LIBRARY BEC 17 C. 4412(1) BECKENHAM BOROUGH OF BECKENHAM REPORT OF THE MEDICAL OFFICER OF HEALTH for 1950 BY T. PHILIPS COLE, M.B., D.P.H. BOROUGH OF BECKENHAM REPORT OF THE medical officer of health for 1950 BY T. PHILIPS COLE, M.B., D.P.H. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1950. TABLE OF CONTENTS. PAGE 1. Members of the Public Health Committee 1 2. Staff of the Public Health Department 2 3. Introduction 4 4. General Provision of Health Services in the Area 7 5. Local Clinic Services 9 6. Infectious Disease:— (a) Table of Cases 10 (b) Medical Officer's comments 11 (c) Tuberculosis—Incidence and Deaths 12 (d) The work of the Chest Clinics—Report by Dr. D. G. Madigan 13 7. Housing 15 8. Report on the Sanitary Administration of the District by Mr. G. A. Webber, Chief Sanitary Inspector Introduction 16 Nuisances found and remedied 17 Housing inspections 17 Properties not possessing main drainage 17 Legal proceedings 18 Moveable Dwellings 18 Food premises 18 Unsound food 19 Food and Drugs sampling 19 Waterways 22 Noise Nuisances 22 Smoke Nuisances 22 Disinfection 22 Rat and Mouse Repression 22 Ice Cream Manufacture and Sale 23 Factories 23 Water Supply 23 Shops Acts 24 Mortuary 24 2 MEMBERS OF THE PUBLIC HEALTH COMMITTEE YEAR 1950-1951. Chairman: Councillor C. P. Christie. Deputy Chairman: Councillor C. B. Curtis, M.B.E. Alderman R. S. Jackson. Councillor W. J. Brooks. Councillor R. C. Cheeseman. Councillor Miss K. A. Moore. Councillor G. A. Petty. Councillor G. H. Robertson. Councillor F. R. Took. Councillor R. A. Waylett. Ex-Officio: The Mayor and Deputy Mayor. C. Eric Staddon, O.B.E., Town Clerk. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health T. Philips Cole, M.B., D.P.H. Chief Sanitary Inspector G. A. Webber, Certificate of the Royal Sanitary Institute and the Sanitary Inspectors' Examination Joint Board. Certificated Food Inspector. Deputy Chief Sanitary Inspector E. U. Williams, Cert. R.S.I.and S.I.E.J.B., Certificated Food Inspector. District Sanitary Inspectors H. G. Richards, Cert. R.S.I. Certificated Food Inspector. W. Newman, Cert. R.S.I. (Deceased, September 1950). W. T. G. Woodard, Cert. R.S.I. and S.I.E.J.B. Certificated Food Inspector. V. C. Jordan, Cert. R.S.I.and S.I.E.J.B. (Resigned April, 1950). H. R. Dawkins, Cert. R.S.I. and S.I.E.J.B. (Appointed April, 1950). G. W. Mathews, Cert. R.S.I. and S.I.E.J.B. (Appointed October, 1950). 3 Clerical Staff Mrs. E. A. Best. Mrs. D. Foster. (Resigned August, 1950). Miss C. Mawbey. Miss A. Keen. (Appointed October 1950). Miss A. Hobbs. (Appointed October, 1950). Rodent Operators W. J. E. Wickenden. E. J. Read. Disinfector-General Assistant J. Symonds. Mortuary Attendant—General Assistant A. L. Jarvis. (Appointed July, 1950). INTRODUCTION. THE Report for 1950 is the last report which I shall have the honour to submit. It is the twenty-fourth annual report which I have prepared, and, like its immediate predecessors is concerned with only a portion of the health services which are carried on in the BoroughIt was not always thus: until 1948, the Annual Report of the Medical Officer of Health was a comprehensive one which dealt in detail with almost every aspect of Public Health. Until that time, the Health Services in Beckenham were developed and administered by Beckenham residents, people who had a personal knowledge of their fellow citizens and a natural interest in their particular needs and welfare. I am not suggesting that the Services have declined in efficiency in any way since they were transferred to more distant authority, but it would be idle to pretend that it is possible"1 maintain that intimate contact with the people which was so characteristic a part of the old local administration, and which enabled one so frequently to adjust the provisions of the services to suit the special needs of a particular person, instead of having to adhere to sets of regulations and to try to force all cases within their rigid framework. Beckenham has had only two whole-time Medical Officers of Health. My predecessor, Dr. J. M. Clements was appointed to advise the Council on the best practical steps to take to implement the new powers which were being conferred on Local Government Authorities for the care of the health of school children and of mothers and infants. During his tenure of office, the Council laid the foundations of a complete and highly efficient Public Health Service; during my years in Beckenham, additional powers were granted and the services expanded and adapted to meet the needs of a rapidly growing population. Now, those services have been transferred and the need for a wholetime Medical Officer of Health has ceased to exist. 4 This is not a personal lament: there are scores of districts—large districts, with highly efficient administration—whose position to-day in Public Health is similar to that of Beckenham. Looking back, one feels that the years were good, that the work was well worth while, that the personal knowledge of and friendship with so many of the people whom we served was a source of happiness. Looking forward, it far too easy to be pessimistic—and there should be no real need for pessimism: the future depends on the vision of those who hold authority to-day. The Public Health Service has dealt very successfully with most of the problems of environment: it must now be re-oriented if it is to go on being of service in the improvement of Health, and it must be an integral part of a real National Health Service. The danger is that it may cease to attract medical men and women of sufficiently high capacity and zeal. There is little inducement to enter a service in which one's outlook is bounded by the walls of clinics in which, although one may have the title of Medical Officer of Health, the bulk of one's work is done under the direction of an officer in a remote country town. There must be room for expansion, for originality and initiative, for revolutionary ideas: the service which stands still is already beginning to decay—and what is true of a service is true of a man. Is the Medical Officer of Health of the future to be an important factor in developing Social Medicine, or is he to become fixed as a subordinate officer in the clinics of Part III authorities? I have enjoyed the twenty-odd years which I have spent in Beckenham: they were full years; there was usually some new project or service to be instituted or developed; there was plenty of scope for initiative, and the mind was always occupied with ideas—many of them Utopian and seemingly wildly impracticable: and yet, oddly enough, quite a number of these came to fruition. When I took up my duties in November 1927, the district was suffering from one of those extensive outbreaks of diphtheria which appeared every few years: it was a serious outbreak and a number of children lost their lives. Of course, such incidents were quite common in those days, but such an experience had not happened previously to me. I felt that, come what may, this must not occur again. Diphtheria Immunisation had by then passed the trial stage, but was not in extensive use: the Council in 1928 agreed to its introduction into our Health Services. It is with a feeling of gratitude that I can record now that during my last two years of office, not one case of Diphtheria was notified. With one matter which concerned me very much I have less reason for satisfaction. I refer to Housing. I have not failed to express my views on this at fairly regular intervals. Remembering how willing successive Councils have always been to approve and finance measures proposed for the maintenance and improvement of the General Health Services, I have always been puzzled by the obvious reluctance with which 5 they have approached the question of municipal housing. I have never been able to understand this attitude in the past, and now I never shall: it is perhaps the only subject—certainly the only major subjectwhich the Council and I have not been able to regard in the same light. I shall always be grateful for the help given and the consideration shown to me by Health Committee and Council. And I shall retire with the firm conviction that no Chief Officer of any Corporation has ever been sustained by a more loyal and devoted staff. T. PHILIPS COLE, Medical Officer of Health. 6 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (a) Provided by the Regional Hospital Board (South-East Metropolitan Region). 1. Isolation Hospital. Accommodation is provided at The Lennard Hospital, Lennard Road, Bromley, Kent, for Beckenham and a number of other districts. 2. Maternity Hospitals. The Beckenham Maternity Hospital and a Maternity Ward at Farnborough Hospital are maintained for cases from this and other districts. 3. General Hospitals. Farnborough Hospital and Beckenham Hospital provide for the treatment of acute cases and the chronic sick, and children are specifically catered for at the Sydenham Children's Hospital. The Children's Hospital, West Wickham is provided for invalid children. 4. Tuberculosis. The Board provide Sanatoria and Hospitals for Tubercular patients, and Chest Clinics for diagnosis and treatment. The Chest Clinic for Beckenham and Penge is at 1, Westbury Road, Penge and for Wickham at Tiger Lane, Mason's Hill Bromley. (b) Local Health Services provided by the Kent County Council. 1. Local Clinic Services. The Table on pages 8 and 9 shews the Centres and Clinics in operation in the Borough. 2. Day Nurseries. The County maintain two Day Nurseries in the Borough, with accommodation for 85 children. 3. Ambulance Facilities. The County Council provide motor ambulances for the removal of (1) Fever cases (2) Maternity cases and (3) Accident cases, to the appropriate hospitals. 4. Nursing Arrangements. (a) Midwifery. The County Council remain the supervising Authority under the National Health Act, 1946. (b) General. There are seven District Nurses operating in the Borough, all of whom are now under the authority of the Kent County Council. 5. After Care and Mental Welfare. These services are supervised locally by the District Officer of the Kent County Council. (c) Local Services provided by Voluntary Organisations. 1. Homeless Children. There are several voluntary institutions in the district which provide excellent care for orphans and homeless children. 7 2. Homes for the Aged. The County Council remains responsible for the care of old people, but it is extremely difficult to obtain accommodation in homes for the aged. The S.O.S. Society opened a Hostel in 1944 at 75, Bromley Road, Beckenham, which has met a real need and The Beckenham Old People's Committee has helped in many ways to provide extra comforts and furnishings for the occupants of this Hostel. The Salvation Army provide a Home for the aged in Crystal Palace Park Road, Anerley. 3. Private Nursing Homes. Most of the premises used for this purpose were damaged by bombing and had to be closed. At the end of 1950 there were 6 private homes registered in the Borough and these provided a total of 96 beds. These premises were inspected under the Nursing Homes (Registration) Act, and 21 visits were made to the premises, HOME HELP SERVICE. This Service is administered by the Kent County Council to whom it was transferred in 1948. The demand for this Service continues to be very heavy—unfortunately the number of applications still outweigh the assistance that can be given. During 1950, the total number of requests for help exceeded 700 and approximately 85 cases per week received some assistance. During the early part of the year there was a reduction in the maximum number of hours that could be given to any one household in one week. Forty hours became the maximum that could be given in any one week instead of forty-seven hours given previously; also the number of workers dropped to an average of 40. This fact, together with the enormous amount of illness which occurred this year, tended to add to the difficulties of running this very necessary Service. 8 LOCAL CLINIC SERVICES. Arrangements in Force. Service Days and Times Premises in Use Ante-Natal 1st and 3rd Fridays in each month, 2—4 p.m. (by appointment) Clinic Block, Hawes Lane, W. Wickham Other Fridays in each month, 2—4 p.m. (by appointment) Clinic Block, Town Hall, Beckenham Child Welfare Monday, 2—4 p.m. Clinic Block, Hawes Lane, W. Wickham Tuesday, 2—4 p.m. (a) Baths Annexe, Beckenham Road (b) Coney Hall Club, W. Wickham Wednesday, 2—4 p.m. (a) Church Hall Langley Road, Elmers End (b) Church Hall, Valley Road, Shortlands Thursday, 10—12 noon 2—4 p.m. Church Hall, Lennard Road, Penge Thursday, 2—4 p.m. (a) Clinic Block, Town Hall, Beckenham (b) Clinic Block, Hawes Lane, W. Wickham Friday, 2—4 p.m. Church Hall, Langley Road, Elmers End Immunisation Second Monday in each month, 2—4 p.m. Clinic Block, Town Hall, Beckenham Every Thursday, 2—4 p.m. Clinic Block, Hawes Lane, W. Wickham (Immunisation is also carried out at most of the above Infant Welfare Centres.) Vaccination First Monday in each month (by appointment —up to 1 year of age), 2—4 p.m. Clinic Block, Town Hall, Beckenham 1st & 3rd Thursday in each month (by appointment) 2—4 p.m. Clinic Block, Hawes Lane, W. Wickham DENTAL (INFANT WELFARE CASES) Fridays—(by appointment) Clinic Block, Town Hall By appointment Clinic Block, Hawes Lane, W. Wickham I Ophthalmic Tuesdays, 2—4 p.m. (by Appointment) Clinic Block, Town Hall, Beckenham I Aural By Appointment Clinic Block, Town Hall, Beckenham 9 Service Days and Times Premises in use Wednesday mornings (twice per month) Surgeon in attendance. Clinic Block, Town Hall, Beckenham Orthopaedic Saturday mornings (once per month) (by Appointment) Surgeon in attendance. Clinic Block, Hawes Lane, W. Wickham Treatment. The Physiotherapist attends daily, by appointment, as follows:— Mondays—All day Tuesdays—Afternoons Wednesdays—All day Thursdays—All day Fridays—Afternoons Clinic Block, Town Hall, Beckenham Tuesdays—Mornings Hawes Lane, Fridays—Mornings Clinic Block Nursing Mothers and Infants. Supervision was carried out at the Infant Welfare Centres and by visits to the homes made by the Health Visitors who are now County staff. There were seven Infant Welfare Centres in the Borough and during the period 9 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. INFANT WELFARE CENTRE ATTENDANCES, 1950 (a) The number of Sessions held during the year was 458. (b) Attendances during the same period 25,070. Diphtheria Immunisation. All the Infant Welfare Clinics in the Borough carry out Diphtheria Immunisation. (a) The number of Sessions held during the year was 355. (b) Attendances during the same period 1,373. Smallpox Vaccination. (a) The number of Sessions held during the year was 202. (b) Number of Vaccinations was 635. 10 INFECTIOUS DISEASE. The number of cases notified during 1950 are shown in the appended Table:— Disease beckenham west Wickham total beckenham west wickham 0-4 years 5—14 years 15 years & over 0—4 years 5—14 years 15 years & over Cerebro-Spinal Meningitis 1 - 1 - - 1 - - - Scarlet Fever 54 39 93 8 40 6 10 27 2 Puerperal Pyrexia 6 1 7 — — 6 — — 1 Erysipelas 7 6 13 — — 7 — — 6 Pneumonia 20 8 28 3 2 15 — 1 7 Typhoid Fever 1 — 1 — 1 — — — — Paratyphoid Fever 2 — 2 1 1 - — — — Dysentery (Amoebic) 2 — 2 — — 2 — — — Dysentery (Bacillary) 12 — 12 3 7 2 - — — Food-poisoning 7 10 17 1 1 5 i 1 8 Acute Anterior Poliomyelitis 6 1 7 1 3 2 i - — Ophthalmia Neonatorum 16 — 16 16 — — — — — Measles 182 11 193 97 77 8 3 8 — Whooping Cough 190 20 210 86 100 4 13 6 1 Chickenpox 65 13 78 10 52 3 — 12 1 Mumps 99 18 117 3 94 2 2 16 11 The table calls for little comment. For the second year in succession no case of Diphtheria was notified. Scarlet Fever, which had been increasing during the later months of the previous year, continued to increase during the early months of 1950: the peak was passed in the month of March and thereafter incidence declined rapidly. The incidence of Infantile Paralysis was again quite high in the country as a whole, but Beckenham escaped comparatively lightly; seven cases were notified and most of them were slight; the cases were scattered and there was no apparent connection between them. The cases of Amoebic Dysentery were puzzling; prevalent in the East, this type of Dysentery does not often appear in this country as a primary infection. There was no evidence that the infection was imported from abroad, and the sufferers were small children; the source of infection was never discovered. The incidence of Measles was lower than in recent years; there are signs that the bi-annual periodicity is beginning to re-establish itself. The percentage of cases among children under school age was markedly greater than it used to be. Although complete and thorough investigation was made into alll of the cases which were notified as Food Poisoning, pathogenic bacteria were not found in any of the specimens of the foods consumed, or in the excreta of the patients. Bacteriological Work. The services of the Kent County Council Laboratories at Maidstone and the Public Health Laboratories at the Park Hospital, Lewisham, are available for use by Beckenham Medical Practitioners. It is not possible to give any factual statistics regarding this work for quite a large number of specimens are sent direct to the Laboratories by Medical Practitioners. New Cases attending the Tuberculosis Dispensaries for the first time during 1950. (INFORMATION FROM THE TUBERCULOSIS OFFICER) Adults Children under 15 years Male Female Male Female Pulmonary 37 28 — - Non-Pulmonary — 1 — - Negative 87 80 7 13 Negative Positive Contacts Examined 131 2 Number of patients admitted to Sanatoria during the year: 68. 12 Dr. Madigan has sent me this report on the work of the Chest Clinics:— Our greatest problem, as in previous years, is the lack of sufficient sanatorium and hospital beds for treating cases of tuberculosis. The numbers of such beds fall far short of what is required; consequently large waiting lists accumulate, and many patients have a considerable time to wait before admission can be secured. There have been great advances in the treatment of tuberculosis since the onset of chemotherapy, which has given great help in getting earlier control over the disease. It has added tremendously to the clinical work, in view of the frequent treatments necessary. Chemotherapy has shown the weakness of the dearth of Thoracic Surgeons in the Country, as patients are made ready for surgery much quicker by this form of treatment. Unfortunately, however, they still have to wait between eighteen months to two years in the majority of cases before surgical treatment is available for them. Advances in the treatment of tuberculosis have thrown a great strain on the Health Visitors. Where formerly their duties were home visitation, propaganda, and prevention and helping patients and their families in their day to day problems, their services are now very much in demand for active treatment measures, such as artificial pneumothorax, etc. The great increase in this form of treatment has made it necessary for an appeal to be made for more Health Visitors. Tiberculosis 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 the Committee for their continued good work for the benefit of the Tuberculosis patient. 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 mile 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. 13 TUBERCULOSIS—Table of Notifications and Deaths, 1950, 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. PK. K.H. m.h. C.C. E.P. PK. L. Shortlands w.w. Notifications New Cases only Pulmonary 47 28 75 1 2 1 14 11 17 11 11 4 3 7 6 15 2 16 9 8 12 Non-Pulmonary 2 3 5 2 1 - - 1 1 — — — — 1 2 1 — — — — 1 Totals 49 31 80 3 3 1 14 12 18 11 11 4 3 8 8 16 2 16 9 8 13 Deaths Pulmonary 12 8 20 — - — - 1 3 3 7 4 2 1 3 3 1 4 3 1 4 Non-Pulmonary - 1 1 - 1 - - - - - - - - - - - - - - - 1 Totals 12 9 21 — 1 — — 1 3 3 7 4 2 1 3 3 1 4 3 1 5 14 HOUSING. Although there was no immediate change for the better in the Housing situation during the year, there wis a more hopeful outlook for the future. More building sites were discovered and preliminary steps were taken in determining their possibilities. These sites, if fully developed, would provide space for nearly 350 new housing units. The proposals before the Council contained suggestions for the redevelopment of part of the Borough, and for some changes in building density. If this principle is accepted and extended it should be possible ultimately to cope with the housing needs of the Borough without encroaching on any existing open spaces. The matter is still very urgent. During 1950 it was only possible to rehouse 75 families, and of this number 45 were rehoused in requisitioned properties. 15 REPORT ON THE SANITARY ADMINISTRATION of the DISTRICT FOR THE YEAR, 1950. By G. A. Webber, Chief Sanitary Inspector, Borough of Beckenham It is my privilege to submit my sixth Annual Report of the work of the Sanitary Inspectors. There were many staff changes during the year, and this tends to upset the smooth routine working of any Department. The death of Mr. William Newman, a District Sanitary Inspector, was very keenly felt by us all, and the Council thereby suffered the loss of a concientious and efficient officer. Mr. Victor Jordan, who was appointed in 1949. resigned his appointment in April, 1950, to take up duties as one of His Majesty's Inspectors of Factories, after having been placed second in the English examination lists for this appointment. Mr. H. R. Dawkins, and Mr. G. W. Mathews filled the vacancies arising. There have,too, been resignations and new appointments to the clerical staff. There has been a decrease in the number of complaints of alleged statutory nuisances during the year. These complaints, which come mainly from the lower standard houses in the area, usually relate to matters of structural and decorative repair, and it was quite normal to receive, during any year, many complaints about the same property For some time, however, the Department has concentrated on this type of property, serving Notices, after complete and thorough inspection, under the Housing Act, 1936. The complete reconditioning of many such properties due to this work provides a reason for the decrease in the number of complaints. The continuance of war damage repair to all types of property in the Borough has also removed many possible sources of complaint. During 1950, 49 houses have been completely reconditioned, and, at the close of the year work was in progress on 71 other properties. 125 houses have been made fit in all respects since this work was commenced. Where we are satisfied that only one or two items require attention in a property we proceed under the nuisance sections of the Public Health Act, 1936, and by far the larger number of Notices are served under this Act. Special mention should be made of the co-operation of the majority of Owners concerned. In many instances the cost of work required under a Housing Act Notice absorbs the net annual income of the property for many years, and the operation of the Rent Restrictions Acts precludes, in most cases, the increase of rental to meet these costs. Nevertheless, whilst our sympathies may frequently be with an Owner, particularly when that person is aged, and more than partly dependant on the income of the property, there is always the other side of the picture. The Local Authority's duty is clear. It should not tolerate the occupation of unfit property, and it should be remembered that in particularly distressing cases of financial hardship assistance can be given to enable an owner to re-pay by instalments the cost of the repairs. 16 Statistical information is appended relating to the work of house inspection:— Number of complaints received and investigated 1,619 Number of initial visits 4,023 Number of revisits 6,603 Number of Intimation Notices served 478 Number of Statutory Notices served 133 Nuisances Found and Remedied. found remedied Structural defects—external 688 1,185 Structural defects—internal 1,652 1,833 Insanitary conditions, other than vermin 95 129 Verminous conditions 6 8 Choked drains 242 240 Other drainage defects 185 183 Defective sanitary appliances 128 122 Insufficient or unsuitable water supply 14 14 Absence of dustbins 36 40 Offensive accumulations 6 6 3,052 3,760 Housing—Inspection of Dwelling Houses during the Year. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,371 Number of inspections made for the purpose 4,896 Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 100 Number of inspections made for the purpose 1,086 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 to be in all respects reasonably fit for human habitation 478 Number of dwelling-houses in respect of which informal notices were served 478 Number of dwelling-houses in which defects were remedied after service of informal notices 345 Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 133 Number of dwelling-houses in which defects were remedied after service of formal notices: (a) by owners 130 (b) by Local Authority in default of owners 3 Properties not Possessing Main Drainage Systems. The position remains substantially the same as the details given in the 1949 Annual Report, and may be summarised as follows:— Number of cesspools in the area 17 Number of domestic properties connected to cesspools 24 Number of sports pavilions connected to cesspools 11 Number of properties having earth closet or chemical closet accommodation 7 (Not including moveable dwellings). 17 Legal Proceedings. (a) Statutory Nuisances. Proceedings were instituted in four cases where persons responsible failed to comply with Statutory Notices served by the Authority In one instance the Summons was withdrawn on the payment of £3 3s. 0d. costs. Nuisance Orders were made, and costs imposed, in the other cases, in one of which the Council sought and obtained a penalty and further costs for non-compliance with the Nuisance Order. The necessary work was subsequently completed. (b) Unsound Food. Proceedings were instituted in three cases all concerned with the careless contamination of food. Fines and costs amounting to £39 15s. 0d. were imposed upon the defendants. Moveable Dwellings. Six families occupied moveable dwellings under licence from the Council during 1950. Frequent inspections were made, but no public health nuisance was discovered. Food Premises. We have devoted a good deal of time to the inspection of food shops, and foodstuffs. During the year the Council made Byelaws under Section 15 of the Food and Drugs Act, 1938, for securing the observance of sanitary and cleanly conditions and practice in connection with the handling, wrapping, and delivery of food, and each occupier of food premises in the area received a copy of the Byelaws, together with a covering letter emphasising the more important points, and seeking co-operation. It was not necessary to take statutory action under the Byelaws. Warnings were given to certain traders, but, generally speaking, satisfaction may be expressed with the conduct of food shops in the area. One should, I think, make a plea for a reasonable and common sense attitude on this subject. Some of the suggestions and demand made by inexperienced persons for the improvement of food handling border on the farcical. We should, and do, emphasise the need for the exercise of personal hygiene by all food handlers, keeping particular vigilance on those dealing with foods which provide an excellent medium for the spread of infection. Through the co-operation of traders, many tons of food were surrendered to the Inspectors as unfit for human consumption. This is destroyed under supervision, or if the food is allowed to return to the original vendor in some other district, the Inspector of that area is notified It was not necessary formally to sieze any food because of its unsoundness. 18 Complaints of unsound or contaminated food. During the course of any year many and varied types of food are brought to the Department for examination. Each case is thoroughly investigated, and where considered necessary the Council has instituted proceedings against the manufacturers or vendors. Some complaints are completely unjustified. Others may have some justification but do not allow of official action being taken. Meat particularly comes into this latter category. It is sometimes difficult for the public to realise that what is unappetising or distasteful is not necessarily unfit for human consumption. It is only if we are able to certify food as unfit for human consumption that we can condemn and destroy it. A few instances of the delivery of milk in "dirty" bottles were brought to our notice, but we were satisfied that no case of wilful neglect or unnecessary carelessness was brought to light. When one considers the millions of bottles delivered in Beckenham annually the number of failures to find and reject the dirty or stained bottle are surprisingly few. Great care is exercised, as may be judged by the thousands of bottles which are discarded by dairymen because of careless handling by the public after the milk has been consumed. The filthy condition in which some bottles are returned to vendors has to be seen to be believed. Bacon, alleged to have caused illness to one member of a family, was examined and found to be perfectly fit for food. As a result of the inspection of a quantity of soya flour found to contain maggots, supplies in this area and in other boroughs were withdrawn. The sale in certain shops of food so varied as sweets and greengrocery, leaves, in my opinion, much to be desired. However there exists no law to forbid this practice, but we pay particular attention to such an establishment in order that the dangers of contamination are minimised. Complaint was made, by the consumer of a proprietary brand of Glycerine, Lemon, and Ipecac, that burning of the mouth and throat was caused after drinking the mixture. The Analyst could find no reason for this happening, but his remarks on the article generally were interesting:- ... the article is a very poor thing altogether. Really it is a sugar syrup, coloured and flavoured with citric acid, containing only about 2½ per cent glycerine, and a minute amount of ipecacuhana. It is doubtful whether it contains any other constituents of lemon apart from the citric acid" The retail cost of this article was one shilling and ninepence per bottle. It was not sold "recommended as a medicine" and there fore no legal standard has to be attained. Food and Drugs Sampling. One of the most important duties of sanitary officers is the official sampling of food and drugs. It is essential that this work shall be culously carried out, with strict observance of all the requirements of the 19 law. The importance of attention to detail cannot be overestimated for failure to observe any of the rules laid down may well lead to an; ensuing legal proceedings being dismissed by a Court on technical grounds. Samples may be taken formally or informally, but, in the interest of the public, formal sampling is to be preferred. Any adulteration of foods and drugs discovered by informal sampling cannot be followed by legal proceedings. Of the 132 samples obtained by the sampling officers during 1950 only 14 were obtained informally, and these were all returned as genuine. It is indeed very rare for sampling authorities to obtain adulterated samples in these days, whereas twenty to thirty years ago wilful adulteration was consistently brought to light. This statement does not refer to Beckenham particularly but to the country as a whole. The article most sampled, following usual custom, was milk. Sixty formal samples were obtained, and no instance of wilful adulteration was discovered. One wonders whether it is necessary in Beckenham to maintain such frequent sampling of milk supplies. At one time, of course, it was the food most commonly adulterated. The vast majority of milk now consumed in Beckenham is delivered in sealed containers, and with the greatly improved conduct of the industry the adulteration of such milk is unlikely. On the other hand we do receive queries from some residents who feel that some tampering has taken place. Our regular sampling enables us satisfactorily to answer these statements. The procedure for formal sampling is very fair to all concerned. Each formal sample obtained is immediately divided into three parts, in or at the place of sampling, be that in shop premises or in the open street. Each "third" is placed into a container in the presence of the vendor, and officially sealed, and stamped for identification. One part is returned to the vendor, another is submitted to the Public Analyst, and the remaining part retained by the sampling officer, who is required to produce that part in the event of proceedings ensuing. If desired, this part of the sample may subsequently be submitted to a Government Analyst. The officer is required to make a statutory declaration of his intention to submit the sample for analysis, and he must on no account leave the shop or place of taking the sample until all these formalities are fulfilled. Of the other samples taken (a list is appended) a sample of sausages was returned as inferior by the Analyst. On his advice, however, no legal proceedings were commenced against the vendor. The meat content of the sausages was not quite up to standard in quantity, but the Analyst submitted that the deficit was not sufficiently removed from "toleration point" to justify action. A sample of curry powder was found to contain fifteen parts per million of lead, whereas the statutory maximum is ten parts per million. Again the Analyst submitted that legal action was not called for, and a letter was sent to the manufacturers, calling attention to matter, and certain stocks were withdrawn. 20 Samples of a mineral water "soft drink," made by dissolving tablets in water with the addition of carbonic acid gas proved to be adulterated, being deficient in sugar and saccharine content. This drink was however sold and consumed on the premises where it was prepared, and in these circumstances no offence was committed, the legal standard not being applicable to such a sale. The drink was retailed at one penny per bottle, and was quite harmless to the consumer. Its price certainly did not indicate nutritive value. It is worthy of note, however, that had the drink been sold for consumption off the premises where it was made and vended, an offence against statute would have been committed and legal proceedings would have been instituted. This appears to be an instance where Mr. Bumble's remarks on the law are completely justified. article formal samples informal samples Milk 60 — Currant Sugar 1 — Honey 1 — Peanut Butter 1 — Gravy Powder 1 — Sandwich Spread 2 — Sausages 12 — Potted Meat — 1 Golden Raising Powder — 1 Bicarbonate of Soda — 1 Custard Powder — 1 Glycerine 1 — Pepper Compound 1 — Onion Powder 1 — Black Pepper 1 — Olive Oil 3 — White Pepper 4 — Malt Vinegar 1 — Salad Cream 1 — Coffee and Chicory Extract 2 — Potato Crisps — 2 Cough Mixture 1 — Aspirin 1 — Gelatine 1 — Fish Cakes — 2 Pastries — 1 Sweets — 1 Liquid Paraffin 1 — Parrish's Food 1 — Glauber Salts 1 — Apple Juice 1 — Ground Ginger 2 — Coffee Extract 2 — Whisky — 2 Glace Cherries 1 — Curry Powder 1 — Ground Almonds 3 — Ginger Wine 3 — Rum 1 Epsom Salts 1 - Mineral Water 2 1 Mineral Water Tablets — 1 Eucalyptus 1 — Lemon Squash 1 — 21 Waterways. The streams which flow through the Borough become polluted from various sources, and give rise to complaint. I am happy to report that we have been able to track down and eliminate some sources of pollution, but it is possible that nuisance will continue to arise from this cause, and every care will be shown in dealing with the matter. Noise Nuisances. Complaints arise from noise nuisances and effluvia from business premises. Again, wherever possible, remedial action is taken. The answer, in many cases, is that nuisance to one party or another cannot entirely be eliminated where residences and business premises art closely related, sometimes in the same building. Smoke Nuisances. A recurring complaint related to the smoke and grit issuing from the chimney of the London Electricity Board's Power Station in Churchfields Road. Following the service of a Statutory Notice under The provisions of the Public Health Act, 1936, the position considerably improved, although isolated instances of heavy smoke and grit emission still occurred. The greatest co-operation was received from the staff of the Station, and they kept regular observation and records in an effort to minimise the nuisance, which undoubtedly is due largely to the inferior quality of the fuel supplied. The Superintendent of the station personally interviewed any complainant known to him, and offered to show any interested persons over the Station to learn the steps which had been taken to deal with the matter. It is a sound defence, in law, to show that the best practicable means have been taken to deal with a nuisance arising from smoke emission, and this defence is now, I am sure, available to the London Electricity Board. The point, once again, is that there exists an industrial undertaking in a residential area. Disinfection. The Council undertakes, free of charge, the disinfection of rooms, articles of clothing, and bedding after cases of Tuberculosis, and, occasionally, other infectious diseases. Many requests, however, are received from residents for the steam disinfection of bedding, etc., after its use in cases of illness other than infectious disease. The requests are met but a charge is made for this service. During 1950 one hundred and twenty-six such applications were received, and accounts for £118 10s. 0d. were rendered by the Department. The steam disinfector is situated in Churchfields Road. The service includes the collection and return of all articles dealt with. Ninety-eight library books were collected from houses Where infectious disease had occurred, were disinfected, and returned library of origin. 22 Rat and Mouse Repression. The service offered by the Council to assist householders, free of charge, to reduce infestation in their properties, continued during 1950 ; and many business premises were serviced, a charge being made. The Council works at the Direction of the Ministry of Agriculture and Fisheries in this matter, and the work has come to assume quite large proportions, both practically and administratively, in the Department. I am glad to be able to report that in the vast majority of rat infestations in private houses, the nuisance was confined to the gardens of the properties. There was a considerable increase in the number of complaints of mice. This, I find from my colleagues in other areas, is general. 753 complaints were received during the year and the rodent staff paid 5,315 visits to premises. It is impossible to give any idea of the number of rats and mice destroyed, but the measure of control exercised over the problem was completely satisfactory. In addition to our work against the "surface" rat, the sewers serving the Borough are serviced twice annually, in accordance with Ministerial Direction, to destroy rats in sewers. This work has proceeded, and the evidence available is satisfactory in that it proves that infestation of the sewers is kept at a minimum. Ice Cream Manufacture and Sale. Whereas in 1949, seven local tradesmen manufactured and sold their own ice cream, this number was, in 1950, reduced to three, the remainder obtaining their supplies from manufacturers outside the Borough. Thirty nine samples of ice cream were obtained during the year, and submitted for bacteriological examination. In no case were pathogenic organisms isolated from the samples. A very full report on this subject was included in the Annual Report for 1949, and there has been no further development calling for special report here. Factories Act, 1937. Two hundred and twenty two visits of inspection were made to factories in the area. The following nuisances were remedied following the service of informal notices:— Want of cleanliness 4 Insufficient sanitary accommodation 1 Unsuitable or defective sanitary accommodation 8 Sanitary accommodation not separate for the sexes 2 Water Supply. The water supply of the area has been satisfactory in quality and quantity, the Metropolitan Water Board supplying all properties in the area by main. 23 Bacteriological examination has been regular, thirty-eight samples being taken during the year. All proved to be satisfactory. Shops Acts. Nine hundred and fifty four (954) visits were paid in connection with the Shops Acts. Thirty four (34) contraventions were discovered and remedied. Mortuary. The Beckenham Mortuary has always been the responsibility of the Public Health Department, but prior to 1950, the Mortuary Attendant was a part time officer attached to the Borough Engineer's Department In 1950 the Council appointed a Mortuary Attendant-Handyman to the staff of the Public Health Department, and consequently it has been possible to keep a closer check on the administration of the service. It is not possible to confine the use of such premises to routine hours, but with the co-operation of local undertakers, and the Coroner's Officers, it has been possible to establish a system which enables the service to receive the discreet treatment it should. During 1950, one hundred and twenty bodies were brought to the Mortuary, where post-mortem examinations were conducted by the Home Office Pathologist. The Department's Mortuary Attendant is responsible for the clean maintenance of the building, the reception and collection of bodies, assistance at post-mortems, and the preparation and arrangements of a Town Hall room for the purposes of inquest. In addition he takes charge of any clothing or valuables found, the latter, of course, being returned almost immediately to the next-of-kin. In conclusion I should like to express my sincere thanks to Dr. T. Philips Cole for his help and guidance in the conduct of the work of the Sanitary Inspectors, and to my immediate colleagues my thanks are due for their loyal co-operation in every aspect of our work. G. A. WEBBER, Chief Sanitary Inspector 24 c.4412 (1) BECITENHAM BOROUGH OF BECKENHAM SUPPLEMENT TO THE REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1950 T. PHILIPS COLE, M.B., D.P.H. Medical Officer of Health BOROUGH OF BECKENHAM SUPPLEMENT TO THE REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1950 T. PHILIPS COLE, M.B., D.P.H. Medical Officer of Health SUMMARY OF VITAL STATISTICS, 1950. Area of District in acres 5,935 Civilian Population as estimated by Registrar-General at 30th June, 1950 75,850 Civilian Population per acre .. .. .. .. .. 12.7 Rateable Value at 1 /10/50 £879,563 Births Registered: male female Legitimate 475 438 Illegitimate 10 14 Total 937 Birth Rate per 1,000 of Civilian Population 12.3 Deaths Registered: male female 382 401 Total 783 Death Rate per 1,000 population 103 Infant Mortality Rate per 1,000 births 192 Maternal Mortality Rate per 1,000 births Nil Deaths of Infants under 1 year of age: male female Legitimate 11 7 Illegitimate — — Total 18 Deaths from Enteritis under 2 years of age Still Births— Rate per 1,000 population 0.23 Rate per 1,000 births 19.2 male female Legitimate 8 10 Illegitimate — — Total 18 Death Rate from Cancer (131 deaths) 1.72 Death Rate from Pulmonary Tuberculosis (18 deaths) 0.23 Death Rate for Non-Pulmonary Tuberculosis (1 death) 0.01 2 Table A. Birth rates, Civilian death rates, and Infant Mortality in the year 1950. 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: BirthsLive 15.8 17.6 16.7 17.8 12.1 Still 0.37 0.45 0.38 0.36 0.23 Deaths 11.6 12.3 11.6 11.8 10.3 Rates per 1,000 Live Births. Deaths under 1 year of age 29.8 33.8 29.4 26.3 19.5 Deaths from Diarrhoea and Enteritis under 2 years of age 1.9 2.2 1.6 1.0 1.1 3 TOTAL DEATHS, 1950 (Registrar-General's Official Returns). All causes—783; Male, 382; Female, 401. Causes of Death males females 1 Tuberculosis, respiratory 12 6 2. Tuberculosis, other — 1 3. Syphilitic disease 1 1 4. Diphtheria — — 5. Whooping Cough — 1 6. Meningococcal infections — — 7. Acute poliomyelitis — - 8. Measles — — 9. Other infective and parasitic diseases 1 1 10. Malignant neoplasm, stomach 7 11 11. Malignant neoplasm, lung, bronchus 17 5 12. Malignant neoplasm, breast — 21 13. Malignant neoplasm, uterus — 4 14. Other malignant and lymphatic neoplasms 40 26 15. Leukaemia, aleukaemia — — 16. Diabetes 2 4 17. Vascular lesions of nervous system 42 62 18. Coronary disease, angina 74 38 19. Hypertension with heart disease 15 18 20. Other heart disease 50 108 9 21. Other circulatory disease 14 22. Influenza 2 4 23. Pneumonia 11 6 24. Bronchitis 20 11 25. Other diseases of respiratory system 4 2 26. Ulcer of stomach and duodenum 7 — 27. Gastritis, enteritis and diarrhoea — 1 28. Nephritis and nephrosis 4 7 29. Hyperplasia of prostate 10 — 30. Pregnancy, childbirth, abortion — — 31. Congenital malformations 2 1 32. Other defined and ill-defined diseases 38 41 33. Motor vehicle accidents 2 3 34. All other accidents 3 5 35. Suicide 4 4 36. Homicide and operations of war — Totals 382 401 4 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 per 1,000 of population Legitimate Illegitimate Total Legitimate Illegitimate Total Rate per 1,000 live Births 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 1947 74,030 1,278 36 1,314 17.749 36 3 39 33 4 37 28.15 1948 75,050 1,051 22 1,073 14.297 22 2 24 12 3 15 13.98 1949 75,630 1.046 30 1,076 14.227 23 1 24 29 - 29 26.95 1950 75,850 895 24 919 12.116 18 - 18 18 - 18 19.58 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 population Number Rate per 1,000 population 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 0.314 142 2.190 1947 736 9.975 3 19 0.256 136 1.775 1948 695 9.260 1 26 0.346 128 1.706 1949 798 10.551 1 22 0.290 130 1.718 1950 783 10.323 NIL 18 0.237 131 1.727 5 INFANTILE MORTALITY, 1950. The number of deaths of infants under the age of twelve months was 19 as compared with 29 in 1949. The Registrar-General returns only 18 infant deaths and the Infant Mortality Rate for the year was 19.5 per 1,000 live births. The following Table shows the causes of death in 19 cases for which full records exist. Table of Infantile Mortality. Age in Weeks. Total under one mth. Age in Months. Total under one year. under 1 1-2 2-3 3-4 1-3 4-6 7-9 10-1 A. Congenital Defects. Hydrocephalus - - - - - - 1 - 1 B. Ante-natal or Intra-natal Conditions. Prematurity 10 - - - 10 - - - - 10 Obstructed Labour 1 — — — 1 — — — - 1 C. Infections. Broncho-pneumonia - - - - - 1 - - - 1 Broncho-pneumonia— Empyema - - - - - - 1 - - 1 Broncho-pneumoniaMongolism - - - 1 1 - - - - 1 Pneumonia - - - - - 1 - - — 1 Whooping-Cough - - - - - - - 1 — 1 Acute Pharyngitis - - - - - - - 1 — 1 Cerebellar Abscess 1 — — — 1 — — — — 1 12 — — 1 13 2 2 2 - 19 It will be noted that over half the deaths were due to Prematurity. Of the infants who survived the first week of life, seven subsequently died before reaching the age of twelve months. 6