Ac 642 (1) 5B 2 kikary BEC 20 BOROUGH OF BECKENHAM REPORT OF THE MEDICAL OFFICEROF HEALTH FOR 1953 BY L. R. L. EDWARDS, M.D. (Lond.), D.P.H. Medical Officer of Health BOROUGH OF BECKENHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1953 BY L. R. L. EDWARDS, M.D. (Lond.), D.P.H. Medical Officer of Health MEMBERS OF THE PUBLIC HEALTH COMMITTEE YEAR 1953-54. Chairman: Councillor A. C. Garrett. Deputy Chairman: Councillor L. E. MacCallum, M.C. Alderman Mrs. E. Campbell, M.B.E. Alderman R. S. Jackson. Councillor K. D. Aldcroft. Councillor R. J. Butcher. Councillor C. B. Curtis, M.B.E. Councillor G. E. Fish. Councillor D. R. Knox-Johnson. Councillor Miss K. A. Moore. Ex-Officio: The Mayor. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health L. R. L. Edwards, M.D. (Lond.), D.P.H. Chief Sanitary Inspector G. A. Webber, Certificate of the Royal Sanitary Institute and the Sanitary Inspector's 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. (Retired 31st August, 1953.) 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., Cert Inst.Hsg. G. W. Matthews, Cert. R.S.I. and S.l.E.J.B., Certificated Food Inspector. (Resigned September 1953.) K. J. Coppin, Cert. R.S.I. and S.l.E.J.B. Certificated Food Inspector. (Appointed September 1953.) Clerical Staff: Secretarial Assistant: Mrs. E. A. Best. Clerks: 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. 3 INTRODUCTION. To the Chairman and Members of the Public Health Committee. I H A V E the honour to present a report on the health of the Borough during 1953. The Infantile Mortality rate has now fallen to a record low figure of 12.5 per 1,000 live births. My impression is that this is due to a diminution of deaths of infants from infections possibly related to increasing use of new drugs, increasing care of premature infants including improved hospital accommodation and improving facilities for the care of Rhesus mothers and babies. The present Beckenham figure is less than half the total for England and Wales. The number of births is slightly lower this year (891 compared with 937 last year) but I do not think this fully accounts for the lower figure of infant mortality. The Maternal Mortality rate increased by .06 per 1,000, though there was in England and Wales a general reduction in this rate. Though statistically small this figure is still significant. There were fifteen fewer deaths from cancer with a corresponding reduction in the rate which now stands at 2.08 per 1,000 population. This is however much larger than the rate of 30 years ago which was 1.55 per 1,000. No classification of cancer deaths was kept at this time and the emphasis then was on deaths from infectious diesases. To-day the emphasis is on deaths from cancer, especially cancer of the lung and on other causes of death more related to the times, such as deaths from motor vehicle accidents, other accidental causes and circulatory diseases. In view of the increase in interest in accidents in the home and industry, it might be of value to further classify the other accidental causes on these lines in the list of causes issued by the General Register Office to Medical Officers of Health. In Beckenham there was an increase of 8 deaths from cancer of the lung (7 male, 1 female). Deaths from other cancers slightly decreased. There was, early in May, a very small outbreak of acute poliomyelitis. There were no deaths. In spite of this increased incidence there were two less cases for the whole year, and the number of paralytic cases remained at the same figure of 8. Measles and Whooping Cough were very prevalent. From January to May, 1,078 cases of Measles were reported compared with 3 during the same period in 1952 (total 1952 was 179). 308 cases of Whooping Cough were reported compared with 125 in 1952. Notified cases of Food Poisoning decreased by 7. A case of Enteric Fever was notified after the diagnosis had been confirmed in hospital 4 Infection had been acquired while on a touring holiday so that no further information as to source was obtainable. The patient recovered and on notification of discharge from hospital, arrangements were made with her medical practitioner so that she would take from her patient, further specimens for examination and final clearance. Of other intestinal diseases there were 21 cases of Dysentery of which 6 occurred in children of school age. 12 of all such notifications received occurred in the practice of one doctor, and this probably indicated a localised epidemic in his area. All but one of these cases were reported during the last two weeks of January. There is a certain incompleteness in the notifications of dysentery which must lead to caution in reporting on the incidence of this disease. The same caution must also apply to reports of food poisoning. It is when reports are especially asked for that the Medical Officer of Health hopes to obtain records of all the slight cases that must occur from time to time in his district. It is not always possible to confirm the illness, and assistance in the examination of specimens, which is readily given, only partially helps the Medical Officer to keep a finger on the pulse of the situation. More general approach to his Department for advice on disinfection would be of great assistance in limiting the development of outbreaks of these diseases. Serious cases of food poisoning often occur when the food is not obviously bad. Salmonella typhi-murium infection which occurs in animals, poultry, humans and rodents, was found in three cases. Out of 11 cases of notified food poisoning, 4 were admitted to hospital. In 6 cases no particular food was suspect; in the remaining 5 cases the foods were tinned salmon, kippers and eggs, chopped ham, marshmallows, and salt beef. During the past year, Influenza has been changing in its character and attacks have become milder, more often associated with sickness and diarrhoea, and often tending to affect children more than adults. Laboratory facilities seem rarely used for the identification of viruses; this is probably because no specific medicine has yet been found for a particular virus and because illness is so short in duration. For all illness or injury, morbidity figures are received each week, hut the overlapping of districts inevitably minimises the value of these figures for assessing at any time the incidence of minor illness. The most reliable information is obtained from medical colleagues but must be sought. The Mass Radiography Units were unable to visit Beckenham in 1953 but visits are planned for next autumn. I do not think the absence of the visits was responsible for the decrease in cases referred for investigation, but the admission of many more cases for short-term treatment means the discovery of earlier illness, and is a most satisfactory feature in an encouraging report. 5 Advice on the pointing of medical conditions, including Tuberculosis, advanced by applicants with medical certificates, for prior consideration on the Council's Housing and re-housing lists is another function of the Health Department. Liaison with the Housing Manager, the County District Officer, medical practitioners or hospitals was necessary in dealing with a variety of borderline problems relating to old houses, elderly persons, problem families, mental and moral defectives, and alleged sanitary nuisances. One of the most difficult problems to solve is how to ameliorate the conditions under which some old persons live. It is especially difficult to determine their needs when they become infirm in their own homes. In sickness the responsibility lies with the medical practitioner and the geriatric services of the hospital. In infirmity, the Medical Officer of the local authority is approached, when, for various reasons the welfare authority cannot deal with the problem. Visits by Inspectors or by the Medical Officer are often necessary and this work is too varied and detailed to be easily reported by a single table in this Annual Report. The admirable assistance given by the W.V.S. to old people known to their workers is covered by the report of the area organiser. One of the problems that must remain is to hear of all old people, many of whom prefer to remain anonymous for fear of drastic official action entering into their lives and homes. During the year the Council were informed of proposed changes, subject to review, by the County Council on the advice of the County Medical Officer in the scheme of daily minding. They were also informed of changes brought about by new Public Health (Infectious Diseases) Regulations applying to Typhoid Fever, Paratyphoid Fever, Dysentery, and staphylococcal Food Poisoning in connection with food trades, to enable the Medical Officer to take more immediate action. The difficulty still remains that only sick persons are legally notifiable to the Medical Officer so reliance must still be on the good faith of persons connected with the food trade to stay off work if, though recovered, they may be carrying infection until necessary examinations have proved them free from infection. One still finds most causes of food poisoning in disease of animals or disease of food handlers. In conclusion, I again wish to express my sincere thanks to Dr. Elliott, the County Medical Officer of Health, and to Dr. Ward of the County Staff. Despite quite a few changes on the staff, the work of the Health Department has been maintained with undiminished zeal for which I offer my thanks. To you, and Members of the Health Committee, my appreciation is due for your understanding of health problems of the Borough and for your continued encouragement to myself and members of my staff L. R. L. EDWARDS, Medical Officer of Health. 6 SUMMARY OF VITAL STATISTICS, 1953 Area of District in acres 5,935 Civilian Population as estimated by the Registrar-General at 30th June, 1953 75,120 Civilian population per acre 12.7 Rateable Value at 1st October, 1953 £907,988 Births Registered (Including Stillbirths): Male Female Legitimate 448 420 Illegitimate 12 11 Total 891 Birth Rate (Including Stillbirths) per 1,000 of Civilian Population 12.69 Male Female Deaths Registered 385 434 Total 819 Death Rate per 1,000 population 9.59 Infant Mortality Rate per 1,000 live births 12.5 Maternal Mortality Rate per 1,000 births 1.12 Deaths of Infants under 1 year of age: Male Female Legitimate 7 3 Illegitimate — 1 Total 11 Still Births— Rate per 1,000 population 0.17 Rate per 1,000 births 14.48 Male Female Legitimate 7 5 Illegitimate 1 — Total 13 Death Rate per 1,000 of Civilian Population from Cancer (156 deaths) 2.08 Death Rate per 1,000 of Civilian Population from Pulmonary Tuberculosis (6 deaths) 0.08 Death Rate per 1,000 of Civilian Population from Non- Pulmonary Tuberculosis (1 death) 0.01 7 Table A. Birth Rates, Civilian Death Rates and Infant Mortality for the year 1953. Rate per 1,000 Population Rate per 1,000 live births Live Births Still Births All Deaths Deaths under 1 yr. Beckenham 12.49 0.17 9.59 12.5 England and Wales 15.5 0.35 11.4 26.8 160 County Boroughs and Great Towns, including London 17.0 0.43 12.2 30.8 160 Smaller Towns, etc. 15.7 0.34 11.3 24.3 London Administrative County 17.5 0.38 12.5 24.8 The Birth Rates and Death Rates for the Borough have been adjusted by the comparability factors supplied by the Registrar-General (1.07 for Births and .88 for Deaths) to make a true comparison with the rest of England and Wales. 8 TOTAL DEATHS 1953 (Registrar-General's Official Returns) All causes—819; Male, 385; Female, 434. causes of death males females 1. Tuberculosis, respiratory 5 1 2. Tuberculosis, other 1 — 3. Syphilitic disease 1 — 4. Diphtheria — — 5. Whooping Cough — 1 6. Meningococcal infections 1 - 7. Acute poliomyelitis — — 8. Measles — - 9. Other infective and parasitic diseases 1 1 10. Malignant neoplasm, stomach 7 10 11. Malignant neoplasm, lung, bronchus 27 9 12. Malignant neoplasm, breast — 17 13. Malignant neoplasm, uterus — 3 14. Other malignant and lymphatic neoplasms 41 42 15. Leukaemia, aleukaemia 1 5 16. Diabetes 2 7 17. Vascular lesions of nervous system 42 79 18. Coronary disease, angina 84 41 19. Hypertension with heart disease 11 11 20. Other heart disease 42 90 21. Other circulatory disease 15 27 22. Influenza 4 3 23. Pneumonia 10 9 24. Bronchitis 31 26 25. Other diseases of respiratory system 4 4 26. Ulcer of stomach and duodenum 5 3 27. Gastritis, enteritis and diarrhœa 1 1 28. Nephritis and nephrosis — 2 29. Hyperplasia of prostate 9 — 30. Pregnancy, childbirth, abortion — 1 31. Congenital malformations 1 2 32. Other defined and ill-defined diseases 31 30 33. Motor vehicle accidents 3 - 34. All other accidents 3 6 35. Suicide 2 3 36. Homicide and operations of war — — Totals 385 434 9 10 VITAL STATISTICS FOR YEARS 1945 to 1953 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 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 1952 75,160 906 16 922 12.267 15 — 15 16 1 17 18.43 1953 75,120 856 22 878 12.505 12 1 13 10 1 11 12.53 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 j Rate per 1,000 of population Number Number Rate per 1,000 population Number Rate per 1,000 population 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 1952 890 11.841 l 10 0.133 171 2.275 1953 819 9.593 NIL 6 0.080 156 2.076 INFANTILE MORTALITY, 1953 The number of deaths of infants under the age of twelve months was 9 as compared with 16 in 1952. The Registrar-General returns 11 infant deaths and the Infant Mortality Rate for the year was 12.5 per 1,000 live births. The following Table shows the causes of death in 9 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. Congenital Defects 3 1 - - - - 1 - 1 6 B. Ante-natal or Intranatal Conditions 2 - - - - - - - - 2 C. Infections - - - - - - - - - - D Accidental 1 - - - - - - - - 1 Totals 6 1 — — — — 1 — 1 9 11 12 INFECTIOUS DISEASE (1). DISEASE 0—4 years 5—14 years 15 years and over Age unknown TOTAL ADMITTED TO HOSPITAL Cerebro-spinal Meningitis - 1 2 - 3 3 Dysentery (Bacillary) 3 6 12 — 21 3 Enteric Fever — — 1 — 1 1 Erysipelas — — 8 2 10 2 Food Poisoning 5 4 2 — 11 4 German Measles — 1 1 — 2 — Measles 485 582 15 12 1,094 9 Pneumonia 4 6 27 3 40 5 Poliomyelitis: Paralytic 1 5 2 — 8 8 Non-Paralytic — 2 1 — 3 2 Puerperal Pyrexia — — 39 — 39 39 Scarlet Fever 30 94 12 — 136 47 Whooping Cough 163 138 7 — 308 2 13 INFECTIOUS DISEASE (2). disease jan. feb. mar. apr. may june july aug. sept. oct. nov. dec. total Cerebro-spinal Meningitis 1 1 - - - - 1 - - - - - 3 Dysentery (Bacillary) 12 3 1 1 — — 1 2 — — 1 — 21 Enteric Fever - - - - - - - 1 - - - - 1 Erysipelas — 1 2 4 — — 1 - — 1 — 1 10 Food Poisoning — - — — 1 — — 4 1 4 — 1 11 German Measles 2 - — — — — — — — — — — 2 Measles 245 442 300 91 9 3 2 2 — — — — 1,094 Pneumonia 7 22 6 2 1 2 - - - - - - 40 Poliomyelitis: Paralytic — — 1 1 4 1 — — — — 1 — 8 Non-Paralytic — — — — 3 — — — — — — - 3 Puerperal Pyrexia 4 4 1 3 2 3 5 6 3 5 1 2 39 Scarlet Fever 11 13 23 5 8 9 20 2 5 12 19 9 136 Whooping Cough 36 17 28 21 31 63 64 24 13 7 3 1 308 Totals 318 503 362 128 59 81 94 41 22 29 25 14 1,676 14 TUBERCULOSIS—Table of Notifications and Deaths, 1952, from Local Records. Sex Total Ages Wards* M. F. 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 66 and over Age unknown L.Pk. and K.H. M.H. C.C. C.H. E.P. Shortlands W.W. Notifications New Cases only Pulmonary 37 21 58 2 1 1 7 5 14 8 6 6 5 3 14 6 4 8 8 5 13 Non-Pulmonary 1 4 5 — 1 — — — 2 — 1 — 1 — 2 — — 1 — — 2 Totals 38 25 63 2 2 1 7 5 16 8 7 6 6 3 16 6 4 9 8 5 15 Deaths Pulmonary 7 2 9 — — — — — 2 4 1 2 — — 3 3 — — 1 — 2 Non-Pulmonary — — — — — — — — — — — — — — — — — — — — — Totals 7 2 9 — — — — — 2 4 1 2 — — 3 3 — — 1 — 2 * L.Pk. and K.H.—Lawrie Park and Kent House. M.H.—Manor House. C.C.—Copers Cope. C.H.—Clock House. E.P.—Eden Park. W.W.—West Wickham. WORK OF THE CHEST CLINIC. I extend grateful thanks to Dr. Madigan for the following report on the work of the Chest Clinics and the subsequent Table :— " It will be seen from these figures that less cases were referred for investigation than in the previous year, but the total number of definite cases of tuberculosis discovered during the year shows very little change from that of recent years. From the point of view of preventive measures, contact examinations have been well up to average, and B.C.G. vaccination of child contacts has again been widely used. More cases were admitted to Hospitals or Sanatoria than previously, but I think this can be explained by the fact that many of these were found to be suitable for short-term treatment, thus allowing a greater number of patients to be accommodated. The waiting lists for admission have certainly been kept down to reasonable levels, but cases awaiting surgical treatment still have to wait an inordinate time." New Cases attending the Tuberculosis Dispensaries for the first time during 1953. Adults Children under 15 years Male Female Male Female Pulmonary 35 29 2 1 Non-Pulmonary — 1 — — Negative 86 76 53 39 Negative Positive Contacts Examined 138 3 Nmuber of patients admitted to Sanatoria during the year : 85. These figures relate to patients resident in Beckenham Borough only. 15 Beckenham Tuberculosis Care Committee. The Hon. Secretary, Mr. S. W. Collett, has submitted the following report on the work of the Beckenham Tuberculosis Care Committee, for which I express my thanks :— " The Voluntary Tuberculosis Care Committee, which has been working for the welfare of local patients since 1938 continues to meet many and varied needs of patients and their families. Assistance with fares has made it possible for relatives to visit patients away in hospital for many months and these visits help to sustain morale ; also patients on leaving sanatoria need to be helped to re-establish themselves either in their old job or in other more suitable employment." WOMEN'S VOLUNTARY SERVICE. The following report on the W.V.S. work in the Borough has been submitted by Mrs. S. E. Porter, the local Area Organiser, to whom I express my thanks. Darby and Joan Clubs. Three Darby and Joan Clubs and two Over 60's Clubs are running in the Borough. Two of the Clubs are held on Tuesdays and one on Thursday from 1.45 to 4.15 p.m. Membership averages 100/120 and the Clubs are attended by people over 60 years of age. The membership fee is Id. and usually a nominal sum of 3d. per person is charged for the tea provided. A free library is available. The members enjoy weekly Whist Drives, Darts Matches and Raffles. The Clubs are subsidised by voluntary subscriptions. Spring and Autumn outings are arranged for the old people in addition to a pantomime and Christmas show. The members save a small amount weekly in order to pay for such outings. A Savings Group is run particularly for members who wish to save towards holidays, outings, etc. The two Over 60's Clubs are run in West Wickham with an average attendance of 130/150 in the Lecture Hall and 50 at Coney Hall. The total membership of the Over 60's Clubs is 255. Old People's Welfare. Many visits are made to elderly people living alone and assistance is given in regard to clothing which is supplied free on the authority of any reliable body such as the National Assistance Board. 16 Meals on Wheels. Twenty-seven persons are served with meals twice a week—on Tuesday and Friday. It is principally run for the benefit of invalids and elderly people who cannot do their shopping or cooking. Appeals for such assistance usually come from Hospital Almoners, District Nurses and through the Darby and Joan Clubs. The meals are provided by a local Caterer and an allowance for transport is made through the Local and County Authorities. The meals are subsidised by voluntary funds, so those who cannot afford the full cost of the meal obtain one at a very moderate sum. A total of 2,230 meals were served during 1953. Luncheon Club. A Luncheon Club is still being run by the West Wickham W.V.S. and only a nominal charge is made for meals. An average of 25 to 30 meals are served weekly. Hospital Work. Work in connection with the hospital library is carried out at Beckenham and Swanley Hospitals and other work is done at the Heart Hospital, West Wickham. In addition to the aforementioned activities, the W.V.S. has a close liaison with the Tuberculosis After Care Committee ; S.S.A.F.A. (giving financial assistance and clothing) ; Area Pensions Officer ; British Legion ; The Disabled Persons Committee ; Children's Homes ; Child Welfare Clinics. The Children's Clothing Exchange is still being run every Wednesday. Orange Juice, Cod Liver Oil and Vitamin Tablets are sold in the Centre. 17 INFANT WELFARE CENTRE ATTENDANCES, 1953. (a) The number of Sessions held during the year was 460. (b) Attendances during the same period 22,657. Diphtheria Immunisation. All the Infant Welfare Clinics in the Borough carry out Diphtheria Immunisation. (a) The number of Sessions held during the year was 314 (b) Attendances during the same period 994 (c) The number of special Sessions held during the year was 11 (d) Attendances at special Sessions for same period 360 Smallpox Vaccination. (a) The number of Sessions held during the year was 202 (b) The number of vaccinations given was 334 (c) The number of special Sessions held during the year was 11 (d) Attendance at special Sessions for same period 115 18 HEALTH SERVICES. 1. Hospitals and Clinics. Beckenham Hospital—Croydon Road, Beckenham. Beckenham Maternity Hospital—Stone Park Avenue, Beckenham. Widmore Road and Mason's Hill Maternity Units, Bromley, Kent. Bromley Hospital—Cromwell Avenue, Bromley, Kent. Children's Heart Hospital—West Wickham. Children's Hospital—Sydenham. Farnborough Hospital—Farnborough. Lennard Isolation Hospital—Bromley Common. The Babies' Hospital—Sydenham Hill. Bromley Chest Clinic—Tiger Lane, Masons Hill, Bromley. Penge Chest Clinic—1, Westbury Road. Penge. 2. Other Services (Kent County Council). Home Helps. Beckenham District Office, 12, Beckenham Road, Beckenham. Home Nurses. Beckenham District Office, 12, Beckenham Road, Beckenham. Midwives. West Wickham : 4, Grosvenor Road. 105a, Station Road. Beckenham : 12, Beckenham Road, Beckenham. Ambulances. Through Hospital or Beckenham District Office. Old People's Homes. Thornton House—(Save our Souls Society). The Chestnuts—(Private) Gwydor Road, Beckenham. Rutland Lodge, Mays Hill Road, Beckenham. Under the supervision of Kent County Council. Mental Welfare. District Offices, Beckenham Road, Beckenham. General Welfare. District Offices, Beckenham Road, Beckenham. Clinics for Maternity and Child Welfare. 19 3. Private and Voluntary Services. Private Nursing Homes. (1) 54, The Avenue, Beckenham. (2) " Parklands," 51, Crystal Palace Park Road. (3) " Petersfield Lodge," 69, Crystal Palace Park Road. (4) 12, Westgate Road, Beckenham. (5) " Inglewood," 25, Durham Avenue, Bromley. (6) 131, Albemarle Road. (7) 46, Foxgrove Road. Registration and supervision is delegated to the Borough Council. Medical Loan Depot of B.R.C.S. 45, Beckenham Road, Beckenham. Women's Voluntary Services. 12, Bromley Road, Beckenham. 103, High Street, West Wickham. LOCAL CLINICS FOR MATERNITY AND CHILD WELFARE Service Days and Times Premises in Use Ante-Natal 2nd and 4th Fridays in each month, 10—12 noon (by appointment) Clinic Block, Town Hall, Beckenham Other Fridays in each month, 2—4 p.m. (by appointment) Clinic Block, Hawes Lane. W. Wickham Child Welfare Monday, 2—4 p.m. Clinic Block, Hawes Lane, W. Wickham Tuesday, 2—4 p.m. (a) Baths Annexe, Beckenham Road (b) Assembly Hall, W. Wickham Wednesday, 2—4 p.m. (a) Church Hall Langley Road, Elmers End (b) Church Hall, Valley Road, Shortlands Thursday, 10—12 noon [ Church Hall, Lennard Road, Penge 2—4 p.m. | 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 20 Service Days and Times Premises in use Dental (Infant Welfare Cases) By appointment By appointment Clinic Block, Town Hall Clinic Block, Hawes Lane, W. Wickham Ophthalmic .. Wednesdays, 2—4 p.m. (by Appointment) Clinic Block, Town Hall, Beckenham Orthopaedic Wednesday mornings (twice per month) (By appointment) Surgeon in attendance. Clinic Block, Town Hall, Beckenham Friday afternoons (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 Fridays—Mornings Clinic Block, Hawes Lane, W. Wickham, Mothercraft Classes and Relaxation Exercises .. 1st and 3rd Fridays in each month, 10—12 noon Clinic Block, Town Hall, Beckenham 2nd and 4th Fridays in each month, 2—4 p.m. Clinic Block, Hawes Lane, W. Wickham Vaccination (by appointment only) and Diphtheria Immunisation are carried out during certain Infant Welfare Sessions at the above Clinics. 21 REPORT OF THE SANITARY ADMINISTRATION of the DISTRICT FOR THE YEAR 1953 By G. A. Webber, Chief Sanitary Inspector, Borough of Beckenham. Mr. H. G. Richards, who has served the Beckenham Borough Council as a District Sanitary Inspector since 1920, retired in 1953. His resignation was marked by a special reference in the Council Minutes to the value of his services, and I should like to add my appreciation of his efficiency as an Officer and his friendliness as a colleague. His intimate knowledge of the District was invaluable to us on many occasions, and I was always able to rely upon his full co-operation from the very first moment of my service with this Council. Mr. G. W. Matthews, a younger but equally respected colleague left to take up a more lucrative appointment with Guildford Council. Mr. K. Coppin joined the staff as a Sanitary Inspector in September, 1953. At the close of the year, one vacancy existed. This has again been a year in which the Department has continued its work towards the reconditioning of the many sub-standard houses which may, for some years to come, have to provide dwelling accommodation for many families. Experience tends to show that the tenants of such properties are quick to avail themselves of the powers granted to local authorities to demand the abatement of nuisances, and the remedy of sanitary defects and disrepair in their homes. Whilst we have not had time to re-visit many of the properties which have been reconditioned under our supervision since the work was commenced in 1946, the absence of complaint is a sure guide to the success of the work, and to the duration of the better structural and decorative repair into which the properties were put. Compared to so many other districts, Beckenham is fortunate in the facilities enabling progress in environmental hygiene, and perhaps not least so in the type of sub-standard property which is within its boundaries. Such houses come into that category mainly because they do not have bathrooms, internal water closets, and facilities for the supply of constant hot water. They are not tumbledown, nor dangerous in structure ; the vast majority are dry, and of sound construction, both as to external walls and roofing. They are well- 22 ventilated, having adequate natural light, and, in nearly all cases, having artificial lighting points in each room. They are not situated in narrow streets. They all have an individual piped water supply of the highest purity, and are connected to main drainage. Each has its own water closet, even though it be external. Improvement and addition in food storage facility would be an advantage in the light of modern knowledge but unfortunately this is rarely practicable. (So far as the orientation of food storage facility is concerned, it is not only our sub-standard houses that invite criticism.) Above all, these houses are rented at a figure which it is within the means of the tenant to pay. From our observations and many conversations with the tenants, we have no doubt that the disadvantages these dwellings offer are more easily borne than would be the worry and distress caused by an insufficient income to pay the high rentals which are necessary for a modern dwelling. Sanitary Inspectors, whose work brings them into the closest touch with the domestic lives of the people, will be among the first to welcome the wholesale demolition of all properties which fail to reach a health-giving standard, so soon as such action is a practical proposition, but if the matter is to be dealt with as a national problem, it may be found that Beckenham is very low in the list of area priorities. At the end of the year 1952, there still remained between four and five hundred properties which by reason of disrepair and sanitary defects, must be considered " not in all respects fit for human habitation " in accordance with the Housing Acts. These properties are scheduled for inspection and such action as the Council may decide. Complicated administrative and legal procedure necessitated by statutory machinery still prevails, and progress will be slow. The words " unfit for human habitation " taken out of their context appear to cause much confusion. A house in any respect unfit for human habitation calls for action under Section 9 of the Housing Act, 1936. In determining whether a house is fit, regard must be paid to disrepair and sanitary defects. The former term is not defined, but the latter is, and includes :— Lack of air space. Darkness, Dampness. Absence of adequate and readily accessible water supply or sanitary accommodation. Inadequate paving or drainage of house, etc. It will be seen that a house with broken yard paving and small areas of dampness is properly classed as unfit for habitation so far as the Law defines, but the loose use of the term in general conversation and report, frequently presents a picture of circumstances infinitely worse than reality. 23 Certain statistical information, relating to the work of the Inspectors, is appended :— Number of complaints received and investigated.. 1,244 Number of initial visits 5,372 Number of revisits 4,735 Number of Intimation Notices served 339 Number of Statutory Notices served 88 Nuisances Remedied. Structural defects—external 422 Structural defects—internal 888 Insanitary conditions, other than vermin 82 Verminous conditions 10 Choked drains 200 Other drainage defects 255 Defective sanitary appliances 75 Insufficient or unsuitable water supply 4 Absence of dustbins 32 Offensive accumulations 6 1,974 Dustbins. It was necessary to report 19 cases of insufficient or unsuitable dustbin accommodation in properties in the Borough. The Council has to determine whether the Statutory Notice calling for proper provision shall be served upon the owner or occupier of the property. In order to assist in a fair determination, information is obtained regarding the rental of the property, the age and treatment of the offending bin, and any relevant comments which, on invitation, the owner and tenant submit. The Public Health Committee decided, in seven cases, that the owner should be held responsible, and in the remaining 12 cases, the Notices were served, at the Committee's direction, upon the occupiers. New legislation provided by the Local Government (Miscellaneous Provisions) Act, 1953, helped in small measure to clarify the legal position affecting dustbin provision. A local authority has still to decide, on the facts of the case, whether the Statutory Notice shall be served on the owner or occupier of a property, but whereas previously the Court could invalidate a decision of a local authority, the Bench may now make such order as it thinks fit with respect to compliance with the Notice either by the Owner or the Occupier, and any person appealing against the Notice of a local authority must serve a copy of his appeal on the other party concerned. Actually, during 1953, there were no appeals against the decisions arrived at by this Council. 24 Housing—Inspection of Dwelling Houses during the Year Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,793 Number of inspections made for the purpose 5,545 Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 126 Number of inspections made for the purpose 1,117 Number of dwelling-houses (exclusive of those referred to under the following sub-head) found not to be in all respects reasonably fit for human habitation 339 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 in respect of which informal notices were served 339 Number of dwelling-houses in which defects were remedied after service of informal notices 251 Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 88 Number of dwelling-houses in which defects were remedied after service of formal notices : (a) by owners 88 (b) by Local Authority in default of owners — Properties not Possessing Main Drainage Systems. The position remains substantially the same as the details given 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 10 (not including moveable dwellings) Unsound Food. There continues to exist the closest co-operation between the Vendors of food and the Council's Sanitary Inspectors. It was not necessary, during the year, formally to seize any unsound food offered and exposed for sale. As a result of our visits and inspection of suspect packs of foods, approximately 9½ tons of various foodstuffs were condemned and surrendered by the Vendors for destruction under our supervision. 25 Although there was a great increase in the amount of " fresh" meat condemned, the majority of the foods condemned are canned goods and unfitness for human consumption arises through improper canning or from damaged packs. Of the two tons of meat condemned, only a small proportion was found to be diseased. The remainder both home killed and imported having decomposed probably through improper storage at some point in its transit between Slaughter House and Retailer. It is unfortunate that we had to take this action at a time when meat was still rationed and in short supply. A crumpet purchased in Beckenham was found to contain part of a cigarette. The vendor was prosecuted and fined £10 0s. Od. with £4 7s. Od. costs. An informal sample of Tomato Sauce (imported from Australia) proved to be inferior. Tomato sauce is supposed to contain a minimum of 6% of tomato solids. This sample contained only 3.6%. Upon receipt of the Analyst's report, a formal sample was taken but this proved to be genuine, containing 6.2% tomato solids. Two Cheese Spread samples were reported by the Analyst as inferior, because of their poor fat content. No statutory standard has been prescribed but the matter has been reported to the Ministry of Food, and it is understood that the Food Standard Division of the Ministry is given attention to the desirability of setting up a standard for this food. 26 Food and Drugs Sampling. During 1953, 85 formal and 31 informal samples were purchased and submitted to the Council's Public Analyst. Sampling for the Year 1953. article formal samples informal samples Milk 25 1 Suet l7 Ice Cream 4 Coffee and Chicory 3 1 Coffee Essence 1 French Coffee 1 Vinegar 5 Pork Sausage — 4 White Pepper 3 Cayenne Pepper 2 Olive Oil 2 Glauber Salts 1 Mustard 2 Lime Juice Cordial 1 Orange Squash 1 1 Cake Mixture 2 Sponge Mixture 1 Liver Salts 1 Castor Oil 1 Herring Roes — 1 Mushroom Ketchup 1 Ground Ginger 1 Custard Powder 1 Butter Beans 2 Sweets 1 Aspirin — 1 Salad Cream 1 Tea 1 Dessicated Coconut — 1 Cheese Spread — 3 Saccharine — 1 Mince Meat 1 Parsley and Thyme Stuffing — 1 Vanilla Flavouring — 1 Tinned Tomatoes — 1 Beans in Tomato Sauce 1 Welsh Rarebit 1 Jelly 7 1 Jelly Crystals 1 1 Chocolate Blancmange Powder 1 Tomato Sauce 2 1 Sauce 3 – Shrimps – 1 Frozen Pork Sausage 2 – Ham and Beef Paste 1 Curry Powder 1 – Table Cream 1 – Meat Paste 1 1 27 Ice Cream Sampling. Fifty-one samples of Ice Cream were examined during the year. No pathogenic organisms were isolated from the samples. Nine of the samples proved to be unsatisfactory in that they showed a degree of contamination. This does not mean that the ice cream was unfit for consumption, but rather is an indication that all possible care in the use of sterile equipment had not been taken. The receipt of such a result brings about a very close check on the manufacturer's premises, and further sampling until a satisfactory result is obtained. 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 1953, 66 applications were received and accounts rendered for £46 7s. Od. During the year, 169 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, 200 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 200 cases discovered, however, 26 related to private drainage, and in these cases, a charge is made for the work undertaken. Accounts were rendered for£640s.0d. 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 £659 18s. Id. 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. 28 Moveable Dwellings. Eleven families occupied moveable dwellings under licence from the Council during 1953. Frequent inspections of the sites of the caravans were made and in no instance was a Public Health nuisance discovered. Factories Act, 1937. Four hundred and twenty-eight 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 8 Unsuitable or defective sanitary conveniences 44 Insufficient sanitary accommodation 2 Unreasonable temperature1 Shops Acts. One thousand, five hundred and forty-two visits were paid in connection with the Shops Acts.. Twenty-four contraventions were discovered and remedied. 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 1952, 131 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 Post Mortems, 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. National Assistance Act, 1948. Burial and Cremation of Dead. Section 50 of this Act places responsibility on a local authority for the burial of persons who have died, or been found dead in their area where it appears that no suitable arrangements for disposal have been made. During 1953, four burials had thus to be arranged. In all but one ease, the Council was able to recover the costs involved, either from the deceased person's estate, or from an interested relative or friend. 29 This work involves a considerable amount of work as the Officers have to act as enquiry agents in their endeavours to trace the history of deceased persons and the possibility of surviving relatives. In the absence of any legitimate claimant to valuables or money found, the matter is referred to the Treasury Solicitor. In one case in 1953, a man who had lived in the most abject poverty and loneliness, left scattered thoughout his dwelling, moneys amounting to several hundred pounds which was eventually passed to the Treasury Solicitor. Rat and Mouse Infestation. The free service given for the extermination of rats and mice in domestic properties has continued throughout the year and it has again been necessary to exercise continual care to control the nuisance which remains widespread. Altogether, 642 complaints were received during the year. Most of the complaints relate to very minor infestations of rats or mice, and of the total number of cases investigated, only 32 related to what may be called major infestations, i.e. infestations of large numbers of rats or mice causing a nuisance. Included in the figures given are complaints relating to business premises and altogether 57 such premises were serviced and in these cases, accounts were submitted for £107 8s. Od. During the course of their work, the Rodent Operators paid 5,171 visits to 1,254 premises and there is no doubt that the service given is one which is particularly welcomed by the residential population. During 1953, the sewers of the Town have been baited and poisoned on two occasions, and I am able to report that the infestation below ground is still kept at a minimum. 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. 30