4412 C??? BEC 25 BOROUGH OF BECKENHAM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 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 1958 BY L. R. L. EDWARDS, M.D. (Lond.), D.P.H. Medical Officer of Health Borouggh of Bechenham With the Compliments of the Medical Officer of Health Town Hall, Beckenham Hont. MEMBERS OF THE PUBLIC HEALTH COMMITTEE FROM JUNE, 1958 Chairman Councillor R. J. Butcher. Deputy Chairman: Councillor A. C. Garrett. Alderman C. P. Christie. Alderman R. S. Jackson. Councillor W. Duncan. Councillor R. G. Cook. Councillor E. R. Smithers. Councillor W. E. Palmer. Councillor J. P. M. Coulter. Councillor K. W. T. Hunter. Councillor D. R. Knox-Johnston. Councillor J. Lloyd-Eley. Councillor M. Williams 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. Wilxiams, Cert. R.S.I. and S.I.E.J.B. Certificated Food Inspector. District Public Health Inspectors W. T. G. Woodard, Cert. R.S.I. and S.l.E.J.B. Certificated Food Inspector. W. F. Forrest, Cert R.S.I. and S.l.E.J.B. Certificated Food Inspector. H. J. Rogers, Cert. R.S.I. and S.l.E.J.B. (Commenced 1/3/58— Resigned 31/12/58) 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 (Resigned 14/1/58) T. J. Field (Commenced 17/2/58) 3 CONTENTS page Introductory Letter 5 Section A. Vital Statistics Natural and Environmental Conditions 9 Summary of Vital Statistics 11 Vital Statistics for years 1949 to 1958 12 Total Deaths 13 Cancer Deaths, 1954 to 1958 14 Notifications and Deaths from Tuberculosis 15 Infantile Mortality 16 National Insurance Sickness Claims (Graph) 17 Section B. Health and Social Services Group Hospitals and Clinics 18 County Council Health Services 18 Private and Voluntary Services 19 Local Clinics for Maternity and Child Welfare 20 Report of District Officer 21 Report of Home Help Organiser 21 Report of Chest Physician 22 Tuberculosis Care Committee 23 Old Peoples Welfare Committee 24 Women's Voluntary Service 26 Home Safety Committee 28 National Assistance Act, 1948 (Section 47) 28 Housing—Medical Applications 29 Sections C, D and E. Environmental Services Housing 32 Nuisances 32 Food and Drugs 33 Unsound Food 35 Ice Cream 38 Rent Act, 1957 38 Factories Act, 1957 38 Disinfection 39 Mortuary 39 Moveable Dwellings 39 Water Supply 39 Drainage 39 Rodent Control 39 Shops Act, 1950 40 National Assistance Act, 1948 (Section 50) 40 Section F. Infectious Diseases Control Age and Sex Incidence 43 Monthly Prevalence 44 District Distribution 45 Vaccination and Immunisation 46 Poliomyelitis Vaccination 47 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 1958. Statistics For the first time in 5 years, there has been a reversal of the steady increase in population, and this year there was a decrease of 60 in the estimated mid-year population. The reason for this was an increase of 181 deaths over the previous year so that in spite of an increase in births of 22, the total deaths exceeded births by 15. It seems that these deaths were related to the outbreak of Influenza in 1957. This outbreak is clearly shewn later in the Report on a graph which illustrates over four years, illnesses in the employed part of the population. This is compiled from the number of new claims for sickness benefit, and is one method of illustrating the incidence of colds and influenza. It does not include the pensioned part of the population, but perusal of death returns for this year, shews that deaths occurred mainly in older persons with a relative increase in deaths from respiratory diseases and various forms of heart disease. The usual excess of female deaths over male deaths was increased from 21 in 1957 to 181 in 1958. Pulmonary Tuberculosis caused one death, a male, and this is the lowest figure ever recorded in Beckenham. On the other hand, deaths from Cancer of the Lung were the highest recorded for 5 years, and in males, there were twice as many as 7 years ago. There was a slight increase in the total of births and consequently in the birth rate. The birth rate depends on the number of married couples and the marital fertility rate, and these two factors vary enormously from area to area throughout the Country, and so afford no true comparisons of social health. There were reductions in the Infant Mortality rate and Neonatal Mortality rate, and these rates are taken as representing the best indications of comparative standards of living. Perusal of the 10 year Table of Comparative Rates, shews that the most significant reduction in deaths in recent years has been that of mothers in childbirth. Environmental Health and Social Services The number of Clubs and local organisations helping handicapped persons has continued to grow. We have now a Beckenham and District Hard of Hearing Club meeting once a month, and a local 5 branch of the Alcoholics Anonymous Society meeting once a week. Other handicapped groups such as Spastics, Infantile Paralysis Fellowship, Diabetics and Multiple Sclerosis are members of other groups in the district, already well established. The District Officer, makes the interesting observation that need for financial care and after care of tuberculous patients is declining. The Care Committee spent over £500 in 1955, whereas the present expenditure is just over £300. He also reports that there was a marked increase in applications for admission to Old Persons Homes. The publicity attendant on efforts by voluntary organisations to assess the number of old persons needing flats with or without a resident Warden Service, may have contributed to this increase. Many old persons previously fit and independent may have had their resistance and morale lowered by the cold and influenza epidemics in 1957. It is particularly difficult to find the actual number of old persons over 70 years of age, who are in need of, or who would benefit from more care and supervision. Vigorous efforts are being made by various associations to compile such a list. The final list for admission to Old Persons Homes will need to be very carefully pruned to avoid an undue bias of overhelpfulness, or failure to recognise types of persons who are not good " mixers " and whose health would suffer from well-meant efforts to enforce this removal from their familiar surroundings to Old Persons Homes. These are the problems already recognised in the Geriatric Units of our general hospitals. The report of the Centre Organiser of the Women's Voluntary Service refers to the Clubs for the elderly and also to the Meals on Wheels service for invalids and single elderly persons who cannot cook for themselves. The cost of this midday meal was reduced by 3d. to 1/- during the summer and this reduction is regarded as permanent. Thirty to forty two-course meals are cooked at the W.V.S. Centre in Bromley Road, and are taken round in a Van. The round normally takes about two hours. The need for such a service is clear when one considers a detailed list set out later in the report under Housing Medical Applications. It seems unlikely that the waiting list for places in Homes will be appreciably reduced for years to come, so that services such as Chiropody, Meals on Wheels, Emergency Help Schemes, and visiting will need to be expanded, and more helpers for these services are urgently required. On the Mental Health side, changes in procedure in future will increase the need for community services and visiting, and diminish admissions to such hospitals as Cane Hill Hospital and Farnborough which serve this area. On the environmental health side, the expert is being increasingly called upon for advice in the examination of foodstuffs and in the 6 assessment of certain special housing defects such as " condensation " dampness and insulation against noise. Details are given later in the report by the Chief Public Health Inspector of examples of food privately purchased and containing a miscellany of objects. These have been reported collectively in detail for the first time, as the Public Health Committee are concerned at the increase in these complaints. The present self-service method of shopping requires greater care by the retailer in observing that food is not kept too long in stock by being overlooked by assistants when at the bottom of stacked food. Chocolate rolls and other wrapped food may under these conditions become mouldy underneath the paper coverings. The report also shews that the Committee consider each complaint on its merits. Trader, consumer and legislator are fairly consulted before prosecution is undertaken, but clearly it would appear that some cases have few extenuating circumstances. The Committee at their October meeting, heard an interesting report from Mr. H. E. Monk, County Analyst, and Public Analyst for Beckenham since April, 1946, on the work of analysing samples of food and drugs. He referred to the considerations which he felt should be taken into account before deciding to take prosecutions, the value of sampling foods for which there is no prescribed standard and the relationship between price and quality. He reported that six and a half million pounds per annum is spent onfood in Beckenham. Infectious Diseases Control In this section, a Table shews a decrease in cases of Poliomyelitis in persons under the age of 15 years over the past 8 years, but there is an increase in cases above this age over the same period. The increase is almost entirely in persons between 26 years and 45 years of age. In 1958, the number of persons given two injections of poliomyelitis vaccine, increased from 2,709 to 7,307. In addition a further 1,643 persons received a third injection in accordance with the extension of the scheme of vaccination against Poliomyelitis announced by the Ministry of Health, in Circular 20/58. The scheme was also extended to offer vaccination to all persons (over the age of 6 months) born since 1st January, 1933. It is not yet possible to include in this year's Report, accurate returns of this additional group of 15 to 26 years old persons many of whom have been immunised at Clinics near their place of work, some at evening Clinics near their homes and many by their own family doctors. There has been a decrease of 143 in the number of primary Smallpox vaccinations, and of 35 in the number of revaccinations. The greater decrease has occurred in Clinic vaccinations—94 as compared with a decrease of 49 in private vaccinations. It is possible 7 that the advent of Whooping Cough and Poliomyelitis immunisation in Clinics was largely responsible for this regrettable decrease in vaccinations. It is more than ever desirable to combine immunisations provided severe reactions are not likely to occur. At the time of writing this Report, the number of Smallpox vaccinations carried out seems to be returning rapidly to normal proportions. Medical Research in which the Burroughs Wellcome Laboratory situated in Beckenham is playing its part, is moving ahead to the cultivation of the virus responsible for Measles, and so to the next stage to the production of a vaccine and the necessary trials. Every two years in Beckenham, we experience a large epidemic increase, but 1958, an inter-epidemic year, shewed a decrease from 751 to 146 cases. The number of food poisoning cases serious enough for notification, were few. An investigation carried out by a working party of the Public Health Laboratory Service in which Beckenham, among several other authorities co-operated, found a high incidence of Salmonella organisms in many types of feeding stuffs and fertilisers. The authors concluded that the greatest danger from organic fertilisers is probably to those who handle them—Gardeners and Farmers. Salmonella organisms do not survive long when exposed to sun and rain. Scarlet Fever varies little in severity from year to year. Most enquiries concerning this disease are from retailers and laundry managements with regard to their staff who have been in contact with people who have this illness. In conclusion, I wish to thank Dr. Elliott, Dr. Lyon and other members of the County Staff for the helpful advice and co-operation which I have received. The Inspectors have tackled the problems which each year brings, and have eagerly sought opportunities to keep abreast of the times. I am grateful to them and to the Clerical Staff. I thank the Chairman and Members of the Health Committee for their continued support and for the enthusiasm and impartiality they have shewn on all occasions. L. R. L. EDWARDS, Medical Officer of Health. 8 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 occupies part of the extreme North-West corner of Kent. The contours fall in height from South to North, so that the district of West Wickham on the South side of the borough, averages 210 feet above sea level, whereas Beckenham proper, averages 150 feet above sea level. This is shewn by the Bench marks of West Wickham which are 238 feet for Links Road, 202 feet for The Avenue, and 190 feet for Ravenswood Crescent, to 111 feet opposite the Regal Cinema at the lower end of the main street to 135 feet opposite the Parish Church at the upper end of this street. The South to North direction is followed approximately by four streams—the Ravensbourne, the Beck, the Chaffinch Brook, and Pool River. These are culverted through the greater part of their course which is through beds of " Valley Gravel Half of the area geologically consists of " Blackheath Pebble Beds " and the remaining half of " London Clay The Ravensbourne forms part of the boundary between Bromley and Beckenham but otherwise is outside the borough. The Pool River is formed by the junction of the Boundary Brook and the Beck, the conjoined stream of which joins the Chaffinch Brook in Cator Park. The Pool River leaves the borough in the Worsley Bridge area. The Chaffinch Brook is formed from the South Norwood and St. James Tributaries in the South of the borough. The Climate is comparatively mild, and the annual rainfall is low. The average for 1958 was 29.745 inches. Beckenham is a coherent and well-ordered borough, 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. 180 acres of the rolling farmland and wooded areas to the South between Well Wood (43 acres) and the Croydon boundary were acquired under the Green Belt Act, 1938 and held on a 999 years lease to act as a permanent barrier to any further outward spread of Urban building. Much of the development of Beckenham has taken place since 1925, and to-day it includes the districts of Lower Sydenham, New Beckenham. Beckenham (proper), Elmers End, Shortlands, Park Langley, West Wickham and Coney Hall. It is primarily a residential borough of modern houses in the South half, with the well-ordered 9 conversion of many of the larger older houses into conmfortable selfcontained flats in buildings with wide frontages in well laid out treelined streets in the greater part of the North of the borough. There are thirteen 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 population has grown from 26,330 in 1901 to 74,834 in the 1951 Census (Estimated population in June 1958 was 75,380)—Male 34,102, Female 40,732. The Registrar General estimated the population of the West Wickham area in 1955 as 20,600. The water supply of Beckenham on the Western side of the boundary comes from the Thames through the Southern area of the Metropolitan Water Board. The remainder of the district is in the Kent area. West Wickham obtains most of its water from its own Well in Addington Road. The rest of Beckenham including Shortlands and Elmers End, is supplied from the Wells in Valley Road, Shortlands, which are 250 feet deep. Beckenham contains two well-defined Industrial Areas—one at Elmers End, and the other at Lower Sydenham. These factory premises provide employment for some 7,000 persons. The main light industries are concerned with the production of vaccines, and other biological products, precision electrical instruments (including instruments for remote control, vibration measurement, transmission of charts and pictures by wire, small electric motors (for vehicles, heating, ventilation, 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, telecommunication equipment. There is a total of approximately 700 shops which are largely situated along four main roads in the borough. 10 SUMMARY OF VITAL STATISTICS, 1958 Area of District in acres 5,935 Estimated mid-year population 75,380 Population Density—persons per acre 12.70 Rateable Value at 1st April, 1959 £1,466,340 Number of Inhabited Dwellings 23,929 Product of a Penny Rate (Estimated 1959/60) £5,969 Male Female Live Births 501 452 Total 953 Live Birth rate per 1,000 population 12.64 Male Female Still-births 7 14 Total 21 Still-births rate per 1,000 live and still-births 21.56 Total live and still-births 974 Infant deaths 14 Infant mortality rate per 1,000 live births. Total 14.69 Infant mortality rate per 1,000 live births (legitimate) 12.95 Infant mortality rate per 1,000 live births (illegitimate) 76.90 Neonatal mortality rate per 1,000 live births (First four weeks—(10).) 10.49 Illegitimate live births per cent of total live bitths 2.73 Maternal deaths (including abortion) 1 Maternal mortality rate per 1,000 live and still-births 0.10 Death Rate per 1,000 population from Cancer (177 deaths) 2.36 Death Rate per 1,000 population from Pulmonary Tuberculosis (1 death) 0.01 Death Rate per 1,000 population from Non-Pulmonary Tuberculosis (no deaths) 0.00 Death Rate per 1,000 population from Accidents (33 deaths) 0.43 Birth Rate (including Stillbirths) per 1,000 population: Crude 12.92 Corrected (X 1.06) 13.70 Male Female All Deaths Registered 456 512 Total .. 968 Death Rate per 1,000 population: Crude 12.84 Corrected (X 0.92) 11.81 Natural Decrease: Deaths exceeded births by 15. 11 12 VITAL STATISTICS FOR YEARS 1949 to 1958 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 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 1958 75,380 927 26 953 12.64 21 — 21 12 2 14 14.69 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 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 1958 968 12.84 — 1 0.01 177 2.36 TOTAL DEATHS, 1958 (Registrar-General's Official Returns). All causes—968. Male, 456 ; Female, 512. CAUSES OF DEATH MALES FEMALES 1. Tuberculosis, respiratory 1 — 2. Tuberculosis, other — — 3. Syphilitic disease — — 4. Diphtheria — — 5. Whooping Cough — — 6. Meningococcal infections — — 7. Acute poliomyelitis — — 8. Measles — — 9. Other infective and parasitic diseases 1 — 10. Malignant neoplasm, stomach 14 7 11. Malignant neoplasm, lung, bronchus 41 6 12. Malignant neoplasm, breast — 13 13. Malignant neoplasm, uterus — 6 14. Other malignant and lymphatic neoplasms 38 52 15. Leukaemia, aleukaemia 6 1 16. Diabetes 2 3 17. Vascular lesions of nervous system 40 78 18. Coronary disease, angina 111 73 19. Hypertension with heart disease 10 16 20. Other heart disease 41 91 21. Other circulatory disease 24 38 22. Influenza 4 2 23. Pneumonia 24 36 24. Bronchitis 25 19 25. Other diseases of respiratory system 5 2 26. Ulcer of stomach and duodenum 11 4 27. Gastritis, enteritis and diarrhoea 2 6 28. Nephritis and nephrosis — 2 29. Hyperplasia of prostate 6 — 30. Pregnancy, childbirth, abortion — 1 31. Congenital malformations 1 3 32. Other defined and ill-defined diseases 28 33 33. Motor vehicle accidents 6 3 34. All other accidents 12 12 35. Suicide 3 5 36. Homicide and operations of war — — Totals 456 512 13 CANCER DEATHS 1954 1955 1956 1957 1958 Cancer of Lung 42 34 30 29 47 Males 163 Females 19 Total 182 Cancer of Breast 22 12 23 26 13 96 Cancer of Uterus 4 6 6 8 6 30 Cancer of Stomach 16 18 17 23 21 Males 56 Females 39 Total 95 Other Malignant Neoplasms 100 82 76 83 90 Males 209 Females 222 Total 431 Total Deaths from Cancer 184 152 152 169 177 Males 428 Females 306 Total 734 For comparison, deaths from Respiratory Tuberculosis are shown:— 1954 1955 1956 1957 1958 8 6 2 3 1 Males 18 Females 2 Total 20 1 J 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 27 15 42 — 1 I 4 2 11 10 5 5 3 — 7 8 2 2 5 5 4 9 Non-Pulmonary — 2 2 — — — — 2 — — — — — — 1 1 — — — — — — Totals 27 17 44 — 1 1 4 4 11 10 5 5 3 — 8 9 2 2 5 5 4 9 Deaths Pulmonary 6 — 6 — — — — — — — — — 6 — — — 1 1 1 0 1 2 Non-Pulmonary — — — — — — — — — — — — — — — — — — — — — — Totals 6 — 6 — — — — — — — — — 6 — — — 1 1 1 0 1 2 *L.Pk. and K.H.—Lawrie Park and Kent House. M.H.—Manor House. C.C.—Copers Cope. C.H.—Clock House. E.P.—Eden Park. W.W. (North)—West Wickham North. W.W. (South)—West Wickham (South). 16 INFANTILE MORTALITY, 1958 The number of deaths of infants under the age of twelve months was 11, as compared with 14 in 1957. The Registrar-General returns 14 infants deaths, and the Infant Mortality Rate for the year was 14.69 per 1,000 live births. The following Table shows the cause of death in 11 cases for which full records exist. Table of Infantile Mortality Under one day Over one day Total under one week AGE IN WEEKS 1 1 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 — — — — — — — — 1 — — — 1 Lungs — — — — — — — — — — — — — Spine — — — — — — — 1 — — — — 1 Other — — — — — — — — — — — — — B. Ante-Natal or Intranatal — — — — — — — — — — — — — Immaturity and Prematurity 2 1 3 — — — — — — — — 2 1 Erythroblastosis (Rhesus incompatibility) 2 — 2 — — — — — — — — 1 1 Cerebral Haemorrhage — 1 1 — — — — — — — — 1 — C. Infections : Pneumonia and Bronchitis — — — — — — — — 1 — — — 1 Gastro-enteritis — — — — — — — 1 — — — 1 — d. Accidental and Violence (including Asphyxia due to button in throat) — 1 1 — — — — — — — — — 1 Totals 4 3 7 — — — — 2 2 — — 5 6 17 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 in Borough. Durham House, 50, Durham Avenue, Shortlands (K.C.C.). Thornton House, 75, Bromley Road, Beckenham (Voluntary). Rutland Lodge, 6, Mays Hill Road, Shortlands (Private). Rest Haven, 99, Venner Road, Sydenham, S.E.26 (Private). " Craigie Vane 3, Durham Rd., Shortlands. (Private). 24, Cromwell Road, Beckenham. (Private). 18 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 aforesaid County Health Services. 3. Private and Voluntary Services. Private Nursing Homes. (1) " Petersfield Lodge," 69, Crystal Palace Park Road, S.E.26 (2) " Inglewood," 25, Durham Avenue, Bromley, Kent. (3) " Sloane," 131, Albemarle Road, Beckenham, Kent. (4) " Lynton House," 14, Bromley Grove, Shortlands, Kent. (5) " Waverley," 51, Albemarle Road, Beckenham, Kent. 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. 19 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—3.0 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 (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 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 Down, West Wickham Vaccination (by appointment only); Poliomyelitis, 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 Relaxation Exercises Friday mornings, 10.30 a.m. Clinic Block, Town Hall, Beckenham Thursday afternoons, 2 p.m. Clinic Block, Hawes Lane, West Wickham 20 REPORT OF THE DISTRICT OFFICER The District Officer, Mr. Moore, has submitted the following report, for which I express my thanks:— "There have been no spectacular developments in the work of the District Office during the year under review, but there is still a growing demand for the services provided. A pleasing exception to this statement is the steady decline over the past few years in the number of tubercular patients assisted under the County Council's care and after care scheme. My figures for 1958 are only a little more than half those for 1955. On the other hand, the number of applications for admission to Homes for Old People showed a particularly marked increase over the previous year, and while each year more places are provided, and the number of admissions increases, it is not possible yet to balance supply and demand. A system of priorities is therefore operated to ensure that as far as is possible the vacancies are allocated to those whose need is most urgent." REPORT OF THE HOME HELP ORGANISER 1 have received the following information from Miss Hocking, Home Help Organiser for this area, to whom I express my appreciation. 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. 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. 4 cases were assisted in the year. 21 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. D. G. Madigan, Chest Physician, to whom I express my thanks :— " Out of a total of 197 new contacts examined, two were found to be positive, one an adult, and one a child. 79 contacts were given B.C.G. Vaccination at the Chest Clinic which is well up to the yearly average, and in addition, there are those thirteen year old School children who were vaccinated by the School Medical Officers. There is thus a fair proportion of the younger population who have had this form of protection, particularly amongst those who are more exposed to infection by the tubercle bacillus. Chemotherapy still remains the dominant factor in the successful treatment of Tuberculosis. Comparatively few infectious cases remain persistently sputum positive after a course of such treatment. Besides being a matter of considerable benefit to each individual concerned, it also lessens the risks of infection to others. We can thus hope with some confidence, that the means available to us in both the field of treatment and prevention, will result in an ever decreasing incidence of the disease." New Cases attending the Chest Clinics for the first time during 1958. Adults Children under 15 years Male Female Male Female Pulmonary Tuberculosis 22 19 1 — Non-Pulmonary Tuberculosis — 2 — — Non-Tuberculous 72 47 10 10 Non-Tuberculous Tuberculous New Contacts Examined 195 2 B.C.G. Vaccination of contacts : 79. Number of Patients admitted to Hospital or Sanatorium during the year : 33. 22 BECKENHAM DISTRICT TUBERCULOSIS CARE COMMITTEE The following report has been submitted by Mr. M. E. Forster, Hon. Secretary of the above Committee, to whom I express my thanks. " 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 has still been found, as last year, that more help was required by patients whilst they were at home, as they did not spend so much time in Hospitals or Sanitoria, 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 have authority 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. Two families were sent away during the summer to approved Holiday Homes for recuperation . Three families were helped with fares to visit patients in Sanitoria. One family was helped with house repairs. One patient's outstanding debt was paid. Four patients were granted free meat for periods ranging from 4 weeks to 12 weeks. Two patients were assisted with clothing and two with shoes. One patient had his Car Tax paid and an Oil Heater was purchased for another. Three patients were helped with coal or coke. One patient was provided with lino and another a mattress A car was hired to take one patient for an outing ; also four patients received emergency help. In addition, the Committee have three Radio Sets which they loan to patients, and at Christmas time some 38 patients received a Christmas Card and Gift. The Committee spent over £320 and to help offset this the usual sale of ½d. Christmas Seals was organised ; also a Jumble Sale was held." 23 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 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. 24 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.) Health Visitor Service (K.C.C.) 25 WOMEN'S VOLUNTARY SERVICE I have received the following report on the work of the W.V.S. over the past year, from Mrs. J. M. Fisher, Centre Organizer, to whom 1 express my thanks. Derby and Joan Clubs In Beckenham, there are three Darby and Joan Clubs and two Over 60's Clubs in West Wickham. Of the Beckenham Clubs, two are held on Tuesday and one on Thursday from 1.45 to 4.15 p.m. All the members of the three Beckenham Clubs are over 60 years of age, and the total membership is approximately 500. The fee for membership is only Id., and a charge of 3d. is made for tea supplied. Each week, Whist Drives, Dart Matches and Raffles are held and at least two of the Clubs have talented choirs which entertain generally. For those interested, a free library is available and plenty of magazines are supplied. Outings are arranged for Club members about twice a year, and during the winter, visits are made to Pantomimes, etc., Holidays are arranged at reduced rates during the ' out of season ' period of the year. In addition, a Savings Group is run for members who wish to save weekly towards holidays, outings, etc. The two Over 60's Clubs in West Wickham, have an average membership of 130-150, and all Clubs are subsidised by voluntary subscriptions. Meals on Wheels These meals are served on Tuesdays and Fridays, and this service is run principally for the benefit of invalids and the elderly people who, for some reason, cannot cook for themselves, and live alone. All meals are cooked in the Centre by members of the W.V.S. Appeals for such meals usually come from Hospital Almoners, Doctors, and through the Darby and Joan Clubs. The cost of meals is subsidised by voluntary funds and an allowance towards cost of transport made through the Local and County Authorities. Those in need-are tequired only to pay a very small sum for this service. About 40 meals aer at present served twice a week. West Wickham Luncheon Club Meals for this Club are cooked by W.V.S. and only a nominal charge is made. On an average, 35 meals are served weekly, in addition to the Meals on Wheels, an average of 16 served twice a week. Old People's Welfare Visits are made to elderly people who live alone and where necessary, assistance is given with clothing supplied free on the authority of the National Assistance Board, District Nurses, etc. 26 Hospital Work The West Wickham W.V.S. now run a Canteen at the Cheyne Hospital for Children. Help continues to be given to Beckenham Hospital and consists of assistance with the Library, flowers and magazines. Baby Clinics Helpers are supplied at three of the baby clinics in the Borough who assist with the selling of Welfare Foods, Weighing and Clerical Work. S.S.A.F.A. The W.V.S. continue to run the local branch of S.S.A.F.A. and £348 has passed through its hands during the year. In addition to giving financial assistance, clothing has been given and advice on many matters. Clothing Depot This Depot is run for the benefit of old, sick and needy people in the Borough who are referred to us by the National Assistance Board, Doctor or Health Visitor. Mothers are helped with baby clothes, and The Children's Clothing Exchange is still run every Wednesday. Welfare Foods The Centre dispenses National Dried Milk, Orange Juice, Cod Liver Oil and Vitamin Tablets. Periodicals for the Forces Books and magazines continue to be sent out each month to members of the Forces in the Middle and Far East. Only a small grant is received from the County Office towards postage, and the remainder has to be found by the Centre, usually from any moneys we obtain from the sale of salvage. Services C lub A W.V.S. member attends the Victory Club each Friday, where she works in the library. Canning The West Wickham Centre continue to can quantities of fruit which are given to the Maternity Hospital. Other Activities In addition to all aforementioned activities, the W.V.S. is closely connected with the Tuberculosis Care Committee, Area Pension Officer, British Legion, the Disabled Persons' Committee and Children's Homes. Holidays During the year, holidays have been arranged for three children, °ne mother and one old couple. More such help could have been given if funds had permitted. Parents pay what they can towards such holidays and the W.V.S. has to find the rest. 27 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. 28 HOUSING—MEDICAL APPLICATIONS From January 10th to December 16th, 1958, 70 applications with medical certificates were received representing an increase of five. In 14 applications, no additional medical points were recommended. There were 18 re-applications, and in 4 of these, further additional medical points were recommended. Fifteen applications were awarded maximum points of which 11 applications were for Ground Floor flat accommodation. The medical causes are classified in the following groups. The major causes alone are considered. In one instance the reason advanced was that the house was " haunted " ; investigations were carried out and points were awarded for other reasons. Tuberculosis, Pulmonary and Non-Pulmonary 6 Chest Diseases 5 Rheumatism, Arthritis, Arthropathy Angina or Cardiac Weakness 2 Cerebral Thrombosis, Hypertension 4 Coronary Thrombosis Psychosis or Psychoneurosis 22 Psychosis 3 Psychoneurosis 19 Epilepsy 5 Children, Illness or Overcrowding 9 Abdominal Operations or Disease 8 Endocrine disorder including Thyroid disease 3 Metabolic disorder including Diabetes 1 Blindness 1 Miscellaneous 3 A Table below shews a comparison over four years for the main causes. In chronic diseases such as Tuberculosis, Chest diseases and Arthritis, there is clearly little change from year to year. There is a significant increase under anxiety state, or mental illness, and a decrease under children's diseases. Certificates are now put forward more on the condition of the mother than of the illnesses of the children. Tuberculosis Chest Diseases Rheumatism and Arthritis Angina or Cardiac Weakness Coronary Thrombosis Anxiety State or Mental Illness Children, Illness or Overcrowding 1955 1956 1957 1958 6 10 8 6 10 12 3 5 9 12 11 7 5 2 2 2 2 3 11 15 11 13 22 3 15 22 9 The number of re-applications is 25.7% of the total applications, compared with 26% in the previous year. As a matter of interest, records of medical applications received from old persons over the age of 60 years, from September, 1955 to 29 September, 1958 were reviewed. These are set out in a Table which shews the type of medical problems encountered, and the number recommended for Ground Floor Flat accommodation. Applicant Age Recommendation Other Medical Conditions Female 81 Ground Floor Flat Widow 81, Sister 79 years. Female 62 15 points Rheumatoid Arthritis (has Ground Floor Flat). Male 70 10 points Husband Gastric Ulcer. Wife 67 years—Meniere's disease. Female 69 10 points Rheumatism. Sister artificial leg. Female 64 Ground Floor Flat (Urgent) Brother—Colostomy. 25 steps to W.C. Female 67 Ground Floor Flat Resident domestic. Arthritis and Senility. Female 73 10 points Arthritis. Occupies Ground Floor Flat. Female 73 Ground Floor Flat Senility, Arthritis, Varicose veins. Female 66 Ground Floor Flat Top Flat. Rheumatism ankles. Cardiac debility. Male 86 Ground Floor Flat Male Bronchopneumonia. Female 77. Coronary Thrombosis. Upper Flat. Male Over 70 Ground Floor Flat Cardiac weakness. 24 steps to street. Male 71 Ground Floor Flat Female 72. Both have high blood pressure. Female 66 Ground Floor Flat Widow. Coronary Thrombosis leaving heart failure. Male 65 15 points Wife 60. Nervous debility. Male 70 Ground Floor Flat Wife confined to bed (OAP) Arthritis. Female Over 60 Ground Floor Flat Widow. Hypertension. Hysterectomy. Male 74 Ground Floor Flat Husband, Angina and Varicose Veins. Wife, Arthritis in Knees. Female 61 15 points Bronchitis. Nervous Debility. Female 78 Ground Floor Flat Debility. Female 66 Ground Floor Flat Living on own. Chronic Bronchitis. Male 68 15 points Wife 66 years. Anaemia—living with son-in-law who is buying house. Female 65 Ground Floor Flat Coronary Thrombosis. Living on First Floor—under notice to leave —relatives. Female 66 Ground Floor Flat Police Widow in six-roomed large house. Arthritic Hip. Female 72 Ground Floor Flat Daughter 56. Mother and daughter in top flat. Mental strain. Male 62 Ground Floor Flat Wife 61. Hysterectomy. Arthritis Hip and Knees. Coronary Thrombosis. Male 84 Ground Floor Flat Wife 77. Old Age and failing health. One bedroom on First Floor. Female 72 Ground Floor Flat Widow. Arthritis. First Floor Room Female 73 Remains Ground Floor Flat Senility, Arthritis, Varicose Veins. Male 68 15 points Bronchitis. Male 62 15 points Nervous debility—shares Attic witn daughter. 30 Applicant Age Recommendation Other Medical Conditions Male 65 10 points .. Resident Caretaker retired Bronchitis Female 77 Ground Floor Flat Retired personal maid—Acromegaly. Female 67 15 points Arthritis. First Floor Bedroom. Male 65 15 points Bronchitis. Wife over 60 years. Female 78 Ground Floor Flat Nervous debility. Female Over 60 Ground Floor Flat Widow myocardial weakness. Female 65 10 points Nervous Strain. Female 73 Ground Floor Flat 20 points Already Ground Floor Flat, but friction with landlady. Male 68 Ground Floor Flat Wife over 60 years. Cardiac weakness. Husband, Angina. Female 65 Ground Floor Flat Angina. Male 66 15 points Wife has Arthritis. Male 61 15 points Bronchitis and Neurosis. Female Over 60 Ground Floor Flat Arthritis in back. Asthma. Colostomy. 4 flights of stairs. Female 78 20 points Diabetes. Heart failure. Female 81 Ground Floor Flat Cardiac weakness after cerebral stroke. Female Over 60 15 points Bronchitis. Male 70 Ground Floor Flat Wife 68 years. Fractured femur. Husband, Colostomy—16 stairs to W.C. Female 72 Ground Floor Flat Widow—Arthritis knees. Male 60 Ground Floor Flat Housekeeper to old couple. Gastritis. Female 72 Ground Floor Flat Nervous debility. Female 68 Ground Floor Flat Coronary Thrombosis. Female 64 Ground Floor Flat On Blind Person's Register. Water supply on 2nd floor. 31 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. REPORT ON THE WORK OF THE PUBLIC HEALTH INSPECTORS FOR THE YEAR 1958 One vacancy existed in the Inspectorial staff at the commencement of the year, which was filled in March, 1958, by the appointment of Mr. H. J. Rogers, and for the remainder of the year, we had the benefit of a full establishment. Since 1952 there has not been a complete calendar year with a full establishment of Inspectors. The full continuity of inspection routine has thus been affected. SECTIONS C, D, E. Statistical information relating to the work of the Inspectors js appended :— Housing—Inspection of Dwelling Houses during the Year. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,567 Number of inspections made for the purpose 2,809 Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 89 Number of inspections made for the purpose 89 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 276 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 276 Number of dwelling-houses in which defects were remedied after service of informal notices 251 Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 25 Number of dwelling-houses in which defects were remedied after service of formal notices : (a) by owners 25 (6) by Local Authority in default of owners 0 Number of complaints received 1,228 Number of initial visits 5,440 Number of re-visits 1,954 Total visits and re-visits 7,394 Nuisances Remedied Structural Defects of properties—External 115 Internal 196 Insanitary conditions other than vermin 42 Verminous conditions 11 271 Choked drains Other drainage defects 177 Defective sanitary appliances 20 Insufficient or unsuitable water supply 2 Absence of dustbin accommodation 7 Offensive accumulations 8 32 Food and Drugs Sampling 264 samples of food and drugs were submitted to the Public Analyst during the year. 54 were taken formally, the remainder informally. The latter method entails the purchase of food or drug as an ordinary buyer, the vendor being unaware that the product is to be submitted to analytical examination. The disadvantage of informal procedure is that legal action cannot be taken against the vendor should any adulteration of the articles sampled be found. On the other hand, the method is economical in time and money, and formal samples of any adulterated product are immediately obtained. It is our practice to confine our formal sampling to foods manufactured or produced from day to day (milk and sausages are two examples). A list of samples taken is appended. article formal informal Almonds (Ground) 6 2 Aspirin — 2 Beans in Tomato Sauce — 1 Beef Steak with Gravy — 2 Biscuits — 1 Blackcurrant Flavour — 1 Blackcurrant Syrup — 2 Butter — 1 Cabbage (Pickled) — 1 Cake Mix — 1 Capers in Malt Vinegar — 1 Cashews (Ground) — 1 Cheese (Processed Cheddar) — 1 Cheese Spread — 5 Cheese and Tomato (Processed) — 1 Chicken (Chopped) — 2 Chicken in Jelly (Minced) — 2 Chickelettes — 1 Chocolate (American Buttered) — 1 Christmas Pudding — 2 Cinnamon (Ground) — 1 Coffee and Chicory Essence — 1 Crab (Dressed) — 4 Cremola Foam Crystals — 1 Cream — 6 Cream Rice Pudding — 1 Cream Butter — 1 Curry Powder — 2 Custard Powder — 1 Essence of Rennet — 1 Dairy Ice Cream — 1 Doughnut (Fresh Dairy Cream) — — Evaporated Milk — 1 Figs in Heavy Syrup — 1 Fish Cake — 3 Flour (Plain) — 2 Flour (Self Raising) — 2 Ginger (Ground) — 6 Golden Cake Covering — 1 Hamburger Steaks — 1 33 ARTICLE formal INFORMAL Herrings in Tomato Sauce — 1 Honey (Jamaican) — 1 Honey (Pure) — 1 Ice Cream — 12 Jam — 7 Jelly Powder — 1 Jelly (Table) — 5 Lard — 2 Lemon Curd — 2 Lemon Squash — 1 Lemonade Crystals — 1 Lemonade Powder — 1 Luncheon Meat — 1 Margarine — 2 Marmalade — 1 Marzipan (Pure Almond) — 2 Meat Pie — 1 Meat Pudding — 1 Milk (Pasteurised) 40 1 Milk (T.T.) 4 1 Milk Pudding — 1 Milk Shake Powder — 1 Mint Sauce — 2 Mussels (Danish) — 1 Nutmeg (Ground) — 2 Nut Oil (Ground) — 1 Olive Oil — 1 Orange Crush — 1 Orange Drink — 6 Orange Juice — 2 Orange Marmalade — 1 Orange Spread — 1 Orange Squash — 4 Pancake Mixture — 1 Paste (Anchovy) — 1 Peas — 3 Pepper (Ground) — 3 Piccalilli Pickle — 1 Pilchards in Tomato Sauce . — 3 Pork and Beef Luncheon Meat — 1 Pork (Jellied) — 1 Pork Luncheon Meat 1 6 Pork (Rolled and Stuffed) — 1 Rice (Ground) — 3 Sago Milk Pudding — 1 Salmon — 2 Salmon Spread — 2 Salmon Potted with Butter — 1 Sardines in Pure Olive Oil — I Sauce (Dinki Chopped) — 1 Sauce (Fruit) — 1 Sausages(Pork) 3 — Soda Water — 1 Spaghetti in Tomato Sauce — 1 Sponge Mixture — 2 Steak (Casserole) — 2 Stewed Steak — 3 Strawberries in Syrup — 1 Syrup of Figs — 1 34 article formal informal Tartare Sauce — 1 Tomato Ketchup — 2 Tomato Sauce — 1 Tomato Soup — 2 Vinegar — 1 Whisky — 7 In 1958, there were no instances of adulteration discovered, but in 20 cases (or 7.5% of the total samples submitted) the Public Analyst expressed dissatisfaction with the consistency of the food in relation to its description by the Vendor or Manufacturer. Details are appended :— article sampled Creamed Rice Milk Pudding. (Seven samples of different manufacture). Beef steak with Gravy. (Australian). Chopped Chicken. (Three samples of different manufacture). Pork Luncheon Meat (Five samples of different manufacture). Pilchards in Tomato Sauce. Whole Orange Drink Cheese Spread Blackcurrant Syrup. analyst's report Excessive water content . . Description " creamed " and listed ingredient " full cream milk" not justified. 62% meat content considered unreasonably low. 83% chicken. Should be described as chopped chicken with gravy. Low meat content Consistency of Tomato sauce considered inferior. Slightly deficient in fruit content. Claim " made from a cream cheese base " not justified Insufficient fruit content .. action taken Manufacturers improved consistency to comply with label. Subsequent samples satisfactory. Subsequently found to comply with Australian standard. No Action. Matter receiving attention of Food Standards Committee of Ministry of Food. In the absence of a standard, no formal action possible. Information submitted (with results from other areas) to the Min. of Food by the Asscn. of Public Analysts with a view to obtaining statutory standard. No formal action possible, but Vendors withdrew article from sale. Due to faulty mixing of concentrate. Further sample satisfactory. Manufacturers agree to alter label description. Correspondence with Manufacturer's Analysts still proceeding. Food privately purchased, and alleged by the purchaser to be unsound Numerous instances of alleged unsound food are brought to our notice by complainants. Whenever the circumstances warrant, the matter is referred to the Public Health Committee for decision on the action to be taken. 35 Chocolate rolls were found to be mouldy. It appeared that due care had not been exercised by the Vendor. Legal proceedings resulted a fine of £20 being imposed, the Defendants pleading guilty. A Banbury Tart was found to contain a nail. There was no evidence of wilful negligence on the part of the Manufacturer, and the bakery premises were well conducted. The Council having heard all the facts, concluded that a warning letter should be sent to the Manufacturer. A bottle of soda water, partly consumed, was alleged to have caused illness. The Public Analyst reported that the soda water was of normal taste, and composition, and the complainant was so informed. A complainant alleged that a bottle of milk delivered to her had been tampered with before delivery, and that cream had been removed. There was no visual evidence to support this contention, but in view of the fact that the complainant alleged this to be a frequent happening, the bottle of milk produced was submitted to analysis. It was found to be perfectly genuine. The complainant was so informed. A bottle of " School" milk was alleged to have been delivered containing the husk of a sweet chestnut. Having considered all the facts, the Council decided to take no action. It was alleged that a used metal cap of a milk bottle was found in a bottle of milk. The known facts did not warrant official action. Sausages were found to be fly-blown, but the available evidence did not warrant official action against the Vendor. Cod-fish was alleged to be ' wormy It was in fact, very slightly affected with a parasite—Filaria bicolar. The worm is not harmful to man, but when severely affected the fish is condemned. There was no evidence whatsoever that the Vendor shewed negligence here, or that he could have known this parasitic infestation was present when the fish was sold. Sausages were purchased, and later the customer complained of the presence of a squashed insect on the exterior of one of the sausages. There was no evidence at all to warrant official action against the Vendor. A fruit loaf was found to contain a piece of sacking—later identified as being part of a flour bag. The complainant stated that he was satisfied with the explanation offered by the Baker, and did not wish for further official action. A carton of Jellied Eels was alleged to have caused food poisoning, but this was disproved by bacteriological examination of the unconsumed contents of the carton. A partly consumed jar of marmalade was produced and found to contain a piece of wire and other foreign bodies. It was impossible to prove where such contamination took place, although the 36 facturers accepted full responsibility. The customer later expressed satisfaction with her negotiations with the firm concerned. A worm, later identified as an immature earthworm, was alleged to have been in a full bottle of milk delivered to a consumer. Investigation shewed the worm to be alive two days after the milk was bottled. It is known that the worm could not remain alive longer than 24 hours in the bottle of milk, and therefore, the contamination could not have arisen in the dairy. The complainant was informed that no further official action was called for. Two cases of alleged dirty milk in full bottles, were brought to our notice. The milk was decanted and the consumer was satisfied that the dirt was on the outside of the bottle. Glass was alleged to have been found in milk, but the consumer had destroyed any useful evidence which might have been used. No official action was possible. Mouldy bread was admitted to be over three days old when brought to our notice. No official action possible, although the Vendor reimbursed the consumer. Fruit Malt Loaf was found to contain a piece of insulating tape. The Council prosecuted the Vendor, who, pleading guilty, was fined £10. It was alleged that mouse droppings were found in a loaf. The contamination was found to be due to machinery grease (a minute quantity). A further case of alleged mouse droppings in bread proved, on analytical examination, to be pieces of charred dough. There was every reason for the complaint, for the ' contamination although definitely not rodent excrement, was of similar shape, size and appearance. Bread found to contain adhesive tape was reported to the Council, The manufacturers explanation was accepted and no further action was taken. Mouldy wrapped bread was produced by a consumer. The facts were considered by the Council, who decided to send a warning letter to the manufacturers. Packet Junket was alleged, when made up, to have a fermented taste, and to be unwholesome. This was not confirmed by practical experiment, or by bacteriological and analytical examination. The complainant was informed that no official action was called for. Food vendors frequently seek official aid in decisions regarding the soundness or otherwise of food for human consumption. During 1958, some 15 cwts of food was thus condemned and destroyed as unfit for human consumption. In no case did circumstances justify the official seizure of unsound food exposed or deposited for the purpose of sale. 37 Food Hygiene Regulations 1955 Endeavour has been made to maintain regular visits to food premises. The additional hygienic requirements of the above Regulations have been reasonably enforced and the vast majority of food vendors have co-operated very willingly with us. It was not necessary to institute legal proceedings for contraventions of the Regulations during the year under review. Ice Cream Thirteen samples of Ice Cream were submitted to chemical analysis during 1958 and all were found to comply with the statutory standard for this product. Thirty-six samples were submitted to bacteriological examination, as a result of which the samples are graded into four degrees of bacterial cleanliness. The results were as follows :— Grade I Grade II Grade III Grade IV 26 8 Nil 2 Samples falling into Grades III and IV are regarded as unsatisfactory, indicating some bacterial contamination either in the manufacture or the retail serving of the product. Two of our samples fell into Grade IV and although in neither case was there evidence of contamination by pathogenic organisms, immediate checks were made on the manufacturing plant through the co-operation of the Authority in whose area the manufacture took place, and in the Beckenham retail shop. The offending stocks were withdrawn immediately from sale, and replacement supplies proved on examination, to be entirely satisfactory. Rent Act, 1957 The details of the administration of this Act, and the difficulties met were referred to in full in the 1957 Annual Report. Fifty applications for Certificates of Disrepair were received during 1958, bringing the total applications to 118 since the Act came into operation in June, 1957. Thirty undertakings to complete the required works were received from owners. In the remaining 20 cases, Certificates were issued, five of which were cancelled subsequent to the completion of the required works. It appears that about 30 per cent of owners prefer to forego the rent increase rather than complete the repairs which, under the Act, the tenant may demand. Factories Act, 1957 Two hundred and eight-seven visits of inspection were made to factories in the area, and the following nuisances were remedied following the service of Intimation Notices :— Want of Cleanliness 2 Insufficient sanitary accommodation 2 Unsuitable or defective sanitary conveniences 10 38 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 for the steam disinfection of bedding, etc., other than for notifiable illness, are met but a charge is made for the service. During 1958, 23 applications were received and accounts rendered for £23 16s. During the year, 463 Library books were collected from homes and hospitals where infectious disease had occurred, disinfected and returned to the Library of origin. 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 1958, 151 bodies were brought to the Mortuary where post-mortem examinations were conducted by a Home Office Pathologist. Thirty-seven Inquests were held in the Town Hall. Movable Dwellings Fifteen families occupied movable dwellings under licence from the Council during 1958. Twenty-one inspections of the sites of the caravans were made, and in no instance was a Public Health nuisance discovered. 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, 271 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 271 cases discovered, however, 180 related to private drainage, and in these cases a charge is made for the work undertaken. Accounts were rendered for £130 18s. for this work. The Smoke Testing of the house drains of 14 properties was undertaken, and Accounts were rendered for £29 8s. Infestation by Rats and Mice Five hundred and sixty-two complaints were received in 1958 of which 57 related to business premises. A charge is made for the 39 service provided in respect of business premises, whereas private residential property is served free of charge. During the year, Accounts for £113 13s. 9d. were rendered in respect of business premises. Baiting of certain sections of the main sewers of the Town has continued during the year. The indications mentioned in the Annual Report of 1957 that permanent disinfestation is being achieved even in heavily infested sections of sewers, have been maintained. 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 halfholiday 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 1958, 1,169 visits were made to shops in the Borough. 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 1958, it was necessary to take action under this Section on one occasion only. 10 SECTION F. INFECTIOUS DISEASES CONTROL For the first time on record there were no notifications of nonparalytic Poliomyelitis, and the number of paralytic cases which was only 4, is the third lowest figure of paralytic Poliomyelitis since 1943 when one case was recorded. It may be of interest to compare the incidence to-day of other diseases with their incidence in 1943. In this particular year there were 261 cases of Scarlet Fever; in 1958 the number was 64 ; Erysipelas was 18 compared with last year's figure of 5 ; Puerperal Pyrexia 30, compared with 2 ; Whooping Cough notifications in 1943 were 39 ; last year the number was 108. The increase in Whooping Cough dates from the period 1948-50. In 1943 Food Poisoning was not a notifiable disease but Dysentery was. There were 2 cases of Dysentery compared with 4 cases in 1958, and 5 cases in 1957. The highest figures for Dysentery were in 1953 and 1954 when there were 21 and 48 cases respectively. In 1943 there were 60 notifications of Pneumonia, compared with 35 cases in 1958, and 292 cases of Measles compared with 146 this year. Clearly there has been a long-term reduction in the respiratory diseases with the exception of Whooping Cough and even here, there has been a decrease from 235 in 1956 to 153 in 1957 and 108 in 1958. The epidemic increase of Measles in 1951 and 1953 to over 1,000 was reduced in 1957 to 751. With regard to Poliomyelitis and Whooping Cough, it is to be hoped that this improvement represents the turn of the tide and that in both diseases immunisation procedures are now assisting natural processes. Table (1) shews that some cases of Measles and Whooping Cough occurred in adults ; .though the majority were notified in the 5-15 years and 0-4 years groups respectively. Scarlet Fever cases were chiefly confined to the 5-14 years group. In the course of investigations, various specimens were sent to the Southern Group Laboratory, Hither Green Hospital, and to the Central Public Health Laboratory, Hither Green Hospital, and to the Central Public Health Laboratory, Colindale Avenue, N.W.9. These were for the following examinations :— faeces examination for pathogenic organisms including examination for Bact coli Sero types Result New admissions to St. Hilda's Nursery 69 2 Positive Bact coli Type 0127 1 Positive Bact coli Type 026 Investigation by Medical Practitioners 19 Negative. 41 Throat swab for pathogenic organisms including diphtheria and haemolytic streptococci 3 Negative. Scab Smears Smallpox Complement Fixation Test Negative for variola-vaccinia group. Egg Culture Negative for variola-vaccinia group. In the above group are seen several cases of Bact coli infection. These were found in an outbreak of Enteritis in a Nursery. The positive cases were admitted to Farnborough Hospital. One baby of 3 months died after admission to hospital. In the Nursery, one baby of two months found to have Type 026 was cleared, only to be reinfected with Type 0127. Two twin sisters negative on admission, apparently became infected 9 days later. Full investigation revealed no obvious link between the cases ; the whole episode dragged out for a month, and in February ended as abruptly as it commenced following the excellent work of the medical staff in arranging investigation, isolation and treatment. Helpful advice was received from the Epidemiological Section of the Ministry of Health. The examination of scab smears was carried out on an Indian of 32 years, recently returned from abroad with an illness that was clinically diagnosed as confluent chickenpox. Two other children shewed signs of a milder attack. No particular food was incriminated in the investigations of Food Poisoning outbreaks. The organism was identified as Salmonella Typhi-Murium in one family outbreak affecting a mother and two children, and again in two other unrelated cases. At the beginning of this Section, reference was made to Poliomyelitis. It is of interest to set out for the past 8 years, the age distribution of Poliomyelitis. During this period there were 4 deaths (paralytic cases) in 1952, 1956, 1957 and 1958, in the proportion of 3 males to 1 female. The ages were 15, 32, 33 and 33 respectively. The greatest number of cases occurred in the 5-15 years age period, and was 27. 53 out of 68 cases were admitted to hospital. There were 36 females to 32 males. Under 1 yr. 1-4 5-15 16-25 26-45 46 and Over Total Deaths 1950 1 3 2 — 6 — 1951 — 2 — 1 — 3 — 1952 1 7 2 3 — 13 1 1953 — I 7 2 1 — 11 — 1954 — 1 — — 1 — 2 — 1955 — 3 5 2 2 — 12 — 1956 — 2 2 1 — 5 1 1957 — 2 1 4 4 1 12 1 1958 — 1 — 2 1 — 4 1 2 8 27 14 16 1 68 4 42 43 INFECTIOUS DISEASE (1) disease 0—4 years 5—14 years 15 years and over Age Unknown admitted to Hospital total total M. R M. F. M. F. M. F. M. F. M. F. Dysentery (Bacillary) 1 2 — — — 1 — — — 1 1 3 4 Erysipelas 1 — — 1 2 1 — — — — 3 2 5 Food Poisoning — — 1 1 2 1 — — 1 — 3 2 5 Pneumonia — 2 5 3 16 9 — — 4 5 21 14 35 Measles 22 17 56 46 2 2 1 80 66 146 Poliomyelitis : Paralytic — 1 — — — 3 — — — 3 — 4 4 Non-Paralytic — — — — — — — — — — — — — Puerperal Pyrexia — — — — — 2 — — — 1 — 2 2 Scarlet Fever 7 4 30 23 — — — — 8 3 37 27 64 Whooping Cough 32 24 21 27 1 3 — — — 54 54 108 Para Typhoid ' B ' — — — — — 1 — — — 1 — 1 1 44 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 3 1 3 1 4 3 1 — — — 9 121 146 Scarlet Fever 6 4 14 1 1 2 2 1 7 7 11 8 64 Whooping Cough 7 9 23 34 13 8 5 3 3 1 2 — 108 Dysentery — 1 — — — 2 — — 1 — — — 4 Puerperal Pyrexia — — — — — 1 — — — 1 — — 2 Pneumonia 7 7 2 6 1 2 — — — 3 7 35 Erysipelas — — 2 — — 1 — — 1 — 1 — 5 Poliomyelitis : Paralytic 1 — — — — — — — 1 — 2 — 4 Non-Paralytic — — — — — — — — — — — — — Food Poisoning — — — — — — — — 1 2 2 — 5 Para Typhoid'B' — — — — — — — 1 — — — — 1 Totals 24 22 44 42 19 19 8 5 14 11 30 136 374 45 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 30 3 55 33 11 6 3 5 Scarlet Fever 16 6 2 5 5 3 12 15 Whooping Cough 31 5 3l 11 11 5 8 6 Dysentery — — — 2 — 1 1 — Puerperal Pyrexia — — 1 — 1 — — — Pneumonia 2 2 3 14 5 — 5 4 Erysipelas 2 — 1 1 — — — 1 Poliomyelitis : Paralytic — — — 1 — 2 1 — Non-paralytic — — — — — — — — Food Poisoning — 3 — — — — 1 1 Para-Typhoid 'B' — — — 1 — — — — Totals 81 19 93 68 33 17 31 32 *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, 1958 (a) The number of sessions held during the year 460 (b) Attendances during the same period 18,032 Diphtheria and Whooping Cough Immunisation (a) The number of Child Welfare Sessions at which Diphtheria and Whooping Cough immunisation was available 408 (b) The number of attendances for Diphtheria Immunisation 508 (c) The number of attendances for Whooping Cough Immunisation 897 Smallpox Vaccination (a) The number of Child Welfare Sessions at which Smallpox Vaccination was available340 (b) Attendances during the same period 290 46 47 POLIOMYELITIS VACCINATION, 1958 The following Table gives the numbers of persons resident in the Borough who received injections against Poliomyelitis during the year ended 31st December, 1958 :— Year of Birth 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 Others Total Given two Injections 123 663 445 393 558 523 529 445 349 313 346 369 558 385 418 890 7,307 Given third Injection — 54 241 211 165 134 118 138 124 124 137 10 9 4 1 49 1,643 IMMUNISATION AGAINST DIPHTHERIA, 1958 The following is a return of the number of children under the age of 15 years on 31st December, 1958, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1944). Year of Birth 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 Total Last complete course of injections (whether primary or booster) 1954-1958 29 63 425 732 534 609 632 594 542 772 707 646 642 612 166 7,705 1953 or earlier 553 598 592 457 335 207 219 323 366 46 — — — — — 3,696 IMMUNISATION AND VACCINATION I have set out below the Diphtheria Immunisation, Whooping Cough Immunisation and Smallpox Vaccination figures for 1958 based on record cards received. Year of Birth Diphtheria Immunisation Smallpox Immunisation Whooping-Cough Immunisation Primary Reinforcing Primary Revaccination Primary 1958 166 — 347 — 231 1957 481 5 266 — 424 1956 48 1 11 — 77 1955 11 4 7 1 20 1954 14 34 6 — 17 1953 22 295 4 2 13 1952 12 84 1 3 5 1951 3 19 1 1 3 1950 2 15 1 3 1 1949 1 17 — 1 1 1948 3 8 1 3 3 1947 — 2 3 4 — 1946 — 1 1 3 1 1945 — 1 2 2 — 1944 — — — 1 — Before 1944 — 1 28 65 1 Total 763 487 679 89 797 48