4412(1) Library BEC 26 BOROUGH OF BECKENHAM REPORT OF THE 1EDICAL OFFICER OF HEALTH FOR 1959 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 1959 BY L. R. L. EDWARDS, M.D. (Lond.), D.P.H. Medical Officer of Health "The chief function of the Medical Officer of Health is to safeguard the health of the area for which he acts by such means as are at his disposal". "He should endeavour to acquire an accurate knowledge of the influences, social, environmental and industrial, which may operate prejudicially to health in the area . . (From the Ministry of Health memorandum on the duties of Medical Officers of Health.) 2 MEMBERS OF THE PUBLIC HEALTH COMMITTEE FROM JUNE, 1959 Chairman Councillor R. J. Butcher. Deputy Chairman: Councillor D. R. Knox-Johnston. Alderman T. Boyd Boyd. Alderman R. S. Jackson. Alderman 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 A. C. Garrett. Councillor J. Lloyd-Eley. Councillor M. Williams Councillor Mrs. D. E. L. West, M.B.E. 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 E. U. Williams, Cert. R.S.I, and Inspector S.I.E.J.B. Certificated Food Inspector. District Public Health Inspectors W. T. G. Woodard, Cert. R.S.I. and S.I.E.J.B. Certificated Food Inspector. W. F. Forrest, Cert R.S.I, and S.I.E.J.B. Certificated Food Inspector. D. W. Foster, Cert. R.S.I, and S.I.E.J.B., Certificated Food Inspector. (Commenced 2/2/59) Clerical Staff: Secretarial Assistant Mrs. E. A. Best. Clerks Miss Y. Read. Miss J. Siggs. Mrs. H. Whipp. Rodent Operators W. J. E. Wickenden. E. J. Read. Disinfector-General Assistant M. Hindson. Mortuary Attendant—General Assistant T. J. Field 3 CONTENTS PAGE Introductory Letter 5 Section A. Vital Statistics Natural and Environmental Conditions 9 Summary of Vital Statistics 11 Total Deaths 12 Cancer Deaths, 1955 to 1959 13 Notifications and Deaths from Tuberculosis 14 Infantile Mortality 15 Section B. Health and Social Services Hospitals and Clinics 16 County Council Health Services 16 Private and Voluntary Services 17 Local Clinics for Maternity and Child Welfare 18 Report of District Officer 20 Report of Home Help Organiser 20 Report of Chest Physician 21 Tuberculosis Care Committee 22 Old People's Welfare Services 23 Women's Voluntary Service 25 Home Safety Committee 26 National Assistance Act, 1948 (Section 47) 26 Housing—Medical Applications 27 Sections C, D and E. Environmental Services Housing 29 Nuisances 29 Food and Drugs 30 Unsound Food 32 Ice Cream 33 Rent Act, 1957 33 Factories Act, 1957 33 Disinfection 33 Mortuary 34 Moveable Dwellings 34 Water Supply 34 Drainage 34 Rodent Control 34 Shops Act, 1950 35 National Assistance Act, 1948 (Section 50) Section F. Infectious Disceases Control Age and Sex Incidence 38 Monihly Prevalence 39 District Distribution 40 Smallpox Vaccination and Whooping Cough Immunisation 41 Poliomyelitis Vaccination 42 Diphtheria Immunisation (1945-59) 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 1959. In general the year has been a good one, and in certain particulars momentous. These concern the incidence of Poliomyelitis, the operation of the Clean Air Act and the presentation of evidence to the Royal Commission on Local Government in Greater London. It is encouraging to report that for the first time throughout a year, no cases of paralytic or non-paralytic Poliomyelitis were notified. This happened in spite of a comparatively dry summer when conditions are most favourable to the spread of this disease. The inference that protective inoculations are proving worthwhile is obvious. In June, the Council decided in principle to establish a Smoke Control area in a part of the borough adjacent to the south-west boundary with Croydon and with the approval of the Minister to commence a detailed survey so that the area (involving some 2,000 dwellings) may be established during the next two years. Also in June, a comprehensive report on the Health Services in the Borough was included in evidence on other aspects of local government presented to the Royal Commission by the Corporation. Supporting verbal evidence was given by Members of the Council. The views of the Royal Commission are expected to be known towards the end of 1960. Statistics The number of live births exactly equals that of the previous year and as the estimated mid-year population has again fallen slightly, there is a neglible increase of .03 in the Live Birth Rate. The Births have not followed the National increase so that the live birth rate of 12.67 is less than the figure for England and Wales which, at 16.5, is reported to be the highest rate since 1949 (16.7). The Infant Mortality figure of 14 is, however, much less than the figure of 22 for England and Wales which itself is a low rate. Even this low death rate needs to be bettered, and nationally, a check is being kept on its component parts, so that this year, attention is drawn to the important period immediately following birth by two new component rates during the first week—the early Neonatal Mortality Rate and the Perinatal Mortality Rate from which, in future years, comparisons may be drawn. The number of all deaths registered was less by 92, and the corrected Death Rate of 10.71 is better than the figure for England and wales of 11.6 per thousand population. Another rate which is better than the figure for England and wales is the Stillbirth Rate of 15.49 compared with the low national rate of 20.7 per thousand total Live and Stillbirths. 5 Shewn also is an increase of 92 in the number of inhabited dwellings, of £118 in the product of a penny rate to over £6,000, and a reduction of the accident death rate from 0.43 to 0.28 per 1,000 population. Infectious Diseases Control The Annual Report for 1957 referred to a special investigation of Poliomyelitis in Beckenham which dealt with 118 confirmed cases occurring in the Borough between 1947 and 1957. Eighty-five of these cases occurred over a 9-year period, so that it is especially pleasing to record that this year there were no notifications of poliomyelitis in Beckenham. Poliomyelitis vaccinations commenced in the Autumn of 1956— in 1957, 2,709 children had received a course of two injections and by the end of 1959, 10,799 children had received a third injection. In November 1958 evening Clinics were commenced to enable persons in the 15-26 age group to be immunised other than at their place of work or by their own family doctor. These are still held on the first Monday and Tuesday of the month (excepting bank holidays) at 6 p.m. at the Town Hall Clinic. Special evening Clinics were held at West Wickham as and when necessary. From the start there was a good response of young persons to this opportunity, with an average attendance of 70 per session, and even today, a few of this age group attend the Clinic. One hundred and twenty-one more persons were vaccinated against Smallpox, and this is a much better figure than last year's decrease of 175. The figures for primary immunisation against Diphtheria and Whooping Cough show a rather surprising consistency over the years; only three less children were immunised for the first time against diphtheria, and 73 less children against whooping cough. With births each year at about 900, approximately 600 children are immunised in their first year against whooping cough and diphtheria. There is room for much improvement as this year more children were vaccinated against Smallpox than were immunised against either diphtheria or whooping cough. Dysentery is a disease which year by year, is just kept at bay. As the organisms live in the lining of the bowel, and do not normally enter the body, no satisfactory vaccines can be prepared, and control is largely a question of treatment of cases which are notifiable and carriers which are not. Temporary carriers are numerous, largely harmless and mainly evanescent, and action by the Health Department Inspectors is directed to assist the family doctor and to seek the convalescent carriers by the bacteriological examination of feca specimens. Investigations in recent years shew how much general contact infections in schools spread the disease, and this is our experience in Beckenham as shewn by the report in Section F. 6 There was no special incidence of influenza during the year, but in the autumn there was an increase of infectious hepatitis. Other Disease Control The Mass Radiography Units have now commenced a special X-ray Service for male persons of 45 years and over. The object is the early detection of Cancer of the lung. Among males, investigations shew that Cancer of the lung is responsible for 1 in 18 of all deaths, whereas among females, the frequency is 1 in 103 of all deaths. About 400 men accepted the opportunity when the service approached them in 1958 following a routine Mass X-ray and when a leaflet on Lung Cancer was sent to firms in the area. About 200/300 attend every six months when the Unit visits the Civil Defence Car Park. The Unit visits twice with a two-week interval to allow for holiday cancellations. The full Service consists of the completion of an Index Card, a Questionnaire on smoking habits, etc., a master record of all X-rays, and comparison of films. The full Service is restricted to men in the prescribed age group, but any person over 15 years can be X-rayed during these visits. This Service has to be limited because the Units visit every two to three years for general surveys and their service to medical practitioners must still be maintained. The special service is being offered to approximately 30,000 men by three Units in South-East London, and three Units in South-West London. Clearly a hope for disease prevention in the future by early detection, is that similar facilities might be offered for electrocardiography, electroencephalography and selected laboratory investigations. Environmental Health and Social Services The establishment of smoke control has been referred to early in this introductory letter, and it remains only to emphasize that the operative word is "control" and the objective is to diminish the pollution of the atmosphere. Pollution of the atmosphere by radiostrontium and radiocassium and of streams and drainage systems by radioactive products is to be controlled by special inspectors of the Ministry of Housing and Local Government and by the A.E.R.E. Reports of these very specialised investigations are forwarded to the Medical Officer of Health. Establishments whose work involves a possible radioactive risk are required 'o communicate directly with the Ministry. A summary of eleven instances of unsound food in which the Public Health Committee authorised legal proceedings, shews that contaminated food articles continue to be milk, bread, rolls and pies. About 28 less samples of food and drugs were submitted to the Public Analyst. 7 It is noted also that last year's improvement in regard to complaints of rat and mouse infestations has not been maintained, and the figure is back to the high level of over 700 complaints a year. This is another figure, the yearly consistency of which is of interest. This year the Report includes for the first time, the number of families provided with a Home Help, weekly and throughout the year, and shews that this Service is carrying out a very big task. In addition, certain Home Helps care for young children in their own homes when the mother is temporarily away from home—the Family Help Service— and others care for the aged sick in their homes in extreme emergencies —the Night Attendant Service. The District Officer reports two very favourable developmentsCo) increased adaptations of homes of handicapped persons so that invalid chairs can become more useful, or special appliances can be used, and (b) a decrease in the number of persons waiting for admission to Old Persons Homes. The waiting list is still high for this Part III accommodation, and it is also difficult to get accommodation in hospitals. In one important way relatives of elderly persons could help the Authorities by giving notice of proposed holidays to enable the Authority to obtain temporary accommodation for the elderly or handicapped for a short period, and so relieve neighbours of the onus of supervision where this is necessary. The provision of an information service in both directions is vital to the care of the elderly, and the Report gives an account of the various Services at present known to exist in the borough. I wish to conclude by expressing my thanks to the Chairman and Members of the Health Committee for their patience and confidence in the staff that they have shewn throughout the year ; to my colleagues in general practice and in the hospital services of the borough for their industry, understanding and co-operation ; to Dr. Elliott and members of the County Health Services for wise advice and helpful reports and to my own staff for the energy, enterprise and tact so necessary in public service which they have given in full measure. L. R. L. EDWARDS, Medical Officer of Health. 8 SECTION A NATURAL AND ENVIRONMENTAL CONDITIONS OF BECKENHAM The Borough lies on the outskirts of London and occupies part of the extreme North-west corner of Kent. It has an area of 5,935 acres of which 2,000 acres are open spaces consisting of Parks, Recreation Grounds, Playing Fields and privately owned Sports Grounds. It contains 270 acres of public open spaces of various kinds, and over 300 acres of other open land without full public access. From North to South of the Borough is a chain of open spaces while farmland and woods to the South form a green belt. The Town extends from the Crystal Palace Grounds to the fringe of the Kentish farmlands and its neighbours are Lewisham (Sydenham and Catford) to the North, Bromley and Hayes to the East—Penge and Croydon to the West and Orpington to the South. 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 itself averages 150 feet above sea level. Running from South to North are 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 ". These valleys create a series of undulations. The Ravesbourne in the East forms part of the boundary between Bromley and Beckenham, but otherwise lies outside the borough. The Pool River is a stream formed by the junction of the Boundary Brook in Cator Park. It 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 1959 was 17.746 inches. The population has grown from 26,330 in 1901 to 74,834 in the 1951 Census (Estimated population in June 1959 was 75,220). The figure is likely to remain fairly steady in the future because the process of development of the existing area is practically complete. Areas of west Wickham and Hayes were added to the former Urban District in 1934 and in 1955 the Registrar General estimated the population of the West Wickham area as 20,600. Beckenham is now a coherent and well-ordered borough with a wide variety of houses most of which are owner occupied and have been built between the wars. Most of the larger older houses have been converted or replaced by self-contained flats. 9 The Borough has a total of approximately 700 shops which are largely sited along the four main roads in the Borough in two main shopping centres. Beckenham obtains its water supply in the West of the Borough from the Thames through the distribution of the Southern area of the Metropolitan Water Board. The rest of Beckenham, including Shortlands and Elmers End is supplied from the Wells in a chalk strata through a Pumping Station in Valley Road, Shortlands. These Wells are 250 feet deep. West Wickham obtains most of its water from its own Well and Pumping Station in Addington Road. Three Public Swimming Baths (modernised in 1938) of 100 ft., 80 ft., and 70 ft. lengths are supplied from a borehole 300 ft. into chalk strata. The method of treatment is by rapid pressure, filtration and chlorination with a change over period of one in four hours' duration. As a check on the efficiency of chlorination plant, every two weeks, and more frequently at times of excessive load, a 100 c.c. sample of water from the exit end of the Baths is taken in the middle part of the day and tested for B. Coli in the Laboratory of the Establishment. Three or four times a year, full bacteriological examination at a Public Health Laboratory is carried out. Results even at times of heaviest bathing loads have been very satisfactory. Beckenham possesses quite a large number of Industrial and Commercial Firms, but most of the Industries fall in the category of "Light Industry and the majority come under the general heading of Engineering. The Industries are almost confined to two main zones of the Borough on the Northern and Southern edges, and in all, employ 7,000 persons, the greatest number being in the engineering firms. Twenty-four establishments employ 50 or more employees. The main industries are concerned with the production of drugs, serums, vaccines, chemical apparatus, electric tools and electric motors, electronic equipment, compressed air equipment, including spray guns for paint or cellulose, bronze nameplates, vitreous enamelled, perspex and plastic signs and letters, bronze founding, metal founding, sheet metal work, general engineering and grading of scrap metals, office accessories, motor accessories, glues and adhesives, cellulose lacquers, leather products, protective food packaging, dyers and cleaners and almond millers. Smaller firms are concerned with printing, film bag manufacture, landscape gardening and rustic work. 10 SUMMARY OF VITAL STATISTICS, 1959 Area of District in acres 5,935 Estimated mid-year population 75,220 Population Density—persons per acre 12.70 Rateable Value at 1st April, 1960 £1,483,838 Number of Inhabited Dwellings 24,088 Product of a Penny Rate (Estimated 1960/61) £6,087 Male Female Live Births 484 469 Total 953 Live Birth rate per 1,000 population 12.67 Illegitimate Live Births per cent of total live births (29) 3.04 Male Female Still-births 7 8 Total 15 Still-births rate per 1,000 live and still-births 15.49 Total live and still-births 968 Infant Deaths (deaths under 1 year) 14 Total infant deaths per 1,000 total live births 14.69 Legitimate infant deaths per 1,000 legitimate live births 15.16 Illegitimate infant deaths per 1,000 illegitimate live births 34.48 Neonatal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 11.54 Early Neonatal Mortality Rate (deaths under 1 week per 1,000 total live births) 11.54 Perinatal Mortality Rate (Stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 26.86 Maternal Mortality (including abortion) 0 Maternal mortality rate per 1,000 live and still-births 0.00 Death Rate per 1,000 population from Cancer (186 deaths) 2.47 Death Rate per 1,000 population from Pulmonary Tuberculosis (2 deaths) 0.03 Death Rate per 1,000 population from Non-Pulmonary Tuberculosis (1 death) 0.01 Death Rate per 1,000 population from Accidents (21 deaths) 0.28 Birth Rate (including Stillbirths) per 1,000 population : Crude 12.87 Corrected (x 1.06) 13.64 Male Female All Deaths Registered 428 448 Total 876 Death Rate per 1,000 population: Crude 11.65 Corrected (x 0.92) 10.71 Natural Increase: Births exceeded deaths by 77. 11 TOTAL DEATHS, 1959 (Registrar-General's Official Returns). All causes—876. Male, 428 ; Female, 448. causes of death males females 1. Tuberculosis, respiratory – 2 2. Tuberculosis, other 1 – 3. Syphilitic disease – – 4. Diphtheria – – 5. Whooping Cough – – 6. Meningococcal infections – – 7. Acute poliomyelitis – – 8. Measles – – 9. Other infective and parasitic diseases – – 10. Malignant neoplasm, stomach 8 6 11. Malignant neoplasm, lung, bronchus 41 8 12. Malignant neoplasm, breast – 15 13. Malignant neoplasm, uterus – 10 14. Other malignant and lymphatic neoplasms 54 44 15. Leukaemia, aleukaemia 2 2 16. Diabetes 2 2 17. Vascular lesions of nervous system 45 69 18. Coronary disease, angina 94 59 19. Hypertension with heart disease 7 10 20. Other heart disease 38 79 21. Other circulatory disease 23 39 22. Influenza 6 2 23. Pneumonia 19 28 24. Bronchitis 28 21 25. Other diseases of respiratory system 4 1 26. Ulcer of stomach and duodenum 5 2 27. Gastritis, enteritis and diarrhœa 1 3 28. Nephritis and nephrosis 2 1 29. Hyperplasia of prostate 7 – 30. Pregnancy, childbirth, abortion – – 31. Congenital malformations – 4 32. Other defined and ill-defined diseases 17 29 33. Motor vehicle accidents 8 – 34. All other accidents 6 7 35. Suicide 10 5 36. Homicide and operations of war – – Totals 428 448 12 CANCER DEATHS 1955 1956 1957 1958 1959 Cancer of Lung 34 30 29 47 49 Males 167 Females 22 Total 189 Cancer of Breast 12 23 26 13 15 89 Cancer of Uterus 6 6 8 6 10 36 Cancer of Stomach 18 17 23 21 14 Males 54 Females 39 Total 93 Other Malignant Neoplasms 82 76 83 90 98 Males 216 Females 213 Total 429 Total Deaths from Cancer 152 152 169 177 186 Males 437 Females 399 Total 836 For comparison, deaths from Respiratory Tuberculosis are shown:— 1955 1956 1957 1958 1959 6 2 3 1 2 Males 11 Females 3 Total 14 14 TUBERCULOSIS—Table of Notifications and Deaths, 1959, from Local Records. Sex Total Ages 1 1 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 29 8 37 1 1 2 1 4 12 2 4 6 3 1 7 7 5 5 3 4 3 3 Non-Pulmonary 4 1 5 1 – – 1 – 1 2 – – – – 1 – – 3 – 1 – – Totals 33 9 42 2 1 2 2 4 13 4 4 6 3 1 8 7 5 8 3 5 3 3 Deaths Pulmonary 5 2 7 – – – – – – – 2 2 3 – 2 – 1 – – – 1 3 Non-Pulmonary — 1 1 – – – – – – – – – – – – – – – – – – – Totals 5 3 8 – – – – – – – 3 2 3 – 2 – 1 1 – – 1 3 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 The number or deaths of infants under the age of twelve months was 14, as compared with 11 in 1958. 1 he Registrar-General returns 14 infant 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 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 Malformations: Heart – – – – – – – – – – – – – Lungs – – – – – – – – – – – – – Spine, or Brain 1 – 1 – – – 1 1 – – – – 2 Other – 1 1 – – – 1 – – – – – 1 B. Other Prenatal and Natal conditions: Immaturity – 1 1 – – – 1 – – – – 1 – Immaturity and Atelectasis 2 1 3 – – – 3 – – – – 1 2 Birth Injuries – 2 2 – – – 2 – – – – 1 1 Attributed to Maternal Toxaemia 1 – 1 – – – 1 – – – – 1 – Erythroblastosis (Rhesus) 2 – 2 – – – 2 – – – – – – Haemorrhagic Disease – – – – – – – – – – – – – C. Post-Natal Causes: – – – – – – – – – – – – – Pneumonia, Tracheobronchitis – – – – – – – 1 1 – – – 2 Gastro Enteritis and – – – – – – – – – – – – – Other Infections – – – – – – – – – – – – – Lack of Care—Neglect – – – – – – – – – – – – – D. Accidental and Violence – – – – – – – – – – – – – All other causes – – – – – – – – – – – – – Totals 6 5 11 – – – 11 2 1 – – 6 8 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. 1. Hospitals and Clinics The Babies' Hospital—Sydenham Hill, S.E.26. Beckenham Hospital—Croydon Road, Beckenham. Beckenham Maternity Hospital—Stone Park Avenue, Beckenham. Bethlem Royal Hospital, Monks Orchard Road, Beckenham. Bromley Chest Clinic—Tiger Lane, Mason's Hill, Bromley. Bromley Hospital—Cromwell Avenue, Bromley, Kent. Brook General Hospital—Shooters Hill, S.E.I8. Cane Hill Hospital—Coulsdon, Surrey. Children's Hospital—Sydenham, S.E.26. Children's Heart Hospital—West Wickham, Kent. Farnborough Hospital—Farnborough, Kent. Joyce Green Hospital—Dartford, Kent. Lennard Isolation Hospital—Bromley Common, Bromley. Leybourne Grange Colony—West Mailing, Kent. Netherne Hospital—Coulsdon, Surrey. Orpington Hospital—Sevenoaks, Orpington, Kent. Penge Chest Clinic—1, Westbury Road, Penge, S.E.20. Sundridge Hospital, Sundridge, Nr. Sevenoaks, Kent. Widmore Road and Mason's Hill Maternity Units, Bromley, Kent. 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. Beckenham : 12, Beckenham Road, Beckenham West Wickham : 4, Grosvenor Road and 105a, Station Road. 16 Ambulances. Through Ha or Beckenham District Office. Old People's Homes "Craigie Vane 3, Durham Rd., Shortin Borough. lands. (Private). 24, Cromwell Road, Beckenham. (Private), Durham House, 50, Durham Avenue. Shortlands (K.C.C.). 13, Gwydor Road, Beckenham (private) Rest Haven, 99, Venner Road, Sydenham. S.E.26 (Private). Rutland Lodge, 6, Mays Hill Road, Short- lands (Private). Thornton House, 75, Bromley Road Beckenham (Voluntary). 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) "Inglewood," 25, Durham Avenue, Bromley, Kent. (2) "Lynton House," 14, Bromley Grove, Shortlands, Kent. (3) "Petersfield Lodge," 69, Crystal Palace Park Road, S.E.26 (4) "Sloane," 131, Albemarle Road, Beckenham, Kent. (5) "Waverley," 51, Albemarle Road, Beckenham, Kent. Registration and supervision is delegated to the Borough Council, Children's Homes. (1) Dr. Barnardo's Home, 16, Park Road, Beckenham. (2) Maude Nathan Home, 72, Crystal Palace Park Road. S.E.26. (3) St. Hilda's Home, Crescent Road, Beckenham. (4) Salvation Army Children's Home, 42, Crystal Palace Park Road, S.E.26. 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. 17 LOCAL CLINICS FOR MATERNITY AND CHILD WELFARE Service Days and Times Premises in Use Ante Natal 2nd and 4th Fridays, in each month, 10 a.m.-12 noon (by appointment). 1st, 3rd and 5th Mondays in each month, 10 a.m.-12 noon (by appointment). Mondays 10 a.m.-12 noon and 2 p.m.-4 p.m. (by appointment). Wednesdays and Thursdays 10 a.m.-12 noon (by appointment). Boolangs—Tuesdays and Wednesdays, 2-3 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. Maternity Hospital, Stone Park Avenue, Beckenham. Child Weleare Mondays, 2—4 p.m. Tuesdays, 2—4 p.m. Wednesdays, 2—4 p.m. Thursdays, 2—4 p.m. Fridays, 2—4 p.m. Clinic Block, Hawes Lane, West Wickham (а) Baths Annexe, Beckenham Road (b) Assembly Hall, West Wickham (a) Church Hall, Langley Road, Elmers End (b) Church Hall, Valley Road, Shortlands (a) Church Hall, Lennard Road, Penge (b) Clinic Block, Town Hall, Beckenham (a) Church Hall, Langley Road, Elmers End (b) Clinic Block, Hawes Lane, West Wickham Post Natal 2nd and 4th Fridays in each month 10 a.m.-12 noon (by appointment). 1st, 3rd and 5th Monday mornings (by appointment). Every Friday 10 a.m.— 12 noon. Clinic Block, Town Hall, Beckenham. Clinic Block, Hawes Down, West Wickham. Maternity Hospital, Stone Park Avenue, Beckenham. Vaccination and Immunisation Clinics Vaccination and poliomyelitis immunisations (by appointment); Diphtheria and whooping cough immunisations without appointment. Held during Infant Welfare Sessions at above Clinics. (Langley Road—Friday afternoons only). Dental (Infant Welfare Cases) By appointment. By appointment. Clinic Block, Town Hall, Beckenham. Clinic Block, Hawes Lane, West Wickham. 18 LOCAL CLINICS FOR MATERNITY AND CHILD WELFARE Service Days and Times Premises in Use Speech Mondays to Fridays inclusive (by appointment) Clinic Block, Town Hall, Beckenham. Orthopaedic Wednesday mornings (twice per month) (by appointment) Clinic Block, Town Hall Beckenham Treatment. Surgeon in attendance The Physiotherapist attends by Monday afternoons Tuesday mornings Thursday afternoons Friday afternoons J appointment as follows:— Clinic Block, Town Hall, Beckenham Mothercraft Cusses 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 19 REPORT OF THE DISTRICT OFFICER The following report has been submitted by Mr. C. J. Moore, District Officer, for which I express my thanks. "The year under review has been one of steady if unspectacular progress. No major developments have been introduced, but in general there has been an increased demand for the various services provided through this office. However, I would like to mention two exceptions. Firstly, the number of applications which I received for admission to Old People's Homes was lower than in the previous year, and the number still waiting at the end of the year was also lower. This I think is due to greater use being made of the services which are provided for the elderly by various bodies both voluntary and statutory. The second exception is the continued downward trend in the number of patients suffering from tuberculosis who seek assistance under the County Council's care and after-care scheme. This is entirely due to the progress made in recent years in the treatment and control of the disease. A service which has shewn a marked expansion during the year is the scheme for the welfare of the physically handicapped. A number of disabled people have been assisted by adaptations in their homes or by the provision of special equipment or appliances, to lead a more independent life. Plans are in hand for the further development of this scrvice." REPORT OF HOME HELP ORGANISER My thanks are due to Miss Hocking for the report on this Service. "During the year 1959, demands for this Service continued to increase steadily. Approximately 300 cases per week received assistance, and over 400 new cases were serviced during the year. Fourteen families received assistance under the Family Help Service. All applications for Domestic Help Service should be made to the District Organiser, 12, Beckenham Road, Beckenham." 20 WORK OF THE CHEST CLINICS I extend grateful thanks to Dr. D. G. Madigan for submitting his report on the work carried out at the Chest Clinics on behalf of patients residing in this Borough. "The number of new contacts examined during the year has risen slightly, and it is gratifying to note that none of these was found to be suffering from tuberculosis, a fact that speaks well of the combined measures for prevention available at the present time. Chemotherapy continues to be the chief weapon in combating the disease, but its predominance may be temporarily compromised by an increase in the number of cases having resistant organisms. It is a little disquieting to notice in recent years that the disciplines so important in the management of tuberculosis are not being observed with the same tenacity. It is difficult to persuade patients to take chemotherapeutic drugs at home as scientifically prescribed. Some do not take P.A.S. regularly, and thus it enhances the possibility of the infective organisms becoming resistant to the other drugs taken in conjunction with it. Nevertheless, it is correct to say that sputum conversion is being achieved fairly rapidly in the vast majority of newly diagnosed cases of tuberculosis, which cuts down the risk of spreading the infection. There is no doubt that the incidence of tuberculosis will fall as time goes on, but there is no room for complacency, or relaxation of the well-established measures of prevention which have evolved since the introduction of the Tuberculosis Service." New Cases attending the Chest Clinics for the first time during 1959 Adults Children under 15 years Male Female Male Female Pulmonary Tuberculosis 27 13 – 1 Non-Pulmonary Tuberculosis 3 1 – – Non-Tuberculous 60 54 33 35 Non-Tuberculous Tuberculous New Contacts Examined 226 Nil IB.C.G. Vaccination of contacts:78. .^Number of Patients admitted to Hospital or Sanatorium during 21 BECKENHAM DISTRICT TUBERCULOSIS CARE COMMITTEE I extend grateful thanks to Mr. M. E. Forster, Hon. Secretary of the above Committee, for kindly submitting the following report. "During 1959 the Beckenham District Tuberculosis Care Committee, which works in close connection with the County Tuberculosis Care Committee and the Kent Council of Social Service, continued its work amongst the tubercular patients and their families in the Borough of Beckenham. The main help needed was found to be in the home, as experience over the last few years has shewn that this is due to the shorter stay in Hospital or Sanatorium. Patients are recommended to the Committee by the Chest Clinic through their Health Visitors and if immediate help is needed one of the Committee's two Liaison Officers will call and is authorised to spend up to £5. At each monthly meeting cases are reviewed and given very careful consideration. Expenditure during last year was over £317. This was once again a drop—due not to the decline in the services of the Committee, but due to the increased difficulty found in raising money. Fortunately, the 1959 Christmas Sale of ½d. Seals increased, due to the very energetic effort of the Hon. Organising Secretary. This, coupled with money donated and raised at the yearly Jumble Sale, should provide funds to expand the scope of the Committee next year. During the year, the following grants were made:— Four patients were assisted with their housing problems and three with employment problems. Five patients were given free meat grants for periods ranging from four weeks to twelve weeks. Three patients had their debts settled and one was helped with coal. Six families were helped with fares to visit patients in Hospital or Sanatoria. Two families were sent on recuperative holidays during the summer to approved Holiday Homes, and one family had their fares paid. Two patients were provided with clothing and one received emergency help. Two families were assisted with their Removals, and one family was assisted with House Decorations. A car was hired for a Holiday outing for one patient, and a night light bought for an elderly patient. In addition, the Committee's three Radio Sets are still on loan to patients, and at Christmas time some 36 patients received a Christmas Card and gift." 22 BECKENHAM OLD PEOPLE'S WELFARE SERVICES It is estimated that there are approximately 2,400 men over 65 years and 5,800 women over 60 years in the Borough ; the number in need is not known. The main voluntary welfare work for old persons in need consists of the provision of" Meals on Wheels " service, Clubs, holidays, home visits, and emergency help for the handicapped. Home visits are carried out at the request of organisations whose representatives attend meetings of the Old People's Welfare Committee, and this Committee can investigate requests for services and needs not already provided for by existing statutory or voluntary services. 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. In the future, this Committee will be enlarged in scope and membership, and executive functions will be carried out by smaller Committees rather than as hitherto by individual members of the main Committee. Statutory services are provided by the County Welfare Authority, and include provision of residential accommodation where there is need for care and attention (Homes and Part 3 accommodation), supervision of privately run Homes, provision of domestic help service (including evening and night attendance), provision of home nursing service, and grants towards certain Welfare services which include recuperative holidays and loan of nursing requisites (including bedding) either directly or through the British Red Cross Society. Housing accommodation (separate dwellings or hostels) are provided by the Borough Council which also contributes towards the "Meals on Wheels" service and "Chiropody" service. Various organisations, either directly from their own funds, or acting as agents, provide a variety of services. The services of the W.V.S. include the provision of recreation, Clubs, meals and holidays. Other organisations help in various ways as shewn below. National Assistance Board Issue supplementary pensions and grants for special needs. Citizens Advice Bureau Deal with enquiries concerning general welfare (sickness, meals, medical, etc.) which are referred to the Old People's Welfare Committee, or if the case is urgent, direct to the County Welfare Service District Office, or concerning accommodation, which are referred to a Social Worker employed by the Bureau's Headquarters (North-West Kent Council of Social Service). This Social Worker arranges accommodation either with families willing to take old people into their homes, or with Societies such as the Abbeyfield for those who prefer their own accommodation and will share a house and housekeeper with four or five other old persons. 23 Townswomen's Guilds Provide home visiting, act as escorts, entertain in Old People's Clubs, visit and make gifts to Old People's Homes, report needy cases, help towards funds of the Old People's Welfare Committee. There is a need to organise home visiting on an area basis throughout the Borough. British Red Cross Society Provide a Chiropody service for old persons referred by medical practitioners, Hospital Almoners, District Nurses and Darby and Joan Clubs. A Foot Clinic is held on Wednesday mornings every two weeks at the Detachment Headquarters in the North of the Borough. In the South of the Borough, a Chiropodist sees persons at her own Clinic every two weeks, at a fee per service. The Cadet Service does some shopping for old persons. Rotary and Inner Wheel Clubs Established a Veterans' Club. Arrange outings twice a year, and tea parties, individual assistance or " adoption " of old persons really in need of financial and other help. Regular visits by Club members with gifts of coal and grocery at Christmas. Veteran's Club Provides games and pastimes once a week, a yearly outing and concerts. Visits to sick members. Toc H Help in homes and gardens with "odd" jobs. Distribute logs and parcels at Christmas. Soroptimist Club Organise a summer outing for 20 old persons, home visits and Christmas coal and parcels. Round Table Members assist individual cases of hardship. 24 WOMEN'S VOLUNTARY SERVICE I am grateful to Mrs. Fisher, Centre Organiser of the W.V.S. for the following contribution :— "The work of the W.V.S. continues on the lines given in previous Reports, but in 1959, 10 children were sent to the sea or country. Two mothers who were in need of a rest were sent to a holiday home in Northampton and an old couple were given a holiday by the sea. Beckenham and West Wickham Centres have each adopted a Refugee living in Austria. These two refugees have both lived in Displaced Persons Camps for years, and are in a very poor state of health. Parcels are sent which contain canned milk, meat, tins of sweets, biscuits and Bovril. It is hoped to be able to send woollen goods in the future. During the year under review, the sum of £570 has passed through the medium of S.S.A.F.A." 25 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 Councilthe 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. Propaganda material is distributed to Libraries, Schools and local Shops, and essay competitions are organised in local schools. 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. 26 HOUSING—MEDICAL APPLICATIONS From January 15th to December 18th, 1959, 46 applications with medical certificates were received. Twenty-four less applications is a considerable fall to this total number from last year's total figure of 70 applications with medical certificates. In 1957 and 1956, the number of applications were 65 and 68 respectively. It is noted also that the total number of applications is half that of the Housing List and one-eighth of the combined Housing and Supplementary list in the middle of the year. This year, additional points were recommended for all new applications. Five were re-applications, and in four, additional medical points were awarded. Maximum medical points were recommended for 19 applications, and of these 14 were referred for Ground Floor flat accommodation. Consultation with the Housing Manager takes place in special cases, as for example, when there is a possibility of first floor accommodation becoming available sooner, or if additional medical details are required by his Committee. The average age of all the applicants recommended for maximum points was 61 years, of whom the youngest applicant was a mother of 29 years and the oldest a widow of 88 years. The medical causes are classified in the following groups. Nervous Disorder Functional 12* Organic Nil Total 12 Illness of Children (With or without overcrowding or dampness) Total 11 Tuberculosis Total 2 Diseases of Bones and Joints Total 5 Bronchitis or Asthma Total 3 Varicose Veins or Ulcers Total 3 Cardiovascular Angina Nil Coronary Thrombosis Nil Hypertension or Cerebral Haemorrhage 1 Other heart conditions 2 Total 3 Miscellaneous† Total 7* tOne case—wife completely blind, husband partially blind. One case—wife completely blind. *One case—lost home through fire. 27 There is a continued decrease in cases of Tuberculosis, and excluding last year's figure, the cases of nervous illness are similar to those of previous years as shewn below. There is a slight increase under illnesses of children. Certificates are forwarded less for chronic diseases and more for temporary or recurrent illness for which low medical points are awarded and for which greater discrimination in the award of medical certificates is necessary. 1955 1956 1957 1958 1959 Tuberculosis 6 10 8 6 2 Chest Diseases 10 12 3 5 3 Rheumatism and Arthritis 9 12 11 7 5 Angina or Cardiac Weakness 5 2 2 2 3 Coronary Thrombosis 2 3 1 1 0 Anxiety State or Mental Illness 15 11 13 22 12 Children, Illness or Overcrowding 3 15 22 9 11 28 REPORT ON THE WORK OF THE PUBLIC HEALTH INSPECTORS FOR THE YEAR 1959 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. " One vacancy existed in the Inspectorial staff at the commencement of the year, which in February, 1959, was filled by the appointment of Mr. D. W. Foster, 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." 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) 823 Number of inspections made for the purpose 1,553 Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 25 Number of inspections made for the purpose 29 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 112 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 112 Number of dwelling-houses in which defects were remedied after service of informal notices 74 Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 48 Number of dwelling-houses in which defects were remedied after service of formal notices: (a) by owners 48 (b) by Local Authority in default of owners 0 Number of complaints received 1,442 Number of initial visits 6,115 Number of re-visits 2,440 Total visits and re-visits 8,555 Nuisances Remedied Structural Defects of properties—External 187 Internal 468 Insanitary conditions other than vermin 3 Verminous conditions 16 Smoke Nuisances 15 Choked drains 296 Other drainage defects 158 Defective sanitary appliances 28 Insufficient or unsuitable water supply 19 Absence of dustbin accommodation 12 Offensive accumulations 20 29 Two hundred and thirty-six samples of food and drugs were submitted to the Public Analyst. Details are appended Article Formal Informal Almonds (Ground) 7 1 Apples — 3 Aspirin Tablets — 1 Beef and Kidney Pie — 1 Biscuits (Milk and Honey) — 1 Blackberries in heavy Syrup — 1 Blackcurrant Juice — 1 Blackcurrant Vitamin " C " Drink — 1 Bronchial Elexir — 1 Butter — 2 Butter Coconut Macaroons 1 — Butter Drops — 1 Butter Mints — 1 Buttered Brazils — 1 Cheese Spread — 3 Chocolate (Full Cream Nut Block) — 1 Chopped Chicken in Jelly — 1 Chutney Pickle — 1 Coffee — 3 Coffee Spread — 1 Crab (Dressed) — 2 Crab (Potted with Butter) — 1 Cream — 3 Cream Doughnuts 1 — Custard Powder with added Glucose — 1 Flour (Self Raising) — 2 Gelatine (Instant Powdered) — 1 Gin — 5 Glucose Drink — 1 Glycerine and Honey — 1 Grape and Blackcurrant Juice — 1 Grapefruit Segments in heavy Syrup — 1 Halibut Liver Oil Capsules — 1 Ham (Potted) — 1 Ham and Chicken — 1 Ham and Chicken Roll — 1 Ice Cream — 20 Ice Cream (Butter) — 1 Ice Cream (Cremier) — 1 Jam — 4 Jelly (Table) — 2 Lard — 1 Lemon Curd — 1 Lemon Juice — 4 Limeade Powder — 1 Lobster (Dressed) — 1 Luncheon Meat — 5 Margarine — 2 Marmalade — 1 Marzipan (Pure Almond) — 1 Milk (Evaporated) — 2 Milk (Pasteurised) 46 7 Milk (Sterilised) 5 Milk (T.T.) 4 - Milk Pudding — 6 30 Article Formal Informal Minced Meat Loaf — 1 Mint in Vinegar — 1 Mushroom Soup — 1 Olive Oil — 2 Oranges — 4 Orange Crush — 1 Orange Drink .. — 4 Orange Pie Filling — 1 Orange Squash — 5 Paregoric Tablets 1 1 Paste (Curry) — 1 Pate de Foie with Truffles — 1 Peaches in heavy Syrup — 1 Peas — 1 Pepper (Ground) — 1 Pilchards in Tomato Sauce - 2 Rhubarb in heavy Syrup — 1 Salmon — 6 Sauce (Fruit) — 1 Sausages (Pork) 4 2 Sausages (Pork Chipolata) 1 — Savoury Minced Steak — 1 Sparkling Health Drink — 1 Steak (Casseroled) — 1 Stewed Steak — 1 Strawberries in Syrup — 1 Syrup of Figs — 1 Syrup of White Pine with Tar — 1 Tea — 2 Tincture of Quinine — 1 Tomato Catsup — 1 Tomato Chutney — 1 Tomato Sauce — 1 Turkey Croquettes — 1 Turkey in Jelly (Chopped) — I Tuna — 1 Vinegar — 3 Whipped Cream Bon-Bons — 2 No instances of adulteration were found, but in eight cases, the Public Analyst expressed dissatisfaction with the consistency of the food or drug in relation to its description by the vendor or manufacturer. Details are appended:— Article sampled Analyst's report Action Taken Paregoric Tablets. (Two Samples of the same product.) The samples contained no morphine. The principal active ingredient of Paregoric is Tincture of opium and the British Pharmacopoeia requires that the morphine derived from the tincture, shall be 0.05% weight in volume in the finished article. The samples, containing no morphine, cannot therefore contain any Paregoric. Legal proceedings instituted against Suppliers to the Vendor who brought in the Manufacturers.The Suppliers were dismissed from the suit, the Manufacturers being fined £1. Costs were refused. 31 Sparkling Health Drink. Contains an ingredient described as Lacto-serum which is neither a dictionary nor a scientific word. Manufacturers agreed to an alteration of the label wording. Cream Dough Nuts. No butter fat. The filling is not cream. Vendor warned of necessity prominently to display proper declaration and designation of cream fillings. Pork Luncheon Meat. (Two samples.) (1) Total Meat 73% (2) Total Meat 65% Manufacturers reminded of Trade agreement for 80% meat content. Creamed Rice Pudding. Full Cream Milk, not more than 80; rice 6, sugar 4, water not more than 10%. The full cream milk is watered. Manufacturers agree lo improve consistency to comply with label. Casserole Steak (Australian). Meat 65%. No action possible owing to absence of legal standard. Matter referred to Association of Municipal Corporation. Orange Squash Orange juice not more than 20%. (Standard not less than 25 %). Manufacturers prosecuted. Fined £10 and £49 15s. costs. Food privately purchased, and alleged by the purchaser to be unsound Instances of unsound food sold to the public which came to our notice were reported to the Public Health Committee. As a result, the manufacturers and/or vendors responsible in eleven of the cases were prosecuted. Details are appended :— February, 1959 May, 1959 July, 1959 October, 1959 November, 1959 December, 1959 complaint Maggot in Meat Pasty. Wood in Loaf. Bacon Rind in Loaf. Dirty Milk Bottle. Metal in Biscuit. Mould in Meat Pie. Mould in Fruit Pie. String in Bread. Dirty Milk Bottle. Maggot of Flour Moth embedded in loaf crust. Mouldy Swiss Roll. Dirty Milk Bottle. result of prosecution Fined £5 and £1 3s. costs. Fined £10. Fined £5 and 10s. 6d. costs. Fined £2. Fined £20. Fined £10 and £5 5s. costs. Fined £10 and £5 5s. costs. Fined £5 and £5 5s. costs. Fined £2. Magistrates unable to agree. Council decided to withdraw case. Fined £25 and £5 5s. costs. Fined £20 and £2 10s. costs. Legal proceedings were instituted under the Food Hygiene Regulations 1955, against the Owner of premises used for food preparation. It was the first case of its kind to be taken in this Borough, and followed only after repeated warnings had failed to check unhygienic practices in the premises. The defendant was fined £250 and ordered to pay 40 guineas costs. A marked improvement in the conduct of the premises followed the prosecution. 32 Ice Cream Twenty samples of Ice Cream were submitted to chemical analysis during 1959, and all were found to comply with the statutory standard for this product. Fifty-nine 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 1 Grade 2 Grade 3 Grade 4 44 12 1 2 Samples falling into Grades 3 and 4 are regarded as unsatisfactory, indicating some bacterial contamination either in the manufacture or the retail serving of the product. Three of our samples fall into these Grades, and although there was no 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 immediately withdrawn from sale, the replacement supplies proved on examination, to be entirely satisfactory. Rent Act, 1957 The details of the administration of this Act were referred to fully in the 1957 Annual Report. Sixteen applications were received for Certificates of Disrepair during the year 1959, bringing the total number of applications to 134 since the Act came into operation in June, 1957. Factories Act, 1957 Three hundred and seventy-six 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 3 Insufficient sanitary accommodation 1 Unsuitable or defective sanitary conveniences 15 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 1959, 33 applications were received and accounts rendered for £34 12s. During the year, 207 Library books were collected from homes and hospitals where infectious disease had occurred, disinfected and returned to the Library of origin. 33 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 1959, 145 bodies were brought to the Mortuary where post-mortem examinations were conducted by a Home Office Pathologist. Thirty-four Inquests were held in the Town Hall. Movable Dwellings Thirteen families occupied movable dwellings under licence from the Council during 1959. Twenty-four 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, 296 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 296 cases discovered, however, 200 related to private drainage, and in these cases a charge is made for the work undertaken. Accounts were rendered for £148 15s. 7d. for this work. The Smoke Testing of the house drains of 11 properties was undertaken, and Accounts were rendered for £23 2s. Infestation by Rats and Mice Seven hundred and thirty complaints were received in 1959 of which 70 related to business premises. A charge is made for the service provided in respect of business premises, whereas private residential property is served free of charge. During the year, Accounts for £105 5s. were rendered in respect of business premises. Baiting of certain sections of the main sewers known to be rat infested, has been maintained during the year. 34 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 1959, 950 visits were made to shops in the Borough, and 34 contraventions remedied. 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 1959, it was necessary to take action under this Section on two occasions. 35 SECTION F INFECTIOUS DISEASES CONTROL A notable feature of the year has been the complete absence of Poliomyelitis. For the first time there were no notifications of either paralytic or non-paralytic illness, and while some notifications of non-paralytic illness may still occur in future years, if this improvement is maintained the diagnosis will need to be more definite than it is today. The biennial increase of Measles was nearly 200 more than in 1957, but Whooping Cough notifications were about half those of last year, and a third of those of two years ago. A considerable increase in the number of cases of Sonne Dysenterv was part of a general increase in the district adjacent to the West and North of the Borough. Of 33 cases notified between the 23rd January and the 16th July, the largest number of 15 occurred during June. Seventeen families were involved and 108 faecal specimens were sent to the Public Health Laboratory by the Health Department. In 17 cases, specimens were sent by the family doctor for examination to the Hospital Laboratory. In 26 cases, the patient was a child and 17 children were of school age. Six children from different families attended the same school in the period 12th June to 6th July and two children, the first and second cases notified from different families attended the same Preparatory School in London. The evidence strongly suggested a contact infection in School. In four families, two or more contacts in the home were negative on bacteriological examination, while in two other families, there was one secondary case; the other members were negative on bacteriological examination. In one family, a baby of 1 year 10 months was confirmed as a case of dysentery, while three other members of the family were unaffected, and bacteriological examinations were negative. Contact with other children seems a likely link. In seven families, visits by the Inspectors, followed by bacteriological examinations, brought to light other cases or carriers—one child known to have the disease had a fall and was admitted to Isolation accommodation in the Accident Ward of a local hospital, but all other cases were nursed at home. The annual Return of Food Poisoning which was forwarded to the Ministry of Health, shewed five cases of Food Poisoning ; in one case the agent was not identified and in four others, Salmonella Typhimunum was reported. One case occurred in the second quarter and four cases in the third quarter of the year. Three cases of Salmonella food poisoning occurred in one family, but a time lag of 17 days was too long to ascertain details of suspected food or other source of infection. The father and younger sister had felt unwell three weeks prior to onset of acute symptoms. 36 Two cases of Salmonella Typhimurium infection were unconnected, and one, not diagnosed until after admission to hospital, was not notified until after transfer to an Infectious Diseases Hospital. Two cases of Food poisoning in which the agent was not diagnosed were reported. One case was strongly suggestive of toxic food poisoning either staphylococcal or due to Cl.Welchii. Notification was received from the family doctor and from the hospital to which the patient had been admitted almost moribund four hours after a meal of cold lamb consumed at a Luncheon Meeting in another borough. After a severe illness, recovery was complete. Eleven other persons who partook of this meal were similarly affected. The other incident took place eight hours after the consumption of mushrooms. The suspected food and faeces of the family were examined with negative results. The report on the mushrooms stated that a low viable count of coagulase-negative staphylococcus albus was obtained and saprophytic bact. coli. No pathogens were isolated. In another investigation, a convalescent carrier of Salmonella Newport stayed temporarily with friends in this borough, after the death of his wife in another area from Salmonella Newport. He was kept under surveillance until further faecal specimens proved negative. A home was visited to report on the suitability of the accommodation of an elderly patient about to be discharged from the Infectious Diseases Hospital, and who was a carrier of Salmonella Typhimurium. An unusual surveillance in these days of freedom from Diphtheria outbreaks was that of a School Teacher living in the borough, but employed in a North London School, who had been a Diphtheria contact. The necessary clearance throat swabs were arranged. Later in the year, an outbreak of Diphtheria in a School in a neighbouring borough was reported. Of the many carriers of Diphtheria resulting from the epidemic, a Teacher who was found to be a nasal carrier of virulent diphtheria bacilli, was reported and kept under surveillance until the necessary three consecutive negative nasal swabs had been obtained. Arrangements with St. Hilda's Nursery for the bacteriological control by the Public Health Laboratory Service of new admissions, continued during the year. Thirty-nine faecal specimens were examined. No pathogenic organisms were isolated including examination for bact. coli. virulent types which are associated with enteritis in babies and are highly infectious. There was a slight increase in notifications from the Maternity Hospital of Puerperal Pyrexia and Ophthalmia Neonatorum. 37 38 INFECTIOUS DISEASE (1) Disease 0—4 years 5—14 years 15 years and over Age Unknown Admitted to Hospital Total Total M. F- M. F. M. F. M. F. M. F. M. F. Measles 218 221 250 233 6 6 1 1 2 474 461 935 Scarlet Fever 10 9 24 23 4 — — — 5 2 38 32 70 Whooping Cough 13 13 13 19 — — — — 1 3 26 32 58 Dysentery (Bacillary) 3 5 10 4 4 7 — — — — 17 16 33 Meningococcal Infection — — — — 1 — — — 1 — 1 — 1 Puerperal Pyrexia — — — — — 7 — — — 7 — 7 7 Pneumonia 3 3 6 4 20 23 — 1 3 2 29 31 60 Erysipelas — — — — 2 2 — — — — 2 2 4 Food Poisoning — 1 — 3 1 — — — 1 1 1 4 5 Para Typhoid ' B ' - - - - - 1 - - - - - 1 1 Ophthalmia Neonatorum 2 2 - - - - - - 2 2 2 2 4 39 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 176 217 255 142 88 40 10 5 1 _ 1 935 Scarlet Fever 5 8 15 9 8 6 4 3 1 3 3 5 70 Whooping Cough 7 12 8 10 7 3 7 4 - - - - 58 Dysentery 1 1 9 3 1 15 3 — - - — — 33 Meningococcal Infection - - - 1 - - - - - - - - 1 Puerperal Pyrexia - 3 - - 1 - - - 2 - - 1 7 Pneumonia 4 29 11 5 1 1 — 1 - 2 1 5 60 Erysipelas — 1 — — — — — — 2 1 — — 4 Food Poisoning — — — — — 1 — 4 — — — — 5 ParaTyphoid'B' — — 1 — — — — — — — — — 1 Ophthalmia Neonatorum — — 4 — — — — — — — — — 4 Totals 193 271 302 170 106 66 24 17 6 6 5 11 1,178 40 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 158 117 66 126 82 118 105 163 Scarlet Fever 16 6 7 4 6 11 6 14 Whooping Cough 19 5 3 9 3 2 10 7 Dysentery 17 — 7 1 — 8 — — Meningococcal Infection — — — — — — — 1 Puerperal Pyrexia — — — — 7 — — — Pneumonia 1 2 3 27 10 3 6 8 Erysipelas — — 1 — — — 1 2 Food Poisoning 3 — 1 — — — 1 — Para-Typhoid 'B' — — — — 1 — — — Ophthalmia Neonatorum - - - - 4 - - - Totals 214 130 88 167 113 142 129 195 *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. IMMUNISATION AND VACCINATION I have set out below the Diphtheria Immunisation, Whooping Cough Immunisation and Smallpox Vaccination figures for 1959 based on record cards received. Year of Birth Diphtheria Vaccination Smallpox Vaccination Whooping-Cough Immunisation Primary Reinforcing Primary Revaccination Primary 1959 185 382 271 1958 459 1 336 376 1957 66 1 13 45 1956 15 9 9 10 1955 8 40 8 3 12 1954 13 266 5 1 7 1953 5 71 2 2 1 1952 2 14 1 3 1 1951 1 10 1 - 1950 1 12 1 1 1949 — 5 2 1 1948 1 2 7 2 1947 2 4 2 - 1946 2 2 1945 Before 1 — — 1 — 1945 1 1 28 72 1 Total 760 434 798 91 724 41 42 POLIOMYELITIS VACCINATION, 1959 The following Table gives the number of persons resident in the Borough (A) who have received second injections and (B) who have received third injections, given during the year ended 31st December, 1959 :— Year of Birth 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 Before 1943 Others Total (A) 168 660 118 71 67 71 80 72 61 65 84 81 119 84 56 78 81 2,795 436 5,247 (B) — 310 550 408 393 501 515 552 519 587 595 567 723 812 547 626 436 127 357 10,125 IMMUNISATION AGAINST DIPHTHERIA, 1959 The following is a return of the number of children in the Borough under the age of 15 years on 31st December 1959, who had completed a course of immunisation at any time before that date (i.e., at any time since Is January, 1945). Year of Birth 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 Total Last complete course of injections (whether primary or booster) 1955-1959 57 413 689 443 237 600 595 512 485 767 664 658 679 626 185 7,610 1954 or earlier 60S 606 502 428 582 252 328 403 369 48 — — — — — 4,123