4412 (1) BOROUGH OF BECKENHAM REPORT Of The MEDIC AL OFFICER OF HEALTH FOR 1956 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 1956 BY L. R. L. EDWARDS, M.D. (Lond.), D.P.H. Medical Officer of Health MEMBERS OF THE PUBLIC HEALTH COMMITTEE FROM JUNE, 1956 Chairman: Councillor L. E. MacCallum, M.C. Deputy Chairman: Councillor R. J. Butcher. Alderman C. P. Christie. Alderman R. S. Jackson. Councillor K. D. Aldcroft. Councillor H. E. W. Botting. Councillor C. M. Hamilton. Councillor W. Duncan. Councillor R. G. Cook. Councillor G. E. Fish. Councillor E. R. Smithers. Councillor A. C. Garrett. Councillor E. J. Porter. Councillor Mrs. D. E. L. West. Ex-Officio: The Mayor. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health Chief Public Health Inspector Deputy Chief Public Health Inspector District Public Health Inspector Clerical Staff: Secretarial Assistant. Clerks.. Rodent Operators. Disinfector-General Assistant Mortuary Attendant—General Assistant L. R. L. Edwards, M.D. (Lond.), D.P.H. G. A. Webber, Certificate of the Royal Sanitary Institute and the Sanitary Inspectors' Examination Joint Board. Certificated Food Inspector. E. U. Williams, Cert. R.S.I, and S.I.E.J.B. Certificated Food Inspector. W. T. G. Woodard, Cert. R.S.I. and S.I.E.J.B. Certificated Food Inspector. K. J. Coppin, Cert. R.S.I.and S.I.E.J.B. Certificated Food Inspector. J. A. Keen, Cert. R.S.I. nd S.I.E.J.B. Certificated Food Inspector. T. P. Jarrett, Cert. R.S.I. nd S.I.E.J.B. (Resigned 12/10/56.) \ Mrs. E. A. Best. Miss C. Mawbey (Resigned 6/4/56) Miss J. Sigs (Appointed 1/7/56) Miss Y. Read (Appointed 9/4/56). Miss H. Lomas. W. J. E. Wickenden. E. J. Read. M. Hindson. A. L. Jarvis. 3 CONTENTS page Introductory Letter 5 Vital Statistics 11 Total Deaths 1956 12 Cancer Deaths 13 Infantile Mortality 14 Vital Statistics for years 1947 to 1956 15 Infectious Diseases: Table (1) 16 Table (2) 17 Table (3) 18 Tuberculosis Table 19 Mass Miniature Radiography 20 Chest Clinic 20 Tuberculosis Care Committee 21 Women's Voluntary Service 22 Care of Old Persons, Old People's Welfare Committee 24 National Assistance Act 25 Vaccination and Immunisation 25 Morbidity Returns 26 Health Services, including Hospitals and Nursing Homes 27 Clinics for Maternity and Child Welfare 29 Report of the Chief Public Health Inspector 30 4 INTRODUCTION To the Chairman and Members of the Public Health Committee. 1 have the honour to present my Report on the health of the Borough during 1956. Genera). The year was notable for the introduction of Poliomyelitis vaccination, the increasing use of Mobile Units for Mass X-Ray, and the introduction of new Food Hygiene Regulations. Apart from an epidemic of Whooping Cough, and an increase of Measles in parts of the borough, the general health was good. An interesting event was that the population figure exactly matched that of the previous year. The slow increase previously noted has come to an abrupt halt. Improvement with regard to prevention of deaths from Cancer of the Lung and Pulmonary Tuberculosis largely depends on early detection, and the report shows the various ways by which this is carried out. Poliomyelitis Vaccination. A British Poliomyelitis vaccine available early in 1956 was administered to children born in the years 1947 to 1954 whose parents registered their wish for vaccination. During the first week in April the local Journal published an article in “Question and Answer” form on parents' polio problems. Parents were informed that they had until the end of the week to decide whether they wanted their children to be vaccinated against poliomyelitis. This article was most helpful, and the Council also co-operated magnificently in making known the scheme. As a result the parents of 2,939 children registered for vaccination. It is estimated that approximately 7,800 children were eligible, so that slightly more than a third accepted. Only sufficient vaccine was available to complete 368 vaccinations. The order of priority decided by the Medical Research Council was according to month of birth. November for all children aged 2 to 9 years, and March for children aged 6 to 9 years. August children aged 2 to 9 years were given any surplus vaccine. There were few reactions and these were slight. Up-to-date tests conducted by the Medical Research Council through certain selected public health research laboratories have shown that a considerable amount of protective substances are present as a result of these vaccinations in the blood of those children who have been examined. These children before the vaccination had no protective substances. We now have down to the age of 2 years a practically safe and assured product in preventing paralysis in children; the earlier the product can be given the better, so that the future trials are likely to be for younger children. As the disease is more common up to the age of 6 years, it is easy to see the reason for the selection of the present age group. 5 Infectious Diseases. During the past two years a new Table in the Annual Report has shown the distribution of infectious diseases according to the various Wards in the Borough. The relation of Whooping Cough to density of population is well shown in the "House" Wards in the Borough in which an epidemic of this disease occurred in 1956. A measles epidemic occurred in the two West Wickham Wards. Only one case of Poliomyelitis was recorded during the months of July and August. The majority occurred from October to December. Of eight confirmed cases there was one death in an adult of 32 years from bulbar spinal poliomyelitis. It may well be that this incidence of poliomyelitis in cooler weather is a feature of the disease when it is not epidemic. In January, an Ex-Serviceman who had returned from Malaya in June, 1955, was admitted to the Hospital for Tropical Diseases, where he was diagnosed as Benign Tertian Malaria. There was no history of a previous attack and no secondary cases. Investigations of food poisoning incidents were carried out with the helpful co-operation of the family doctor. In one instance, two tins of cream of celery soup were examined from a family where vomiting occurred three hours after taking the food. The unopened tin gave a negative result ; the opened tin showed slight sporing aerobes–not a cause of food poisoning. Faecal specimens from four other members of the family were negative. Of the salmonella infections, one, a boy of 4 years, was notified on discharge from hospital as a carrier of salmonella typhi-murium. Contact specimens from three members of the family were negative, and within a week of discharge two further negative specimens were obtained by the hospital and the boy was declared free from infection. Another infection was of salmonella Reading. The organism was first isolated on the 13th September. Specimens from two other members of the family were negative, but from the mother one specimen was positive. Subsequent specimens from the contacts proved negative. In spite of full antibiotic treatment, which resulted in two negative specimens on the 11th and 12th days after treatment, positive specimens were obtained from the 14th day, and the patient, though fit, has had to be transferred to a different occupation for a year. In April, three cases of sonne dysentery were notified. Final negative specimens were obtained on 13th May. Another family of two adults and five children had positive specimens for one adult and three children, and negative specimens for one adult and two children. Final negative specimens were obtained after supervision from the 7th to 25th June. In another, salmonella typhi-murium infection in a baby 1 year old, specimens from other members of the family were negative, while in a fourth family, the father and a daughter of 15 months had salmonella typhi-murium infection, but cleared in 14 days. Three 6 other contacts were negative. In no instance of salmonella infection was a definite food incriminated, and there would seem to be little hope of controlling this infection other than by increasing measures of pasteurisation and heat control of manufactured food products. Side by side with this, there needs to be further investigation into the contamination of food from fertilizers and the like. It is believed that salmonella infection is much more widespread than notifications indicate. These inspections or investigations are necessary to protect the relatives and others who are contacts of the disease or consumers of the same food. Their value is more obvious in an epidemic than in isolated incidents, and it is easier to appreciate their intrinsic value if inadvertently things go wrong than it is if there is little or nothing to report. Their effectiveness is in direct proportion to the number and completeness of notifications of a disease. The uncertainty about the need or value of notifying a particular disease makes this work of limited value. In this respect, there has never been such uncertainty as at the present time. Medical Officers await a revision of notifiable diseases; a more definite policy with regard to scarlet fever and streptococcal infections and closer liaison with hospital laboratories outside the public health service. There was an increase of three new cases of tuberculosis, but Dr. Madigan's report is reassuring as to the present position with regard to treatment. It is to be hoped that the combined approach of family contact examination, vaccination, mass X-ray of selected groups and new drugs will, in the next decade, reduce Tuberculosis to the present size of Diphtheria as a health problem. Vital Statistics. The birth rate comparability factor for Beckenham remains the same. There are no significant alterations in the general birth and death rates from the previous year, but there was a reduction in the infant mortality rate due to the decrease of four deaths and an increase of thirty-six births. Later in the report a Table shows that these deaths are mainly in the first week of life and are due to congenital or allied conditions or immaturity. Prevention of these must depend on studies of the commencement of life and subsequent development of the embryo. Such microscopical studies are now a reality. Though the total of deaths from Cancer remains the same, there were four less deaths from cancer of the lung. Two deaths from pulmonary tuberculosis is the lowest ever recorded for the Borough. It may be noted that the area comparability factor, by which the crude death rate is multiplied to give a corrected rate, has this year for Beckenham increased from 0.88 to 0.91. This is because this year, for the first time, the Registrar-General has made adjustments especially to take into account the presence of any residential institutions. After correction, there is no significant alteration in the death 7 rate from the previous year. The area comparability factors for use with crude birth and death rates are to provide fair comparison of rates of different districts, and contain adjustments for boundary changes and for rapid alterations of increase or decrease in areas affccting the age and sex grouping. Environmental Health. The object of the new Food Regulations is to promote increased hygiene consciousness in connection with food handling in food and catering premises, and this is the second great step forward in the campaign for clean food. The Regulations are more difficult to enforce, as in part they refer to less tangible offences such as the unhygienic acts of persons rather than the more obvious offences of dirty premises, formerly alone dealt with by Regulations under the 1938 Act. Consequently, initially more inspections are required, but ultimately good habits through home and Schools must be established. Registration is a useful measure if there are enough Inspectors to carry out the necessary visits and reports. The national shortage of Inspectors hinders the extension of registration to many establishments. Similarly, a determined effort is needed nationally to deal with the problem of noise, and it is hoped that in the near future, powers similar to those now available to deal with smoke pollution will be available as a public health measure. Medical Applications for Rehousing. From 6th January to the 27th December, 1956, 68 applications with certificates were awarded points on medical grounds. Fourteen were re-applications, and in six of these further medical points were recommended. In 23 applications the maximum points were allotted, with a recommendation in 17 cases specifically for ground floor flat accommodation for elderly persons. In 11 applications for which maximum points were recommended the total points were 40 or less. In seven cases no additional points were recommended. The medical causes are classified in the following groups:— Tuberculosis 10 Coronary Thrombosis 3 Chest disease 12 Hypertension 2 Asthma 5 Anxiety state or Nervous Rheumatoid arthritis 12 strain 11 Angina or Cardiac weak- Children illnesses or over- ness 2 crowding 15 In 17 cases out of 68 applications considered, either one or other applicant was over 60 years of age; this compares with 17 out of 59 applications for the previous year. Most of the heart cases were associated with unsuitable accommodation, due to stairs. A typical case was a man of 70 with cardiac 8 weakness who had 24 steps from flat to street to negotiate. He was awarded 30 points towards a Ground Floor flat, although on other grounds of accommodation he had obtained only 5 points. In another instance, a man of 70, whose elderly wife was confined to bed with arthritis, was also awarded 30 points for a ground floor flat, though on other grounds he had obtained only one additional point. In a third case, a single woman with rheumatoid arthritis, who had to carry all water up two flights of stairs from bathroom to kitchen, was awarded 30 points for a ground floor flat, though only 7 points had been awarded on other grounds. There were two other similar cases, but in the remaining 12 recommended ground floor flat accommodations there were considerable additional points up to 85. From the medical causes, it is seen that the applications arise from the type of housing used by old people and children, immobilising the former on top floors and providing too frequent illness for the latter in small flats. Private Nursing Homes. Rising costs, difficulties of recruitment of nursing and domestic staff, transfer of surgery and midwifery to the hospitals, have everywhere during post-war years led to the closure of one Nursing Home after another. Beckenham is no exception, and in June it was unfortunately necessary to report the closure of the VVoodcote Nursing Home 12, Westgate Road, and a Nursing Home at 54, The Avenue, Beckenham. The former Nursing Home was the largest in the borough and had been registered for 26 years, during which time, as many local doctors know, it had provided a very valuable service for the borough. In latter years the beds had been used more particularly for the treatment of chronic sick or senile patients. On the closure of the Home the patients or their relatives had to find accommodation, according to means, in other Homes ; and for three patients the District Officer found accommodation in County Old Persons Homes. Care of Elderly Persons. Previous reports have referred to various ways by which authorities within the limits of their statutory powers, and voluntary committees without these restrictions, combine in the Borough to provide as comprehensive a service as possible for old people. Admission to hospital is as for all illness arranged by the family doctor through the Admissions Officer for acute emergencies, and in the case of the chronic sick in a similar way after consultation with the Geriatric Consultant or a member of his staff. This is a hospital service in which the greatest economic use of available nursing staff is determined by medical and social priorities. There is a lack of beds for male chronic sick patients in this area. The needs of old people are best determined by visiting them ; surveys of this character are being carried out by health visitors. Proper housing accommodation is the first need for the majority ; there is a particular need for one-room unfurnished flatlets, though 9 the majority of these should be ground floor or there should be few stairs to climb. A more elaborate scheme is one with small bungalows, accommodation for a Warden, wife and family, communal rooms and visitors' bedrooms. These schemes require co-operation between several authorities, but they do provide, day and night, a man's advice and help for the men, and a woman's advice and help for the women. In an area of Beckenham's size and character the practical dayto-day need is to bring old persons from unsuitable top floor or back of the house flats to ground floor and front positions. Th; majority of these old persons in need are single—either widows or widowers, spinsters or bachelors. Most old persons, either single or married, are known through the Health Visitor service or the W.V.S. ; the latter hear through friends who attend the Clubs. Visits enable information to be obtained as to the name and address of nearest relative, other occupants of the household, whether a home help or district nurse, or the Meals on Wheels service is required. Notes are made of financial resources and a survey of safety measures is carried out. In this area there are no requests for a laundry service or a shopping service. A Foot Clinic is run by the Red Cross and helped by the B.O.P.W.C. Many persons need transport to get to the Clinic. Vaccination and Immunisation. Section 26 of the National Health Service Act, 1946, gives authorities under this Act powers to introduce arrangements with medical practitioners for vaccination against Smallpox and immunisation against Diphtheria (and against other diseases if so directed by the Minister), and the necessary vaccines, etc., are distributed free of charge. Under this section, most authorities included measures such as Smallpox vaccination, immunisation against Diphtheria, and immunisation against Whooping Cough, and with the advent of a Poliomyelitis vaccine schemes were modified to include this measure. During the year 2,338 immunisations against Diphtheria, 802 vaccinations against Smallpox and 73 B.C.G. vaccinations against T.B. (Chest Clinic) were carried out. In conclusion, I wish to thank Dr. Elliott, Dr. Lyon and Dr. Ward and other members of the County Staff, including the District Officer, Mr. Moore, for their co-operation during the past year. The continued teamwork of the Health Department has been a feature of the work of the Inspectors and Clerical Staff, to whom I wish to record my thanks and appreciation. Members of the Health Committee have tackled a variety of health problems with administrative fairness and decisive action, and I thank them for their help, consideration and continued enthusiasm. L. R. L. EDWARDS, Medical Officer of Health. 10 SUMMARY OF VITAL STATISTICS, 1956 Area of District in acres 5,935 Civilian Population as estimated by the Registrar-General at 30th June, 1956 75,340 Civilian population per acre 12.7 Rateable Value at 1st October, 1956 £1,413,911 Births Registered (Including Stillbirths): Male Female Legitimate 452 415 Illegitimate 17 15 Total 899 Birth Rate (including Stillbirths) per 1,000 of Civilian Population (Corrected) (11.93 x 1.07) 12.77 (Crude) 11.93 Male Female Deaths Registered 410 433 Total 843 Death Rate per 1,000 population (Corrected) (11.18 x 0.91) 10.17 (Crude) 11.18 Infant Mortality Rate per 1,000 live births 12.40 Maternal Mortality Rate per 1,000 births 0.00 Deaths of Infants under 1 year of age: Male Female Legitimate 5 6 Illegitimate Total 11 Still Births: Rate per 1,000 population 0.16 Rate per 1,000 live births 13.54 Male Female Legitimate 5 5 Illegitimate 2– Total 12 Death Rate per 1,000 of Civilian Population from Cancer (152 deaths) 2.02 Death Rate per 1,000 of Civilian Population from Pulmonary Tuberculosis (2 deaths) 0.03 Death Rate per 1,000 of Civilian Population from Non- Pulmonary Tuberculosis (nil) 0.00 Death Rate per 1,000 of Civilian Population from Accidents (12 deaths) 0.16 Natural Increase: The Births registered exceeded the deaths by 44. 11 TOTAL DEATHS, 1956 (Registrar-General's Official Returns). All causes–843 ; Male, 410 : Female, 433. causes of death males females 1. Tuberculosis, respiratory 2 – 2. Tuberculosis, other – – 3. Syphilitic disease 1 1 4. Diphtheria – – 5. Whooping Cough – – 6. Meningococcal infections – – 7. Acute poliomyelitis 1 – 8. Measles – – 9. Other infective and parasitic diseases – 2 10. Malignant neoplasm, stomach 8 9 11. Malignant neoplasm, lung, bronchus 28 2 12. Malignant neoplasm, breast – 23 13. Malignant neoplasm, uterus – 6 14. Other malignant and lymphatic neoplasms 41 35 15. Leukaemia, aleukaemia 2 2 16. Diabetes – 4 17. Vascular lesions of nervous system 42 80 18. Coronary disease, angina 110 51 19. Hypertension with heart disease 4 10 20. Other heart disease 48 90 21. Other circulatory disease 22 22 22. Influenza 1 1 23. Pneumonia 18 13 24. Bronchitis 28 22 25. Other diseases of respiratory system 4 2 26. Ulcer of stomach and duodenum 7 5 27. Gastritis, enteritis and diarrhoea 2 2 28. Nephritis and nephrosis 3 2 29. Hyperplasia of prostate 5 – 30. Pregnancy, childbirth, abortion – – 31. Congenital malformations 2 2 32. Other defined and ill-defined diseases 21 39 33. Motor vehicle accidents 2 2 34. All other accidents 4 4 35. Suicide 4 2 36. Homicide and operations of war – – Totals 410 433 12 CANCER DEATHS 1952 1953 1954 1955 1956 Cancer of Lung 28 36 42 34 30 Males 143 Females 27 Total 170 Cancer of Breast 24 17 22 12 23 98 Cancer of Uterus 5 3 4 6 6 24 Cancer of Stomach 17 17 16 18 17 Males 44 Females 41 Total 85 Other Malignant Neoplasms 97 83 100 82 76 Males 220 Females 218 Total 438 Deaths 171 156 184 152 152 Males 407 Females 408 Total 815 For comparison, deaths from Respiratory Tuberculosis are shown:– 1952 1953 1954 1955 1956 10 6 8 6 2 Males 27 Females 14 Total 41 13 14 INFANTILE MORTALITY, 1956 The number of deaths of infants under the age of twelve months was 10, as compared with 15 in 1955. The Registrar-General returns 11 infants deaths, and the Infant Mortality Rate for the year was 12.40 per 1,000 live births. The following Table shows the cause of death in 10 cases for which full records exist. Table of Infantile Mortality AGE IN WEEK," Total under one month. AGE IN MONTH; Total under one year. m. f. Under 1 1–2 2–3 3–4 1–3 4–6 7–9 10–12 A. Congenital: Heart 1 – – – 1 – – – – 1 – Lungs 1 – – – 1 – – – – 1 – Spine Other – – – – – 1 – – – – 1 B. Ante-Natal or Intranatal: Prematurity 2 – – – 2 – – – – 1 1 Rhesus incompatability 1 – – – 1 – – – – 1 – Cerebral haemorrhage 1 – – – 1 – – – – 1 – C. Infections: Staphylococcal – – – – – 1 – – – – 1 Gastro-enteritis – – – – – 1 – – – – 1 D. Accidental: AsphyxiaNeonatorum 1 – – – 1 – – – – – 1 Totals 7 – – – 7 3 – – – 5 5 15 VITAL STATISTICS FOR YEARS 1947 to 1956 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 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 1955 75,340 838 16 854 11.335 9 – 9 15 – 15 17.38 1956 75.340 867 32 899 11.932 10 2 12 11 – 11 12.40 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 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 1955 836 11.096 – 6 0.080 152 2.017 1956 843 11.18 – 2 0.030 152 2.017 16 INFECTIOUS DISEASE (1) disease 0–4 years 5–14 years 15 years and over Age Unknown admitted to hospital total M. F. M. F. M. F. M. F. M. F. M. F. Measles 40 44 99 102 1 – – – 1 1 140 146 Scarlet Fever 5 5 12 14 1 – – – 8 4 18 19 Whooping Cough 53 58 47 72 1 4 – – 3 1 101 134 Dysentery – 1 – 3 3 1 2 – – – 5 5 Meningococcal Infection 1 – 1 – – – – – 2 – 2 – Puerperal Pyrexia – – – – – 45 – – – 45 – 45 Pneumonia – – – – 9 11 1 – 1 1 10 11 Erysipelas – – – – 5 2 – – – 1 5 2 Poliomyelitis: Paralytic – 1 1 – 2 – – – 3 1 3 1 Non-Paralytic – – 1 1 1 1 – – 2 2 2 2 Food Poisoning 2 2 2 – I 3 – – 2 – 5 5 Malaria – – – – 1 – – – 1 – 1 – 17 INFECTIOUS DISEASE (2). The following Table gives the number of cases notified during the year:— disease jan. feb. mar. apr. may june july aug. sept. oct. nov. dec. total Measles 5 19 21 58 115 52 8 1 1 1 5 286 Scarlet Fever 7 5 3 2 5 3 3 – 1 3 2 3 37 Whooping Cough 7 4 5 13 29 31 46 26 20 13 24 17 235 Dysentery – – – – 2 5 – 1 1 – 1 10 Meningococcal Infection – – – – – – – 1 – – – 1 2 Puerperal Pyrexia 4 4 5 4 5 5 4 3 7 – I 2 45 Pneumonia 3 5 5 1 2 – – – 1 2 1 1 21 Erysipelas 1 1 – – 2 – 1 – – 2 – – 7 Poliomyelitis: Paralytic 1 1 2 4 Non-Paralytic – – – – – – – 1 – 1 1 1 4 Food Poisoning – 1 — — — — 1 4 3 – 1 – 10 Malaria 1 – – – – – – – – – – – 1 Totals 29 39 39 78 160 96 63 36 34 22 33 33 662 18 INFECTIOUS DISEASE (3) disease Wards* L. Pk. and K.H. C.C. C.H. M.H. E.P. Shortlands W.W. (North) W.W. (South) Measles 5 4 4 27 29 8 118 91 Scarlet Fever 4 3 3 5 3 3 11 5 Whooping Cough 52 34 61 51 13 17 1 6 Dysentery 1 1 6 1 – 1 – – Meningococcal Infection – – – – – – 1 1 Puerperal Pyrexia 1 – – – 44 – – – Pneumonia 1 – 1 9 2 – 1 7 Erysipelas 3 – 1 – 1 – 2 – Poliomyelitis: Paralytic 1 – – – 1 2 – – Non-paralytic – 1 1 – – 1 – 1 Food Poisoning – 1 2 2 – – 2 3 Malaria 1 – – – – – – – Totals 69 44 79 95 93 32 163 114 *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. (North)—West Wickham North. W.W. (South)—West Wickham South. 19 TUBERCULOSIS—Table of Notifications and Deaths, 1956, from Local Records. Sex Total Ages Wards* 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. (Nth.) W.W. (Sth.) M. F. notifications New Cases only Pulmonary 28 13 41 2 – – – 6 6 8 9 5 5 – 4 8 5 6 3 4 5 6 Non-Pulmonary 4 4 8 1 – – 2 – 1 – 1 1 2 – 2 – 2 2 – – 1 1 Totals 32 17 49 3 – – 2 6 7 8 10 6 7 – 6 8 7 8 3 4 6 7 Deaths Pulmonary 3 1 4 – – – – – – – 1 1 2 – 2 1 – – – 1 – – Non-Pulmonary – – – – – – – – – – – – – – – – – – – – – – Totals 3 1 4 – – – – – – – 1 1 2 – 2 1 – – – 1 – – 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. (North)—West Wickham North. W.W. (South)—West Wickham (South). MASS RADIOGRAPHY I am indebted to the Director of the South-East London Mass Radiography Units for information, from which the following particulars of persons examined and abnormalities found has been compiled:— NO. OF PERSONS ACTIVE INACTIVE NON-TUBERCULOUS EXAMINED PULMONARY PULMONARY CONDITIONS TUBERCULOSIS TUBERCULOSIS 11,974 25 33 158 The incidence of new cases of pulmonary tuberculosis is 2.0 per 1,000, compared with a National average of 2.2 per 1,000, and an incidence for the period 1951-1955 of 5.0 per 1,000. Non-Tuberculosis conditions consisted of:— Cancer of Lung 7 Pneumonia, Pneumonitis 11 Brochiectasis, Sarcoidosis 6 Cardiovascular 16 Abnormalities requiring no action 117 The examinations were carried out by Fixed Units at Toe H Hall, West Wickham, in July, and Civil Defence Hall, Beckenham, in September ; and by Mobile Units visiting points in Eden Park, Coney Hall (Civil Defence Hall), various large firms, hospitals and Research Laboratories. 4,886 and 1,516 persons were X-rayed at the Civil Defence Hall, Beckenham, and Toc H Hall, West Wickham. respectively. WORK OF THE CHEST CLINICS I have pleasure in submitting the following report and Table on the work of the Chest Clinics during the year under review, forwarded to me by Dr. Madigan, Chest Physician, to whom I express my thanks:— "Although the total number of patients investigated shows an increase on the previous year's figures, the average new attendances over the past few years has not altered very much. The number of tuberculous patients admitted to hospital or sanatorium, however, has progressively diminished. It has thus been possible to utilize more beds in investigating and treating other chest conditions, such as chronic bronchitis, bronchiectasis and carcinoma of the lung. Out of a total of 182 new contacts examined, three were found to be positive, two being adults and one a child. Seventythree contacts were given B.G.C. vaccination. 20 The County Authority is, as you know, offering B.C.G. vaccination to those children approaching school-leaving age, and no doubt this will later on be extended to cover other age groups. It will be very interesting in a few years' time to assess what effect B.C.G. will have had on the incidence of tuberculosis among the young adult population." New Cases attending the Chest Clinics for the first time during 1956. Adults Children under 15 years Male Female Male Female Pulmonary Tukerculosis 34 17 – – Non-Pulmonary Tuberculosis 1 2 – – Non-Tuberculous 63 54 8 7 Negative Positive New Contacts Examined 179 3 Number of patients admitted to hospital or sanatorium during the year: 38. These figures relate to patients resident in Beckenham Borough only. BECKENHAM DISTRICT TUBERCULOSIS CARE COMMITTEE The valuable work of the above Tuberculosis Care Committee, which was originally formed in 1948, continues, and I am again happy to incorporate the following report on the Committee's work during the year under review, submitted by Mr. M. E. Forster, the present Hon. Secretary:— "The welfare work among tubercular patients and their families in the Borough of Beckenham was continued with renewed vigour during the past year by the Beckenham District Tuberculosis Care Committee, which is associated with the Kent Council of Social Service. Patients who had been recommended by the Chest Clinic through their Health Visitors received prompt attention from the Committee's two Liaison Officers, one working in Beckenham and the other in West Wickham. If their needs were small, it could usually be settled on the spot, but more complicated cases were put before the Committee, which meets once a month. Cases dealt with vary considerably, and during the year the following assistance was given:— 21 Six families were sent on recuperative holidays to approved Holiday Homes; Eight patients were supplied with clothes; Four were supplied with meat; Five were supplied with coal; Four were helped with furnishings; Twelve families were helped with the cost of fares to visit patients in Hospitals and Sanatoria. In addition, help was given with payments towards radio batteries for three patients; radio repairs for two; insurance arrears for two; groceries for two; house decorations for one; and car tax for one. Also two patients were helped with hirepurchase payments, and two were supplied with material for occupational therapy. At Christmas-time 42 patients received a Christmas Card and a gift. The Committee spent over £345, and, to help offset this, a very energetic sale of id. Christmas Seals was organised, which brought in more than £325." WOMEN'S VOLUNTARY SERVICE The following report on the W.V.S. work in the Borough has been submitted by Mrs. J. M. Fisher, the Centre Organizer, to whom I express my thanks. Darby and Joan Clubs. Three Darby and Joan Clubs in Beckenham and two Over 60's Clubs in West Wickham are still 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 the three Clubs in Beckenham is about 500, and all the members are over 60 years of age. The membership fee is 1d. and a charge of 3d. is made for tea. Whist Drives, Darts Matches and Raffles are held each week, and at least two of the Clubs have talented choirs which entertain not only their own members, but other organisations as well. A free library is available to members and there are also plenty of magazines for reading. Spring and Autumn outings are arranged for the Club members and in the winter visits are made to pantomimes and ice shows. Members also have holidays at reduced rates—out of season—at the seaside, and a party from one Club spent a week on the Continent. A Savings Group is run for members who wish to save weekly towards holidays, outings, etc. The Clubs are subsidised by voluntary subscriptions. 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, Tuesdays and Fridays. The service is run principally for the benefit of invalids and elderly people 22 who live alone and cannot cook for themselves. The meals are now cooked in the Centre by members of W.V.S. Appeals for meals usually come from Hospital Almoners, Doctors, and through the Darby and Joan Clubs. An allowance towards the cost of 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. About 20 meals are served each time. West Wickham Luncheon Club. Meals for this Luncheon Club are cooked by W.V.S. and only a nominal charge is made. An average of 35 meals are served weekly, in addition to an average of 16 meals on Wheels twice a week. 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. 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 W.V.S. and non-W.V.S. from Beckenham and Penge. Baby Clinics. Helpers are supplied at three 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 of S.S.A.F.A. is still run by W.V.S. from our own Centre, and since last year around £500 has passed through its hands. Apart from financial help, clothing has been given and advice on many matters. Clothing Depot. We hold a good stock of second-hand clothing, which is available for the old and sick people in the Borough who come to us with a note from the National Assistance Board, Doctor or Health Visitor. Over 20,000 garments passed through our hands for the Hungarians, and we are clothing, in the Depot, those who are billeted in the Borough. The Children's Clothing Exchange is still being run every Wednesday, and we understand it is the most flourishing one in Metropolitan Kent. 23 The Centre dispenses National Dried Milk, Orange Juice, Cod Liver Oil and Vitamin Tablets. Periodicals for the Forces. We send 30 parcels of books and magazines each month to our Forces in the Middle and Far East. We get a small grant from the County Office towards postage and the remainder has to be found by the Centre, usually from any money we obtain from the sale of salvage. Services Club. One of our members attends the Victory Club each Friday, where she works in the library. Canning. Members from the West Wickham Centre canned a large quantity of fruit for the Maternity Hospital during the summer. In addition to the aforementioned activities, the W.V.S. is closely connected with the Tuberculosis After Care Committee, Area Pension Officer, British Legion, the Disabled Persons' Committee and Children's Flomes. Children's Holidays. We have been able to arrange holidays for a number of children who are recommended to us by the T.B. After Care Committee and Health Visitors. Last summer ten children benefited from a holiday at the seaside or in the country. We could have helped more had more money been available. The parents pay what they can towards the holiday and we have to find the rest. BECKENHAM OLD PEOPLE'S WELFARE COMMITTEE This voluntary Committee was formed in 1942 to help lonely elderly folk who had lost their homes through bombing. The Committee meets three times a year and co-ordinates the activities in respect of old people's welfare of the various organisations whose representatives attend. The organisations are listed below:— C.R.S. (Companionship of Remembrance and Service). W.V.S. and Over 60's Club. National Assistance Board. Anglican Churches. British Red Cross. Women's Co-operative Guild. Inner Wheel. W.V.S. and Darby and Joan Clubs. Beckenham Women's Citizens' Association. Women's Free Church Council. Rotary and Veterans' Clubs. Eden Park Co-operative Guild. Home Help Service (K.C.C.). 24 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. No cases were reported for investigation during the past year. VACCINATION AND IMMUNISATION Infant Welfare Centre Attendances, 1956. (a) The number of sessions held during the year 460 (b) Attendances during the same period 19,142 Diphtheria Immunisation. (a) The number of sessions held during the year 358 (in conjunction with Child Welfare Clinics) (b) Attendances during the same period 503 Smallpox Vaccination. (a) The number of sessions held during the year 223 (in conjunction with Child Welfare Clinics) (b) The number of vaccinations given 377 25 Immunisation against Diphtheria and Vaccination against Smallpox, 1955. (A) DIPHTHERIA IMMUNISATION. Year of Birth. 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 Total Primary Inoculations. 91 473 71 18 11 22 12 7 9 10 3 2 — — — 729 Re-inforcing Inoculations. — — — 6 34 388 166 54 26 538 352 31 6 5 3 1609 (B) VACCINATION. Year of Birth. 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 Before 1942 Total. Primary Vaccination. 372 258 7 5 2 2 2 2 — — 2 5 1 — 1 35 694 ReVaccination. 2 1 1 1 — 1 1 1 4 4 6 1 — — 85 108 MORBIDITY RETURNS, 1956 CERTIFICATES OF INCAPACITY FIRST INTERMEDIATE FINAL TOTAL January (ended 31.1.56) 1423 4243 1072 6738 February (ended 28.2.56) 1654 4608 1176 7438 March (ended 27.3.56) 1289 4375 1264 6928 April (ended 24.4.56) 741 3871 733 5345 May (ended 29.5.56) 892 4738 792 6422 June (ended 26.6.56) 836 4561 742 6139 July (ended 31.7.56) 544 3216 446 4206 August (ended 31.8.56) 583 3579 439 4601 September (ended 25.9.56) 716 3591 492 4799 October (ended 30.10.56) 1209 4649 945 6803 November (ended 27.11.56) 1042 3791 824 5657 December (ended 1.1.57) 1059 4346 888 6293 26 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, Mason's 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 err Beckenham District Office. Old People's Homes. Durham House, 50, Durham Avenue, Shortlands (K.C.C.). Thornton House, 75, Bromley Road, Beckenham (Voluntary). Rutland Lodge, 6, Mays Hill Road, Short- lands (Private). Rest Haven, 99, Venner Road, Sydenham, S.E.26 (Private). Mental Welfare. District Offices, 12, Beckenham Road, Beckenham. General Welfare. District Offices, 12, Beckenham Road, Beckenham. Clinics for Maternity and Child Welfare. The District Officer and his staff are available to assist in the event of any difficulty arising in the arranging of any of the County Health Services. 27 3. Private and Voluntary Services. Private Nursing Homes. (1) "Parklands," 51, Crystal Palace Park Road. (2) "Petersfield Lodge," 69, Crystal Palace Park Road. (3) "Inglewood," 25, Durham Avenue, Bromley. (4) 131, Albemarle Road, Beckenham. (5) 14, Bromley Grove, Shortlands. Registration and supervision is delegated to the Borough Council. Children's Homes. (1) Maude Nathan Home, 72, Crystal Palace Park Road, S.E.26. (2) Salvation Army Children's Home, 42, Crystal Palace Park Road, S.E.26. (3) Dr. Barnardo's Home, 16, Park Road, Beckenham. (4) The Aberdare Memorial Home for Boys, West Wickham. (5) St. Hilda's Home, Crescent Road, Beckenham. (6) The Home of Compassion, Bromley Road, Beckenham- 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, Kent. Private Day Nursery. Sussex Road. West Wickham. 9.15—12 noon Mon.-Fri. inc 28 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 1st, 3rd and 5th Monday mornings (by appointment) Clinic Block, Hawes Lane, West Wickham Monday to Friday inclusive (by appointment) Maternity Hospital, Stone Park Avenue, Beckenham Bookings— Tuesdays and Wednesdays, 2—2.45 p.m. Maternity Hospital, Stone Park Avenue, Beckenham Child Weleare Mondays, 2—4 p.m. Clinic Block, Hawes Lane, West Wickham Tuesdays, 2—4 p.m. (a) Baths Annexe, Beckenham Road (b) Assembly Hall, West Wickham Wednesdays, 2—4 p.m. (a) Church Hall, Langley Road, Elmers End (b) Church Hall, Valley Road, Shortlands Thursdays, 2—4 p.m. (a) Church Hall, Lennard Road, Penge (6) Clinic Block, Town Hall, Beckenham Fridays, 2—4 p.m. (a) Church Hall, Langley Road, Elmers End (b) Clinic Block, Hawes Lane, West Wickham Post-Natal Fridays, 10—12 noon (by Maternity Hospital, Stone Park appointment) Avenue, Beckenham Vaccination (by appointment only) and Diphtheria Immunisation are carried out during certain Infant Welfare Sessions at the above Clinics. Service Days and Times Premises in Use Dental (Infant By appointment Clinic Block, Town Hall Welfare Cases) By appointment Clinic Block, Hawes Lane, West Wickham Speech Mondays to Fridays inclusive Town Hall Clinic (by ppointment) Orthopaedic Wednesday mornings (twice Clinic Block, Town Hall, per month) (by appoint- Beckenham ment) Surgeon in attendance Treatment. The Physiotherapist attends by appointment as follows:— Monday afternoons Tuesday mornings Thursday afternoons Friday afternoons Clinic Block, Town Hall, Beckenham Mothercraft Classes and Relaxation Exercises Friday mornings, 10 a.m. Clinic Block, Town Hall, Beckenham Thursday afternoons, 2 p.m. Clinic Block, Hawes Lane, West Wickham 29 REPORT ON THE WORK OF THE PUBLIC HEALTH INSPECTORS FOR THE YEAR 1956 By G. A. Webber, Chief Public Health Inspector, Borough of Beckenham. In August, 1956, the designation "Sanitary Inspector" was replaced by "Public Health Inspector The former did not accurately describe the work and duties of the Officers concerned. The word "sanitary" has come to bear a restricted meaning not associated with health in its widest sense. It may well be that this simple alteration of title may have the effect of increasing recruitment to the seriously depleted ranks of such Officers. Whether, to those who need directly and consistently to take advantage of the Inspector's services, he will ever be anything but the "sanitary man" is a matter of conjecture. There is, perhaps, more chance of those who indirectly benefit from the work being brought to a proper understanding of the Officers' duties. During 1956 the establishment of Inspectors was reduced by one, Mr. T. P. Jarrett resigning to take an appointment with another Authority. It was a matter of great regret to me to lose the services of this capable Officer. Housing. The Inspector's function in respect of dwelling houses is to see that they are kept healthy and habitable. Powers derive from two somewhat overlapping statutory codes—the Public Health and Housing Acts. Previous reports have indicated that, since 1946, we have concentrated on the older properties in the Borough, to bring them to a reasonable standard of accommodation. One wishes that report could be made, not only of their structural reconditioning, but also of their improvement by the installation of bathrooms, indoor sanitation, modern lighting and constant hot and cold water, but such amenities are not yet statutorily included in the items comprising standards of fitness for human habitation. The Housing Repairs and Rents Act, 1954, has become in many respects a dead letter. In my Annual Report for 1954 I stated that early indications were that owners were not taking advantage of the Improvement Clauses. The two years intervening since then have confirmed that early impression. In Beckenham there have been 62 applications for Improvement Grants, of which 36 were granted. Nearly all were from owner/occupiers, whose properties, though coming fully within the provisions of the Act, are not those at which the Act was primarily aimed. Experience in Beckenham is comparable with that of most authorities in the country. From attendance at Conferences, and from written reports, one gathers that there is somewhat wholesale criticism of the owners of rented properties for their failure to cooperate in this matter. Whilst, no doubt, some of the responsibility 30 for failure is thus correctly apportioned, to single out only the owners for blame appears to me to be unfair. The occupier of a rented property can have a good deal to say in this matter, for the work of improvement cannot proceed without his or her approval. One owner of a block of 24 houses (in Beckenham), in very reasonable structural repair, is anxious to modernise them all, but the vast majority of the tenants refuse co-operation, and so the matter, perforce, falls through. One wonders whether the outcome of this dilatory approach will not be the compulsory improvement of suitable older properties resulting from further legislation on a subject which, in view of the still desperate housing needs of the country, cannot be overlooked. Housing Defects. Damp houses have always claimed prior attention. In many cases, dampness is due to the absence of a damp-proof course. Where a house, as a result of the absence of proofing, is now damp, it does not appear that to remedy the omission is the only satisfactory answer. During the years a house has been without a damp-course the brickwork has absorbed moisture to such a degree and height that many years will pass before drying out is complete. There are other and better methods of remedy in these cases which, if skilfully introduced, give lasting and quick improvement. These methods, too. are more economical. Not all dampness in houses, however, results from the absence of a damp-proof course. It frequently arises from a continued absence of attention to minor defects. The broken or choked rainwater guttering or pipe, the overflowing lavatory cistern, the broken setting of a gully—such small items, continually ignored, eventually create dilapidation and disrepair which require major repair work with heavy financial outlay, where perhaps the expenditure of only time in the early stages would have prevented it. Some owners sensibly seek the co-operation of their tenants in such matters, and usually this is forthcoming. Others consistently ignore their responsibilities until the nuisance is of such magnitude as to warrant the service of Statutory Notices by the Local Authority, and then it is found that the owner will force the Authority to the final limit of its legal powers before executing the work. This attitude is not easy to understand, for the ultimate financial outlay is so much the greater for the delay, although it is fair comment to say that the obligation, in this respect, is not greatly increased by the fines and penalties imposed by Magistrates for failure to comply with Notices. In certain cases owners might reasonably expect greater co-operation from their tenants, for there are instances where a tenant will refrain from remedying a most trivial defect, but will suffer much discomfort and spend unlimited time in endeavouring to force the local authority to intervene to bring 31 pressure on the owner. A tenant strongly criticized apathy to his complaint that a broken hasp on the lavatory door—a fixture at that time costing 3d.—adversely affected his own health and that of his family. The Housing Repairs and Rents Act, 1954, called upon local authorities to submit to the Ministry of Housing and Local Government details of all houses unfit for human habitation—the judgment, of course, to be made on legal standards. Beckenham was one of the very few (I think five) authorities in the country to make a "Nil" return. The reasons for this are worthy of consideration. Bcckenham is largely composed of houses of modern structure. There are, however, some hundreds of houses which 11 years ago were approaching the borderline between suitability for repair and demolition. Recommendations were made and approved that the further deterioration of these properties should be halted by action under Section 9 of the Housing Act, 1936. At the time when this work commenced (in 1946), and for a considerable time afterwards, it did not appear that this policy was one being generally pursued by local authorities. Since that date 480 houses have been reclaimed, and work is still in progress in many others. Had this work not been done, our return to the Ministry would certainly not have been "Nil", but would have swollen by some hundreds the colossal total of derelict properties which the countrywide summary brings to light, a total so great as to make it completely impossible to forecast when this unfortunate position can be remedied. Only one thing is certain—those people in this country who are now housed in properties officially declared so unfit as to be irrepairable even to the mild standards of the Housing Acts will continue to suffer these living conditions for some years yet to come. That this will not happen in Beckenham is entirely due to the work consistently carried out since 1946. A warning note should be struck, however. We naturally dealt with our worst properties first— that is, 11 years ago. Those blocks of houses will require very close inspection again in 4 to 5 years from now, and it may well be then that demolition will be the answer. The Housing Repairs and Rents Act, 1954, enabled owners, in certain circumstances, to increase the rents of properties. The tenant has the right to apply to the Authority for a Certificate of Disrepair, and if this is granted the increased rent is not payable until the defects listed in this Certificate are dealt with. Owners did not take advantage of these provisions to any extent. Since the Act came into force in August, 1954, 36 Certificates of Disrepair have been applied for in Beckenham, and only two of that number relate to 1956. In 11 of the total cases, after considering the reports of inspection, the tenants' claims for Certificates were refused. 32 Statistical information relating to the work of the Inspectors is appended :— Housing—Inspection of Dwelling Houses during the Year. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 943 Number of inspections made for the purpose 2,185 Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 100 Number of inspections made for the purpose 566 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 v305 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 305 Number of dwelling-houses in which defects were remedied after service of informal notices 283 Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 22 Number of dwelling-houses in which defects were remedied after service of formal notices: (a) by owners 22 (b) by Local Authority in default of owners 0 Number of complaints received 1,401 Number of initial visits 7,426 Number of re-visits 4,581 Total visits and re-visits 12,007 This figure includes some 2,655 visits to Food premises, compared with 1,281 similar visits in 1955. This considerable increase is accounted for partly by the fact that the establishment of Inspectors was at full strength for the greater part of 1956, contrary to the position in 1955, but it also emphasizes the attention paid to the Food Hygiene Regulations which came into force during 1956. It was fortunate that we were thus able to cope with the matter and to achieve, in so many cases, the speedy introduction of the much-needed additional hygiene provisions governing food premises. Total number of Intimation Notices served 405 Total Number of Statutory Notices served 22 These figures indicate the ready co-operation of owners and other responsible persons in dealing quickly with nuisances brought to their notice, thus obviating, in the majority of instances, the need for the Authority to exercise its Statutory powers. Legal proceedings were instituted against an owner of property who failed to comply with a Statutory Notice served by the Authority requiring the abatement of a statutory nuisance. Following the making of an Order, and a fine of £1 and £1 1s. 0d. costs, the required work was completed. 33 Nuisances Remedied. Structural defects of properties—external 304 internal 511 Insanitary conditions other than vermin 72 Verminous conditions 4 Choked drains 305 Other drainage defects 146 Defective sanitary appliances 71 Insufficient or unsuitable water supply 79 Absence of dustbin accommodation 16 Offensive accumulations 1 Food. At the close of the year there were 505 premises concerned with the preparation and the sale of food. The types of business are as follows:— Restaurants and Cafes (including Parks and Stations) 56 Greengrocers and Fruiterers 54 Butchers 46 Delicatessens 2 Grocers and Provision Merchants 103 Grocers and Dairies 9 Confectioners, Tobacconists, Newsagents, Stationers (including Stations) 101 Fishmongers (Wet and Fried) 16 Fried Fish Shops only 5 Bakers 28 Wine and Spirit Merchants 16 Public Houses 17 Factory Canteens 31 Cafes, Bars, Sports Grounds 8 School Canteens 11 Hospital Canteens 2 Fifty-five (55) premises were registered under Section 60 of the Beckenham Urban District Council Act, 1935, for the preparation of potted and preserved foods. Unsound Food. During the year 13 complaints were received that food purchased was unfit for human consumption, but in only six cases was this substantiated. Full investigation followed, reports were furnished to the Public Health Committee, and appropriate action taken. The Committee did not consider it necessary in any case to recommend the institution of legal proceedings against the Vendors or Manufacturers. Food Shopkeepers frequently seek official aid in decisions regarding the soundness or otherwise of food for human consumption During 1956, 1 ton 12 cwts. of food was thus condemned and destroyed as unfit for human consumption. This total weight included, 4 cwts. of meat (mainly imported beef), 2½ cwts. bacon, 1½ cwts. fish 8½ cwts. dried fruit. The remainder comprised canned foods unsound 34 as a result of faulty processing. In no case did the circumstances justify the official seizure of unsound food exposed or deposited for the purpose of sale. Food Hygiene Regulations, 1955. The Minister of Agriculture, Fisheries and Food and the Minister of Health, acting jointly, made these Regulations in exercise of powers conferred on them by the Food and Drugs Act, 1955. The Regulations took the place of Section 13 of the Food and Drugs Act, 1948, and are of considerable importance in that they add a number of new provisions in respect of the handling of food and the construction and maintenance of premises, stalls and vehicles, etc., where food is handled. Certain of the Regulations, which require alteration to premises, or substantial changes in existing practices, did not operate until the 1st July, 1956. Otherwise the general date of operation was from the 1st January, 1956. The principal extensions of the previous law relate to (i) Specific requirements designed to prevent the contamination of the food. (ii) The provision of sinks or other facilities for washing food and equipment. (iii) The provision of a constant supply of hot water for sinks, wash-hand basins, etc., in certain food premises and a supply of hot water on some stalls and vehicles. (iv) Restrictions on the preparation and packing of food in or about domestic premises. (v) The conditions under which certain foods that provide a particularly favourable medium for food poisoning organisms, are to be kept in food premises. (vi) A requirement to provide vehicles for the transport of meat with duckboards and separate receptacles for offal, and, where the vehicles are not enclosed, a cover supported by a frame or poles. (vii) The circumstances in which persons carrying meat are required to wear overalls and head covers. The majority of food traders in Beckenham appreciate the need which evoked the Regulations, but some difficulty was experienced in obtaining ready co-operation in the provision of separate sink and wash-hand basin facilities. The statutory regulations alone were not sufficient to convince many traders of the importance of these particular provisions in reducing the extent of food-borne disease, and it was continually necessary to supplement their application by interviews and explanatory conversation or correspondence. This work added considerably to our duties during the year. 35 It was obvious, in a few cases, that compliance with every new provision could not reasonably be required because of restricted accommodation, or some other special circumstance. The Regulations cover this point by enabling local authorities to issue Certificates of Exemption in appropriate cases. During 1956 this Council issued four such Certificates, but only after the most searching enquiry had been made into all the aspects of the matter. Many applications were refused. There still remain some food premises where compliance with the Regulations in their entirety has not yet been achieved, but work to this end is proceeding continually. A list of Food and Drugs sampled during 1956 is appended Article Formal Informal Almonds (Ground) 8 3 Almonlike 1 — Anchovy Fillets — 1 Apricot Conserve — 1 Arrowroot — 1 Aspirin Tablets — 4 Baking Powder — 1 Bicarbonate of Soda — 1 Black Pudding — 1 Brawn (Nutmeat) — 1 Butter — 1 Butter (Peanut) — 1 Cake Mix — 2 Candied Peel — 1 Caraway Seeds — 1 Castor Oil — 2 Cereal Beverage — 1 Cheese (Gruyere) — 4 Cheese (Processed) — 1 Chickclette — 1 Chicken (Chopped Prime) — 1 Chicken and Ham (Minced) — 1 Chocolate (Creamy Milk) — 2 Chocolate (Buttered) — 1 Christmas Pudding — 2 Cinnamon (Ground) — 1 Cloves (Ground) — 1 Coconut (Desiccated) — 1 Coffee (Chicory Essence) — 1 Crab (Dressed) — 3 Cream — 1 Cream (Sterilised) — 2 Curry Powder — 4 Custard Flavouring and Colouring — 1 Custard Powder — 1 Dripping (Beef) — 2 Energen Flakes — 1 Flavouring Essence — I Flour (Plain) — 3 Flour (White Self-Raising) — 4 Flour (Soya) — 1 Gin — 2 36 ARTICLE FORMAL INFORMAL Ginger Beer — 1 Ginger (Ground) — 4 1 Glucose — Glycerin, Lemon and Honey Pastilles — 1 Honey — 1 Ice Cream — 6 Jams — 4 Jellies — 6 Jelly Crystals — 2 Jelly Powder — 1 Jelly (Vegetarian) — 1 Junket Tablets (Fruit Flavoured) — 1 Lard — 1 Lemon Barley — 1 Lemon Cheese — 1 Lemon Juice — 1 Lemon Squash — 1 Liver Pills — 1 Luncheon Meat — 2 Margarine 1 2 Marmalade — 2 Marzipan — 2 Milk (Pasteurised) 31 3 Milk (Powdered) — 1 Milk (T.T.) 6 — Mincemeat — 1 Nutmeg (Ground) — 2 Olive Oil — 3 Orange Squash — 5 Pancake and Yorkshire Pudding — 1 Pastes (Fish and Meat) — 11 Pepper (Ground White) — 5 Raising Powder (Golden) — 1 Rhubarb (Tinned) — 1 Rice (Creamed) — 3 Rice (Ground) — 2 Saithe (Smoked) — 1 Salad Cream — 1 Salmon Mayonnaise (Smoked) — 1 Salmon (Potted) — 1 Sausages (Pork) 2 4 Sausages (Pork Chippolata) 1 — Sausalatas 1 — Shredded Wheat — 1 Sponge Mix — 1 Spreads — 3 Steak and Kidney Pudding — 2 Spreads — 3 Sugar (Demerara) — 1 Sugar Pieces — 1 Sweets (Buttered Brazils) — 1 „ (Butter Drops) — 2 „ (Butter Ginger) — 1 „ (Butter Mints) — 1 Syrup of Figs — 1 Tea — 6 Tomato Ketchup — 2 Vinegar (Malt) — 5 Whisky 1 2 37 Fourteen, or 6 per cent, were found upon examination by the Public Analyst to be either "inferior" or "adulterated"— Details are as follows:— article result of analysis action taken Processed Cheese Contained an excessive amount of moisture. Manufacturer's explanation accepted. Product withdrawn from sale. Luncheon Meat 65 per cent Control Orders, now defunct, demanded the meat contents of 80 and 90 per cent respectively in this food. No legal action was possible, but the matter was referred to the Ministry of Food Standards Committee. Pork Luncheon Meat 63 per cent Processed Gruyere Cheese Contained an excessive amount of moisture. No legal action taken because of dismissal of legal proceedings taken by another local authority in a similar case. Tinned Rhubarb Contaminated by tin. Unfit for human consumption. Consignment surrendered and destroyed. Shredded Wheat Contaminated by foreign bodies of unknown origin. Owing to the absence of definite information regarding the contamination no formal action was possible, but the packet of Shredded Wheat submitted was destroyed. Sponge Mix Only 3 per cent dried egg content. Manufacturer's attention drawn thereto, but no formal action possible owing to the absence of legal standard. Peanut Butter Deficiency of vitamin A content by comparison on the declaration on the label. Manufacturer's attention drawn thereto, and their explanation accepted. Skimmed Milk Powder Decomposed. Consignment destroyed. Pork Sausages Deficient in meat content. Legal proceedings instituted against Vendor, who was fined £20, with £18 18s. Od. costs. Milk (Tuberculin Tested) Deficient in butter-fat content. No action. No evidence of wilful adulteration. Follow-up samples satisfactory. Pork Sausages Deficient in meat content. Legal proceedings instituted against Vendor, who was fined £10 10s. 0d., with £12 12s. 0d. costs. Ground Almonds (2 samples) Adulterated with sugar. Legal proceedings instituted against Vendor, who was fined £5 0s. 0d., with £2 2s. Od. costs. 38 ICE CREAM There has been a great increase in the sale of this delicacy in recent years, and it now appears that it forms part of everyday diet in summer and winter alike. At the close of the year 1956 there were 180 registered Vendors in Beckenham. There has been, since 1951, a statutory standard for the product, and it is necessary for Ice Cream to contain not less than 5 per cent butter fat, 10 per cent sugar and 7½ per cent of non-fatty milk solids, and Ice Cream containing fruit or fruit pulp or puree must contain a slightly higher proportion of fat. The Town's supplies come from some half-a-dozen large manufacturing firms whose premises are not in Beckenham. Six samples of Ice Cream were submitted for chemical analysis during the year. All were reported genuine. The important constituent parts averaged as follows:— BUTTER FAT % 11.9 SUGAR %o 13 NON-FATTY MILK SOLIDS % 11.7 It will be seen that these percentages are well in excess of the statutory minima. The Ice Cream Heat Treatment Regulations, 1947, made compulsory the pasteurization of all mixes, with minor exceptions. After freezing, the Ice Cream must not be sold unless it has been kept at a temperature of not more than 28 degrees Fahr. A constant check on this is kept by the Inspectors. Tests for the bacterial cleanliness of Ice Cream were introduced in 1947, although this examination is not sufficiently reliable to justify its use as a statutory test, non-compliance with which would constitute an offence. A form of the methylene blue reduction test is adapted for use in this connection. It is not easy to describe in simple terms, but briefly, after very important preliminaries, methylene blue dye is added to the Ice Cream. Bacteria in the Ice Cream extract oxygen for survival and increase, and this chemical change causes the dye to lose its colour. The number of bacteria present will, therefore, bear relation to the speed of the reduction of the dye. The four gradings are as follows :— GRADE TIME TAKEN TO REDUCE METHYLENE BLUE I 4½ hours or more II 2½ to 4 hours III ½ hour to 2 hours IV 0 hours 39 During 1956, 67 samples were obtained for bacteriological examination by this test. The results were as follows:— Grade I 22 Grade II 25 Grade III 9 Grade IV 11 The 20 samples reported in Grades III and IV must be regarded as unsatisfactory, although it is stressed that in no case was there evidence of contamination by pathogenic organisms. These unsatisfactory samples came mainly from one manufacturing plant outside Beckenham, and the high number arose from the fact that, having found one such sample, we continued to take further samples at very frequent intervals until we were satisfied that the efforts which had been introduced to reduce contamination in this plant were successful. We acted in this matter in very close liaison with the Health Inspectors of the Authority in whose area the manufacturing plant was situated. Dustbin Accommodation. It was necessary to report 16 cases of insufficient or unsuitable dustbin accommodation in properties in the Borough. 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 1956 39 applications were received and accounts rendered for £30 0s. 0d. During the year 90 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, 305 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 305 cases discovered, however, 226 related to private drainage, and in these cases a charge is made for the work undertaken. Accounts were rendered for £87 2s. Od. for this work. The Smoke Testing of the house drains of eight properties was undertaken at the request of owners desirous of selling their properties and satisfying prospective purchasers that the drainage was sound. A charge is made for this service and Accounts were rendered for £15 15s. 0d. 40 The repair of combined drains is also undertaken by the Conncil 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. Movable Dwellings. Sixteen families occupied movable dwellings under licence from the Council during 1956. Sixty inspections of the sites of the caravans were made, and in no instance was a Public Health nuisance discovered. Factories Act, 1937. Five hundred and ninety-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 7 Unsuitable or defective sanitary conveniences 34 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 1956 107 bodies were brought to the Mortuary, where post-mortem examinations were conducted by a Home Office Pathologist. Twenty Inquests were held in the Town Hall. 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 1956 it was unnecessary to take any action under this Section. Infestation by Rats and Mice. Sewer Infestation. The extent to which sewers harbour rats is probably not generally appreciated. 41 Some branches of the stwerage system give constant shelter, food and, indeed, every facility for the continued existence of the rat. Beckenham, however, appears to differ in one respect from many other areas, for here the instances where heavy surface infestation occurs as a result of infested sewers are rare. Where such a link-up does occur, however, the remedy may well entail extensive and very costly work, and such are the ramifications of rat burrows beneath the surface of the ground, excavation has frequently to procced on the basis of trial and error. It is fortunate, therefore, that most sewer rats keep to their underground homes, but it is, nevertheless, very necessary to control their prevalence there. In 1946 this Council, in common with other authorities throughout the country, and acting at the direction of the Ministry of Agriculture, Fisheries and Food, instituted twice yearly poison baiting of sewers, and this work has continued, under the supervision of the Public Health Department, twice annually ever since. Infestation was found to be heavy and widespread in the early years of this work, but by 1950/51 much of the sewerage system had been cleared and has since remained free of the vermin. In other sections, however (and this applies particularly to the older sewers in the Town), infestation remains constant and severe. Without doubt each six-monthly baiting in these areas result in a large kill, but the colonies are so well established, and facilities for survival so perfect, that these factors, in conjunction with the natural prolific breeding of the rat, maintains the severe infestation which continues. It appears that we have reached the minimum level to which this problem can be reduced in this area by the present methods of control. Surface Infestation. Although the number of complaints made still maintains a very high level (717 were received in 1956), the degree of the vast majority of infestations is very low. In most cases the nuisance is very speedily remedied by the work of the Rodent Operators, who, because of their ever-increasing experience and understanding of the habits of the rat, are able speedily to get right to the source of the various infestations and deal with them. Their work on private properties (mainly in the gardens thereof) is greatly appreciated by complainants, and many letters and expressions of thanks for services rendered have been received during the year. Shops Act, 1950. The duties of the Public Health Inspectors under this Act differ very widely in character. The health and welfare provisions embrace sanitation, heating, ventilation, rest facilities, etc., but the Inspectors are also the Council's authorised Officers for enforcing the statute so far as it relates to hours of opening and closing, the weekly half-holiday 42 and early closing day, Sunday trading, the type of goods which are prohibited from sale at certain times, the employment of young persons, and the keeping of records. During 1956, 2,871 visits were made to shops in the Borough. In October, 1956, after the matter had been considered by the Public Health Committee, it was decided to circulate detailed information to shopkeepers regarding their duties in regard to early closing day and Sunday trading. This became necessary because there was evidence that certain shopkeepers were not properly interpreting the restrictions placed on them. It was felt that there might be adequate excuse for this happening, for the Shops law in this respect is most complicated and confusing. As a result of the explanatory circular, however, there was a better understanding of the restrictive provisions by shopkeepers, and there has since been an absence of complaint that unfair trading arose from a contravention of the Act in this respect. A new Shops Bill is now before Parliament, and it is to be expected that new legislation will do much to remove many anomalous situations which arise under existing law. 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 Public Health Inspector. 43