BEC 21 BOROUGH OF BECKENHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 BY L. R. L. EDWARDS, M.D. (Lond.), D.P.H. Medical Officer of Health MEMBERS OF THE PUBLIC HEALTH COMMITTEE YEAR 1954 Chairman : Councillor A. C. Garrett. Deputy Chairman : Councillor L. E. MacCallum, M.C. Alderman R. S. Jackson. Councillor R. J. Butcher. Councillor H. E. W. Botting. Councillor A. M. Brady (Resigned, 22-9-54). Councillor C. M. Hamilton {from 22-10-54). Councillor R. G. Cook. Councillor W. Duncan. Councillor G. E. Fish. Councillor D. R. Knox-Johnson. Councillor C. E. Locke. Councillor E. R. Smithers. Councillor Miss K. A. Moore. Councillor Mrs. D. E. L. West. Ex-Officio : The Mayor. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical O fficer 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 W. T. G. Woodward, 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. Certificate, Institute of Housing. K. J. Coppin, Cert. R.S.I, and S.I.E.J.B. Certificated Food Inspector. 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 (Resigned, Nov., 1954). J. G. Freeland (Appointed, Dec., 54): Mortuary Attendant—General Assistant A. L. Jarvis. 3 INTRODUCTION. To the Chairman and Members of the Public Health Committee. I HAVE the honour to present a report on the health of the Borough during 1954. The Infantile Mortality rate has returned to a figure more nearly approaching the average. The figure is still less than for England and Wales, and compared with the previous reports, the rate is intermediate in position under the heading of the table of comparative Vital Statistics, The increase in deaths has occurred among babies of less than a week old, and in 11 out of 12 instances, was attributed to ante-natal or intra-natal conditions including 5 cases of prematurity. For the second successive year there were no deaths of mothers in childbirth. Fluctuations in the general population of the borough are still slight, and the density figure has remained at between 12.5 and 12.7 per acre since 1946. There was a reduction in cases of all infectious diseases with the exception of dysentery in which there was a slight increase in number, In October cases of paratyphoid B due to phage type 3al were reported From one family, but full investigations as to the source of infection proved negative. Consultation with my colleagues of neighbouring areas suggested that these were possibly linked up with cases of whom they had many more to report. The source of infection was probably confectionery eaten outside the borough. Of the three cases admitted to hospital, one, a very young child without symptoms, was admitted for convenience of treatment. In this disease, supervision but not quarantine of contacts is carried out. The increased incidence of dysentery led to a wider investigation of general hygienic conditions, and as a result, to recommendations in respect of maintenance work on sanitary conveniences in Schools and other premises. At the same time there is no doubt that the control of this diseases must depend as much on the effective use of up-to-date medical treatment as on hygienic measures, for the disease spreads most where conditions are crowded and exposure unavoidably intimate, such as occurs all too frequently in homes lacking in modern amenities. Contacts are examined to detect food handlers, unrecognised mild cases and convalescent carriers. But for sporadic cases, these investigations are time consuming and give meagre results, and with the present shortage of Inspectors, may not be justified. 4 Out of 83 cases of whooping cough, none were admitted to hospital. During the past 10 years the number of cases of this disease admitted to hospital in the year has never been more than 2. For the sixth year in succession there have been no cases of diphtheria. No suspected case of smallpox was reported, but contacts of suspected cases removed from ship to Port on route to London were visited daily until either the diagnosis was disproved or the necessary sixteen days supervision of contacts was completed. In all cases contacts had been vaccinated before arrival in Beckenham. Full investigations of 11 cases of food poisoning were carried out. One family outbreak was of interest in the isolation from the suspected food of a food poisoning strain of organism. One adult aged 81 years soon recovered after admission to hospital, but no growth was obtained in vomit, faeces or blood culture. Examination of faeces of the other adults remaining at home were also negative. The investigations confirmed the suspicion that this was a toxic food poisoning. The corned beef stored in a larder had been opened and eaten immediately. During the year, of the remaining 7 cases investigated, Salmonella Typhimurium was found in two instances, and no organisms in the others. In all these enquiries, I should like to commend the assistance of the Chief Sanitary Inspector, and the other Inspectors. A Table has been included in this year's Report to shew the incidence of minor sickness based on illness of more than three days duration. January to March inclusive are the months of greatest ill health. The figures for vaccination and inoculation in Beckenham are now excellent—1,310 diphtheria immunisations, 841 smallpox vaccinations, and 57 B.C.G. vaccinations against tuberculosis were carried out. It is important to recognise that B.C.G. vaccination is only performed at the Chest Clinic on child contacts who are Mantoux skin test negative and whose parents agree to their vaccination. Relating this to the number of adults who were new cases at the Dispensary, the response was excellent. It is important that this measure should be a success, for there is a feeling to-day that while treatment of Tuberculosis has improved enormously, there is as yet, not so great a result from preventive measures. However, Dr. Madigan reports a downward trend so that in this area the position is more satisfactory than elsewhere. An informed public is largely responsible for this satisfactory trend and no small credit is due to Dr. Madigan's guidance of the Care Committee whose Chairman is Mrs. Porter, local area organiser of the Women's Voluntary Service. At these meetings which I have attended, representatives of six or more voluntary organisations, including Works welfare representatives, have conferred with the medical side which includes Tuberculosis Health Visitors, Social Workers and Almoners from local hospitals. Besides helping individual patients and their families, this has afforded continuous health education 5 of the most informed kind. Efforts to raise funds through whist drives, a stall at the local horticulture show and other social events have also helped to this end. The voluntary organisations include the Beckenham Brotherhood, British Legion, Rotary, Women's Guild, Women's Citizens, Women's Co-op, Beckenham and Penge Trades Council, Co-op Guild, B.R.C.S., W.V.S., and S.S.A.F.A. If boredom is the greatest disease of mankind, the work of the Women's Voluntary Service on behalf of old people, including their compaign for radio sets for old age pensioners, in combating this illness in regard to old people is admirably shewn in their report. As a member of the Medical Society for the Care of the Elderly, I can greatly appreciate their efforts. In the case of old persons, the medical condition is the guiding factor in all efforts to assist, including their admission to Nursing Home, Old Persons Home or Hospital. The Health Committee are concerned with the care of old people in other indirect ways, including the registration and supervision of Nursing Homes. The supervision of Old Persons Homes, however, is carried out by special staff of the local health authority. This staff are also responsible for the admission of persons to these homes. Durham House, a home designed for 39 old people, and an extension to Thornton House were also opened during the year. Local efforts provided a Television set for the lounge at the latter Home. Under Section 187 of the Public Health Act, 1936, the Committee recommended registration of one new private Nursing Home of 10-12 beds. Before registration, inspection of each house is carried out with special regard to structure, sanitary arrangements, fire protection to diminish by guards and suitable furnishings the spread of fire, equipment including drug cupboards, sluices, kitchen and food stores, and to suitable and sufficient staff. A difficulty with regard to the supervision of staff is the increasing need of homes to employ part-time staff who live out This gives the impression at times of under-stalling. During the year the Committee received reports on the repair of insanitary houses as part of their review of slum clearance and rehousing, These reports followed the visits of a special sub-committee, accompanied by the Medical Officer of Health, and Chief Sanitary Inspector, to houses which had been reported as being insanitary within the meaning of Section 9 of the Housing Act, 1936, and subsequently repaired by and at the expense of the owners and made fit for habitation. Legally sub-standard houses were in one way or another before the Committee throughout the year, either for the above, or for improvement or for certificates of disrepair. In addition, the Committee considered improvement grants for the conversion of fit houses to form additional dwelling units. 6 The environmental problems of this area often relate to certain annual matters such as occasional temporary pollution of streams or noise or smoke nuisances for which the best practicable means of prevention have been taken. Research is being carried out nationally, and these are problems which are not peculiar to Beckenham, but stand out in greater relief because of our essentially residential character. Research in general practice is also prominent in this borough and it is taking part in the epidemiological survey of non-notifiable diseases, including glandular fever, infective hepatitis and epidemic winter vomiting, which is being conducted in south-east England by the college of general practitioners. A questionnaire was completed on the incidence of influenza as a prelude to the trials of an influenza vaccine in various parts of the country. It was noted that the prevailing type of influenza tends to attack children more than adults and to occur mainly in the period March to May. In many it was associated with sickness and diarrhoea, and often attacked middle-aged city workers, and schoolchildren. One must record the difficulties occasioned by shortage of staff at a time when Inspectors could help in a wider field of public health by their enquiries into the welfare of old persons living alone, and into the circumstances of problem families. In conclusion I wish to record my appreciation of the co-operation of Dr. Elliott, the County Medical Officer, and of Dr. Ward and other members of the County staff. Mr. Moore, the District Officer succeeded a very able Officer in the late Mr. H. G. Smith, with whom the Department had much contact on social welfare problems. The Staff of the Health Department have worked as a team and with great enthusiasm and efficiency. I wish to record my thanks to them and to express to you my appreciation of the interest and understanding shewn by each member of the Committee throughout the year. L. R. L. EDWARDS, Medical Officer of Health. 7 SUMMARY OF VITAL STATISTICS, 1954 Area of District in acres 5,935 Civilian Population as estimated by the Registrar-General at 30th June, 1954 75,280 Civilian population per acre 12.7 Rateable Value at 1st October, 1954 £913,842 Births Registered (Including Stillbirths): Male Female 902 Legitimate 456 426 Illegitimate 11 9 Total Birth Rate (including Stillbirths) per 1,000 of Civilian Population (Corrected) (11.98 × 1.07) 12.82 (Crude) 11.98 Male Female 828 Deaths Registered 405 423 Total Death Rate per 1,000 population (Corrected) (11.00×0.88) 9.68 (Crude) 11.00 Infant Mortality Rate per 1,000 live births 23.57 Maternal Mortality Rate per 1,000 births Deaths of Infants under 1 year of age: 0.00 Male Female 21 Legitimate 10 10 Illegitimate 1 — Total Still Births— Rate per 1,000 population 0.14 Rate per 1,000 live births 12.34 Male Female 11 Legitimate 6 4 Illegitimate — 1 Total Death Rate per 1,000 of Civilian Population from Cancer (184 deaths) 2.44 Death Rate per 1,000 of Civilian Population from Pulmonary Tuberculosis (8 deaths) 0.11 Death Rate per 1,000 of Civilian Population from NonPulmonary Tuberculosis (1 death) 0.01 Death Rate per 1,000 of Civilian Population from Accidents (26 deaths) 0.34 Natural Increase: The Births registered exceeded the deaths by 63. 8 COMPARISON OF BIRTH RATES, DEATH RATES AND INFANT MORTALITY Rate per 1,000 Pop. Rate per 1,000 live births Live Births All Deaths Still Births Deaths under 1 yr. Beckenham 12.82 9.68 12.34 23.6 England and Wales 15.2 11.3 23.4 25.5 160 County Boroughs and Great Towns. 16.8 9.6 25.6 29.2 160 Smaller Towns. 15.4 11.3 22.4 23.8 9 TOTAL DEATHS 1954 (Registrar-General's Official Returns) All causes—828 ; Male, 405 ; Female, 423. CAUSES OF DEATH MALES FEMALES 1. Tuberculosis, respiratory 7 1 2. Tuberculosis, other 1 1 3. Syphilitic disease — — 4. Diphtheria — — 5. Whooping Cough — — 6. Meningococcal infections 1 — 7. Acute poliomyelitis — — 8. Measles — — 9. Other infective and parasitic diseases 1 10. Malignant neoplasm, stomach 10 6 11. Malignant neoplasm, lung, bronchus 37 5 12. Malignant neoplasm, breast — 22 13. Malignant neoplasm, uterus — 4 14. Other malignant and lymphatic neoplasms 47 53 15. Leukaemia, aleukaemia 3 1 16. Diabetes 2 3 17. Vascular lesions of nervous system 48 59 18. Coronary disease, angina 88 52 19. Hypertension with heart disease 7 5 20. Other heart disease 32 95 21. Other circulatory disease 12 30 22. Influenza 1 2 23. Pneumonia 9 11 24. Bronchitis 16 15 25. Other diseases of respiratory system 3 26. Ulcer of stomach and duodenum 7 3 27. Gastritis, enteritis and diarrhoea 1 1 28. Nephritis and nephrosis 10 3 29. Hyperplasia of prostate 9 — 30. Pregnancy, childbirth, abortion — — 31. Congenital malformations 4 3 32. Other defined and ill-defined diseases 30 37 33. Motor vehicle accidents 9 2 34. All other accidents 10 5 35. Suicide 1 3 36. Homicide and operations of war — 1 Totals 405 .. 423 10 11 VITAL STATISTICS FOR YEARS 1946 to 1954 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 population Legitimate Illegitimate Total Legitimate Illegitimate Total Rate per 1,000 live Births 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 1954 75,280 872 19 891 11.835 10 1 11 20 1 21 23.57 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 population Number Number Rate per 1,000 population Number Rate per 1,000 population 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 18 0.237 131 1.727 1951 832 11.111 1 10 0.133 129 1.709 1952 890 11.841 1 10 0.133 171 2.275 1953 819 9.593 6 0.080 156 2.076 1954 828 10.998 — 8 0.106 184 2.444 INFANTILE MORTALITY, 1954 The number of deaths of infants under the age of twelve months was 21 as compared with 11 in 1953. The Registrar-General returns 21 infant deaths and the Infant Mortality Rate for the year was 23.57 per 1,000 live births. The following Table shows the causes of death for which full records exist. 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 1 1 — — — 1 — — — 3 B. Ante-natal or Intranatal Conditions 11 - 1 - - - - 1* - 13 C. Infections — 1 — — — 1 1 1 1 5 D. Accidental - - - - - - - - - - Totals 12† 2 1 — — 2 1 2 1 21 * Pontine (Cerebral) Tumour. † Prematurity=5. 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 - - 1 1 Dysentery (Bacillary) 5 27 15 1 48 2 Encephalitis — 2 — — 2 2 Erysipelas — 1 7 — 8 3 Food Poisoning 5 1 5 11 2 Measles 56 68 1 2 127 — Pneumonia 1 2 13 - 16 3 Paratyphoid 'B' 1 2 3 3 Poliomyelitis: Paralytic 1 - - - 1 1 Non-ParaJytic — 1 1 1 Puerperal Pyrexia — — 14 - 14 14 Scarlet Fever 15 55 3 1 74 18 Whooping Cough 52 29 2 — 83 — 13 INFECTIOUS DISEASE (2). disease jan. feb. mar. apr. may june july aug. sept. oct. nov. dec. total Cerebro-Spinal Meningitis - - - - - - - 1 - - - - 1 Dysentery (Bacillary) 1 - 1 1 9 29 6 1 — — — — 48 Encephalitis - - - - - - - - - - - - 2 Erysipelas — 2 — — 1 1 — — 1 2 1 — 8 Food Poisoning 1 - — 1 2 1 1 — —: 4 — 1 11 Measles 1 - — 1 1 — 2 3 1 1 4 113 127 Paratyphoid 'B' - - - - - - - - - - - 3 3 Pneumonia 2 3 2 1 1 1 — — — 1 — 5 16 Poliomyelitis: Paralytic - - - - - - - - 1 - - - 1 Non-Paralytic — — — — — — 1 — — — — — 1 Puerperal Pyrexia 4 2 — 1 2 2 1 1 — — — 1 14 Scarlet Fever 5 17 11 4 10 2 5 6 2 3 5 4 74 Whooping Cough — 5 — 8 5 3 14 22 6 - 1 19 83 Totals 14 29 14 17 31 41 30 34 11 11 11 146 389 14 TUBERCULOSIS—Table of Notifications and Deaths, 1954, 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 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 29 31 60 5 - 3 5 9 10 3 11 8 6 - 12 7 9 10 3 2 17 Non-Pulmonary 2 2 4 - - 1 - - 1 2 - - - - 1 - - - - - 3 Totals 31 33 64 5 — 4 5 9 11 5 11 8 6 — 13 7 9 10 3 2 20 Deaths Pulmonary 7 3 10 - - - - - 2 1 - 4 3 - 1 1 - 4 2 1 1 Non-Pulmonary — 1 1 - - - - - - - - 1 - - - - 1 - - - - Totals 7 4 11 — — — — — 2 1 — 5 3 — 1 1 1 4 2 1 1 15 *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 am grateful to Dr. Madigan for submitting the following report on the work of the Chest Clinics and the following Table : " It will be seen from these figures that the numbers of patients referred for investigation still show a downward trend, particularly in the case of children. However, there is an appreciable increase in the numbers of contacts attending for examination, which indicates greater co-operation on the part of patients and their families in preventive measures. This I feel is in large part due to the painstaking efforts of the Tuberculosis Health Visitors in educating the public in these measures. B.C.G. Vaccination of child contacts has been well up to average, 57 children from Beckenham Borough having been vaccinated during 1954. There were fewer patients admitted to Hospitals or Sanatoria for treatment than in 1953, and it is gratifying to note that waiting lists for ordinary sanatorium treatment are now almost nonexistent. Even cases awaiting surgical measures are admitted within a reasonable period now ; a vast improvement on the position of a few years ago." New Cases attending the Tuberculosis Dispensaries for the first time during 1954. Adults Children under 15 years Male Female Male Female Pulmonary 28 22 — — Non-Pulmonary — 1 — — Negative 61 47 6 6 Negative Positive Contacts Examined 201 3 Number of patients admitted to Sanatoria during the year : 52. These figures relate to patients resident in Beckenham Borough only. BECKENHAM TUBERCULOSIS CARE COMMITTEE. The voluntary Tuberculosis Care Committee was formed in 1938 and has undoubtedly rendered a most valuable service by raising considerable sums of money which are used for the benefit of local patients. Assistance is given to patients in ways which supplement the official schemes and congratulations are due to the Hon. Secretary and the Committee for their excellent work. 16 My thanks are due to Mr. M. E. Forster, the present Hon. Secretary, for kindly submitting the following report on the Committee's work during the year under review : " The Beckenham Tuberculosis Care Committee, which is one of 28 such Committees associated with the Kent Council of .Social Services, continued its voluntary welfare work amongst local tuberculosis patients and their families, in close co-operation with the local Chest Clinics, as in the past 17 years since it was founded. Last year the Committee spent over £500 in the provision of clothing, fees for Study Courses, fares for visiting Sanatoria, extra meat and milk, and in various other ways. During the summer families received a gift from the Committee which enabled them to have a day's outing to the country or seaside. Also at Christmas time gifts were distributed amongst patients. The Committee has tried to keep before the public, the work that is being done in the prevention and cure of Tuberculosis by way of an Information Stall at the Local Horticultural Show, and by holding a Whist Drive." MORBIDITY RETURNS, 1954 certificates of incapacity total first intermediate final January* (ended 26.1.54) 1175 4305 860 6340 February (ended 23.2.54) 1162 4838 1059 7059 March (ended 30.3.54) 1130 5902 1044 8076 April (ended 27.4.54) 734 4387 718 5839 May (ended 25.5.54) 734 4094 681 5509 June (ended 29.6.54) 676 3922 614 5212 July (ended 27.7.54) 615 4043 527 5185 August (ended 31.8.54) 604 3964 485 5053 September (ended 28.9.54) 676 3937 505 5118 October (ended 30.10.54) 879 4151 655 5685 November (ended 30.11.54) 977 4077 684 5738 December (ended 28.12.54) 853 4222 652 5727 * On January 6th the local office of the Ministry of Pensions and National Insurance telephoned that claims had increased by 200% compared with the previous three weeks. Bronchitis, influenza, chills and gastro-enteritis were the illnesses most prevalent according to certification. WOMEN'S VOLUNTARY SERVICE. 1 again express my thanks to Mrs. S. E. Porter, the local Area Organiser for submitting the following report on the W.V.S. work in this Borough. Darby and Joan Clubs. Three Darby and Joan Clubs in Beckenham and two Over 60's Clubs in West Wickham are running in the Borough. Two of the Clubs are held on Tuesday and one on Thursday from 1.45 to 4.15 p.m. Membership of each Club averages 100/120, and the members are all over 60 years of age. The membership fee is 1d. and an excellent tea is provided for 3d. per person. Whist Drives, Darts Matches and Raffles 17 are held each week and thoroughly enjoyed by the old people. A free library is available. The Clubs are subsidised by voluntary subscriptions. Members are making up a party to go to the coast for a week's holiday under the scheme arranged for old age pensioners. Spring and Autumn outings are arranged for the old people in addition to a pantomime and an Ice Show. The members save a small amount weekly in order to pay for such outings. A Savings Group is run for members who wish to save towards holidays, outings, etc. The two Over 60's Clubs are run in West Wickham with an average membership of 130/150. Meals on Wheels. Meals are still served 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 assistance usually come from Hospital Almoners, Doctors, District Nurses and through the Darby and Joan Clubs. The meals are provided by a local canteen and an allowance for transport is made through the Local and County Authorities. Cost of the Meals is subsidised by voluntary funds, and those in need are only required to pay a very small sum for the service they receive. West Wickham Luncheon Club. Meals for this Luncheon Club are cooked by the W.V.S. and only a nominal charge is made. An average of 25 meals is served weekly. Old People's Welfare. Visits are made to elderly people who live alone, and assistance is given with regard to clothing which is supplied free on the authority of the National Assistance Board, District Nurses, etc. Hospital Work. Work in connection with Beckenham Hospital has been much appreciated and consists of help with the library, flowers and magazines. Other work is done at Swanley Hospital and at the Heart Hospital, West Wickham. Maternity Home. Many baby garments have been knitted and we now have a Guild of Service which will supply help personally to the Matron. This Guild consists of both W.V.S. members and a number of interested people in Beckenham and Penge. 18 Baby Clinics. Helpers are supplied at 3 of the baby clinics in the Borough and assist in the selling of Welfare Foods, weighing and clerical work. S.S.A.F.A. The local branch is still run by us from our own Centre and in the past year over £500 has passed through its hands. Apart from financial help, clothing has been given and advice on many other matters. Clothing Depot. The stock in our Clothing Depot has been increased by clothing from the Mayor's Fund, and we are able to help many more people than in the past. Naturally we can only distribute this clothing on the authority of a reliable person, or body such as the National Assistance Board. In addition to the aforementioned activities, the W.V.S. has a close liaison with the Tuberculosis After Care Committee, Area Pensions Officer, British Legion, The Disabled Persons Committee, and Children's Homes. The Children's Clothing Exchange is still being run every Wednesday. Orange Juice, Cod Liver Oil and Vitamin Tablets are sold in the Centre. NATIONAL ASSISTANCE ACT 1948—SECTION .47 Under Section 47 of the above act as amended by the National Assistance (Amendment) Act 1951, persons suffering from grave chronic disease, or who are aged, infirm or physically handicapped and who are living in insanitary conditions and unable to devote to themselves and not receiving from other persons proper care and attention, may be compulsorily removed. Several possible cases were visited and investigated during the year and in one instance it was necessary to apply to the court for an order of removal which was granted. 19 Immunisation against Diphtheria and Vaccination against Smallpox, 1954. (A) DIPHTHERIA IMMUNISATION. Year of Birth. 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 Total Primary Inoculations. 70 512 65 9 7 14 11 1 — — 1 1 — — — 691 Re-inforcing Inoculations. — - — — 32 377 112 62 14 7 6 5 4 — — 619 (B) VACCINATION. Year of Birth. 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 Before 1940 Total. Primary Vaccination. 379 286 10 3 4 8 5 1 2 — 3 1 2 — — 27 731 Re- Vaccination. — — 3 3 1 3 3 2 3 2 1 3 3 — 3 80 110 INFANT WELFARE CENTRE ATTENDANCES, 1954. (a) The number of Sessions held during the year was 460. (b) Attendances during the same period, 21,596. DIPHTHERIA IMMUNISATION. All the Infant Welfare Clinics in the Borough carry out Diphtheria Immunisation. (a) The number of Sessions held during the year (in conjunction with Child Welfare Clinics) was 356 (b) Attendances during the same period 849 SMALLPOX VACCINATION. (a) The number of Sessions held during the year (in conjunction with Child Welfare Clinics) was 227 (b) The number of vaccinations given was 441 20 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. Bromley Hospital—Cromwell Avenue, Bromley. 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. Bcckenham District Office, 12, Bcckenham Road, Beckenham. Home Nurses. Bcckenham District Office, 12, Bcckenham 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. Durham House. 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. Genera Welfare. District Offices, Beckenham Road, Beckenham. Clinics for Maternity and Child Welfare. 21 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, Albermarle 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 Thursday, 10—12 noon 2—4 p.m. (b) Church Hall, Valley Road, Shortlands Church Hall, Lennard Road, Penge Thursday, 2—4 p.m. (a) Clinic Block, Town Hall, Bcckenham (6) Clinic Block, Hawes Lane W. Wickham Friday, 2—4 p.m. Church Hall, Langley Road Elmers End Vaccination (by appointment only) and Diphtheria Immunisation are carried out during certain Infant Welfare Sessions at the above Clinics. 22 Service Days and Times Premises in use Dental (Infant By appointment Clinic Block, Town Hall Welfare Cases) By appointment Clinic Block, Hawes Lane, W. Wickham Speech .. Mondays, Tuesdays and Thursdays all day Wednesday mornings (by appointment only) Town Hall Clinic Orthopaedic Wednesday mornings (twice Clinic Block, Town Hall, per month) (By appoint- Beckenham ment) Surgeon in attendance. Friday afternoons (once per Clinic Block, Hawes Lane, 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 Fridays—Afternoons Tuesdays—Mornings Clinic Block, Hawes Lane, Fridays—Mornings W. Wickham, Mothercraft Classes and Relaxation Exercises .. 1st and 3rd Fridays in each month, 10—12 noon 2nd and 4th Fridays in each month, 2—4 p.m. Clinic Block, Town Hall, Beckenham Clinic Block, Hawes Lane, W. Wickham 23 REPORT ON THE SANITARY ADMINISTRATION of the DISTRICT FOR THE YEAR 1954 By G. A. Webber, Chief Sanitary Inspector, Borough of Beckenham. Throughout the whole of 1954 there was one vacancy in the Establishment of Sanitary Inspectors; no applications were received to repeated advertisement. The shortage of Sanitary Inspectors is by no means confined to Beckenham, the majority of Authorities being similarly inconvenienced. There has consequently been a decrease in the routine inspection of the district. In the circumstances, we have exercised what we believe to have been a wise discretion in preference. Certain duties have taken pride of place. The speedy investigation of cases of notifiable diseases has been maintained. The 1,466 complaints of alleged statutory and other nuisances (an increase of 222 over 1953) which were received during the year, had reasonably prompt attention. The inspection of food premises received high priority, and, although visits to food shops were not as methodically frequent as had previously been our aim, 1904 visits were paid during 1954 compared to 1,986 in 1953. The inspection of houses, in accordance with the provisions of the Housing Acts, decreased—83 being inspected compared to 126 in 1953 ; the number of premises visited under the Public Health and other associated Acts declined from 3,325 in 1953 to 2,944 in 1954, and the number of nuisances discovered fell by 547. One hundred and eighty-three Intimation Notices and 67 Statutory Notices were served. In 1953 the figures were 339 and 88 respectively. One hundred and one food samples were submitted to the Public Analyst compared to 161 in 1953. This reduction resulted in the Analyst drawing attention to an ageing Ministerial Circular which suggests that 3 food samples per annum be taken for every 1,000 of the population. This would mean approximately 225 samples per annum in Beckenham, and it will be seen that we fall far below that figure. However, it is fair comment to suggest that the need may not be so great in modern times, particularly when it is remembered that the Circular was issued when it was the common practice to sell "loose" milk, and the opportunity for adulteration was greater. Nevertheless, an endeavour must be made to increase our figure to one more in accord with the importance of the subject. It would, at this stage, be unreasonable to imply that the lack of staff involves anything comparable to an immediate threat to the health of the district ; it would be unwise to underestimate its importance. The Sanitary Inspector is concerned with the prevention of nuisances in the field of environmental hygiene. The passage of time may prove that it is easier to judge the value of his work by its unavoidable neglect than by its performance. 24 Dwelling Houses. The demolition of dwelling houses in Beckenham which, for the past 10 or 20 years of their advancing life, have earned inclusion in a sub-standard classification, and their replacement with sound and modern structures, would be an ideal achievement. There must surely be considerable doubt as to whether it is an economic or practicable possibility. Such action does not appear to be so essential here as in other areas of the Country ; areas where, for instance, back-to-back houses, and those without piped water supply and individual water closet provision, abound. Comparison, indeed, indicates that our part of the national housing problem relates more to reclamation rather than to wholesale demolition. A report on one northern Town, as an example, tells of some 45,000 houses where communal watercloset accommodation only is available, and these are not scheduled in the 20,000 worst houses in that Town. Consequently, the Officers intimately concerned with the older properties in Beckenham, and with their lack of modern amenity, viewed with interest and enthusiasm much of the White Paper "Houses—the Next Step" presented to Parliament by the Ministry of Housing and Local Government in November, 1953. The proper emphasis which had been placed on the need for new houses, and the successful achievement, throughout the Country, of numerical targets, led many to overlook the place which properly maintained old properties can take in the solution of the national housing problem. The effect of such proper maintenance on the existing lengthy housing lists may be negligible, but the extended life of these houses will certainly keep the already overloaded lists from expanding. The purpose of the White Paper was to focus attention on existing properties ; to overtake the arrears of repair work which had been neglected ; to keep structurally sound houses in good order ; to improve those which lack modern amenity ; and to demolish those so unfit as to be incapable of repair at reasonable expense. In the wake of the White Paper came several Ministerial Circulars, and, finally, the Housing Repairs and Rents Act, 1954, to give statutory support to the programme. The Public Health Department's concern was with the provisions relating to standards of fitness ; with the latter in relation to reasonable expense; with owners and occupiers rights in the matter of increased rentals; and with facilities for the improvement and conversion of properties. Legislation tends to become overlapping, repetitive, and sometimes contradictory. These were not entireJy new legal provisions, but a variation, and, in part, a clarification of older ones. It may be argued that the standard of fitness for dwellings is not now so stringent as that previously existing. One notices, for instance, in the conditions relating to improvement grants, that a house is now required, inter alia, to be substantially free from damp", whereas the Housing Act, 1949, (which first introduced grant provision) demanded that a house should be "in all 25 respects dry". This subtle alleviation is noteworthy in relation to dampness, undoubtedly the commonest and yet the most difficult of all housing defects to remedy. It suggests a more sensible approach to a condition of infinite variety and degree of importance, and one which appears to invite over emphasis in assessing standards of fitness. Attention having been focussed on the older properties and the need to maintain such houses in habitable condition, it was satisfying to be able to report that this aspect of the problem had not been overlooked in this Borough in recent years, for since 1946 we have used the considerable powers already available in established Housing Law to maintain those houses falling by age and neglect into dilapidation and disrepair. We had already broken the back of our local problem, although there still remain many houses to be dealt with. It should be made clear that this work related only to maintenance, and not to added amenity. It was somewhat unfortunate that the publicity given to this Council's reception of the White Paper, and the new Housing Act, embraced references to "slums" in Beckenham. This received much prominence and it is proper to record the indignant objections expressed by the owners and tenants of many of the properties identified in this connection. The work had nevertheless proceeded and in the year 1954 another fifty was added to the total of repaired properties which now stands at 388. With the full support of the additional legislation, and an adequate staff, this work may more easily be continued, and it is to be hoped that the possibility of improvement of many of these properties by the addition of modern amenities will not be overlooked. The Housing Act, 1954, did not come into operation until August of that year and it is too early to report fully upon its usefulness. The indications, however, arc that Owners are not anxious to take action which automatically invites the close inspection of their properties by the Local Authority. And, unfortunately, there had been little response by the end of the year to the facilities now available for the improvement of properties. Statistical information, relating to the work of the Inspectors, is appended :— Number of complaints received and investigated 1,431 Number of initial visits 4,537 Number of revisits 4,720 Number of Intimation Notices served 183 Number of Statutory Notices served 67 26 Nuisances Remedied Structural defects—external 440 Structural defects—internal 866 Insanitary conditions, other than vermin 44 Choked drains 243 Other drainage defects 216 Defective sanitary appliances 72 Insufficient or unsuitable water supply 4 Absence of dustbins 24 Offensive accumulations 1 1,910 Dustbin Accommodation. It was necessary to report 11 cases of insufficient or unsuitable dustbin accommodation in properties in the Borough. The Council has to determine whether the Statutory Noticc 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 four cases, that the owner should be held responsible, and in the remaining 7 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 1954 there were no appeals against the decisions arrived at by this Council. 27 Housing—Inspection of Dwelling Houses during the Year. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,278 Number of inspections made for the purpose 4,561 Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the HousingConsolidated Regulations, 1925 83 Number of inspections made for the purpose 677 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 183 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 183 Number of dwelling-houses in which defects were remedied after service of informal notices 116 Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 67 Number of dwelling-houses in which defects were remedied after service of formal notices : (a) by owners 67 (b) by Local Authority in default of owners 0 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 6 tons of various foodstuffs were condemned and surrendered by the Vendors for destruction under our supervision. Most of this condemned food was, in fact, found to be due to faulty processing in manufacture. 28 Details are appended of the formal and informal samples submitted to the Public Analyst during the year. ARTICLE FORMAL INFORMAL Milk (Pasteurised) 20 — Milk (Tuberculin Tested) 3 — Milk — 1 Fresh cream — 1 Sterilised cream — 1 Tomato puree — 1 Marmalade — 1 Gooseberry conserve — 1 Raspberry jam — 1 Orange crush — 1 Sauce — 1 Cinnamon — 1 Butterscotch — 1 Aspirin — 1 Buttered chocolate — 2 Licquorice and menthol pellets — 1 Cream toffee — 2 Buttermints — 1 Candied peel — 2 Ground nutmeg — 2 Celery chcese spread — 1 Curry powder — 2 Pork Sausages — 9 Sausage meat — 1 New Zealand butter — 1 Cooking fat — 2 Margarine — 1 Malt Vinegar 1 1 Minced beef loaf — 1 Raisins — 2 Cheese spread — 2 Fish cakes — 1 Sausage rolls — 1 Ice cream — 4 Rum and butter toffee — 1 Yorkshire pudding mixture — 1 Blackcurrant jam — 1 Gelatine — 1 Gravy Powder — 1 Marzipan — 1 Custard Powder — 1 Mincemeat 1 Suet — 1 Flavouring — 1 Loose vinegar — 1 Currants — 1 Sultanas — 1 Soft brown sugar — 1 Dessicated coconut — 1 Mild beer — 6 Whisky — 5 Dripping — 1 29 Certain samples were reported by the Public Analyst to be "inferior" by reason of the fact that labelling requirements were not fully met. In these cases, the Analyst dealt direct with the manufacturers with satisfactory results. Legal proceedings instituted against the Vendors of a loaf of bread (not manufactured locally) contaminated with rodent excrement resulted in the firm being fined £5 with £2 2s. Od. costs. There were other instances of minor contamination of food, in which the Public Health Committee decided that the circumstances could be met by letters of warning being sent to the Vendors. Ice Cream Sampling. Twenty-one samples of Ice Cream were examined during the year. No pathogenic organisms were isolated from the samples. Two 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 1954, 45 applications were received and accounts rendered for £45 3s. Od. During the year, 156 Library books were collected from homes where infectious disease had occurred, disinfected and returned to the Library of origin. School Sanitation. Following Committee discussion regarding sanitary accommodation in Schools, I was instructed to prepare a written report for submission to the Public Health Committee. This report had many repercussions, and perhaps the value of the one which really mattered was overlooked, but the resulting cleaner school lavatories cannot be other than satisfying to a Public Health Official as a factual demonstration of improvement in the field of environmental hygiene. 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. 30 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, 133 related to private drainage, and in these cases, a charge is made for the work undertaken. Accounts were rendered for £73 Is. 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. 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. Fifteen families occupied moveable dwellings under licence from the Council during 1954. 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 forty nine 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 5 Unsuitable or defective sanitary conveniences 32 Shops Acts. One thousand, six hundred and twenty-six visits were paid in connection with the Shops Acts. Sixteen 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 1954, 99 bodies were brought to the Mortuary where postmortem 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. 31 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 1954, six burials had thus to be arranged. In all but two cases the Council was able to recover the costs involved, either from the deceased person's estate, or from an interested relative or friend. This duty 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. 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. 756 complaints were received during the year. Included in the figures given are complaints relating to business premises and altogether 64 such premises were serviced and in these cases, accounts were submitted for £70 9s. Od. During the course of their work, the Rodent Operators paid 5,485 visits to 1,155 premises and there is no doubt that the service given is one which is particularly welcomed by the residential population. During 1954, the sewers of the Town have been baited and poisoned on two occasions, and J am able to report that the infestation below ground is still kept at a minimum. I wish to express my thanks to my colleagues who have worked with me so loyally during the year under review. G. A. WEBBER, Chief Sanitary Inspector. 32