of supreme importance, we need not have any doubt that considerable damage is done to food stocks in more vulnerable areas ; but, in any case, the knowledge of undesirable conditions indicated and produced by the presence of the rat is alone sufficient to justify proper remedial action. 32 With these details of the basis of the problem in mind, we should consider to what extent it had grown in this area. We had the certain knowledge that infestation was increased and widespread; that no single area, and probably no single road, was immune from attack. There were several reasons for this. We knew that the ravages of enemy air attack had left scores of sites which provided harbourage and attraction. There was the restricted refuse collection service, the salvage service, and hundreds of poultry runs. All these provide great scope for a marauder, who is not slow to take advantage of any situation favourable to its continued existence. the public constantly sought advice against an enemy it understood not at all. The Rats & Mice (Destruction) Act, 1919, placed responsibility for taking all steps necessary and reasonably practicable to deal with infested property, upon the occupier of the property. The Act was introduced at a time when the problem and its remedy was understood only by a very few (a position, incidentally, which existed until 1940), and it offered no definition or guidance to the application of the term "necessary and reasonably practicable." It is interesting to note that in one of the few prosecutions instituted under this Act, the case against the defendant was instantly dismissed when the Magistrate was told that the defendant kept a cat. In 1945 the Beckenham Council still endeavoured to base its action in rat repression upon this near useless Act, which had then been in force for 26 years. Advice was offered to complainants, and measures of repression were explained verbally, but had to be instituted by the complainant. The Sanitary Inspectors, although they spent many hours in interviewing and visiting complainants, could not devote all the time necessary to deal with each problem, and to ensure that the result would be successful. Revisits were out of the question. It must be recorded that the time which was given to this work was, on the whole, profitless. An attempt had been made to reduce infestation by employing a professional ratcatcher, whose services were offered to the public for a charge of, usually, two shillings and sixpence. This man's movements were not easily controlled or supervised. Being only a part-time worker, his activities were very limited, and he did the work when he was free from other outside duties. This scheme entailed much administrative work in the rendering of accounts etc., which, I believe, were not always easy to collect. The public objected to paying for the service. The position was one of stalemate. On the one hand the Local Authority tried, unsuccessfully, to enforce an unwieldy Act, and on the other the public found itself insufficiently skilled (and understandably so), to take steps necessary and reasonably practicable to remedy an ever-increasing invasion. The only flourishing success was the vermin itself. The actual amount of money apportioned to rat repression compared very favourably with today's expenditure, but it is suggested that the sums allocated to such measures could not have been entirely comprehensive. The amount of time spent by the 33 Sanitary Inspectors alone was costly, and was, of course, taken up at the expense of work more in keeping with the Inspectors' qualifications. It is important here to emphasise the unsuccessful control which the, perhaps, less costly measures then produced. It became obvious to those intimately concerned that the only sensible approach was, first, to introduce a whole-time skilled service for the destruction of rats and mice. We were in possession of data and experience which could bring us nearer to successful control than ever before. Secondly, experience justified the need for the service tp be free so far as private dwellings were concerned. Accordingly, the Council endorsed the suggestion of the Health & Welfare Committee, and two Rodent Operators were appointed, one for the free private dwelling service, and one for the business premises. It is not reasonably possible to employ sufficient staff to cover the whole area, and to deal with each individual complaint, and so in addition, materials, and instructions for their use in a poisoning campaign, are issued gratis to any person complaining who does not reside in an area where the Rodent Operator is working at the time of the complaint. A visit is paid to such properties as soon as possible to check the work of the householder. In 1946 the Ministry of Food instituted its private dwellings campaign. The Ministry too, had realised that free skilled service to householders was the only sensible method of repression. Local Authorities were offered reimbursement, to the extent of 60% of the cost, to institute such a scheme. The Ministry imposed grant conditions. Suggestions were made by Officers of the Ministry regarding the staff necessary in Beckenham, and it was assumed by them that four investigators, six operators, a supervising Officer, and at least one clerk, were necessary. Your Officers felt that the problem, without being overcome, was reasonably controlled in Beckenham, its new organisation already being in operation. To employ the staff suggested appeared to be unwarrantable, and a waste of public money. The Ministry was so informed, and, after much negotiation, agreement was reached that grant from Central Funds would be paid if one additional Operator was employed. The Council agreed to such an appointment. The really important result of the operation of the present scheme lies in the abolition of the difficulties which attended our previous efforts because those difficulties spelt failure. I feel that statistical information, which must be indefinite, has no place of worth in a report on the control of this vermin. Our factual knowledge of rats leaves us in no doubt that hundreds may breed and flourish in a matter of weeks. Obviously proper control will result in the killing of hundreds. It may be of some interest to know the number of rats killed by the Operators, but one can never be sure of obtaining factual information. The time involved in arriving at hypothetical figures can be ill afforded. It is better to be sure that an infestation is completely overcome. As a matter of interest, and for the purposes of this report, I selected at random ten addresses from my records where infestation did exist, and where the Operators had worked several months ago. 34 I visited each property and nine occupiers reported (gratefully, let it be said) that no further trouble had been experienced. One reported renewed infestation, which occurred long enough after the completion of our work for me to know that it was an entirely fresh invasion. This occupier kept chickens, one of the greatest attractions to marauding rats. Failures are met of course. Few instances of infestation are identical. If immediate re-infestation is found and continues, then we have to look further for the source of the trouble. Recollection of the report on sewer rat infestation in 1946 will show to what severe degree some parts of our sewers are infested. Defective sewers or defective drainage will give rise to an unlimited supply of rats, and work may be costly and extensive before immunity is achieved. The rat problem in Beckenham is controlled, it is suggested, by the present organisation. Hundreds of infestations have been, and are being, successfully eliminated. A sensible service is available to the public, and it is hoped that the facts given in this report will show that its cost is commensurate with the needs of the Borough. I wish to express my thanks to the Medical Officer of Health for his encouragement and support in these early days of my service with the Beckenham Borough Council, to the Officers of the administrative Departments, and particularly to my immediate colleagues, who have given me the greatest co-operation in carrying out the work of the Sanitary Inspector's Department. 35 36 VITAL STATISTICS FOR YEARS 1939 to 1946 The comparative rates given reveal some interesting tendencies Year Population as estimated at mid-June by RegistrarGeneral Live Births Registered Still Births. Deaths of Infants under one year. Legitimate Illegitimate Total Rate pel 1,000 of population Legitimate Illegitimate Total Legitimate Illegitimate Total Rate per 1,000 of population 1939 71,010 897 14 911 12.827 26 1 27 24 6 30 32.96 1940 64,500 757 22 779 12.079 20 — 20 22 1 23 30.06 1941 53,310 548 33 591 10.898 10 3 13 17 3 20 36.70 1942 56,300 890 44 934 16.589 27 — 27 24 1 25 26.77 1943 58,080 950 45 995 17.131 25 1 26 29 1 30 30.15 1944 55,540 848 40 888 15.988 21 3 24 24 2 26 29.28 1945 58,850 836 50 886 15.055 26 2 28 18 4 22 24.94 1946 70,330 1,273 62 1,335 18.413 28 - 28 34 3 37 27.71 Year Deaths of Civilians from all causes (including enemy action) Deaths of Mothers in childbirth Deaths from Pulmonary Tuberculosis. Deaths from all forms of Cancer. Number Rate per 1,000 of population Number Number Rate per 1,000 of population Number Rate per 1,000 of population 1939 677 9.771 1 26 0.366 110 1.580 1940 851 13.190 3 22 0.341 115 1.783 1941 726 13.637 NIL 28 0.525 92 1.725 1942 673 11.953 NIL 25 0.444 122 2.166 1943 663 11.071 NIL 17 0.292 121 2.083 1944 717 12.909 NIL 33 0.594 107 1.926 1945 650 11.045 NIL 31 0.520 109 1.852 1946 757 10.763 2 22 0.114 112 2.190