Ac4412(1)Beckenham BOROUGH OF BECKENHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1951 BY L. R. L. EDWARDS, M.D. (Lond.), M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. BOROUGH OF BECKENHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1951 BY L. R. L. EDWARDS, M.D. (Lond.), M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1951 TABLE OF CONTENTS PAGE 1. Members of Public Health Committee 3 2. Staff of Public Health Department 3 and 4 3. Introduction 4 and 5 4. Summary of Vital Statistics 6, 7, 8, 9 and 10 5. General Provisions of Health Services in Area 11, 12, 13 and 14 6. Infectious Disease :— (a) Table of Cases 15 and 16 (b) Tuberculosis and work cf Chest Clinics—Report by Dr. D. G. Madigan 17 and 18 (c) Tuberculosis— Incidence and Deaths 19 7. Report on the Sanitary Administration of the District by Mr. Mr. G. A. Webber, Chief San.I. Introduction 20 Nuisances found and remedied 21 Housing inspections 22 Properties not possessing main drainage 22 Unsound Food 23 Food Handling and Food Premises 23 and 24 Food and Drugs Sampling 24 and 25 Ice Cream 26 Waterways 26 Smoke Nuisances 26 Disinfection 26 Drainage 27 Water Supply 27 Moveable Dwellings 27 Factories 27 Shops 27 Mortuary 28 Rat and Mouse Repression 28 and 291 2 MEMBERS OF THE PUBLIC HEALTH COMMITTEE YEAR 1951-52. Chairman : Councillor C. B. Curtis, M.B.E. Deputy Chairman : Councillor A. R. Waylett. Alderman R. S. Jackson. Councillor R. A. Barraclough. Councillor R. C. Cheeseman. Councillor Miss K. A. Moore. Councillor G. A. Petty. Councillor G. H. Robertson. Councillor A. C. Garrett. Councillor G. E. Fish. 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 Chief Sanitary Inspector Deputy Chief Sanitary Inspector District Sanitary Inspectors T. Philips Cole, M.B., D.P.H. (resigned June, 1951). L. R. L. Edwards, M.D., D.P.H. (appointed October, 1951). G. A. Webber, Certificate of the Royal Sanitary Institute and the Sanitary Inspectors' Examination Joint Board. Certificated Food Inspector. E. U. Williams, Cert. R.S.I, and S.I.E.J.B., Certificated Food Inspector. H. G. Richards, Cert. R.S.I. Certificated Food Inspector. W. T. G. Woodard, Cert. R.S.I, and S.I.E.J.B. Certificated Food Inspector. H. R. Dawkins, Cert. R.S.I, and S.I.E.J.B. G. W. Mathews, Cert. R.S.I, and S.I.E.J.B. 3 Clerical Staff: Secretarial Assistant Clerks Mrs. E. A. Best. Miss C. Mawbey. Miss A. Keen. Miss A. Hobbs. Rodent Operators W. J. E. Wickenden. E. J. Read. Disinfector-General Assistant .. J. Symonds. Mortuary Attendant— General Assistant A.L.Jarvis. INTRODUCTION. To the Chairman and Members of the Public Health Committee. IH A V E the honour to submit a report on the health of the Borough for the year 1951. I greatly appreciated the advice and assistance of Dr. K. E. Tapper, Medical Officer of Health for Bromley, who acted as Medical Officer during the period between the retirement of Dr. Cole and the time when I could take up my appointment. The statistics show a decrease of 1,030 in the population of the Borough and a reduction in the civilian population per acre. Total deaths from all causes increased by 49 ; of these, 32 are of females and 12 are of males. This preponderance of deaths among females is found to be spread throughout the 36 causes of death for both sexes and is not attributable to any one factor. Deaths due to malignant disease of the lungs are 15 times more common in males who also suffer nearly twice as many deaths from coronary and anginal disease of the heart. Chronic degenerative disease of the heart, not associated with high blood pressure, accounts for nearly twice as many female deaths. Remaining causes of death listed in the report vary little from previous years. Certain mortality rates have increased: the Death Rate by 0.8 per 1,000 ; Infant Mortality Rate by 9.07 per 1,000 and Maternal Mortality by 1.02 per 1,000 on rates for the previous year, while there were 9 more deaths of infants under 1 year of age. Mortality rates which have decreased include Stillbirth death rate by 0.2 per 1,000 ; Cancer death rate by .01 per 1,000 and Pulmonary Tuberculosis death rate by .10 per 1,000. The death rate from NonPulmonary Tuberculosis remains as in 1950. The variations in these rates are mainly statistical and due to the decrease in the population of the Borough. The report on infantile mortality shows that one third of deaths are due to infections and less than one-fifth to congenital conditions. 4 This year the report shows from notifications, the monthly incidence of infectious diseases and their relative frequency in Beckenham. There were no deaths from these diseases to report during the year. It is of interest that 30 out of 84 cases of Scarlet Fever were admitted to hospital while in the case of measles the figure is 10 cases out of 1,108. The number of cases of food poisoning notified is not unduly high and is half that of another intestinal complaint—bacillary dysentery. Two of three cases of infantile paralysis are of school age ; all are of the paralytic type and are receiving hospital treatment. There are no serious epidemics to report but the incidence of measles and chickenpox is rather higher than usual. Notifications of new cases of Tuberculosis show a reduction of 12 during the year. For a population of 74,880 the notification of 68 new cases of tuberculosis must be considered very low and this is confirmed by the results of a mass radiography survey undertaken by the South Eastern Metropolitan Regional Hospital Board. The first Beckenham survey was undertaken in 1948 and this "pilot survey" lasting two weeks was followed in the autumn of 1950 by a more comprehensive survey conducted by a mobile unit operating in central Beckenham over a period of two weeks. In September a survey was carried out in West Wickham over a period of four days when 1,031 persons attended compared with 4,856 persons in 1950 for Central Beckenham. At the same time, it must be recorded that weather conditions were most unfavourable in 1950. The results of the three surveys were excellent. During the year the Department dealt with enquiries covering a wide variety of matters. By some, information was sought on nursing recruitment and employment; by others on accommodation in old people's homes in this area and in other parts of the country; yet by others on risks of infection; and throughout the year enquiries on nuisances are received and dealt with. The Health Department as a Health Centre of Information, situated as it is in the municipal centre, closely linked with other civic departments, fulfills a traditional role which yearly becomes more important with the increase in complexity of modern legislation and social and health services. I wish to express my sincere thanks for their friendly co-operation to Dr. Ward of the County staff and to Dr. Elliott the County Medical Officer of Health : to you Mr. Chairman and members of your Committee I offer my appreciation for your friendly welcome and encouragement, and to the members of my staff—my thanks for the enthusiasm, zeal and happy esprit-de-corps that prevails through the department. L. R. L. EDWARDS, Medical Officer of Health. 5 SUMMARY OF VITAL STATISTICS, 1951. Area of District in acres 5,935 Civilian Population as estimated by Registrar-General at 30th June, 1951 74,880 Civilian Population per acre 12.6 Rateable Value at 1/10/51 £892,458 Births Registered (Including Stillbirths) : male female Legitimate 503 449 Illegitimate 13 12 Total Birth Rate (Including Stillbirths) per 1,000 of Civilian Population 13.04 Deaths Registered : male female 399 433 Total .. 832 Death Rate per 1,000 population 11.1 Infant Mortality Rate per 1,000 live births 28.09 Maternal Mortality Rate per 1,000 births 102 Deaths of Infants under 1 year of age : male female Legitimate 18 8 Illegitimate 1 — Total Deaths from Enteritis under 2 years of age Still Births— Rate per 1,000 population 0.21 Rate per 1,000 births 16.4 male female Legitimate 9 6 Illegitimate 1 Total Death Rate per 1,000 of Civilian Population from Cancer (129 deaths) Death Rate per 1,000 of Civilian Population from Pulmonary Tuberculosis (10 deaths) Death Rate per 1,000 of Civilian Population from Non- Pulmonary Tuberculosis (1 death) 0.01 6 Table A. Birth rates, Civilian death rates, and Infant Mortality for the year 1951. 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 15.5 17.3 16.7 17.8 12.8 Still 0.36 0.45 0.38 0.37 0.21 Deaths 12.5 13.4 12.5 13.1 11.1 Rates per 1,000 Live Births. Deaths under 1 year of age 29.6 33.9 27.6 26.4 28.09 Deaths from Diarrhoea and Enteritis under 2 years of age 1.4 1.6 1.0 0.7 1.04 7 TOTAL DEATHS, 1951 (Registrar-General's Official Returns). All causes—832; Male, 399; Female, 433. causes of death males FEMALES 1. Tuberculosis, respiratory 10 0 2. Tuberculosis, other 0 1 3. Syphilitic disease 4 0 4. Diphtheria 0 0 5. Whooping Cough 0 1 6. Meningococcal infections 0 0 7. Acute poliomyelitis 1 0 8. Measles 0 0 9. Other infective and parasitic diseases 1 1 10. Malignant neoplasm, stomach 14 7 11. Malignant neoplasm, lung, bronchus 15 1 12. Malignant neoplasm, breast 0 12 13. Malignant neoplasm, uterus 0 7 14. Other malignant and lymphatic neoplasms 30 43 15. Leukaemia, aleukaemia 2 2 16. Diabetes 0 3 17. Vascular lesions of nervous system 40 81 18. Coronary disease, angina 71 39 19. Hypertension with heart disease 20 18 20. Other heart disease 61 1ll 21. Other circulatory disease 11 14 22. Influenza 11 9 23. Pneumonia 16 18 24. Bronchitis 14 13 25. Other diseases of respiratory system 6 5 26. Ulcer of stomach and duodenum 5 0 27. Gastritis, enteritis and diarrhoea 1 0 28. Nephritis and nephrosis 3 7 29. Hyperplasia of prostate 7 0 30. Pregnancy, childbirth, abortion 0 1 31. Congenital malformations 3 2 32. Other defined and ill-defined diseases 37 24 33. Motor vehicle accidents 4 4 34. All other accidents 9 5 35. Suicide 3 4 36. Homicide and operations of war 0 0 Totals 399 .. 433 8 9 VITAL STATISTICS FOR YEARS 1943 to 1951 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 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 1951 74,880 937 24 961 12.833 15 1 16 26 1 27 28.09 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 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 1951 832 11.111 1 10 0.133 129 1.709 INFANTILE MORTALITY, 1951. The number of deaths of infants under the age of twelve months was 28 as compared with 19 in 1950. The Registrar-General returns only 27 infant deaths and the Infant Mortality Rate for the year was 28.09 per 1,000 live births. The following Table shows the causes of death in 28 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 10-12 A. Coneenital Defects. Hydrocephalus - - - - - - 1 - - 1 Diaphragmatic hernia 1 - - - 1 - - - - 1 Heart 2 - 1 - 3 - - - - 3 B. Ante-natal or Intra-natal Conditions. Prematurity 6 1 - - 7 - - - - 7 Prematurity and Placenta Praevia 1 - - - 1 - - - - 1 Subarachnoid haemorrhage 1 - - - 1 - - - - 1 Subarachnoid haemorrhage and Toxaemia of Pregnancy 1 - - - 1 - - - - 1 Kernicterus 1 - - - 1 - - - - 1 C. Broncho-pneumonia.. - 1 1 - 2 2 1 - 1 6 Broncho-pneumonia— Mongolism 1 - - - 1 - - - - 1 Whooping-Cough Infantile - - - -*- - - - 1 - 1 Gastroenteritis - - - - - - 1 - - 1 D. Accidental. Asphyxia - - - - - 1 1 - - 2 E. Sacral Teratoma (operation) 1 - - - 1 - - - - 1 Totals 15 2 2 - 19 3 4 1 1 28 Over half the deaths occurred in the first week of life and of these at least three-fifths are regarded as preventable. 10 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 12 and 13 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 several 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. 11 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 1951 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 23 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. LOCAL CLINIC SERVICES. Arrangements in Force. Service Days and Times Premises in Use 2nd and 4th Fridays in each Clinic Block, Town Hall, month, 10—12 noon (by Beckenham Ante-Natal .. appointment) Other Fridays in each Clinic Block, Hawes Lane, month, 2—4 p.m. (by W. Wickham appointment) 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, Child Elmers End Welfare (b) Church Hall, Valley Road, Shortlands Thursday, 10—12 noon Church Hall, Lennard Road, „ 2—4 p.m. Penge Thursday, 2—4 p.m. (a) Clinic Block, Town Hall, Beckenham (6) Clinic Block, Hawes Lane, W. Wickham Friday, 2—4 p.m. Church Hall, Langley Road, Elmers End 12 Service Days and Times Premises in use Second Monday in each Clinic Block, Town Hall, month, 2—4 p.m. .. Beckenham Immunisation Every Monday, 2—4 p.m. Clinic Block, Hawes Lane, W. Wickham First Monday in each Clinic Block, Town Hall, month (by appointment Beckenham —up to 1 year of age), Vaccination .. 2—4 p.m. 1st & 3rd Monday in each Clinic Block, Hawes Lane, month (by appointment) W. Wickham 2—4 p.m. Dental (Infant Fridays— (by appointment) Clinic Block, Town Hall Welfare Cases) By appointment Clinic Block, Hawes Lane, W. Wickham Ophthalmic .. Wednesdays, 2—4 p.m. Clinic Block, Town Hall, (by Appointment) Beckenham Wednesday mornings (twice Clinic Block, Town Hall, per month) Beckenham Surgeon in attendance. Orthopaedic Saturday mornings (once Clinic Block, Hawes Lane, per month) W. Wickham (by Appointment) Surgeon in attendance. Treatment. The Physiotherapist attends daily, by appointment, as follows :— Mondays— All day Tuesdays— Afternoons Clinic Block, Wednesdays— All day Town Hall, Thursdays— All day Beckenham Fridavs— Afternoons Tuesdays— Mornings Fridays— Mornings Hawes Lane, W. Wickham, Clinic Block 13 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 Centre appear in the Table of Local Clinic Services. INFANT WELFARE CENTRE ATTENDANCES, 1951. (a) The number of Sessions held during the year was 460. (b) Attendances during the same period 23,455. Diphtheria Immunisation. All the Infant Welfare Clinics in the Borough carry out Diphtheria Immunisation. (a) The number of Sessions held during the year was 318. (b) Attendances during the same period 1,574. Smallpox Vaccination. (a) The number of Sessions held during the year was 318. (b) Number of Vaccinations was 398. 14 15 INFECTIOUS DISEASE. The following Table gives the number of cases notified during the year, and the number removed to Hospital. disease beckenham west wickham total beckenham w est wickham admitted to hospital 0—4 years 5—14 years 15 years and over 0-4 years 5—14 years 15 years and over Measles 859 249 1,108 428 405 26 100 144 5 10 Whooping Cough 201 44 245 118 76 7 25 17 2 2 Chickenpox 121 37 158 14 105 2 - 35 2 - Mumps 32 28 60 5 23 4 - 26 2 - Rubella 46 - 46 7 37 2 - - - 1 Food poisoning 19 3 22 3 4 12 - 2 1 2 Paratyphoid Fever 1 - 1 - 1 - - - - 1 Dysentery (Bacillary) 32 13 45 5 12 15 3 4 6 6 Scarlet Fever 43 41 84 9 26 8 13 26 2 30 Puerperal Pyrexia 11 - 11 - - 11 - - - 11 Erysipelas 4 - 4 - 1 3 - - - - Cerebro-Spinal Meningitis 1 2 3 - - 1 - 2 - 3 Acute Anterior Poliomyelitis (Paralytic) 2 1 3 - 1 1 - 1 - 3 Pneumonia 44 4 48 4 8 32 2 - 2 2 Ophthalmia Neonatorum 3 - 3 3 - - - - - 3 INFECTIOUS DISEASE. The following Table gives the number of cases notified during the year:— DISEASE JAN. FEB. MAR. APR. MAY JUNE JULY AUG. SEPT. OCT. NOV. DEC. TOTAL Measles 87 412 403 105 68 22 4 3 - 2 1 1 1,108 Whooping Cough 22 47 44 29 31 23 16 14 9 8 2 - 245 Chickenpox 11 11 33 8 4 9 45 12 2 2 7 14 158 Mumps 9 19 6 4 4 3 1 4 1 3 2 4 60 Rubella — 1 9 7 10 8 8 2 — 1 — — 46 Food poisoning - — — 1 1 1 5 — 3 6 2 3 22 Typhoid Fever - - - — — - - - - - - - Paratyphoid Fever - 1 - - - - - - - - - - 1 Dysentery (Amœbic) - — - — — — — — — — — - — Dysentery (Bacillary) 1 7 10 9 1 3 2 — 2 4 — 6 45 Scarlet Fever 5 6 2 5 11 9 10 4 6 8 7 11 84 Puerperal Pyrexia 2 2 — — 2 — 1 3 — — 1 — 11 Erysipelas — 2 — — — 2 — — — — — — 4 Cerebro-Spinal Meningitis — 1 — 1 — — — — — 1 — — 3 Acute Anterior Poliomyelitis: (Paralytic) - - - - - - - 1 2 - - - 3 (Non-Paralytic) - - — — — — — — — — — — — Pneumonia 24 7 3 3 2 1 — 1 — 2 1 4 48 Ophthalmia Neonatorum — 3 - - - — - - - - - - 3 Totals 161 519 510 172 136 79 92 44 25 37 23 44 1,842 16 New Cases attending the Tuberculosis Dispensaries for the first time during 1951. (INFORMATION FROM THE TUBERCULOSIS OFFICER) Adults i Children under 15 years Male Female Male Female Pulmonary 44 23 1 1 Non-Pulmonary — 1 — — Negative 78 100 16 12 Negative Positive Contacts Examined 99 2 Number of patients admitted to Sanatoria during the year: 57 These figures relate to patients resident in Beckenham Borough only. Dr. Madigan has sent me this report on the work of the Chest Clinics:— "The general trend of the incidence of tuberculosis appears to be falling. Comparison between the years 1950 and 1951 illustrates this ; it shows too that 57 patients were admitted to Institution in 1951 as opposed to 61 in 1950. Chemotherapy must be awarded a lot of credit in reducing the incidence of tuberculosis, especially since the introduction of streptomycin. This is self-evident when it is known that suitable sputum positive cases are relatively rapidly converted to negative following adequate chemotherapeutic treatment. Even in the more resistant cases the number of organisms in the sputum is considerably reduced. Social conditions do not seem to have improved, especially in the matter of housing which is a national problem of great magnitude. Admission to Institution is perhaps much easier than heretofore, but there is still great difficulty in getting early admission for major surgery. As regards preventive measures: B.C.G. vaccination has been organised for this area. All negative Mantoux contact children are invited to take advantage of it, and six weeks segregation from open cases is observed. 17 Great stress is again made on the fact that the Health Visitors must essentially have a bias in favour of prevention and that the success of their efforts must be based on the number of contacts they can induce to attend for examination." 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 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 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. TUBERCULOSIS—Table of Notifications and Deaths, 1951, from Local Records. Sex Ages Wards M. F. Total 0 to 5 6 to 10 11 to 15 16 to 20 21 to 25 26 to 35 36 to 45 46 to 55 56 to 65 65 and over Age unknown L. PK. K.H. M.H. C.C. E.P. PK. L. Shortlands W.W. Notifications New Cases only Pulmonary 38 27 65 2 2 2 12 6 19 8 5 7 1 1 8 11 8 10 10 — 3 15 Non-Pulmonary 2 1 3 - - - 1 1 - - - 1 - - - - - - 2 - — 1 Totals 40 28 68 2 2 3 13 6 19 8 5 8 1 1 8 11 8 10 12 - 3 16 Deaths Pulmonary 9 — — — — — — — 1 2 3 — 3 — 4 — 2 — 2 — 1 Non-Pulmonary - - - - - - - - - - - - - - - - - - - - Totals 9 — — — — — — — 1 2 3 — 3 — 4 — 2 — 2 — — 1 REPORT ON THE SANITARY ADMINSTRATION of the DISTRICT FOR THE YEAR 1951. By G. A. Webber, Chief Sanitary Inspector, Borough of Beckenham. This is the seventh Annual Report which I have had the privilege of submitting. I would first like to refer to the resignation of Dr. T. Philips Cole, the Borough's Medical Officer of Health from 1927 until his retirement in June, 1951. It was not until 1944 that I was to know him and to work under his direction, but I remember gratefully the seven years of our association, particularly the first years of my service with the Borough, when he gave me every encouragement to introduce the fresh methods and organisation which are inevitably associated with the appointment of a new Officer. I shall not forget his friendliness, nor his dignity as a Chief Officer; his ability to talk and his willingness to listen on the subject of Public Health; his excellent memory, which so frequently helped me, and indeed, many others; his guidance in the management of staff, and his unfailing kindness to all whatever their station in life: the serenity of mind which he exhorted us all to achieve, is now, we hope, his well deserved prize. There has been no change in the personnel of the Sanitary Inspector's staff during the year. 2,041 complaints were received, an increase of 422 compared with 1950. This is largely accounted for by the steady rise in the number of complaints of rat and mouse infestation in local properties. The subject is dealt with separately in this Report. Our work under the Housing Acts has proceeded apace. The number of insanitary conditions remedied has increased considerably because of this work. During the year 85 houses were completely reconditioned and work was in progress on 15 others at the close of the year. To date the cost of works executed by Owners in compliance with Notices served by this Council exceeds £40,000. Even allowing for the greatly increased cost of labour and materials, this sum reflects the scope of our activities to render our dwellings fit for habitation, and 'he work, has never, I feel, been unreasonably requested. Had this been the case (and I regret to say the suggestion did come from an unexpected quarter) I feel sure the very fair rights of appeal given to an Owner by the Housing Acts would have been exercised. These powers of appeal are fully explained at the time of the service of Notices. 20 The ready co-operation of most owners again calls for an expression of thanks. The ambiguity of the Law relating to the provision of dustbins continues to harass us. In the circumstances one must comment on the strict regard which is paid by the Council to all the relevant details of a case before a decision as to the service of a Notice on Owner or Occupier is made. With so many appeals against Notices up and down the Country, it is pleasing to report that the decisions made by this Council were complied with forthwith by the persons held to be responsible, with one exception. In this case the person served appealed unsuccessfully to the Bench. The responsibility for the repair of combined drains (a combined drain is one which receives the drainage of two or more properties) has always been a knotty legal problem in Public Health administration. The 1936 Act endeavoured, not in all respects successfully, to settle the position. The required work is now undertaken by local authorities and the cost of works is allocated between the respective owners according to the circumstances making the work essential. The administrative work here is lengthy and detailed, but when there is added the complication of War Damage, the matter becomes not a little incongruous. The repair of a combined drain is frequently associated with the repair of branch drains connected thereto; together they form the complete drainage system of a block of adjoining properties. The Council must undertake the work of repair to the combined drain, but the individual owners may themselves arrange for the repair of the branch drains if they so desire. The service of Notices under Section 24 (combined drains) and Section 39 (private branch drains) of the 1936 Act commences the procedure, and usually the owners default on the Section 39 Notice, the Council thereby being enabled to undertake the whole of the works. The costs may then be recovered as aforementioned. Complicated enough, but when the War Damage Commission agree that the defective drainage system is due to War Damage, the method of recovery of costs is varied. The cost of the works to the branch drains is recovered by the Local Authority direct from the War Damage Commission. The cost of works to the combined drains is recovered by the Local Authority from the respective owners who may then, in turn, recover the cost from the War Damage Commission. Bearing in mind that we are talking of one complete drainage system, the unnecessary complications will be apparent, but they are unfortunately maintained. Certain statistical information is appended:— Number of complaints received and investigated 2,041 Number of initial visits 5,786 Number of revisits 6,106 Number of Intimation Notices served 509 Number of Statutory Notices served 99 21 Nuisances Found and Remedied. found remedied Structural defects—external 973 1,149 Structural defects—internal 1,886 2,081 Insanitary conditions, other than vermin 153 144 Verminous conditions 10 10 Choked drains 243 240 Other drainage defects 335 319 Defective sanitary appliances 113 149 Insufficient or unsuitable water supply 4 3 Absence of dustbins 32 30 Offensive accumulations 5 5 3,754 4,130 Housing—Inspection of Dwelling Houses during the Year. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,865 Number of inspections made for the purpose 4,434 Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 95 Number of inspections made for the purpose 1,128 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 509 Number of dwelling-houses in respect of which informal notices were served 509 Number of dwelling-houses in which defects were remedied after service of informal notices 410 Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 99 Number of dwelling-houses in which defects were remedied after service of formal notices: (a) by owners 99 (b) by Local Authority in default of owners - Properties not Possessing Main Drainage Systems. The position remains substantially the same as the details give in the 1950 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). 22 Unsound Food. It was not necessary during the year, formally to seize any unsound food. Approximately 5 tons of foodstuffs certified as unfit for human consumption by the Sanitary Inspectors were surrendered for destruction by food vendors. A few instances of contamination of food in the process of preparation for sale were brought to our notice, but in no case did the Council deem it necessary to prosecute the vendor. The investigation of the circumstances of each case proved beyond doubt that the contamination was accidental and not due in any way to continued or wilful neglect of hygienic principles. In addition, one or two frivolous allegations were made of contamination of food, which proved upon examination to be perfectly sound. Food Handling and Food Premises. This subject has continued to engage the attention of the public, the national and the local press. It has also, following the custom of years, formed the basis of much of our work. A plea was made in a previous report for a balanced and logical view of the subject. Statements, however, continue to receive prominence which give an entirely false view of the general position. Sanitary Inspectors are well aware that malpractice and slipshod conduct arises in certain food premises. They are mainly those which offend aesthetic taste, and normally are not dangerous to public health. Frequently unhygienic conduct must pass without official notice, for we cannot be everywhere at the same time. It is therefore, rather distressing to read or hear of generalisations on the subject which come from the perhaps understandably incensed witness of an instance of malpractice. A case in point in this quotation from a press report:— "In one Beckenham Cafe it is not unusual for food to be served on a plate on which the remains of another customer's lunch are still plainly visible." The report refers to the "present lethargic attitude of the Council" and "the Council has never appeared to be particularly interested in the subject." Such generalisations are unfair and bear no relation to the facts. The members of the Council and the Officers are neither lethargic nor uninterested. Information of malpractices such as that referred to above would be welcomed and thoroughly investigated, and a balanced view given of the action necessary. With the staff available, each of our food premises is visited bi-monthly and where necessary, more frequently. 2,369 visits were made to food premises in 1951. Let it be said, in fairness to the majority of our local caterers, that they have offered whole-hearted co-operation to the Council's Officers in their work of education on matters of hygiene; there is a greater realisation of the 23 fact among the people intimately concerned, that the slogan" Clean Food "is overworked, and that" Safe Food "is the thing that matters. Food which is visibly dirty isn't eaten because it offers its own warning. A "disgusting example of food handling" reads another local press report, which related to frozen fish which had fallen from a van into the gutter. Is it suggested that such food should immediately be destroyed, or that because of an unfortunate accident, the carter should be prosecuted? We did not witness this incident, but it is extremely improbable that this soiled frozen fish ever caused food poisoning to the consumer, and it is equally improbable that a Sanitary Inspector would condemn such a consignment of frozen fish. May I ask that any incidents which are witnessed by members of the public, and offend their senses, be reported to the Council's Officers who will immediately deal with the matter in a manner which our knowledge shows the circumstances to warrant. In an endeavour to stimulate public interest, the Council decided to incorporate a Clean Food Exhibition in the activities of the local Festival of Britain. The Exhibition was finally staged in the Croydon Road Recreation Ground from the 6th to the 16th June, 1951. It is estimated that 10,000 people visted the Exhibition, a number which we know compared very favourably with the attendances at similar Exhibitions held by other local authorities, but which nevertheless, did not by any means exceed our expectations. The staging of such an Exhibition is accomplished only by a lengthy and vast preparation, multitudinouscorrespondence, journeyings, meetings, plus many set-backs and anxieties to harass the organisers. During the preceding months one asked oneself over and over again the question "Is this effort going to achieve the desired purpose?" It may now fairly be said that the Exhibition, to those who visited it, appeared to hold considerable interest, and the activity which has continued to be shewn by the members of the public in the subject generally, may be a tangible result. Formal thanks have long since been tendered to those public bodies and commercial undertakings who so willingly co-operated with us, but it is proper here again to express the greatest possible appreciation for their constructive help without which the Exhibition would not have been possible. Food and Drugs Sampling. In my report for 1950, I set out detailed information of the Sanitary Inspector's work in this regard. The work has continued during 1951 with the same meticulous attention which is so very essential. 137 formal samples and 30 informal samples were taken during the year. No instance of wilful adulteration was brought to light, but certain articles certified as inferior by the Public Analyst were withdrawn from sale on our recommendation. 24 A list is appended of the articles sampled. ARTICLE FORMAL SAMPLES INFORMAL SAMPLES Milk 60 15 Custard Powder 1 — Mustard 1 — Curry Powder 2 — Glace Cherries 1 — Jelly 4 — Cake and Pudding Mixture 1 — Artificial Cream Powder — 1 Australian Fruit Cake — 1 Tinned Peas — 2 Condensed Milk — 1 Blancmange Powder 2 — Blackcurrant Syrup 1 — Coffee and Chicory Essence 4 — White Pepper 4 — Orange Curd 1 — Apple Juice 2 — Jelly Crystals 4 — Royal Dessert 1 — Cream of Tartar 1 — Condensed Full Cream Milk — 1 Potato Crisps — 2 Ice Cream 5 — Pepper Flavoured Compound 1 — Milk Whipping Compound 1 — Quinine 2 — Castor Oil 1 — Tomato Ketchup 5 — Lime Juice Cordial 1 — Cornflour 1 — Lemon Curd 1 — Custard Powder 2 — Dessert Powder I — Honey 1 — Gravy Browning 1 — Vegetable Salad 1 — Essence of Rennet 1 — Apples — 2 Lemon Squash 2 — Milk Jelly Crystals 1 — Tin of Cherries — 2 Malt Vinegar 2 — Malted Milk 1 — Mayonnaise 1 — Blackcurrant Juice 1 — Crab Paste 1 — Ground Almonds 1 — Sponge Mixture 1 — Ginger Wine 2 — Tomato Chutney 1 — Orange Squash 1 — Coffee Extract 1 — Butterscotch Flavouring — 1 Licquorice Allsorts — 1 Danish Butter — 1 Coffee and Chicory 1 — Cocoa 1 — Sausages 3 — Sherry 1 — 25 Ice Cream Sampling. 38 samples of Ice Cream were obtained during the year and submitted to bacteriological examination. No pathogenic organisms were isolated from the samples, but 7 shewed evidence of some contamination. In three of these cases, it was found that contamination was occurring at the place of manufacture, which in all cases was outside this borough. With the co-operation of the local authority concerned, the matter was put right. In other cases, it was obvious that incomplete sterilisation of storage and serving equipment was responsible, and the attention of the Vendor was immediately drawn to the matter. Follow-up samples proved satisfactory. Waterways. As I anticipated in a previous report, further complaints have been received during the year of the pollution of the various waterways which flow through the town. Every endeavour is made to satisfy the complainant but I am afraid that we are not always able to trace the source of pollution. It was found, however, that a Canteen attached to a Factory building in the area was discharging its liquid wastes into the stream. Following recommendations to the firm concerned, the waste was properly connected to the foul water sewers. Smoke Nuisances. Many complaints have been received regarding the chimney of an industrial premises in the area and at the close of the year there was no doubt that many of the complainants were dissatisfied with the existing position. Nevetheless, the Council has taken all possible action in the matter and a great deal of the Sanitary Inspectors' time has been taken in keeping close observation upon the offending chimney. It was not possible on any evidence to recommend that the Council should institute proceedings for the abatement of a statutory nusiance, it being obvious that all practicable and reasonable measures were being taken by the firm concerned to minimise the emission of smoke. The assistance of experts from the Ministry of Fuel and Power and from the Department of Industrial and Scientific Research was sought and readily obtained, and the views expressed by the Council's Officers were confirmed. The matter continues to receive the close attention of the Department. 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 are received from residents for the steam disinfection of bedding etc. after cases of illness other than infectious disease. The requests are met but a charge is made for the service. During 1951, 76 applications were received and accounts rendered for £72 2s. 6d. 26 During the year 63 Library books were collected from homes where infectious disease had occurred, disinfected, and returned to the Library of origin. Drainage. As will be seen from the Table of nuisances remedied, 243 instances of choked drains were discovered during the year. A great many of these chokages related to public sewers, i.e. drains receiving wastes of two or more houses. The Council accepts as a legal responsibility the clearance of public sewers and the work is undertaken without any charge being made to the owners or occupiers of the properties. Of the 243 cases discovered however, 144 related to private drainage, and in these cases a charge is made for the work undertaken. Accounts were rendered for a total of £57 7s. 6d. for this work. The repair of combined drains is also undertaken by the Council in accordance with statute, the cost of works being recovered from the owners of the properties concerned. In this connection, accounts were rendered for £137 0s. 2d. 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. Bacteriological examination has been regular, 36 samples being taken during the year. All proved to be satisfactory. Moveable Dwellings. Seven families occupied moveable dwellings under licence from the Council during 1951. Frequent inspections of the sites of the caravans were made and in no instance was a Public Health nuisance discovered. Factories Act, 1937. Three hundred and fifty-seven visits of inspection were made to factories in the area and the following nuisances were remedied following the service of Intimation Notices:— Want of Cleanliness 4 Insufficient sanitary conveniences 2 Unsuitable or defective sanitary conveniences 27 Sanitary accommodation not separate for the sexes 1 Other offences 3 Shops Acts. One thousand, four hundred and fifty-nine (1,459) visits were paid in connection with the Shops Acts. Fifty-six (56) contraventions were discovered and remedied. 27 Mortuary. The administration of the Beckenham Mortuary is the responsibility of the Public Health Department, the Mortuary Attendant being a member of the Medical Officer's staff. During 1951, 109 bodies were brought to the Mortuary where post mortem examinations were conducted by a Home Office Pathologist. The Mortuary Attendant is responsible, under supervision, for the maintenance and cleanliness of the building, the reception and collection of bodies, assistance at P.M's. and the preparation and arrangement of a Town Hall room for the purposes of Inquest. Charge is taken of any clothing or valuables found on deceased persons and next-of-kin are immediately informed. Rat and Mouse Repression. Great advantage has been taken by the resident Beckenham population of the free service of assistance given in the extermination of rats and mice. The problem is widespread throughout the Borough and whilst major infestations are very few, we have to exercise continual care to control the nuisance. Much of the rat infestation is confined to the gardens of properties and other open spaces, but the house mouse continues to accept every opportunity presented to nest and increase in domestic properties. Speedy reporting by the public (now a statutory duty under the terms of the Prevention of Damage by Pests Act) enables us successfully to combat and minimise this particular problem. 861 complaints were received during the course of the year and the Rodent Operators paid 5,862 visits in the course of their work. I would like to record that I have received many expressions of thanks from residents for the manner in which the Operators have carried out their work. The presence of this vermin is frightening to so many people, particularly housewives with young children, and speedy removal of the pest is a great relief. A similar service is extended to business premises, but here a charge is made. 73 such premises were serviced and accounts rendered for £95 7s. 6d. The whole of this work is carried on with the co-operation of the Ministry of Agriculture and Fisheries whose Officers have paid many visits to the Borough during the year. December, 1951, brought the completion of the eleventh treatment of the Beckenham foul water sewers. This work first commenced in October, 1946, and has continued twice yearly since. Infestation continues to be severe in the northern part of the Borough. The older sewers provide a problem. It appears to be a general opinion that surface infestation is closely allied to, and probably arises from, sewer infestation. This is certainly not the case in the greater part of Beckenham. The Coney 28 Hall area has a widespread surface problem, whereas no single instance of rats in the foul water sewers in this area has ever been recorded, and frequent tests have been made since 1946. The following Table gives a record of this sewer work since 1946. It will be seen that apart from the considerable reduction in infestation in the first eighteen months of the series, the rat life in our sewers continues at a more or less even level. RODENT CONTROL. Sewer Maintenance Treatments. OPERATION NO. DATE NO. OF MANHOLES BAITED NO. SHOWING PREBAIT TAKE NO. SHOWING COMPLETE PREBAIT TAKE ESTIMATED PERCENTAGE OF SEWERAGE SYSTEM INFESTED 1. Oct./Nov. 1946 1,438 479 214 30% 2. Mar./Apl. 1947 1,474 382 161 24% 3. November 1947 785 225 131 14% 4. March 1948 542 115 72 7% 5. Sept. 1948 496 69 28 4% 6. Feb./Mar. 1949 135 59 45 3% 7. Sept. 1949 222 79 56 5% 8. March 1950 319 138 98 9% 9. December 1950 549 192 98 12% 10. June 1951 286 48 29 3% 11. December 1951 175 96 78 6% 12. June 1952 299 141 71 9% My thanks are due to the members of the Public Health staff who have worked with me so loyally during the year under review. G. A. WEBBER, Chief Sanitary Inspector. 29