4412(1) BEC 24 BOROUGH OF BECKENHAM Ke[???] REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 BY L. R. L. EDWARDS, M.D. (Lond.), D.P.H. Medical Officer of Health B. BOROUGH OF BECKENHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 BY L. R. L. EDWARDS, M.D. (Lond.), D.P.H. Medical Officer of Health MEMBERS OF THE PUBLIC HEALTH COMMITTEE FROM JUNE, 1957 Chairman Councillor R. J. Butcher. Deputy Chairman: Councillor A. C. Garrett. Alderman C. P. Christie. Alderman R. S. Jackson. Councillor K. D. Aldcroft. Councillor H. E. W. Botting. Councillor J. P. M. Coulter. Councillor R. G. Cook. Councillor W. Duncan. Councillor C. M. Hamilton. Councillor D. R. Knox-Johnston. Councillor E. J. Porter. Councillor E. R. Smithers. Councillor Mrs. D. E. L. West. Ex-Officio: The Mayor. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health L. R. L. Edwards, M.D. (Lond.), D.P.H. Chief Public Health Inspector G. A. Webber, Certificate of the Royal Sanitary Institute and the Sanitary Inspectors' Examination Joint Board. Certificated Food Inspector. Deputy Chief Public Health Inspector E. U. Williams, Cert. R.S.I, and S.I.E.J.B. Certificated Food Inspector. District Public Health 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 (Resigned 31/7/57) J. A. Keen, Cert. R.S.I, and S.I.E.J.B. Certificated Food Inspector (Resigned 22/4/57) W. F. Forrest, Cert R.S.I. and S.I.E.J.B. Certificated Food Inspector (Commenced 11/11/57) Clerical Staff: Secretarial Assistant Mrs. E. A. Best. Clerks Miss Y. Read. Miss J. Siggs. Miss H. Lomas. Rodent Operators W. J. E. Wickenden. E. J. Read. Disinfector-General Assistant M. Hindson. Mortuary Attendant—General Assistant A. L. Jarvis. 3 CONTENTS page Introductory Letter 5 Section A. Vital Statistics Natural and Environmental Conditions 8 Summary of Vital Statistics 10 Vital Statistics for years 1948 to 1957 11 Total Deaths 12 Cancer Deaths, 1953 to 1957 13 Notifications and Deaths from Tuberculosis 14 Infantile Mortality 15 Morbidity Returns 16 Section B. Health and Social Services Group Hospitals and Clinics 17 County Council Health Services 17 Private and Voluntary Services 18 Local Clinics for Maternity and Child Welfare 19 Report of District Officer 20 Report of Home Help Organiser 20 Report of Chest Physician 21 Tuberculosis Care Committee 22 Mass Radiography 23 Old Peoples Welfare Committee 23 Women's Voluntary Service 25 Home Safety Committee 27 National Assistance Act, 1948 (Section 47) 27 Housing—Medical Applications 28 Sections C, D and E. Environmental Services Housing 30 Nuisances 30 Factories Act, 1937 30 Food 31 Ice Cream 32 Water Supply 33 Drainage 33 Disinfection 33 Moveable Dwellings 33 Mortuary 33 National Assistance Act, 1948 (Section 50) 34 Rats and Mice 34 Shops Act, 1950 34 Section F. Infectious Diseases Control Age and Sex Incidence 37 Monthly Prevalence 38 District Distribution 39 Smallpox Vaccination and Diphtheria 40 Poliomyelitis Vaccination 42 Special Investigation 42 4 INTRODUCTION To the Chairman and Members of the Public Health Committee. I have the honour to present my Report on the health of the Borough during 1957. Vital Statistics « There was a continued small increase in the total population which has been noted since 1953. The annual increases will then have been of the order of 60, 160, and this year 100. In 1956 the figure remained stationary. There is thus a steady healthy growth of the borough and this is shown also by the natural increase of births over deaths. A short description of the natural and environmental conditions enlarged from that detailed in previous Annual Reports is given after this introductory letter. It shows the type of boroughs to which these vital statistics relate. The reduction of Infant Mortality today is largely a question of the reduction of neonatal mortality (mortality in the first month of life) and of stillbirth mortality. Thus in the Table of Infantile Mortality, there are reported, 14 deaths of infants in their first year of life. Eleven deaths occurred in the first month, and of these eight occurred in the first day. Half of these early deaths were from congenital disease, and so in the light of present medical knowledge, were not entirely preventable. These congenital diseases occurred equally in male and female infants. Otherwise there were nearly twice as many deaths in female as in male infants. It is probable that some infant deaths due to congenital diseases are included in the stillbirths. The general rates show an increase in the Birth Rate and a decrease in the Death Rate. There were increases of infant mortality and deaths from cancer, pulmonary tuberculosis and accidental causes. The illegitimate rate which is expressed as a percentage, is not more than the national average. Both Death Rate and Infantile Mortality are lower than for England and Wales. Suicide deaths show a marked increase from 6 to 11. Included in the section on Vital Statistics are the Morbidity Returns. The outbreak of Asian influenza is clearly shown in the figure for October, and an earlier outbreak of influenza in April is also noted. Environmental Health and Social Services The ramifications of voluntary work in the borough is shown in several reports in these two sections, and each year the Chairman has recorded the Committee's appreciation of the vital value of this work in supplementing the statutory health services provided by hospitals, clinics and their staff. Provision of homes continues to solve some problems and yet to raise others connected with rents and the cost of living. Improvements and conversions under the Housing Act consist in the majority of cases of the conversion of bedroom into bathroom and closet. Thus many 5 Victorian houses are adapted for a longer life and the living conditions of the several families occupying them are immediately improved. The fitness of the houses and the rents are controlled. Public health legislation for the past few years has thrown greater emphasis on the fitness and cleanliness of buildings, structures, and appliances than on personal health services. This is reflected in the Acts and Regulations on Housing including slum clearance, food and clean air, and there is an increasing tendency to lay down specific requirements rather than to leave authorities to act only when nuisance occurs. This can be understood in fields of health where it is difficult to be precise as to cause and effect. There are many factors which co-operate to cause a case of food-poisoning, and unfortunately, many investigations are necessarily incomplete. We do not yet know the ultimate price in ill-health and loss of amenity that we pay for the pollution of the atmosphere. In April, the Council considered a report on whether preliminary action should be taken towards the establishment of a smoke control area, or areas in the borough. This would have entailed primarily a building to building (domestic, commercial, industrial) survey of all boiler plant, fireplaces and domestic appliances. It would also have meant the choice of an industrial or residential area reasonably large enough to convert into a smoke control area in which only smokeless fuels could be burnt, or appliances capable of smokeless operation could be used. Information was given on the attitude of neighbouring authorities ; and the Council confirmed a recommendation that at the present time action to establish a smoke control area was not justified and that the time was premature to consider the question of making a bye-law to ensure that suitable appliances were installed in new buildings. The need for the bye-law does seem to depend on whether or not a smoke control area is likely in the borough. Services must depend a great deal on adequacy of staff. It is important to remember that there are national staff shortages in all branches of public health among doctors, nurses and technical staff. In our own borough, the position is now more satisfactory. It is pleasing to see that the local hospitals situated in Beckenham, and under the management of another authority, are making such progress with new building and new functions—a new out-patient department in one, and increased use as a Children's hospital in another. The many ways in which one class of patient may need social help outside the hospital is shown in the comprehensive report of the Secretary of the District Tuberculosis Care Committee; and further liaison between hospital and district welfare services is shown in the reports dealing with the welfare of old persons. 6 The constitution of the Home Safety Committee, the third Committee mentioned in the Health and Social Services Section as a meeting point between statutory and voluntary organisations which are interested in the same subject, enumerates yet more voluntary organisations in the borough. The inclusion of members representing Fire, Electricity and Gas Services, Old Peoples Welfare, Junior Accident Prevention Council, and Pharmaceutical Society on the Committee itself, speaks for the many preventable causes of home accidents of which one cause, namely burns, is outstanding. Infectious Diseases Control For the first time a Table has been included on similar lines to those of former years for Smallpox vaccination and Diphtheria immunisation to show the state of Poliomyelitis vaccination in the borough. The number of poliomyelitis immunisations completed in a year is nearly three times the annual average for diphtheria immunisation over a period of 15 years, or more than one-fifth of all immunisations against diphtheria over the same period. A new Table shows more comprehensively, the number of diphtheria immunisations over the last five years. The number of vaccinations against Smallpox in the Welfare Clinics was slightly increased; while at the Chest Clinic, 59 contacts of Tuberculosis were successfully treated with B.C.G. vaccine. During the year, another vaccination scheme was successfully carried out, but figures are not yet available for the numbers vaccinated against influenza. An investigation into the incidence of poliomyelitis over 10 years has been included at the end of this report. In conclusion, I wish to thank Dr. Elliott, Dr. Lyon and other members of their County Staff for the helpful advice and co-operation which I have received in this, as in previous years. The Inspectors and Clerical Staff of the Health Department have worked as a team ; and difficulties caused by changes in the staff have been successfully overcome. I have received great support from my Chairman and members of the Health Committee and 1 thank them for their patience and understanding of the problems successfully tackled during the past year. L. R. L. EDWARDS, Medical Officer of Health. 7 SECTION A. NATURAL AND ENVIRONMENTAL CONDITIONS OF BECKENHAM The Borough has an area of 5,935 acres, and extends from the Crystal Palace Grounds to the fringe of the Kentish farmlands. It includes the districts of Lower Sydenham, New Beckenham, Beckenham (proper), Elmers End, Shortlands, Park Langley, West Wickham and Coney Hall. While primarily residential, it contains two well defined industrial areas, one at Elmers End and the other at Lower Sydenham. Its neighbours are—Sydenham and Catford to the North, Bromley and Hayes to the East, Penge and Croydon to the West, and Orpington to the South. There are twelve Railway Stations within the Borough giving fast and frequent electric trains to the City and West End termini and to intermediate stations over a wide area of South and South-east London. It is eight miles from the City. The climate is comparatively mild and the annual rainfall is low, averaging 35 inches, for the last year for which records are available. The Borough averages, 150 feet above sea level for Beckenham proper to 210 feet above sea level for the district of West Wickham in the south of the borough. Bench marks are 111 feet opposite the Regal Cinema and 135 feet opposite the Parish Church—to West Wickham with 238 feet for Links Road, 202 feet the Avenue, and 190 feet Ravenswood Crescent. About half the area geologically consists of "Blackheath Pebble Beds" and the remaining half of "London Clay" with beds of "Valley Gravel" following the course of streams known as Chaffinch Brook and Ravensbourne River. Beckenham is a coherent and well ordered town with a wide variety of houses, and possesses numerous privately owned sports grounds, and several parks. It contains more than 2,000 acres of open spaces. To the south, between Well Wood (43 acres) and the Croydon boundary, is a tract of rolling farmland with some wooded areas; just over 180 acres of it were purchased by the Kent County Council under the Green Belt Act, 1938, with contributions from Beckenham and from the London County Council, and are held by Beckenham on a 999 years lease to act as a permanent barrier to any further outward spread of urban building. The population has grown from 26,330 in 1901 to 74,834 in the 1951 Census (Estimated Population in June, 1957, was 75,440)— Male 34,102, Female 40,732. The Registrar General estimated the population of the West Wickham area in 1955 as 20,600. 8 There is a relative shortage of shopping facilities in the borough in spite of the total of 700 shops. Of these, 248 are connected with the sale of food including 28 Bakeries, 46 Meat shops, 16 Fishmongers, and 158 Grocers and Greengrocery shops. The main light industries are concerned with the manufacture of precision electrical instruments (including instruments for remote control, vibration measurement, transmission of charts and pictures by wire) small electric motors (for vehicles, heating, ventilating, dairy and dental equipment, compressors, pumps, refrigerators, machine tools), cellulose lacquers, typewriter ribbons and carbons, loose-leaf systems, stationery and binding, enamel goods and signs, elevators and conveyors, glues and adhesives, and telecommunication equipment. 9 SUMMARY OF VITAL STATISTICS, 1957 Area of District in acres 5,935 Estimated mid-year population 75,440 Population Density—persons per acre 12.7 Rateable Value at 1st April, 1958 £1,390,000 Number of Inhabited Dwellings 24,906 Product of a Penny Rate £5,600 Live Births: Male Female Legitimate 436 468 Illegitimate 12 15 Total 931 Still Births: Male Female Legitimate 12 9 Illegitimate 1 — Total 22 Deaths of Infants under 1 year of age: Male Female Legitimate 6 7 Illegitimate 1 1 Total 15 Deaths of Infants under 4 weeks of age: Male Female Legitimate 5 5 Illegitimate 1 1 Total 12 All Deaths Registered: Male Female 383 404 Total 787 Birth Rate (including Stillbirths) per 1,000 of Civilian population: Crude 12.63 Corrected (x 1.06) 13.387 Death Rate per 1,000 population: Crude 10.43 Corrected (X 0.92) 9.595 Maternal Mortality Rate per 1,000 births 0.00 Infant Mortality Rate per 1,000 live births 16.11 Neonatal Mortality Rate per 1,000 live births 12.87 Illegitimacy Rate 3.0% Death Rate per 1,000 population from Cancer (169 deaths) 2.24 Death Rate per 1,000 population from Pulmonary Tuberculosis (3 deaths) 0.04 Death Rate per 1,000 population from Non-Pulmonary Tuberculosis (no deaths) 0.00 Death Rate per 1,000 population from Accidents (20 deaths) 0.27 Natural Increase: Births exceeded deaths by 185. 10 11 VITAL STATISTICS FOR YEARS 1948 to 1957 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 1948 75,050 1,051 22 1,073 14.30 22 2 24 12 3 15 13.98 1949 75,630 1,046 30 1,076 14.23 23 1 24 29 — 29 26.95 1950 75,850 895 24 919 12.12 18 — 18 18 — 18 19.58 1951 74,880 937 24 961 12.83 15 1 16 26 1 27 28.09 1952 75,160 906 16 922 12.27 15 — 15 16 1 17 18.43 1953 75,120 856 22 878 12.51 12 1 13 10 1 11 12.53 1954 75,280 872 19 891 11.84 10 1 11 20 1 21 23.57 1955 75,340 838 16 854 11.34 9 — 9 15 — 15 17.38 1956 75,340 867 32 899 11.93 10 2 12 11 — 11 12.40 1957 75,440 904 27 931 12.63 21 1 22 13 2 15 16.11 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 1948 695 9.26 1 26 0.35 128 1.71 1949 798 10.55 1 22 0.29 130 1.72 1950 783 10.32 — 18 0.24 131 1.73 1951 832 11.11 1 10 0.13 129 1.71 1952 890 11.84 1 10 0.13 171 2.28 1953 819 9.59 — 6 0.08 156 2.08 1954 828 11.00 — 8 0.11 184 2.44 1955 836 11.10 — 6 0.08 152 2.02 1956 843 11.18 — 2 0.03 152 2.02 1957 787 10.43 — 3 0.04 169 2.24 TOTAL DEATHS, 1957 (Registrar-General's Official Returns). All causes—787. Male, 383 ; Female, 404. causes of death males females 1. Tuberculosis, respiratory 2 1 2. Tuberculosis, other — — 3. Syphilitic disease 1 1 4. Diphtheria — — 5. Whooping Cough — — 6. Meningococcal infections — — 7. Acute poliomyelitis 2 — 8. Measles — — 9. Other infective and parasitic diseases — 1 10. Malignant neoplasm, stomach 14 9 11. Malignant neoplasm, lung, bronchus 26 3 12. Malignant neoplasm, breast — 26 13. Malignant neoplasm, uterus — 8 14. Other malignant and lymphatic neoplasms 46 37 15. Leukaemia, aleukaemia 6 2 16. Diabetes 3 2 17. Vascular lesions of nervous system 32 78 18. Coronary disease, angina 85 60 19. Hypertension with heart disease 9 7 20. Other heart disease 25 62 21. Other circulatory disease 19 21 22. Influenza 5 4 23. Pneumonia 18 12 24. Bronchitis 30 8 25. Other diseases of respiratory system 4 2 26. Ulcer of stomach and duodenum 7 5 27. Gastritis, enteritis and diarrhœa 1 2 28. Nephritis and nephrosis 2 1 29. Hyperplasia of prostate 5 — 30. Pregnancy, childbirth, abortion — — 31. Congenital malformations 6 5 32. Other defined and ill-defined diseases 23 28 33. Motor vehicle accidents 2 — 34. All other accidents 5 13 35. Suicide 5 6 36. Homicide and operations of war — — Totals 383 404 12 CANCER DEATHS  1953 1954 1955 1956 1957 Cancer of Lung 36 42 34 30 29 Males 149 Females 22 Total 171 Cancer of Breast 17 22 12 23 26 100 Cancer of Uterus 3 4 6 6 8 27 Cancer of Stomach 17 16 18 17 23 Males 49 Females 42 Total 91 Other Malignant Neoplasms 83 100 82 76 83 Males 212 Females 212 Total 424 Total Deaths from Cancer 156 184 152 152 169 Males 410 Females 403 Total 813 For comparison, deaths from Respiratory Tuberculosis are shown:— 1953 1954 1955 1956 1957 6 8 6 2 3 Males 22 Females 2 Total 24 13 14 TUBERCULOSIS—Table of Notifications and Deaths, 1957, 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 26 10 36 — 1 — 4 1 4 6 9 5 5 1 4 4 3 5 3 3 6 8 Non-Pulmonary 1 — 1 1 — — — — — — — — — — — 1 — — — — — — Totals 27 10 37 1 1 — 4 1 4 6 9 5 5 1 4 5 3 5 3 3 6 8 Deaths Pulmonary 8 3 — — — — — — 1 1 3 2 4 — 2 — 2 1 2 2 1 1 Non-Pulmonary — — — — — — — — — — — — — — — — — — — — — — Totals 8 3 — — — — — — 1 1 3 2 4 — 2 — 2 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). 15 INFANTILE MORTALITY, 1957 The number of deaths of infants under the age of twelve months was 14, as compared with 10 in 1956. The Registrar-General returns 15 infants deaths, and the Infant Mortality Rate for the year was 16.11 per 1,000 live births. The following Table shows the cause of death in 14 cases for which full records exist. Table of Infantile Mortality Under one day Over one day Total under one week age in weeks Total under one month age in months Total under one year 1-2 2-3 3-4 1-3 4-6 7-9 10-12 M. F. A. Congenital: Heart 2 1 3 — — — 3 — — — — 1 2 Lungs 1 — 1 — — — 1 — — — — 1 — Spine — — — — — — — 3 — — — 1 2 Other 1 — 1 — — — 1 — — — — 1 — B. Ante-Natal or Intranatal 1 1 2 — — — 2 — — — — — 2 Immaturity and Prematurity — — — — — — — — — — — — — Erythroblastosis (Rhesus incompatibility) — 1 1 — — — 1 — — — — — 1 Cerebral Haemorrhage 1 — 1 — — — 1 — — — — 1 — C. Infections: Pneumonia and Bronchitis — — — — — — — — — — — — — Gastro-enteritis — — — — — — — — — — — — — D. Accidental and Violence (including inattention at birth) 2 — 2 — — — 2 — — — — — 2 Totals 8 3 11 — — — 11 3 — — — 5 9 MORBIDITY RETURNS, 1957 certificates of incapacity first intermediate final total January (ended 29.1.57) 1122 3943 820 5885 February (ended 26.2.57) 972 3912 831 5715 March (ended 26.3.57) 1086 3963 907 5956 April (ended 30.4.57) 991 4709 913 6613 May (ended 28.5.57) 827 3660 620 5107 June (ended 25.6.57) 681 3485 563 4729 July (ended 30.7.57) 772 4132 681 5585 August (ended 27.8.57) 630 3172 472 4274 September (ended 24.9.57) 793 3214 538 4545 October (ended 29.10.57) 3685 5008 2640 11333 November (ended 26.11.57) 1355 3964 1510 6829 December (ended 31.12.57) 2019 4349 1490 7858 Each January a calculation is made of new claims to sickness benefit in the 35 weeks from early April to early December of previous year. An increase to 250 per cent of this average or an increase of 30 per cent over the previous week indicates an epidemic which is almost always due to influenza. Notifications were received from the local office of the Ministry of Pensions and National Insurance on the 7th January and on the 25th September. The figures relate only to the working population eligible for sickness benefit and excludes such important sections as the aged who have retired and are drawing retirement pensions, school children and pre-school children and the considerable number of married women who have decided not to pay contributions. 16 SECTION B. HEALTH AND SOCIAL SERVICES In this section are included hospitals and clinics serving the Borough but not all of which are situated within the Borough. Many of these services including the provision and supervision of old persons homes within the Borough are directly administered by the County, and the District Officer and District Organiser of the Home Help Service have contributed information for which I am grateful. I am indebted to Mr. Forster and to Mrs. Fisher for their accounts of the work of the T.B. Care Committee and the Women's Voluntary Service ; and Mrs. Bristowe has kindly advised me of the voluntary welfare work for old persons co-ordinated by the Committee. 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 or 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). 17 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. 3. Private and Voluntary Services. Private Nursing Homes. (1) "Parklands," 51, Crystal Pakce 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. (6) 51, Albemarle Road, Beckenham. 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. 18 LOCAL CLINICS FOR MATERNITY AND CHILD WELFARE Service Days and Times Premises in Use Anti-Natal 2nd and 4th Fridays in each month, 10—12 noon (by appointment) 1st, 3rd and 5th Monday mornings (by appointment) Monday to Friday inclusive (by appointment) Bookings—Tuesdays and Wednesdays, 2—2.30 p.m. Clinic Block, Town Hall, Beckenham Clinic Block, Hawes Lane, West Wickham Maternity Hospital, Stone Park Avenue, Beckenham Maternity Hospital, Stone Park Avenue, Beckenham 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 Child Weleare 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 (b)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 appointment) Maternity Hospital, Stone Park Avenue, Beckenham Vaccination (by appointment only); Diphtheria and Whooping Cough Immunisations 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 (by appointment) Town Hall Clinic Orthopaedic Wednesday mornings (twice per month) (by appointment) Clinic Block, Town Hall Beckenham Surgeon in attendance Treatment. The Physiotherapist attends by appointment as follows:— Monday afternoons Clinic Block, Town Hall, Beckenham Tuesday mornings Thursday afternoons Friday afternoons Mothercraft Classes and Friday mornings, 10.30 a.m. Clinic Block, Town Hall, Beckenham Relaxation Exercises Thursday afternoons, 2 p.m. Clinic Block, Hawes Lane, West Wickham 19 REPORT OF DISTRICT OFFICER I am pleased to incorporate the following interesting report I have this year received from Mr. Moore, District Officer, in connection with the above:— "So far as Beckenham is concerned, there were two developments of particular interest in the County Council's Health services during the year under review. The first, mainly of local interest, was the opening of 28, South Hill Road, Shortlands, as an annexe to Durham House Old People's Home, thus providing a further 21 places. The second, of a more general application, was the introduction of the Child Help Service. The object of the scheme is threefold: to raise the standard of living of the families concerned, to improve the standard of child care; to keep the family together and prevent its break-up. This scheme is intended to deal with certain problem families by an extension of the Domestic Help and Family Help Services. It is considered that there are many problem families known to the Health Department who may be materially assisted and rehabilitated by the practical help and guidance of specially selected domestic helps." REPORT OF HOME HELP ORGANISER I am grateful to Miss Hocking for the report on these services. Domestic Help Service All applications for the above service should be made to the District Organiser, 12, Beckenham Road, Beckenham, Telephone No. BEC. 8986. Demands for this service continue to increase steadily throughout the year. Family Help Service All applications for this service should be received through the Children's Officer. The service is provided to deal with the care of young children in their own homes when the mother is temporarily away from home. Night Attendant Service This service is for the care of aged sick in their own homes in extreme emergencies. 20 WORK OF THE CHEST CLINICS I am again grateful to Dr. Madigan for submitting the following report and Table on the work of the Chest Clinics during the year under review:— "There has been a steady decline in the numbers of newly diagnosed tuberculous cases over the past few years, and it is gratifying to note that amongst the new contacts examined, none was found to be suffering with the disease. A further 59 contacts were given B.C.G. vaccination. During the year, the voluntary scheme for B.C.G. vaccination of thirteen year old schoolchildren began. At my request, positive Mantoux reactors found in the preliminary tests, are referred to the Chest Clinics for fuller investigation. The families of these children are also invited to attend, and we are thus given additional facilities in tracking down unsuspected sources of infection. Whilst welcoming these further measures in dealing with the problem of tuberculosis, one must admit that the voluntary nature of the scheme necessarily limits its scope." New Cases attending the Chest Clinics for the first time during 1957. Adults Children under 15 years Male Female Male Female Pulmonary Tuberculosis 28 14 1 1 Non-Pulmonary Tuberculosis — — — — Non-Tuberculous 47 44 15 13 Non-Tuberculous Tuberculous New Contacts Examined 189 Nil B.C.G. Vaccination of contacts: 59. Number of Patients admitted to Hospital or Sanatorium during the year: 29. These figures relate to patients resident in Beckenham Borough only. 21 BECKENHAM DISTRICT TUBERCULOSIS CARE COMMITTEE I have pleasure in submitting the following report forwarded to me by Mr. M. E. Forster, the present Hon. Secretary of the above Committee:- "During the past year the Beckenham District Tuberculosis Care Committee, which is associated with the Kent Council of Social Service, continued its welfare work amongst the tubercular patients and their families in the Borough of Beckenham. It had been found that more help was required by patients whilst they were at home, as they did not spend so much time in hospitals or sanatoria, due to the improved treatment by drugs. Patients who were recommended to the Committee by the Chest Clinic were visited by one of the Liaison Officers, who were authorised to spend up to £5 on immediate needs, but more complicated cases were brought before the Committee at one of their monthly meetings. Each case was given careful consideration and the help provided covered a wide field. Below is a list of the various assistance given. Three families were sent away during the summer to approved Holiday Homes for recuperation. One patient was helped with railway fares for a holiday, and two families were helped with fares to visit patients in sanatoria. One family was helped with house repairs, and one family was helped with repairs to a water main. One patient had his hire purchase debt settled, and three other patients' outstanding debts were paid. Four patients were granted free meat for periods ranging from four weeks to 12 weeks. One family was helped with moving furniture. Two patients were assisted with clothing and one with shoes. One patient had his Car Tax paid and a Convector Heater was purchased for another. One patient had a rent debt settled and another had his Electricity Bill paid. In addition, the Committee have four Radio Sets which they loan to patients, and at Christmas time some 34 patients received a Christmas Card and gift. The Committee spent over £260 and to help offset this the usual sale of id. Christmas Seals was organised, and next year it is hoped that a Jumble Sale will be held. 22 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. The number examined is lower this year as there was no visit by fixed units and the only visit possible by a Mobile Unit was made to one firm at Elmers End at which employees from other firms attended. no. of persons active inactive non-tuberculous examined pulmonary pulmonary conditions tuberculosis tuberculosis 1,722 2 1 26 Non-Tuberculous conditions, consisted of :— Cancer of Lung 1 Pneumonitis 1 Emphysema 1 Abnormalities requiring no action 22 BECKENHAM OLD PEOPLES WELFARE COMMITTEE The main voluntary welfare work for old persons consists in home visiting and continued visits when these are welcomed. Visits are carried out at the request of organisations whose representatives attend meetings of the Committee and who are in touch with each other and with necessary services in between meetings. The main function of the Committee is to act as a meeting point for representatives of organisations and departments interested in some aspect of the welfare of old persons. By reports of the work of these organisations, overlapping of help may be avoided. Thus the District Officer brings information about County homes for old persons and mental health services; the Home Help Organiser brings information about development of these services to help old persons, e.g. night attendant service; the W.V.S., Veterans Club, etc., bring information about activities of such services as old persons clubs, meals on wheels and outings. Individual problem cases can be investigated by the Secretary. Many of the associations listed below help by organising whist drives, bazaars and the like, towards the fund of the Committee. Apart from financial help of needful old persons the Committee helps with such problems as can be dealt with. They may include searching for smaller accommodation and arranging exchange, and in providing shopping services, chiropody service equipment and parcels. The Committee shares with other organisations such as Friends of Beckenham Hospital, W.V.S., some part of the proceeds of the collections on Rose Day. The various organisations help in various ways, a few of which are as follows 23 Chiropody Service Once a week a clinic is held at 45, Beckenham Road, and the chiropodist also visits Thornton House. Another chiropodist sees persons at her own home. Fees are reduced in all cases. Guilds Main service is in finding needy cases, visiting and helping towards funds. Inner Wheel Help with funds, visits and providing afternoon teas at Thornton House. Clubs The Veterans Club is a men's club which is self-supporting and meets each Thursday afternoon at the Azelia Club. Darby and Joan Clubs are mentioned among the activities of the W.V.S. Ascertainment Most old persons in the course of a year need to contact their own doctors. Others are put in touch with services through contacts with friends who are members of clubs or through the British Red Cross, or by visits from Health Visitors, Almoners or Officers of National Assistance Board. But in the main it is medical practitioners who find the needful old persons. Services Many services are listed in the report of the Women's Voluntary Service, but mention can be made of two services. In this area there seems little call for the night attendant service, as most old persons live with or near relatives. There is no call for a laundry service as a private firm arrange for old persons' laundry to be dealt with for a reduced charge on production of the old age pension book. The cadet service of the B.R.C.S., and certain school children do shopping for older persons and help with parcels at Christmas. Organisations represented on the Committee are :— 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 WOMEN'S VOLUNTARY SERVICE I am very grateful to Mrs. J. M. Fisher, the Centre Organizer, who has submitted the following interesting report on the very valuable work of the W.V.S. Derby 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. Of the Beckenham Clubs, two 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. 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. It is a most important service, run principally for the benefit of invalids and elderly people who live alone and cannot cook for themselves. The meals are cooked in the Centre by members of the 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 36 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. 25 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 over £600 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. We are also able to help younger people with clothes and mothers with baby clothes. The Children's Clothing Exchange is still being run every Wednesday, and we understand it is the most flourishing one in Metropolitan Kent. Welfare Foods 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 Homes. 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, eight children benefited from a holiday at the seaside or in the country. More children could have received such help had more money been available. The parents pay what they can towards the holiday and the W.V.S. find the rest. 26 BECKENHAM HOME SAFETY COMMITTEE This voluntary Committee has been in existence for some years and its members represent various organisations most interested in the question of home safety. It is not a Committee of the Authority, but receives an annual donation towards its funds from a special committee of the Council— the Accident Prevention Committee. Other funds are extremely small consisting of voluntary donations. Funds are used to purchase posters, leaflets and other publicity material from R.O.S.P.A. Meetings are held every other month and Sub-Committees meet according to the requirements of special campaigns. The following Organisations are represented on the Committee : Kent Fire Brigade. L.E.B. and S.E.G.B. Accident Prevention Committee. Old People's Welfare Committee. Townswomen's Guild, West Wickham. Townswomen's Guild, Park Langley. N.W. Kent Federation of Townswomen's Guilds. Elmers End Co-operative Guild. Women's Gas Federation. Women's Citizens Association. Soroptimists. Conservative Party—Women's Section. Labour Party—Women's Section. Pharmaceutical Society (G.B.) West Kent Branch. District Tuberculosis Care Committee. Junior Accident Prevention Council. British Red Cross Society. Girl Guides Organisation. 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. 27 HOUSING—MEDICAL APPLICATIONS From January 1st to December 12th, 1957, 65 applications with certificates were received. Twenty were re-applications, and in eleven of these, further medical points were recommended, and in one case the number of points was reduced. In 21 cases the maximum number of points were recommended of which 18 cases were for ground floor accommodation. The average age of all the applicants recommended maximum points, was 66 years. In only one application for which maximum points were recommended, were the total points 40 or less. In six cases, no additional points were recommended. The medical causes are classified in the following groups. The major causes alone are considered, but more than one may apply to each case. Tuberculosis 8 Chest Disease 3 Rheumatoid Arthritis 1 Arthritis, Spine or hips, or Rheumatism 10 Angina or Cardiac weakness 2 Coronary Thrombosis 1 Anxiety state, Nervous Strain or Mental illness 13 Children, illnesses or overcrowding 22 In 15 cases out of 65 applications considered, either one or other applicant was over 60 years of age; this compares with 17 out of 68 applications for the previous year. Over the past three years for which these records have been kept, there is very little difference in the relative proportions of the various groups. The figures for 1955 and 1956 are given below for comparison. 1955 1956 Tuberculosis 6 10 Chest Disease 10 Rheumatism and Arthritis 9 12 Angina or Cardiac weakness 5 Coronary Thrombosis 2 3 Anxiety State or Mental Illness 15 Children, illness or overcrowding 3 15 The average number of re-applications is only 17 or 26 per cent of the total applications, so that this little difference in incidence between medical applications on the current waiting list and previous years could mean that these cases are being rehoused before other cases. 28 I am very grateful for the following report and Tables from Mr. G. A. Webber, Chief Public Health Inspector, which sets out the work of the Inspectors during the year. The Rent Act, 1957, which came into operation in June, 1957, has made considerable demands on the time of the staff. At the same time, there are signs that its continued operation is having the effect of reducing the number of complaints from tenants of rented properties. The main reason for this may well be due to the anticipated result of the Act, that the Landlord and tenant would negotiate, on the one hand the rent increase, and on the other the proper repair of the property, all without the intervention of the Local Authority. This has undoubtedly happened in numerous instances, but no official statistics are available. There are, however, at least two other reasons. When the Landlord gives notice that he intends to increase the rent, the tenant can submit a list of defects of repair. If the Landlord fails to give an undertaking to do this work, and providing the list, or part of the list, of defects is factual and approved by the Local Authority, the Authority must issue a Certificate of Disrepair. Whilst the Certificate remains operative (i.e. until the works are completed) no increase of rent can be demanded. It should not, however, be assumed that where Certificates of Disrepair are issued, the works required are completed forthwith. In very many cases, as will be seen from statistics given later, a position of stalemate appears to be reached—the Landlord does not do the work, and the tenant does not pay the increased rent, and there the matter rests, with both parties apparently satisfied. Secondly, not all Landlords have increased the rent of their properties. In such cases one imagines that the tenant does not complain to the Local Authority about defects of repair in his occupancy, preferring either to put up with them, or to do the work himself, in order to remain free of increased rent demands. Upon receipt of an approved application, the Local Authority's first duty is to serve a Notice of Intention to issue a Certificate of Disrepair on the Landlord. Should the Landlord then give a written undertaking to complete the works within six months, no further action is taken by the Council. The Landlord's failure to give such an undertaking results in the issue of a Certificate of Disrepair. By the end of 1957 in Beckenham, 65 applications had been received, and approved either in full or in part. In 33 instances, written undertakings were submitted by Landlords, and Certificates of Disrepair issued in respect of the remaining 32 cases. Only six of these Certificates have so far been cancelled. 29 SECTIONS C, D, E. 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) 904 Number of inspections made for the purpose 2,168 Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 29 Number of inspections made for the purpose 238 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 181 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 181 Number of dwelling-houses in which defects were remedied after service of informal notices 161 Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 20 Number of dwelling-houses in which defects were remedied after service of formal notices : (a) by owners 20 (b) by Local Authority in default of owners 0 Number of complaints received 1,321 Number of initial visits 4,714 Number of re-visits 2,247 Nuisances Remedied Structural Defects of properties—External 313 Internal 213 Insanitary conditions other than vermin 16 Verminous conditions Choked drains 244 Other drainage defects 127 Defective sanitary appliances 51 Insufficient or unsuitable water supply 11 Absence of dustbin accommodation Offensive accumulations 3 Factories Act, 1937 Two hundred and seventy-two visits of inspection were made to factories in the area, and the following nuisances were remedied following the service of Intimation Notices:— Want of cleanliness 4 Unsuitable or defective sanitary conveniences 15 30 Food and Drugs Sampling A list of food and drugs sampled during the year is appended:- article formal informal Almonds—Ground 8 1 Anchovy Paste - 1 Aspirin — 2 Bakewell Tart — 1 Butter — 2 Cake—Genoa - 1 Cider Vinegar — 1 Chicken (Chopped) - 1 Christmas Pudding - 1 Chutney (Mango) - 1 Coffee — 3 Coffee and Chicory Essence — 1 Crab (Dressed) - 2 Cream - 3 Cream of Tartar — 1 Curry Powder — 1 Custard Powder — 1 Deodorised Groundnut Oil — 1 Epsom Salts — 1 Flour — 2 Gelatine — 2 Ginger (Ground) - 3 Ice Cream — 15 Jam - 1 Jelly (Table) — 1 Lard — 2 Lemon Juice — 1 Lemon Squash — 1 Liquid Apples — 1 Luncheon Meat — 1 Margarine — 1 Meat Pudding — 1 Milk (Pasteurised) 39 - Milk (Tuberculin Tested) 5 - Milk Pudding — 1 Mint Sauce — 1 Mint (Garden) — 1 Mussels — 1 Orange Squash 3 6 Pancake and Yorkshire Pudding - 1 Pepper (Ground White) — 2 Rhubarb — 6 Rice (Ground) — 1 Rum Butter — 1 Salmon Spread — 1 Sauce (Fruit) — 2 Sausages (Pork) 2 7 Soft Drink Powder — 1 Sponge Mixture — 1 Sugar (Demerara) — 2 Sugar (Icing) — 1 Stewed Steak - 1 Tomato Juice - 2 Tomato Ketchup — 4 Vinegar — 3 Yeast Extract — 1 31 Seven, or 4 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 Ground Almond Consisted principally of Commodity withdrawn Mixture. Cashew Nut. from sale. Name "Ground Almond Mixture" not justified. Pork Sausages Deficient in Meat content. Manufacturers agreed to increased meat content to 65% Further samples proved to be genuine. Pork Sausages Ditto. Ditto. Pork Sausages Ditto. Ditto. Orange Squash Deficient in fruit content Manufacturers agreed to increase fruit content. Further samples proved to be genuine. Christmas Pudding Ingredients in wrong order Label amended, on label. Chopped Chicken Incorrectly labelled Label amended. Unsound Food During the year 1957, 19 complaints were received that food purchased by residents was adulterated or unsound, and in 13 of these cases, it was found that the complaint was justified. Full investigation followed and reports were furnished to the Public Health Committee. In only one case did the Committee consider it necessary to institute legal proceedings against the Vendor. This related to the sale of ground almonds which were found to be adulterated with a large proportion of sugar. The Vendor was fined £5 with £2 2s. Od. costs. In all the other cases, the Public Health Committee gave instructions that warning letters should be sent to the Vendors. Food Shopkeepers frequently seek official aid in decisions regarding the soundness or otherwise of food for human consumption. During 1957, approximately 1 ton 9 cwts. of food was thus condemned and destroyed as unfit for human consumption. This total weight included 8½ cwt. fresh meat, 4½ cwt. tinned meat, 4½ cwt. canned fruit, 7 cwts. sundry food packs. In no case did the circumstances justify the official seizure of unsound food exposed or deposited for the purpose of sale. Ice Cream Fifteen samples of Ice Cream were submitted to chemical analysis during the year, and all were reported genuine. 32 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. Drainage As will be seen from the Table of nuisances remedied, 275 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 275 cases discovered, however, 186 related to private drainage, and in these cases a charge is made for the work undertaken. Accounts were rendered for £128 15s. Od. for this work. The Smoke Testing of the house drains of seven 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 £14 14s. Od. 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. Requests are also 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 1957, 22 applications were received and accounts rendered for £17 6s. Od. During the year 129 Library books were collected from homes where infectious disease had occurred, disinfected and returned to the Library of origin. Movable Dwellings Sixteen families occupied movable dwellings under licence from the Council during 1957. Twenty-eight inspections of the sites of the caravans were made, and in no instance was a Public Health nuisance discovered. 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 1957, 142 bodies were brought to the Mortuary, where post-mortem examinations were conducted by a Home Office Pathologist. Thirty-nine Inquests were held in the Town Hall. 33 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 1957 it was unnecessary to take any action under this Section. Infestation by Rats and Mice Seven hundred and fifty-six complaints were received in 1957 of which 82 related to business premises. A charge is made for the service provided in respect of the latter, whereas private residential property is serviced free of charge. During the year, accounts for £123 7s. 3d. were rendered in respect of business premises. Certain sections of the main sewers of the town known to be heavily rat infested were poison baited on three occasions during the year. New methods of control, including the use of a new poison (Warfarin) were introduced with the approval of the Ministry of Agriculture, Fisheries and Food towards the end of the year. The indications are that permanent disinfestation is now being achieved even in the sections of sewers which had remained constantly heavily infested despite our earlier efforts. Shops Act, 1950 The duties of the Public Health Inspectors under this Act differ very widely in character. The health and welfare provisions embrace sanitatin, 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 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 1957, 1,003 visits were made to shops in the Borough. 34 SECTION F. INFECTIOUS DISEASES CONTROL Tables are included in this section to show the progress of various Immunisation campaigns against Diphtheria, Smallpox and Poliomyelitis. There has not yet been a complete year for corresponding figures for the Whooping Cough Immunisation to be included. Other Tables show the distribution of infectious diseases in the Wards of the Borough, during the different months and according to age and sex. Measles was three times more prevalent than last year, but the biennial increase was a third less than the average. There was an increase of four cases of poliomyelitis entirely due to the non-paralytic type of illness. The distribution of paralytic cases was exactly that of 1956 in the ratio of three males to one female. Whooping Cough was slightly less prevalent, and the majority of illnesses were in children between the ages of five and 14 years. There were two girls affected for every boy. It is too early to assess the value of the whooping cough immunisations now being carried out in the Infant Welfare Clinics, and it has to be remembered that for many years these immunisations have been carried out in Beckenham other than in the Clinics. The notifications of whooping cough for this age group over the past ten years are as follows:- 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 64 111 97 52 163 47 118 86 52 70 So far there seems to be little effect of this campaign even allowing for under-notification of whooping cough and epidemic variations, but vaccines have been improved in recent years, and any value of the new vaccines will be shown first of all in this age group. Chickenpox is not a notifiable disease, but the incidence of this illness seems to have increased in recent years, and at times it can cause such a severe illness that smallpox is simulated. An adult of 33 years with confluent chickenpox was examined in consultation with the Smallpox Consultant of the Rivers Hospital Group at the request of the family doctor during the last week of July. It was not necessary to obtain bacteriological exclusion of smallpox and no further action was necessary. The consultation had to be carried out at a late hour owing to the illness of the Consultant who was originally approached. This is only the second such consultation in the past six years. Notifications of food poisoning remain at about the same level, and are so predominantly due to Salmonella typhi-murium that there seems little point in listing the various other types. 35 Visits are made by Inspectors. In some cases reports have to be sought out from the local hospital which has made the bacteriological diagnosis; in others, reports are obtained from the Public Health Laboratory Service. In November, an employee working at a local Bakery (but living outside the Borough) was found to be a contact at home with cases of a salmonella infection. He was excluded from his employment with a view to preventing the spread of the disease, under powers contained in a local Act. A few days later, he was reported a carrier of the disease and thereby came to be excluded under the Public Health (Infectious Disease) Regulations 1953. He was allowed to return to work when four negative specimens had been obtained. In December, two persons in the borough were reported to be suffering from food poisoning which they thought might have been due to eating mussels bought in a neighbouring borough, to which the incident was reported. Mussels were investigated in this borough and though faecal coliforms were isolated in two out of 10 mussels, no salmonella organisms were isolated. Returns are made to the Ministry which must provide valuable information on the distribution of causes of food poisoning, and apart from anything else, the investigations control to some extent the possible development of human carriers of the disease. 36 37 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. Dysentery (Bacillary) - 3 - 1 1 - - - - - 1 4 Erysipelas — — — — 3 3 — — — — 3 3 Food Poisoning 1 1 2 2 3 5 — — 2 2 6 8 Measles 177 168 193 207 2 4 — — 1 — 372 379 Pneumonia — 1 1 3 22 9 — — 2 — 23 13 Poliomyelitis: Paralytic 1 — — — 2 1 — — 3 1 3 1 Non-Paralytic 1 — 1 — 1 5 — — 3 3 3 5 Puerperal Pyrexia — — — — — 21 — — — 20 — 21 Scarlet Fever 8 5 18 16 2 0 — — 10 6 28 21 Whooping Cough 29 35 27 50 2 10 - - - 2 58 95 38 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 23 126 212 253 62 35 19 16 - - 5 - 751 Scarlet Fever 7 1 8 1 7 10 5 — — 3 3 4 49 Whooping Cough 24 25 21 27 16 20 4 3 8 2 1 2 153 Dysentery 2 — — 1 1 1 - — — - 1 5 Puerperal Pyrexia 3 4 3 — — 1 - — 6 - 3 1 21 Pneumonia 2 5 3 2 3 — 2 — — 2 4 13 36 Erysipelas 1 — 2 — — 1 — — — — 1 1 6 Poliomyelitis: 1 A Paralytic — — — — 1 — 1 — 1 - - 4 Non-Paralytic 1 — — 1 — 1 3 2 — — - -— 8 Food Poisoning 1 - 4 2 - - 1 1 2 3 - - 14 Totals 64 161 253 288 89 70 34 23 16 11 17 21 1047 39 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 209 70 121 117 60 55 24 95 Scarlet Fever 8 1 3 5 2 3 10 7 Whooping Cough 11 12 5 32 18 16 21 38 Dysentery 1 2 — — — 2 — - Puerperal Pyrexia — — — — 19 — — 2 Pneumonia 4 3 3 13 3 1 3 6 Erysipelas - 1 1 — 1 — — 3 Poliomyelitis: Paralytic 1 1 — — — — — 2 Non-paralytic 1 1 1 — 1 1 2 1 Food Poisoning 2 4 - 3 - 2 2 1 Totals 237 95 134 170 104 80 62 165 •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. VACCINATION AND IMMUNISATION Infant Welfare Centre Attendances, 1957 (a) The number of sessions held during the year 459 (b) Attendances during the same period 18,558 Diphtheria Immunisation (a) The number of sessions held during the year 357 (in conjunction with Child Welfare Clinics) (b) Attendances during the same period 292 Smallpox Vaccination (a) The number of sessions held during the year 250 (in conjunction with Child Welfare Clinics) (b) The number of vaccinations given 384 Immunisation against Diphtheria and Vaccination against Smallpox, 1957. (A) DIPHTHERIA IMMUNISATION. Year of Birth. 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 Total  Primary Inoculations. 126 503 68 22 15 16 15 3 5 8 4 — 1 - - 786 Re-inforcing Inoculations. - — 4 10 21 334 102 19 27 350 98 12 4 1 1 983 (B) VACCINATION. Year of Birth. 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 Before 1943 Total. Primary Vaccination. 398 : 300 16 18 6 14 5 5 9 3 4 3 2 1 — 38 822 ReVaccination. — — 2 1 3 1 1 5 2 1 2 7 5 4 — 90 124 40 41 IMMUNISATION AGAINST DIPHTHERIA (from 1943 to 1957) Year of Birth 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Total Last complete course of injections (whether primary or booster) 1953-1957 24 39 80 469 806 745 629 634 607 818 684 682 632 594 126 7,569 1952 or earlier 470 543 580 547 385 122 184 209 293 48 - - - - - 3,382 POLIOMYELITIS VACCINATION, 1957 The following Table gives the numbers of children resident in the Borough of Beckenham who received a course of two injections against poliomyelitis during the year ended 31st December, 1597 born no. 1947 482 1948 382 1949 393 1950 344 1951 205 1952 104 1953 138 1954 84 1955 282 1956 294 1957 1 Total 2,709 SPECIAL INVESTIGATION OF POLIOMYELITIS IN BECKENHAM 1947 to 1957 A special investigation of 118 confirmed cases of Poliomyelitis occurring in this Borough between 1947 and 1957 was carried out. Thirty-three of the cases occurred in an epidemic of 1947, while the remaining 85 cases have occurred in non-epidemic years. The age and sex distribution, seasonal prevalence and geographical location of all the cases was described and illustrated by a Map and appropriate Tables. A comparison was made between the picture in Beckenham and that described by other writers for Surrey, for Devon and Cornwall, and for other parts of England and Wales. 42