BEX 3 LIBRAPY BOROUGH OF BEXLEY. Annual Report OF THE Medical Officer of Health, For the Year, 1937. GEO. F. BRAMLEY, M D„ Ch.B., D.P.H., Medical Officer of Health. Printed by T. W. Jenkins (T.TJ., 5-day week), 73-75 Broadway, Bexleyheath, BOROUGH OF BEXLEY. Annual Report OF THE Medical Officer of Health, For the Year, 1937. GEO. F. BRAMLEY, M D.. Ch.B., D.P.H., Medical Officer of Health. Borough of Bexley. Mayor: Councillor A. R. Potter, J.P. Deputy Mayor: Alderman G. A. Bock. HEALTH COMMITTEE. Chairman: *Councillor A. R. Potter, J.P. Vice-Chairman: Alderman G. J. Buckingham, †*Alderman G. A. Bock Councillor C. F. E. Gilham. *Alderman Mrs. Welch. Councillor D. E. Hayes. Councillor H. J. Bennett *Councillor Mrs. G. M. Hoad. *Councillor Mrs. Boswell. Councillor J. A. Lawrence. *Councillor M. J. Corr. Councillor J. C. McLean. Councillor J. Cronin. *Slum Clearance Sub-Committee. tChairman of Slum Clearance Sub-Committee. PUBLIC HEALTH STAFF. Medical Officer of Health, and Superintendent of the Maternity and Child Welfare Services. Medical Superintendent Corporation Maternity Home. Assistant Medical Officer of Health and Medical Officer Corporation Maternity Home. Medical Superintendent of Maternity Home, 315, Broadway, Bexleyheath (closed 6th June, 1937). Chief Sanitary Inspector, Public Cleansing Officer and Shops Acts Inspector. Senior Assistant Sanitary Inspector. Assistant Sanitary Inspectors. Temporary Assistant Sanitary Inspector. General Assistant Health Visitors Geo. F. Bramley, M.D., Ch.B., D.P.H. Janet C. King, M.B., Ch.B., D.P.H. (commenced 22nd April, 1937). C. Kinsley Carroll, M.C., L.R.C.P., L.R.C.S., D.P.H. (part time). R. J. Rayner, M.R.S.I., Certificate Inspection of Meat. G. Hind, Certificate of Sanitary Inspectors' Joint Board; Certificate Inspection of Meat. F. W. Willington, Certificate of Sanitary Inspectors' Joint Board; Certificate Inspection of Meat. A. H. Taylor, Certificate of Sanitary Inspectors' Joint Board ; Certificate Inspection of Meat. J. T. Boocock, Certificate of Sanitary Inspectors' Joint Board (appointed November, 1937). H. W. Ravens. N. Feeley (Miss), C.M.B., and Health Visitor's Certificate. A. W. Martin (Miss), C.M.B., and Health Visitor's Certificate (resigned 5th June, 1937). K. V. Birmingham (Miss), S.R.N., C.M.B., and Health Visitor's Certificate. 4 Health Visitors—con. Matron of the Maternity Home, 315, Broadway, Bexleyheath (closed 6th June, 1937). Matron of the Corporation Maternity Home, Lavernock Road, Bexleyheath (opened 22nd May, 1937). Clerks Consultant for Puerperal Pyrexia and for Ante-natal and Obstetric Complications. Veterinary Surgeon Other Staff I. Smurthwaite (Miss). S.R.N., C.M.B., and Health Visitor's Certificate (resigned 31st July, 1937). N. M. Marshall (Miss), S.R.N., C.M.B., and Health Visitor's Certificate (appointed 19th July, 1937). G. M. Froggatt (Miss), S.R.N.. C.M.B., and Health Visitor's Certificate (appointed 9th August, 1937). D. G. Stanley (Miss), S.R.N., C.M.B., and Health Visitor's Certificate (appointed 9th August, 1937). B. Powell Jenkins (Miss), R.R.C., S.R.N.. C.M.B. F.M.Hammond (Miss), S.B.N., F.R.N., C.M.B. M. Bentley (Miss). G. F. Lovegrove. K. E. Kingston (resigned 30th November, 1937). N. E. Broom (appointed November, 1937). R. V. Hoad. M. J. Priestland (Miss). R. Milligan (Temporary—commenced 19th November, 1937). H. G. Taylor, M.A., M.B., F.R.C.S. (part time). C. E. Rix, M.R.C.V.S. (part time). One Temporary Typist. One Food Sales Clerk (part time). One Disinfector and Mortuary Attendant. Two Ambulance Drivers and one relief Driver. 5 Annual Report of the Medical Officer of Health. Health Department, 14, Brampton Eoad, Bexleyheath, Kent. 9tli -June, 1938. To the Mayor, Aldermen and Councillors of the Borough of Be.rley. Ladies and Gentlemen, I have to present to yon the Annual Report on the health of the Borough for the year 1937. The general health of the Borough continues to maintain a high standard as is shown in the body of the report. There were many developments during the year and although Incorporation was probably the chief of them, it does not effect any change in the administration of the health services except that in future reports it is Ihe intention to give statistics relating to the separate Wards. The five year development programme for health services, commenced in the autumn of 1936, was proceeded with and shows indication of being completed in 1938; it cannot however be anticipated that the services will become static, and I take this opportunity of thanking you for your sympathetic consideration in all matters affecting the services. T hereby express my indebtedness to the able and willing assistance which has been given to me by all the members of the staff of my department, and assistance given by other departments. I am, Your obedient servant, GEO. F. BRAHLEY, Medical Officer of Health. 6 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. Owing to housing developments on the southern boundary adjoining the Chislehurst and Sidcup Urban District and on the northern boundary adjoining the Erith Urban District, and consequent administrative difficulties with relation to sewage, scavenging, refuse collection, etc., and following an Inquiry held by the Kent County Council, these boundaries were adjusted as from the 1st April, 1937, resulting in a net gain of 8.3 acres, bunging the area of the Borough to 4,867.3 acres. Population. Houses erected. Registrar General's Estimate (30.6.37) 74,380 1,373 Mid vear. 1911 (Census) 1921 „ 1931 „ 1932 (R.G.'s Estimate) 1933 1934 1935 1936 16,000 21,510 33,150 37,610 44,860 52,030 59,970 69,247 (includes added area) 1,082 1,165 2,514 3,832 2,412 2,034 Number of inhabited houses (end of 1937 according to Rate Books) 21,572, Rateable Value, £535,776. Sum represented by a penny rate, £2,100. Social Conditions. The district is almost entirely residential in character, and it can no longer be said that market gardening is the chief industry in the district. The chief internal industry is probably building, although there is evidence that the peak in erection of new dwelling houses has passed. Apart from the numbers employed in building, market gardening, at portable building works, the local brewery, a crisp potato manufactory, and a few smaller workshops, practically the whole of the population is engaged in the Metropolitan or other adjacent areas. Many of the latter are employed in the Woolwich Arsenal and other engineering works. 7 I am not aware of any conditions of occupation which are prejudieal to health within this Borough. Conditions of environment which are prejudicial to health obtain only in those houses which are now rapidly becoming the subject of representation by myself as unfit for human habitation. There have been many pleas for a five year Census as opposed to a Decennial Census, and there is no doubt that every argument could be used especially in an area such as this. The many valuable facts to be gleaned from the Registrar General's Reports on the Census are .not available to this Borough as the last Census (1931) refers to a population of less than half that are now living here. The primary facts of the Census, namely, the population, age groups, Housing conditions, etc., would be of infinite value to the work of the Health Department, and no doubt to other Departments also, and although probably the Registrar General's Estimate is fairly close to the actual figure of total population, the other information must await the next Decennial Census in 1941. Until such information is received it is not. possible to give figures relating to the occupations, etc., of the inhabitants, and in the meantime we must accept the position that we are a Greater London dormitory town with a population of which nearly two thirds has been here less than six years. Unemployment. The following figures kindly supplied by the Manager of the Bexleyheath Unemployment Office show the total unemployed at the beginning and end of the year respectively. : — January 4th, 19-37 January 3rd, 1938 Men 633 741 Women 198 222 Boys 26 75 Girls 29 96 Total 886 1134 As the larger proportion of the exchange register is made up of employees in the building trades, thu weather conditions control the present numbers of unemployed, and the above unemployment figures cannot be taken as a present indication of the social or economic conditions. Many of the employed population are now working in armament factories in Woolwich and Crayford, and 8 it is to he hoped that, when the rearmament boom ceases, we do not see a big rise in the number of unemployed persons in this area. Nutrition. There is 110 amount of malnutrition in the Borough, which is not comparable with the rest of the country. The only statistical evidence of nutrition relates to the school children, and the following figures are extracted from the Medical Records of the Kent County Council, with reference to school children in this Borough for (he year 1936, for which I am indebted to Dr. Fox, Deputy School Medical Officer. Age Groups. No. of children inspected. Excellent. Normal. Slightly Subnormal. Bad. Entrants 1,604 84 1,325 189 6 8—9 1,275 83 997 192 3 Leavers 761 106 643 12 0 Total 3,640 273 2,965 393 9 Bexley % 7.5 81.4 10.8 0.24 England and Wales % 14.6 74.2 10.5 0.7 Kent County % 16.0 72.9 10.4 0.7 Whilst I am not aware of an excess of malnutrition, I am aware of widespread ignorance in the matter of food values, economic buying of food, and the wise handling of the child at meal times as seen in the falling off of the toddlers. Increased health visitation and instruction of young girls and mothers on food values, cooking, and so on is required. A bigger consumption of dripping, the despised herring, and the cheap cuts of meat are only a few of the important facts which must be learned, and put into operation to gain improvement up to a standard of excellence in nutrition. The further consumption of milk is unfortunately retarded by its high cost, but as practically the whole of the milk retailed in this area is pasteurised, and, therefore " safe," I do feel justified in using this report to recommend its merits as a first-class food. One hears much these days of the good results of the nursery schools, where, amongst other things, the 9 child is given a good raid-day meal, and I have no doubt that this well balanced meal is probably the largest single factor in producing a five year old child of good nutrition. Now in this district, where few of the fathers return home for a mid-day dinner, the mother has to prepare his dinner for early evening and the preparation of two dinners becomes an extra burden on the already harassed housewife. In the end the children have to go with a makeshift mid-day meal washed down with tea. In 1938, with the possibilities of providing canteen meals at works for the fathers at a very cheap rate, the makeshift meal for the child at home should cease. The Council supply the district with electricity and the South Suburban Gas Company supply gas. The following open spaces have been provided by the Council: — Danson Park, Welling 210 acres Bexley Recreation Ground 10.80 ,, A portion of Bexley Woods 27.25 ,, Hall Place 64.50 „ Russell Park 13.00 „ Bursted Wood 14.60 ,, Riverside Walk 10.50 ,, and other small spaces giving a total of nearly 400 acres. It is estimated that when all land now in negotiation for open spaces is acquired, over 9 per cent of the acreage in the district will be as open spaces and available for the public. This wise provision will no doubt reflect in the healthiness of the population. Facilities for outdoor games are provided or to be provided in many of these open spaces, including the new large Swimming Pool in Danson Park, opened in July, 1936. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR, 1937. For the purposes of calculation the Registrar General's Modified Estimate of population, viz., 74,350, specially designed for use with the composite records of births, deaths and notifiable diseases of the year 1937, is used, as the district has been subject to alterations of boundary. 10 SUMMARY OF VITAL STATISTICS. England and Wales County Boro's and Great Towns including London Smaller Towns (Resident Populations 25 000 to 50,000 at 1931 Census London Administrative County Borough of Bexley Rates per 1,000 Population. Births- Live 14.9 14.9 15.3 13.3 17.7 Still 0.60 0.67 0.64 0 54 0.71 Deaths— All Causes 12.4 12.5 11.9 12.3 8.7 Typhoid and Paratyphoid Fevers — 0.01 — — — Smallpox — — — — — Measles 0.02 0.03 0.02 0.01 — Scarlet Fever 0.01 0.01 0.01 0.01 0 026 Whooping Cough 0.04 0.04 0.03 0.06 0.04 Diphtheria 0.07 0.08 0.05 0.05 0.04 Influenza 0.45 0.39 0.42 0.38 0.24 Violence 0.54 0.45 0.42 0.51 0.44 Notifications— Smallpox — — — — — Scarlet Fever 2.33 2.56 2.42 2 09 2.61 Diphtheria 1.49 1.81 1.38 1. 93 0.79 Enteric Fever 0.05 0.06 0.04 0 05 — Erysipelas 0.37 0.43 0,34 0 44 0.27 Pneumonia 1.36 1.58 1.20 1.18 0 55 Rates per 1,000 Live Births. Deaths under one year of age 58 62 55 60 44.7 Deaths from Diarrhoea & Enteritis under two years of age 58 7.9 3.2 12.0 5.3 Maternal Mortality— Puerperal Sepsis 0.97 Others 2.26 Notavailable 0.77 Total 3.23 J 0.77 Hates per 1,000 Total Births (i.e. Live and Still). Maternal Mortality— Puerperal Sepsis 0.94 Notavailable – Others ... 2.17 0.73 Total 3.11 0.73 Notifications— Puerperal Fever Puerperal 13.93 17.59 11.52 4 15 0.73 Pyrexia 14.34 7.29 11 Births. Males. females. Total. Live Births—Total 665 654 319 Legitimate 648 643 291 Illegitimate 17 11 28 Birth Rate per 1,000 of the estimated resident population 17.74 Stillbirths—Total 29 24 53 ,, Rate per 1,000 total (live and still) births 40.19 Deaths. Males. Females. Total. All causes 353 296 649 Death rate per 1,000 of the estimated resident population 8.72 Number of women dying in, or in consequence of childbirth: From Puerperal Sepsis From other Puerperal causes 1 1 Rate per 1,000 total (live and still) births 0.76 Deaths of Infants under one year of age Males. Females. Total. Legitimate 39 17 56 Illegitimate ... 1 2 3 Death Rate of Infants under one year of age: Total per 1,000 live births 44.73 Legitimate per 1,000 legitimate live births 43.38 Illegitimate per 1,000 illegitimate live births ... 107.14 Deaths from Measles (all ages) — ,, ,, Whooping Cough (all ages) 3 ,, ,, Diarrhoea (under 2 years of age) ... 7 ,, ,, Cancer (all ages) 90 Birth Rate. The following' statement relates to the birth rate during the past seven years: — 12 1931 Birth Rate 16.9 per thousand 1932 „ „ 16.9 „ 1933 „ ,, 16.1 „ 1934 „ „ 17.0 „ 1935 „ „ 18.2 ,, 1936 „ „ 18.5 „ 1937 „ „ 17.7 „ Rate per 1,000 for England and Wales, 1937 14.9 ,, ,, ,, ,, County Boroughs and Great Towns including Loudon 14.9 ,, ,, ,, ,, Smaller Towns (Estimated populations 25,000 to 50,000 at Census 1931) 15.3 ,, ,, ,, ,, London Administrative County 13.3 Twenty-eight illegitimate children were registered as against 16 for the year 1936. Stillbirths. 53 stillbirths (29 males and 24 females) were registered during the year. This represents a rate of 0.71 per thousand population, against 0.60 per thousand in 1936. Rate per 1,000 for England and Wales, 1937 0.60 ,, ,, ,, ,, County Boroughs and Great Towns, including London 0.67 ,, ,, ,, ,, Smaller Towns (Estimated populations 25,000 to 50,000 at Census, 1931) 0.64 Two stillbirths registered were illegitimate. Death Rate. The Death Rates for the area during the last seven years are as follows: — 1931 8.3 per thousand 1932 10.0 ,, 1933 8.2 „ 1934 8.8 „ 3935 8.4 „ 1936 8.7 „ 1937 8.72 „ 13 The rate for Bexley again compares favourably with other parts of the Country, the death rate over England and Wales being 12.4. The low rate in this area is expected in view of the young population. The Registrar General has supplied a comparability factor for the area by which the death rate of the area should be multiplied in order to make it comparable with other parts of the Country. The figure is 1.07 and when applied gives a standardised death rate of 9.3-3. The figure 1.07 is the same as that supplied in each year since 1931, and is obtained from facts revealed by the Census. Its applicability to the present population, which has changed so much in age groups, is therefore doubtful, but is used as the only factor available. CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1937. Causes of death. M. F. All Causes 353 290 1 Typhoid and Paratyphoid Fevers — — 2 Measles — — 3 Scarlet Fever 2 — 4 Whooping Cough 1 2 5 Diphtheria 1 2 0 Influenza 12 6 7 Encephalitis lethargica — — 8 Cerebro spinal Fever — — 9 Tuberculosis of respiratory system ... 13 11 10 Other tuberculous diseases 5 3 11 Syphilis 1 1 12 General paralysis of the insane, tabes dorsalis 2 1 13 Cancer, malignant disease 40 44 14 Diabetes 4 4 15 Cerebral hemorrhage, etc. 16 19 16 Heart disease 73 81 14 Causes of' death. M. F 17 Aneurysm 2 — 18 Other circulatory diseases 22 24 19 Bronchitis 14 5 20 Pneumonia (all forms) 27 17 21 Other respiratory diseases 2 3 22 Peptic Ulcer 12 3 23 Diarrhoea, etc. (under two years) 3 4 24 Appendicitis 4 1 25 Cirrhosis of liver 2 — 26 Other diseases of liver, etc. — 2 27 Other digestive diseases 8 6 28 Acute and chronic nephritis 5 8 29 Puerperal sepsis — — 30 Other puerperal causes — 1 31 Congenital debility, premature birth. 12 malformation, etc 24 32 Senility 2 9 33 Suicide 3 1 34 Other violence 16 ]3 35 Other defined diseases 30 12 36 Causes ill-defined or unknown 1 1 Special causes (included in No. 35 above):— Small-pox — — Poliomyelitis — — Polioencephalitis — — Anthrax 1 — Maternal Mortality. One death only was registered during the year as due to, or in connection with, childbirth, giving a puerperal mortality rate, (rate per thousand (live and still) births) of 0.77, compared with a rate of 2.2 in 1936, and an average over the previous five years of 2.7, and 3.11 for England and Wales. The death which occurred would probably be classed as "unavoidable," and in this Borough where practically all mothers receive antenatal care, one is tempted to regard the low figure as an indication of the good standard of midwifery practised, with the proviso that, as our figures are small, statistics over many years only are of real value. 15 DEATHS IN ACE CROUPS IN 1937. These relate to deaths occurring in 1937, hut not necessarily registered in that year. Short List of Causes of Death in use in General Register Office. Totals Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 30 30 to 35 35 to 40 40 to 45 45 to 50 50 to 55 55 to 60 60 to 65 65 to 70 70 to 75 75 and over ALL CAUSES. 646 59 9 2 2 4 11 7 9 8 11 15 25 23 27 40 58 43 59 75 59 1 Typhoid and Paratyphoid Fevers — 2 Measles — 3 Scarlet Fever 2 2 4 Whooping Cough 2 2 5 Diphtheria 3 I 1 1 6 Influenza 7 I 2 1 1 2 7 Encephalitis Lethargica . 8 Cerebro-Spinal Fever — 9 Tuberculosis of Respiratory System 27 1 1 3 3 4 2 5 2 3 2 1 10 Other Tuberculosis Diseases 6 1 1 1 1 1 1 11 Syphilis 2 1 1 12 General Paralysis of the Insane, Tabes Dorsalis 1 1 13 Cancer, Malignant Disease 8.5 1 3 2 6 7 17 8 16 11 '4 14 Diabetes 7 I 4 2 15 Cerebral Haemorrhage, etc. 25 I 1 3 3 1 3 4 9 16 Heart Disease QZ 1 1 2 2 3 2 1 3 b 7 15 12 37 17 Aneurysm 2 1 1 18 Other Circulatory Diseases 82 1 3 4 5 9 8 9 19 24 19 Bronchitis 44 1 1 1 1 1 3 2 4 2 11 17 16 ]20 Pneumonia (all forms) 62 p 4 5 1 1 4 5 3 5 4 16 21 Other Respiratory Diseases 11 1 S 1 2 2 2 22 Peptic Ulcer 1 2 1 2 1 3 2 23 Diarrhoea, etc. (under 2 years) 4 1 24 Appendicitis 5 i 1 i 1 1 25 Cirrhosis of Liver 1 1 26 Other Diseases of Liver . i 1 27 Other Digestive Diseases 14 6 1 2 i 1 1 2 28 Acute and Chronic Nephritis 12 1 1 3 1 1 2 29 Puerperal Sepsis – 30 Other Puerperal Causes . 1 1 31 Congenital Debility. Premature Birth, Malformation, etc. 15 33 1 1 32 Senility 28 28 33 Suicide 4 2 1 1 34 Other Violence 28 1 2 1 2 2 2 1 3 3 4 1 2 4 35 Other Defined Diseases 38 3 1 1 2 2 1 1 2 5 1 3 1 4 2 1 S 1 36 Causes ill-Defined or unknown Special Causes (included above) Smallpox — Poliomvelitis — Polioencephalitis — Anthrax 1 1 17 Infantile Mortality. DEATHS EROVM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. Causes of Death as Certified. Under 1 week 1 to 2 weeks 2 to 3 weeks 3 to 4 weeks Total under 1 month 1 to 3 months 3 to 6 months 6 to 9 months 9 to 12 months Total deaths under 1 year All causes. 29 1 2 2 34 6 11 6 2 59 Whooping Cough 2 2 Bronchitis 1 1 i Broncho Pneumonia 1 1 2 2 3 2 9 Tubercular Meningitis 1 1 Gastro Enteritis 1 3 1 1 6 Congenital malformation and Premature birth 23 1 2 26 1 1 28 Atrophy, Debility and Marasmus 1 1 1 Pyelitis 1 1 2 Diphtheria 1 1 Icterus Gravis Neonatorum 1 1 Dysentery 1 1 Intestinal Intussusception 1 1 1 1 3 Pulmonary Atelectasis 2 2 2 Neonatal Hemorrhagic Pneumonia 1 1 1 Totals ... 29 1 2 2 34 6 11 6 2 59 18 This table shows that 59 infants under one year of age died during the year 1937. 59 were registered during the year, giving an Infantile Death Rate per 1,000 live births of 44.73. Rates over previous years have been : — 1931 48.2 per 1,000 live births 1932 62.6 1933 48.3 1934 45.0 1935 43.9 1936 53.8 Thirty-four of these deaths, i.e., 57.6 per cent, occurred in the neonatal period, i.e., within one month cf birth. In 1936 the corresponding figure was 57 per cent. Much further reduction in the number of infantile deaths during the neonatal period does not seem imminent, but with increasing knowledge and care of infants, there should be some reduction of deaths due to pulmonary and intestinal infections. SECTION B.—GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Isolation Hospital. Bexley is the largest single constituent authority of the Dartford Joint Hospital Committee, which provides the Isolation Hospital known as Bow Arrow at Dartford. The rebuilding and extensions at Bow Arrow Hospital are continuing, and the most notable feature during 1937 was the opening of the cubicle block so that it is now possible to provide accommodation for almost any type of infectious disease. The value of cubicle isolation will become evident in the prevention of complications of the commoner infectious diseases, and will, no doubt, result in a decrease of the average number of days stay. It is now possible to obtain admission for cases of severe or complicated measles or whooping cough, or for uncomplicated cases where home conditions for adequate nursing are not suitable. The replacement of temporary buildings at the hospital continues, and no doubt future developments there will be on the lines of more provision of cubicle blocks. One feels that future isolation hospital provision should be for cubicle blocks only, and that the ideal hospital will contain a very high proportion of beds in cubicles. The initial costs, and extra nursing' costs will be repaid in the long1 run by a decrease in the average days stay per patient, the reduction of complications, morbidity and deaths. The new Nurses Home was also completed at the Hospital during the year. An arrangement has been in effect for some years, whereby cases of Typhoid Fever were admitted to L.C.C. Hospitals, but in future, such cases will be admitted to Bow Arrow Hospital when accommodation is available. The arrangement with the L.C.C. will not be discontinued. Small pox accommodation has continued to be the subject of negotiation, and the Kent County Council, whose duty it is, under the Local Government Act, 1929, to prepare a scheme, has been held up in its negotiations with the London County Council. It is still not decided whether such cases will be sent to a L.C.C. Hospital, or whether special new provision will be required in Kent. Cases of Puerperal Pyrexia are admitted t*> the Queen Charlotte's Hospital (Isolation Block) with the Authorities of which the Corporation has an agreement. Council Maternity Homes. The new Corporation Maternity Home at Lavernock Road, Bexlevheath, was officially opened on the 22nd May, 1937, and the first case entered on the 24th May, 1937. The last case was admitted to the old Home at 315, Broadway, Bexleyheath, on the 22nd May, and the old Home closed on 6th .Tune, 1937. General Hospitals. The Bexley Cottage Hospital now provides for 25 beds and 1 cot, and hopes are held that the further staues of expansion will not be lonff delayed. of expansion will not be long delayed. The growth of the work done is evidenced by the following figures extracted from the Annual Report of the MaTiagement Committee for 1937: — Total Patient Year. Total No. of In-patients. Out-patients. Days. 1928 156 242 2,815 1937 528 615 6,105 20 The facilities offered bv the Woolwich War Memorial Hospital, the Miller Hospital, Greenwich, and other London Hospitals have again been taken advantage of by the residents within the Council's area. The fact that Bexley is within easy access to the Metropolitan area is a great asset in this respect. The Kent County Council, through its Public Assistance Committee, maintains the County Hospital at Dartford (631 beds) available for this area. AMBULANCE FACILITIES. infectious Disease. The Dartford Joint Hospital Committee provide an ambulance for the removal of cases of infectious disease from the Borough to the Bow Arrow Hospital. An ambulance is requisitioned when necessary from the London County Council for the removal of cases of Small Pox, etc. Non-Infectious Cases. The Council provides an ambulance for removal of accident cases, maternity cases, sudden illness, etc., to Hospital, and arrangements are in force with the neighbouring authorities for a secondary service. The Council's Ambulance Station is situated at the Health Department, and consists of a garage and rest rooms, and living quarters for one married driver. The service comes within the administration of the Health Department. The Welling Branch of the British Red Cross Society provides a voluntary attendant for the ambulance in the evenings, at week-ends, and Bank Holidays, and our best thanks are due to them for the very willing and able service rendered. Cases removed during 1937. Sickness 362 Accidents 182 Maternity 98 Malicious calls 6 Ambulance not required 30 Total 678 21 No. of calls on outside ambulances—15. Crayford Ambulance 101 Sidcup Ambulance 3 L.C.C. Ambulance l Erith Ambulance 1 Sickness 3 Accidents 11 Maternity 1 During the year it was agreed to instal combined fire alarm and ambulance call standards throughout the Borough, the Fire Brigades Committee and the Health Committee each bearing half the cost of installation and maintenance. MORTUARY. The Public Mortuary, which is maintained by the Council, is situated on land at the south side of the Council Offices. During the year it was used on 32 occasions, and 28 post-mortem examinations were made. CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare Centres. Bexleyheath—315, Broadway. Child Welfare Sessions — Mondays and Wednesdays, 2.30-4.30 p.m. Ante-natal Sessions—1st and 3rd Fridays in the month, 10.30 a.m., 2.30 p.m. 2nd and 4th Fridays in the month, 10.30 a.m. Welling—Station Approach. Child Welfare Sessions—Mondays, Tuesdays and Thursdays, 2.30-4.30 p.m. Ante-natal Sessions—2nd and 4th Fridays in the month, 10.30 a.m., 2.30 p.m. Maternity Home-—Lavernock Road. Ante-natal Sessions—Tuesdays and Thursdays, 10.30 a.m. Post-natal Session—Thursdays, 11.30 a.m. 22 The following services are provided by the Kent County Council: — School Children's Clinics, and Dental Clinics, at Hook Lane, Welling and Mayplace Road East, Bexleyheath. Tuberculosis Dispensaries. At Overy Street, Dartford, and Bexley Road, Erith. Venereal Diseases. At the County Hospital, West Hill, Dartford. PROFESSIONAL NURSING IN THE HOME. Home nursing' is provided for by three Nursing Associations in the area, namely: — Bexleyheath Services of two whole time Nurses. Bexley Services of one whole time Nurse. Welling and East Wickham Services of two whole time Nurses. These are very useful services to the district, and tlie untiring manner in which the Committees and helpers of the Associations carried out their arduous duties in this connection during the year is greatly appreciated. The nurses are again to be complimented on the work that they have done in the homes of the patients. LABORATORY FACILITIES. Pathological and bacteriological work for the area is carried out by the Kent County Council at the Public Health Department, Sessions House, Maidstone, but aN there is still too much reliance placed on swabs for the diagnosis of diphtheria, the postal delav has raised the question of providing a small laboratory for such purposes at the Health Department here, and this matter is still being considered in the five year programme of development. 23 MATERNITY AND CHILD WELFARE. (1) Midwifery and Maternity Services. These services have been reviewed again especially in the light of Circular 1622 (7th May, 1937), on Maternal Mortality. (a) Ante-natal Care. The figure 573 denotes that 43.4 per cent of expectant mothers attended the Corporation's ante-natal clinics and, therefore, received antenatal medical care, but it is known that 315 other expectant mothers received similar care at clinics attached to London Maternity Hospitals to which they were admitted for their confinment giving a total percentage of 65.1 known to receive ante-natal medical care. This percentage should be 100, and it is hoped that with the operation of the new Midwives Act, that an increase towards 100 per cent will be noticed in future years. (b) Co-operation with Ceneral Practitioners. With the opening of the new Maternity Home all the practitioners of the area may attend their own cases in the Home, and any patient there may call in her own doctor. To this extent the private practitioners are part of the maternity service though they are not subsidised by the Council. Every medical practitioner is entitled by law to practice midwifery, and under existing conditions the majority of the cases he is called to see are those which have become to a greater or lesser degree, abnormal. He is, then,expected to do difficult midwifery under bad conditions, which may obtain in a private house, and surely he should therefore be given opportunities of doing such work in the best conditions which can obtain in a Maternity Home, if he is to keep up his knowledge in this respect. The question of a panel of General Practitioners to do midwifery work has received attention in recent times, but unless a majority of doctors elect not to do midwifery, the formation of any panel would be fraught with many difficulties, not the least of which is the economic, one. It may be maintained that to carry this argument to its logical conclusion, private practitioners should do the ante-natal clinic work, but here I do not agree. The 24 work of the ante-natal clinic is, to a large measure, educational, for which the practitioner has not the time, nor in many cases the inclination, especially to deal with large numbers. Administrative difficulties are multitudinous, and the question of reasonable economy with efficiency must be considered. The plea of continuity of medical care can be met by interavailabilitv of records, and the fact that two minds bearing on any problem is better than one. (c) Consultant Services. The Council's Consultant Obstetrician is available for Ante-natal, Intra-natal and Post-natal cases, but it is a fact that more use might be made of his services. He was called into the Borough on only two occasions during 1937. Many cases are referred for an opinion to the London Maternity Hospitals, but it will need to be considered whether these journeys which cannot be too comfortable for a mother advanced in pregnancy, should not be avoided bv arranging a periodical clinic held in the Borough by the consultant to which any difficult case may be referred, also whether a further consultant might not be appointed, who is on the staff of the City of London Maternity Hospital with which institution the Council has an arrangement for admission of difficult ante- or intra-natal cases. (d) The provision of an Obstetrical Flying Squad as suggested in the Circular is still receiving attention. (e) Maternity Accommodation. With the provision of the new Home, the arrangements with the City of London Maternity Hospital and Queen Charlotte's Hospital (for septic cases) and the availability of the County Hospital, the Council has a complete scheme. The growth of the Borough and surrounding are:is may, in the near future, warrant a Maternity Hospital and the new Home both in position, site and administrative offices, is ideally fitted to form the nucleus of such a hospital. The use of the new Home has exceeded expectations, and by December was booked to full capacity of use, and since then it has been impossible to book other than residents of the Borough, and now occasional applicants, residents of the Borough, have to be refused admission. Primarily a Home should be available for mothers having their first baby, for mothers whose homes are unsuitable for confinement, and mothers having other than 25 the first baby where the first labour has indicated the need for confinement! under Home conditions. So far applications have not been sifted with these conditions in mind, but it may be necessary to do so before the provision of more beds is considered. On the other hand, it is becoming' more and more evident that mothers in this Borough (in common with London and Greater London, at least), do prefer to be confined under the conditions of a Maternity Home or Hospital. (f) Ante-natal Clinics. With the appointment of an Assistant Medical Officer, the number of Ante-natal Sessions weekly was increased from two to four with five in alternative weeks, and the attendances have averaged 14 per session. (g) Post-natal Clinic. A Post-natal Session is held at the Maternity Home not only for mothers who have been confined there, but for others also. This clinic was commenced in November, 1937, and the number attending was 36. This lias continued to grow in a very pleasing fashion. (h) Nutrition. Milk foods, etc., are available for purchase at cost price at the ante-natal clinics, but little use has been made of this provision, but: increasing: education of the mothers will remedy this defect. During the year the Council made milk available in necessitous cases to mothers throughout the whole of pregnancy, instead of during the last three months, as formerly. A more generous scale was also adopted. S'uch provision is admirable and the Health Visitors and Midwives bring to the notice of expectant mothers the facilities which are available. (i) Home Helps. Thin%ervice, introduced in 1936, has continued to grow slowly and during the year nine applications were approved, and nine homes were attended covering a period of 126 days. (j) Dental Treatment. No facilities for dental care are available through the Corporation, but the urgency of the need for this service has been appreciated and a service will come into operation in 1938. 26 (k) Education. A commencement of this service was made during 19.37, and the Health Visitors using models and display garments demonstrate to mothers at each ante-natal Session. The eagerness of mothers 10 learn is very apparent, and this side of ante-natal clinic work is regarded as not the least important. (1) X-ray Facilities. Mothers are referred to Outpatient departments of general Hospitals for reports, and no difficulty has been experienced in obtaining full us^ of this facility. (m) Ambulance. The Council's service is available for use in this connection. (n) Ultra-Violet Light Treatment. The use of artificial sunshine is limited in connection with Maternity services, but when the treatment becomes available through the Council's scheme full use will be made of it. (o) Domiciliary Midwifery Services. Kent County Council continue to be the Local Supervising Authority for this area. Further consideration of Bexley's application to be a Local Supervising Authority stands deferred until the effect of a year's working of the new Home on the number of domiciliary confinements has been ascertained. Despite the urgent pleadings of Bexley to be allowed to carry out the appropriate provisions of the Midwives Act, 1930, for them, the County Council itself elected to provide and maintain a domiciliary midwifery service. The Council then decided to give every assistance by administrative co-operation in this connection, although it is still maintained that such work would be more effectively done as a local service. The County Council appointed seven full-time salaried midwives to serve in the Borough, and their cooperation in securing attendance of expectant mothers at the ante-natal clinics, or to a doctor, has been noticed, but further educative stimulation is required (2) (a) INSTITUTIONAL PROVISION FOR MOTHERS. Old Maternity Home. The opportunity is taken here, for purposes of record, of setting out the annual admissions, etc., from the dale of opening to closing of the old Home. 27  Year. Cases Admitted. Infant Deaths. nal Deaths. 1921 62 2 1 1922 79 6 1 1923 69 3 — 1924 52 0 — 1925 65 2 — 1920 97 2 — 1927 113 2 — 1928 123 3 1 1929 125 3 — 1930 158 2 — 1931 155 3 — 1932 153 5 — 1933 160 4 — 1934 152 3 — 1935 185 4 — 1936 163 4 1 1937 63 0 — Total 1974 47 5 The accommodation consisted of three two-bedded wards, labour ward, office used as dining room, ante-natal room, kitchen, .scullery, Matron's bedroom and sitting room, tfwo bedrooms for nurses, and one bedroom for tw>> maids. The house was not built for the purpose, and after its many years of useful work, had proved to be too small and unsuited for its purpose. Since closing, two upper floors have been let off as a maisonette, and the ground floor accommodation reserved for purposes in connection with the expansion of the Welfare Services. New Home. This was officially opened on the 22nd May, 1937, by Councillor Mrs. Whomack, a member of the Health Committee, and the first patient received on the 24th May, 1937. The cost of the building was approximately £31,000 and of furniture and equipment £2,350. There is accommodation for twenty-four patients and an isolation block of two beds. The site is approximately five acres in area, and is bounded on the northern and eastern sides by Bursted Wood, one of t'he Council's open spaces at the northeastern corner of the district. It has an altitude of 28 proximately 160 feet above sea level, and is served by two easy means of access, one from Lavernock Road oil the western boundary and one from the main Erith Road on the eastern boundary. The buildings are set back from the south boundary a distance of approximately 185 feet- to the frontage line, thereby providing space in front for a forecourt and laidout gardens, and at the same time guarding the patients from disturbance by noise from the railway, which is on the southern side. The area of ground at' the rear of the buildings is reserved for a kitchen garden. The scheme provides one main ward and administrative block, a laundry block and an isolation unit. The main ward !and administrative building comprises the following accommodation on the around floor: — Nursery (25ft. x 16ft.). Babies' bathroom (12ft. x 10ft.). 1 wo three-bedded wards Two four-bedded wards Four two-bedded wards Two single-bed wards Total 24 beds. Two duty rooms. Doctors' room. Office. Receiving room. Visitors' room. Ante-natal Clinic. Bath rooms, sluice rooms, lavatories, milk store, linen store, etc. In a separate block, approached by a communicating corridor, are two labour rooms, 10ft. x 14ft., and 15ft. x 13ft. respectively, with sterilising room and sluice room, and in a further wing is the kitchen, which is approximately 24ft. 6in. x 20ft.., with larder and stores. Living accommodation for the staff is situated on the first floor, and includes the following: — Staff dining room (25ft. Gin. x 16ft. 3in.). Nurses' sitting room (18ft. x 14ft.). Maids' dining room (16ft. x 12ft.). Matron's sitting room, bedroom and bathroom. Sisters' sitting room. Two bed looms for sisters. 29 Nine bedrooms for nurses. Six bedrooms for maids. Bathroom and lavatory accommodation and storage space and " service " for meals served l.y a lift from the kitchen on the ground floor. The laundry building provides a garage 18ft x 14ft., post mortem and view room, and a laundry 18ft x lift., and the isolation unit provides accommodation for two isolation wards, with duty room, hath and lavatory accommodation, sluice room, etc., on the ground floor, with the boiler attendant's quarters on the first floor. The buildings are constructed of solid brick walls faced with multi-coloured bricks and artificial stone dressings, with a steel framed and pantiled roof. Th'» floors to the ground, and first floors are of fire-resisting construction throughout, and the flat roofs over the projecting wings are also of fire-resisting construction, insulated and covered with asphalt. The floors and ceilings are also insulated to minimise the passage of sound from the administrative quarters to the wards. The windows are of steel construction and of special hospital pattern throughout. Internally the buildings are finished with smooth and dust-free surfaces. The ward floors are finished in hardwood blocks and the corridor floors in cork tiling, while the labour rooms, kitchen, bathrooms, sluice rooms, etc., are paved with terrazzo flooring. The flooring of xhe bedrooms and principal rooms on the first floor are also finished in hardwood blocks. The ward walls are plastered in hard plastei and painted, and in corridors, bathrooms, sluice rooms, kitchen, etc., the walls are similarly treated above a terrazzo dado. The walls of the labour rooms are finished in terrazzo for the full height of the rooms. The doors throughout are of flush hospital pattern finished in alder wood and painted. The buildings are centrally Jieated by means of a fully automatic oil-fired boiler installation, providing low pressure hot water to hospital pattern radiators in .ill looms and corridors. A steam oil-fired boiler is provided which supplies steam for the sterilising units, together with a calorifier which supplies constant hot water to all baths, lavatories, etc. The heating plant is situated in u heating chamber in a basement under the kitchen. 30 A complete sterilising plant) is provided in a room adjacent to the labour rooms. It comprises a mattress and dressing- steriliser, howl steriliser and instrument steriliser; in addition there is a combined bed pan washer and steriliser in each sluice room. The whole of the sterilising units are operated by steam supplied by the steam boiler. The kitchen is completely equipped for gas cooking; it has steam operated hot closets and a steam vegetable boiler, with an electrical refrigerator in one of the larders. The buildings are provided with electrical lightiag augmented by an emergency lighting battery plant which automatically provides artificial light in the labour rooms in the event of a failure in the electrical system. The installation also provides for electric heating in all rooms and corridors as a supplementary system to the central heating. Points are also provided for electric fans, sweepers, cleaners, etc. Each ward and the principal staff rooms are wired for wireless; loudspeakers and electric synchronised clocks are provided in the most advantageous positions. A system of electric bells links up all the wards with the duty rooms and the kitchen and staff rooms. The home is furnished and equipped on lines in ke&ping with the modern ideas incorporated in the building, with a view both to the efficient working of the home and the comfort of patients and staff. The home is administered by the Medical Officer of Health as the Medical Superintendent. Any mother may arrange for her own doctor to attend her in the home or for the nursing staff to attend her, and there is a medical officer who assists the Medical Superintendent, and who can be called to a patient who has not arranged for a private doctor. The Council's Obstetric Consultant acts as consultant to the home, and is available where necessary for all patients. To overcome difficulties of transport arising from the situation of the home in one corner of the district, the Council's Ambulance may be booked to take the patient to the home by the payment of 5s. at the time of booking. Further, mothers are able to attend any of the Council's ante-natal clinics for their examinations, saving the longer journey to the home where necessary, 31 32 but all examinations at the 36th week of pregnancy ore done at the Home so that the patients and staff become acquainted, and the staff have an opportunity of examining the mothers they will deliver. The new home is used for expected normal confinements only, and to form a complete scheme to accommodate other mothers the Council made an agreement with the Citv of London Maternity Hospital for admission of abnormal ante- or intra-natal cases. The nursing staff at the end of the year when the Home was being used to capacity consisted of: — Matron. 2 Sisters. 6 Staff Nurses. 1 Staff Midwife. 1 Assistant Nurse. and domestic staff: — 1 Cook. 1 Housemaid. 2 Ward Maids. 1 Kitchenmaid. 1 Boilerman-Porter. 1 Seamstress—part time 1 Laundry woman. 1 Charwoman. There was extreme difficulty in obtaining staff nurses (State Registered Nurses with Central Midwives Boatd Certificate), as is common throughout the country in lioth small and large hospitals, and it is hoped that if the Home becomes a Part II Training School under the new rules of the Central Midwives Board, this difficulty will be overcome. Statistics. No. of patients in Home 1st January, 1937 Nil No. of patients admitted during 1937 216 No. of patients discharged during 1937 193 No. of patients died during 1937 Nil 33 No. remaining 31st December, 1937 £3 No. of patient days . 2995 Average duration of stay 14.02 days No. of cases delivered by nursing staff (midwives) 175 No. of cases delivered by doctors 41 No. of primiparac 140 No. of multipara! 76 Twin pregnancies 6 No. of calls on Consultant—ante-natal Nil intra-natal Nil post-natal 1 No. of cases in which medical assistance was sought 56 No. of cases notified as: — (a) Puerperal fever Nil (b) Puerperal pyrexia 3 No. of cases of ophthalmia neonatorum Nil No. of cases of pemphigus neonatorum Nil No. of maternal deaths Nil No. of infant deaths 2 Causes—(1) Convulsions, prematurity (2) Broncho pneumonia, atelectasis of lungs No. of stillbirths 6 Causes—(1) Cord round neck (2) Anencephalic (3) Instrumental delivery (4) Breech with extended legs (5) Unknown (6) Premature No. of cases sent to other Hospitals: — Ante-natal 15 Early intra-natal 6 Post-natal 1 No. of Borough cases 188 No. of Out-district cases 28 No. of practitioners private booked cases 28 Forceps rate 8.3% 34 Feeding. Breast alone . 183 Breast supplemented by artificial food 32 Artificial food alone 1 No. of babies born (including twins) 222 (b) OTHER INSTITUTIONAL PROVISION FOR MOTHERS AND CHILDREN. No provision is made bv the Council for children. One case was sent to Queen Charlotte's Hospital foi treatment of a septic puerperal condition through the Council's scheme. (iii) Health Visitors and Climes. A further Health Visitor (bringing the total to five) was appointed during the year in order that the minimum quarterly visits to children under one, and half yearly visits to children over one could be maintained in view of the decrease in time available for visiting as a result of increased clinic sessions. The practice of sending one Health Visitor each year to the Winter School for Health Visitors held by the Women Public Health (Iffieer's Association over nine days has been continued. The number of visits made by the Health Visitors is shown in the table. The total number of visits was 12.645, including visits to ante-natal mothers. Ante-natal Sessions. Bexleyheath—301 mothers made 1,233 attendances. Welling —204 mothers made 672 attendances. Maternity Home, Broadway—63 mothers made 307 attendances. Maternity Home, Lavernock Road—41 mothers made all their attendances at the home. The total visits of mothers to be admitted was 633. 35 Infant and Child Welfare Sessions. Bexleyheath. Total number of attendances: — (a) By children under one year of age 525G (b) By children between one and five years 201T Average attendance 76 Numbei of children attending for the firsttime: Under one yeai of age 383 Between one and five years 120 Number of children medically examined 2072 Welling. Total number of attendances: — (a) By children under one year of age 6169 (b) By children between one and five years 3274 Average attendance 68 Numbei' of children attending for the first time: Under one year of age 473 Between one and five 144 Number of children medically examined 1863 These numbers do not include children who have previously attended a Centre in another district. The Welling Clinic was enlarged during the year providing additionally a toddlers' room, and a nurses' consultation room. The work at the clinics could not have been maintained in view of the large number of children attending but for the help given by Voluntary workers, an! our thanks are hereby expressed. Bexley. The building of the new Clinic at Bexley, in Murchison Avenue was commenced during the year, and opened early in 1938. Births (Registered). 1937 1936 1935 1934 Live births 1,319 1,282 1,045 819 Still births 53 42 27 25 36 The number of births notified from institutions was 701, bv midwives 543, and by parents and doctors, etc. 76. (iv) Assisted Milk Supply. During the year, the number of expectant mothers and children supplied with milk free or at half cost was 177, at a cost of £460 approximately. With the increase in the number of the Health Visitors, and more frequent visits, more children and mothers are found who are in need of assisted milk. The Council's scheme for assisted milk supply was considered during the year in the light of the Ministry's Circular 1519, and as a result a more generous scale was adopted, and the scheme extended l> include children up to the age of five. Where there are two or more children under the age of five in a family twice the amount of milk is allowed. 13,4541bs. of dried milk were supplied at slightly over cost price for infants attending the Centres. Virol and Cod Liver Oil to the ox tent of l,6531bs were also sold. (v) Dental Treatment. Children requiring dental treatment are referred to the School Dental Clinics maintained by the Kent County Council. The Bexley Council pays for the requisite treatment supplied. During the year 92 children under the age of five years were referred for treatment. (vi) Orthopaedic Treatment. The Council has an arrangement with the Kent County Council whereby children under the age of five \ears can attend for consultation and treatment at the Dartford Clinic, held at the County Hospital, Dartford. Sunlight treatment, massage and remedial exercises are also available for appropriate cases suffering from Orthopaedic defects. Seventy-five children attended for the first tinin during 1937 and also made subsequent attendances. 13 children who were previously on the Register also attended. No children were referred for in-patient treatment. 37 (vii) Child Life Protection. Your Health Visitors are appointed Child Life Protection Visitors under the Public Health Act, 19-36. The children under nine years of age who are nursed for reward or gain, are periodically visited in their respective homes. The particulars regarding the number of foster parents and nurse children on the Council's Register are as follows : — Number of foster parents:- (a) At the beginning of the year 61 (b) At the end of the year 54 Number of children : (a) At the beginning of the year 73 (b) At t'he end of the year 70 (viii) Records. It has always been the custom to forward copies of records to the Medical department of the Local Education Authority, and in order to obtain further co-operation as outlined in the Ministry's Circular of 1936 on the Health of the Pre-School Child, the principle of correlating the local Welfare Services with those of the rest of the County has been adopted and it has been agreed that so far as possible similar provisions and arrangements will be made throughout the county. (ix) Maternity Outfits. During the year a scheme was approved to provide a maternity bag and/or a sterilised outfit in tlie case of domiciliary confinements at a charge of 5s. each or less, according to circumstances. Articles of wear and bed linen are required to be returned after the confinement. Three sterilised outfits were loaned during the ye tr, all issued free. (x) Compensation for loss of case. A scheme was approved in 1937, whereby a midwife could be compensated to the extent of ten shillings and sixpence for loss of a booked case by a patient being sent to hospital from an ante-natal clinic. No such cases were dealt with during the year. 38 39 MATERNITY AND CHILD WELFARE WORK DONE. Year Live Births Still Births No. of Health Visitors Visits made to:— Centres (Children) Centres (Antenatal) Expectant Mothers Children under 1 Children 1 to 5 No. of Attendances First Attenders % of Births Attendances No. of Expectant Mothers % of Births First Total First Total Under 1 1 to 5 Under 1 1 to 5 1930 427 12 2 133 216 515 2805 3683 4144 1976 278 70 65.1 957 200 45.5 1931 516 18 2 100 206 561 3318 3565 4812 1921 361 96 69.9 944 242 45.3 1932 608 15 2 107 238 613 3095 3716 5595 2159 377 92 62 1085 231 37 1933 694 23 2 118 245 705 2913 3795 5775 2028 473 102 68.1 1282 242 33 1934 819 34 2 124 232 827 3861 5014 6881 2879 495 150 60.4 1300 268 31.4 1935 1045 27 2 104 191 1070 3945 3809 9414 2502 571 55 54.6 1468 291 27.1 1936 1282 42 *4 127 224 1237 4751 6882 11315 3768 546 95 58.1 1444 275 22.1 1937 1319 53 †5 579 686 1233 5143 6816 ‡11337 ‡5215 848 272 66.5 2538 546 43.4 * 2 for 2/rds. of year. † 4 for 2/3rds. of year. ‡These figures relate to children attending and do not include visits to collect food for a child as in previous years. The table of Maternity and Child Welfare work done is included to show the expansion of work under Welfare Services with the growth of the child population. The increase in the number of Health Visitors was belated as compared with the number of births, but has now been remedied and its effect in visit's and clinic attenders is seen in the later columns of the table. A very pleasing feature is the increased visitation to expectant mothers when advice so urgently needed by mothers at this time can be given. I have no doubt that a bigger proportion of expectant mothers will be visited in future years, but as many mothers from this area are confined in London Institutions, this department does not know of the cases, and so 100 per cent visiting cannot be obtained. Some of the London Institutions do notify bookings, and obtain a report from the Health Visitors and this arrangement is encouraged. . The number of expectant mothers attending the Centres expressed as a percentage of the births shows an increase, and is partly due to the fact that not so many women desiring institutional confinement have had to go out of the Borough with the opening of the new Maternity Home. This percentage should also show a further increase with the operation of the new Midwives Act, and the further encouragement', by midwives, of mothers to receive ante-natal care under a doctor. The percentage in this area will never reach 100 as many mothers being confined in outside institutions receive ante-natal care at that institution, and are not shown in our figures. The reorganisation of visiting, so that visits to children aged 1-5 are now not less frequent than six monthly, first becomes evident in the figure for 1936 and is continued. There is also a better attendance of these children at the clinics, but as more frequent sessions are now held, and by more encouragement this figure should show a further increase in future years. 40 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. 1. List of Adoptive Acts, etc., in force. Acts. DATE ADOPTED Public Health Acts (Amendment) Act, 1890, Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 Private Street Works Act, 1892 Jan. 1899 Public Health Acts Amendment Act, 1907, Parts 8 and 9 Apr. 1909 Part 2—the whole May 1909 ,, 4—Sees. 53 and 54 „ 6—the whole ,, 10—Sec. 95 Public Libraries Act, 1892-1919 Oct. 1893 Local Government and Other Officers Superannuation Act, 1922 June 1932 Slaughter of Animals Act, 1933 Jan. 1934 Public Health Act, 1925, Part 2 Jan. 1926 Bye-laws. Cleansing of Earth Closets and Cesspools Jan. 1883 Common Lodging Houses Oct. 1900 Hop Pickers' and Fruit Pickers' Lodgings Oct. 1900 Nuisances and Cleansing of Privies Nov.1901 Nuisances, Removal of Offensive and Noxious Matters Dec. 1907 Nuisances Sept. 1912 Tents, Vans, Sheds and Similar Structures June 1926 Offensive Trades (Fish Frying) Dec. 1923 Parks and Pleasure Grounds June 1926 Lodging Houses (Housing Act, 1925) Sec. 6 Jan. 1927 New Streets and Buildings May 1927 New Streets and Buildings Dec. 1931 Slaughterhouses Mar. 1934 41 (i) Water Supply, The district is supplied with water by the Metropolitan Water Board, and during the year a good aNd constant supply has been provided. I am informed by the Clerk of the Metropolitan Water Board that "No new sources of water supply have been introduced in connection with the Borough of Bexley during the year 1937. Approximately 9,390 yards of water mains were laid in the Borough during the year." "The wells from which the supply has been derived have all provided excellent results during the year, and all samples have yielded only three typical bact. coli in the year, which is proof of the highest purity and reliability. There has been 110 evidence of contamination in any of the wells which furnished the supply and no treatment has been installed." Examination of samples of water from piped supplies to houses in the district have been made with the following results:— Bacteriological. No. of organisms per c.c. capable of B. Coli of growth on agar at presumptive 37° C. 22° C. 0-9 2-44 Absent in 100 c.c.'s Chemical (parts per 100,000). Total Ammonia Nitrogen Oxygen Absorbed solid Chlorine Free Albuminoid. as ¼ hr. 4 hrs. at Nitrites. residue. Nitrites. at 80°F. 80°F. 37.5-42 2.8-2.9 0.0 0.0 0.2-0.3 0.009 0.015 absent -0.065 -0.122 The only remaining houses in the Borough where the water is not led by a pipe to a tap inside were the subject of demolition orders during the year. 42 (ii) Rivers and Streams. It was unnecessary to take any action with regard to the pollution of the rivers and streams. On the 1st of April, 1937, the Kent: Rivers Catchment Board took over the control of the Rivers Cray and Shuttle and are now responsible for their maintenance. 2. Drainage and Sewerage. With a few exceptions, the Council's sewers are connected with those of the West Kent Sewerage Board, and the sewage is disposed of at that Authorities Disposal Works at Joyce Green, Dartford. The exceptions are certain low lying properties situated in Wickham Lane. The sewage from these properties is dealt with by the London County Council's sewers. During 1937, approximately 4½ miles of roads and 10 miles of Foul and Surface Water Sewers have been constructed by private enterprise. In addition the Council has completed two schemes this year to relieve surcharging and flooding of foul and surface water sewers on the Falconwood Estate. A Contract is at present being carried out at an estimated cost of £28,500, which when completed will be a great improvement in the foul drainage facilities of the Borough. This scheme includes a Pumping Station at East Wickham, which will enable the East Wickham valley to be sewered, and also part of Stevens Estate. The course of the sewer is from this valley to Tanyard Lane, Bexley, through Upper Wickham Lane and Danson Park. The Woolwich Borough Council in conjunction with this Authority are constructing a surface water sewer in Upper Wickham Lane for the drainage of this road, Lodge Hill, part of Stevens Estate and the Hutments site. Projected Schemes for 1938 include a surface water sewer through the new tip site at East Wickham, a new foul sewer along Rochester Way and several sewerage schemes throughout the district. (i) Closet Accommodation. All the closet accommodation in the district is on the water carriage system. 43 (ii) Public Cleansing. House refuse from the Borough continues to be tipped at Bursted Wood in accordance with the Bradford system. During the year preparations were commenced in order that the proposed site at East Wickham would be ready during 1938 for an additional tip. (iii) and (iv) Sanitary Inspection of the Area and Shops. This matter is dealt with in the report of the Chief Sanitary Inspector. CHIEF SANITARY INSPECTOR'S REPORT. Health Department, 14, Brampton lload, Bexleyheath. To the Mayor, Aldermen and Councillors of the Borough of Bexley. Ladies and Gentlemen, I submit herewith my Twenty-third Annual Report as Sanitary Inspector to your Council, being for the year 1937. The report consists, as on former occasions, of a tabulated record of the work carried out. TABLE No. 1. Number of complaints received and investigated 43.3 ,, Statutory Notices served 15 ,, Statutory Notices complied with 6 ,, Informal notices, letters, etc. 578 44 TABLE No. 2. Details of Inspection Work carried out during the year. Number of. Inspec- Re-intions spections Houses Inspected Housing Acts (all particulars recorded) 390 701 Houses Inspected (defects only recorded) 88 325 Houses Inspected (Housing Act, 1930, Overcrowding) 401 07 Houses Inspected re Infectious Disease 324 7 Inspections—Factory and Workshops 147 2 Outworkers 94 — Schools 0 — Refuse Tips 270 — Van Dwellers 6 — Bakehouses 48 28 Slaughterhouses 935 — Meat Shops and Premises where food is prepared 1389 — Cowsheds and Dairies 07 10 Common Lodging House 15 — re offensive Accumulations 102 92 re Keeping of Animals 38 20 re Rats 138 132 re offensive Trades 87 14 re Verminous Premises 59 82 Drains Inspected 4S1 585 Drains Tested (Water, Smoke or Grenade) 219 — Housing Estate Visits— Inspections 408 — Re-inspections — 1215 Miscellaneous Visits 1303 — Miscellaneous Inspections (including Refuse Removal, Conveniences) 2254 — 45 TABLE No. 3. Improvements effected and defective sanitary conditions remedied. Houses— With Notice Without Notice Provided with sufficient W.C. accommodation l 219 Provided with sufficient ashplace accommodation — 175 Houses improved internally— Dirty rooms cleansed 7 248 Walls and ceilings repaired 4 123 Dampness in rooms remedied 4 99 Defective floors repaired 1 26 Ventilation of rooms improved 2 47 Windows repaired 3 126 Coppers repaired 1 19 Stoves, fireplaces, etc., provided or repaired 1 56 Houses improved externally— Roofs repaired 2 55 Eaves, gutters and down spouts fixed or repaired 2 44 Yards paved or repaired 1 24 Yards cleansed — 8 Chimney stacks rebuilt or repaired — 18 Walls repointed or repaired — 119 Miscellaneous repairs 2 83 Drainage— Drains cleansed or repaired 3 394 New drains constructed 1 8 New gullies provided — 2 Ventilation of drainage system proved 2 25 Inspection chambers built or improved — 29 Waste pipes provided or improved 1 110 offensive accumulations removed — 58 Nuisances from animals abated — 2 Tents, Vans and Sheds, nuisances abated — — Other nuisances abated — 121 46 TABLE No. 4. Infectious Disease— Cases removed to Isolation Hospitals 208 Houses visited including revisits 331 Rooms disinfected 311 Notices delivered to Educational Authorities, Royal Factories, etc. 772 Houses at which defective sanitary conditions were found and remedied 4 TABLE No. 5. Food Inspection. 4.962 carcases were inspected during the time of or after slaughter as follows:— Cattle 147 Sheep and Lambs 957 Pigs 3,621 Calves 237 Total 4,902 The following are the details of food condemned within the district during the year as being unfit for human consumption:— Tuberculosis. Animals Affected. No. of Entire Carcases. Condemnations. Parts of Carcases. or Organs. Weight in lbs. Cattle — 10 136 Sheep — — — Pigs 2 304 2,391 Calves 2 — 324 Total weight 2,851 Diseases other than Tuberculosis. Cattle — 9 92 Sheep 4 1 81 Pigs 11 195 1,204 Calves 1 — 35 Total weight 1,412 3011bs. of Shrimps; 1741bs. of Chilled beef; and 401bs. of Fish were also condemned. 47 TABLE NO. 6. FACTORY AND WORKSHOP ACT, 1901. 1. Inspection of Factories, Workshops, and Workplaces. Premises. Number of:— Inspections. Written Notices. Prosecutions. I 2 3 4 Factories (including Factory Laundries) 98 8 — Workshops ( ,, Workshop „ ) 221 — — Workplaces (other than Outworkers' premises) — — — Total 319 8 — 2. Defects found in Factories, Workshops and Workplaces. Particulars- Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. I 2 3 4 5[/##] Nuisances under the Public Health Acts— Want of Cleanliness 23 18 — — „ ,, Ventilation — — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances Sanitary Accommodation — 6 6 Insufficient — — — — Unsuitable or defective 4 2 — — Not separate for sexes — — Offences under the Factory and Workshop Acts — Illegal occupation of underground bakehouse — — — — Other Offences — — — — Total 33 26 — — 48 SHOPS ACTS, 1912 to 1936. The following Closing Orders are in operation within the area:— Bexley Urban District (Butchers) No. 6 Order, 1920. Bexley Urban District (Grocers and Provision Merchants) No. 7 Order, 1923. Bexley Urban District (Miscellaneous Trades) No. 8 Order, 1923. Approximately 750 shops in the district were on the Council's Register at the end of the year. During the year inspections were made as follows:— Inspections. Reinspections. Shops Acts, 1912-36 1,363 953 Several warnings were given re contraventions of the above Acts, but in no cases were legal proceedings taken. 1 am, Ladies and Gentlemen, Yours obediently, R. J. RAYNER, Chief Sanitary inspector. (v) Smoke Abatement. Observations of the few factory chimneys within the area have been made, but in no case has a report been made to the Council of a contravention of the Public Health (Smoke Abatement) Act, 1926, or the Public Health Act, 1936. A few complaints have been received in the Department with respect to two chimneys in commercial areas bordering on residential areas, but these have been dealt with in the main, by use of appropriate fuel and improved methods of stoking. (vi) Swimming Pool. The only swimming pool in tlie area open to the public is in Danson Park and is owned by the Council. The scheme actually includes three open-air pools, one large 49 pool, a smaller one for children and another for paddling. The water is kept- pure hy restricting entry to the main pool except through foot baths, and the modern system of purification by circulation of water through filters, automatic treatment with chlorine and ammonia gas and final oxygenation in the heating chamber and the cascade. Samples of water have been taken by this Department from time to time, and the results of bacteriological examination have been satisfactory on each occasion. Results. No. of organisms per c.c. capable of B. Coli growing on agar at (presumptive) -37° C. 22° C. Deep end 0 0-15 Absent in Shallow end 0-1 0-2 100 c.c.'s (vii) Eradication of Bed Bugs. For tenants removed from houses which are the subject of Demolition Orders, to Council Estates, the Council has resolved to disinfest the furniture. The work is carried out by a contractor and hydrogen cyanide gas is used. Although the use of this gas under the precautions taken is probably safe, a gas fatal to the bug, but harmless to man is needed and it appears from recent experiments that we may not have much longer to wait before such a gas will he found and proven efficient. The Council has also resolved that where houses to be demolished under the Housing Acts are found to be infested, they shall be disinfested where possible. Pending the production of a more suitable substitute, hydrogen cyanide will be used and the work done by a contractor. Where Council houses are found to be infested, the skirting boards, picture rails and architraves, and other similar woodwork, are stripped from the walls and these places treated with a blow lamp, and after sealing the rooms the house is treated with sulphur dioxide vapour. The house is similarly treated after 14 days. In some cases one treatment has been reported to be efficient. This method has been found to be fairly successful, but it is cumbersome and expensive and can only be properlv done when the house is vacant. This work 50 is done by workmen employed in the general maintenance of the Council houses under the general superintendence of the Chief Sanitary Inspector. Proprietary articles have been tried with only relatively good results. Privately owned houses are not generally treated, the tenant and owner being advised by the Staff of the Health Department. In a few instances, however, for a fee the Housing Staff undertake disinfestation on the lines indicated above. No. of Council houses No. of other houses infested with bugs 6 infested with bugs 4 Disinfested c6 Disinfested 4 Result: Good. Result: Good. In cases of mild infestation only, it has been found that fumigation of one or more rooms (in some instances once only), has been sufficient to obtain good results and to clear the house of vermin. Council Houses Other Houses. Three rooms only 6 One room only 4 Two rooms only 7 One room only 3 19 families were transferred from properties to be demolished and their furniture, etc., was disinfested by HCN in vans by a contractor. Visits by the Sanitary Inspectors are made at intervals after disinfestation to determine whether the treatment has been efficacious, and to instruct the tenant how to maintain freedom from vermin. SCHOOLS. There are now 27 Elementary Schools and a day Technical School for Girls in the Borough, and the sanitary conditions are satisfactory. Some pressure on the accommodation at Brampton Road Council School has occurred pending the erection of a proposed new Church School at Welling. During the year it was not found to be necessary to close any school for infectious disease, under the procedure outlined in the Memorandum of 1927. 51 Section D. HOUSING. The following particulars relate to the houses built by the Council on the various Estates. Welling— Welling Estate 428 houses East Wickham— Glenmore Road 24 houses Bexleyheath— Highland Road Estate 88 houses Pickford Road Estate 216 houses Pickford Road Estate 50 bungalows Bexley— Hartford Road Estate 18 houses Victoria Road Estate 36 houses Total 860 Statistics for 1937. Total number of new houses erected during the year 1373 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses spected for housing defects (under Public Health or Housing Acts) 484 (b) Number of inspections made for the purpose 1570 (2) (a) Number of dwelling-houses cluded under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 396 (b) Number of inspections made for the purpose 1157 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 294 52 (4) Number of dwelling-houses sive of those referred to under the preceding sub-head) found not to be in all respects, reasonably fit for human habitation 190 2. Remedy of Defects during the Year without Service of Formal Notice. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 121 3. Action under Statutory Powers during the Year. A. Proceedings under Sections 9, 10, and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 10 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 2 (b) By local authority in default of owners — B. Proceedings under Public Health Acts — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 4 (b) By local authority in default of owners — C. Proceedings under Sections 11 and 13 of Housing Act, 1936:— (1) Number of dwelling-bouses in respect of which Demolition Orders were made 61 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 23 53 (3) Number of houses made fit. in pursuance of undertakings given 1 1). Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — (3) Number of separate tenements in respect of which undertakings to make fit were accepted 1 4. Housing Act, 1936—Part IV—Overcrowding. A. 1936 1937 (1) Number of dwellings overcrowded at the end of the year 89 45 (2) Number of families dwelling therein 89 45 (3) Number of persons dwelling therein 496½ 320½ B. Number of new cases of overcrowding reported during the year 8 7 C. (1) Number of cases of overcrowding during the year relieved 23 51 (2) Number of persons concerned in such cases 158 375 D. Any cases in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil Nil Housing—Overcrowding. The 45 outstanding cases of overcrowding are receiving the attention of the Housing Committee and 96 houses (including bungalows for aged persons) are 54 to be erected at Glenmore Road, East Wickham, to accommodate families displaced from houses which are the subject of demolition orders, and to offer accommodation to certain overcrowded families. The particulars of ownership of overcrowded dwellings and the comparison with 1936 is shown in the following tahle:— Owners. No. of overcrowded dwellings. Jan. 31st, 1936. Dec. 31st, 1937. Owner occupiers 16 6 Welling Hutments 20 12 Corporation 31 8 Private owners 37 19* * Eight of these houses are the subject of demolition orders. Housing—General. I reported last year that a solution for the problem of the wooden hutments erected by the Government 1914-18 was nearly in sight. This solution was that the owner of the. bulk of them proposed to re-develope and erect permanent structures. Unfortunately this proposal did not mature, and the Council decided to proceed under the Housing Act, 1936, by means of the clearance and compulsory purchase provisions following representations by myself. The resolutions adopted by the Council during 1937 covered the following:— Bexley (Lodge Lane Hutments) Clearance Area, 1937 : 294 Hutments Bexley (East Wickham Hutments) Clearance Area No. 1, 1937 : 154 Hutments. Bexley (East Wickham Hutments) Clearance Area No. 2, 1937: 85 Hutments.. Bexley (East Wickham Hutments) Clearance Area No. 3, 1937: 71 Hutments. An additional temporary Sanitary Inspector and additional clerical assistance were appointed in November, 1937, to assist in the preliminary work involved in preparation of necessary records. 55 Section E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The milk retailed for consumption in the area is railborne, pasteurised and bottled except for one small supply by a producer retailer. Licences granted by the Council during 19.37 under the Milk (Special Designations) Order, 193fi, are as follows:— For the sale of:— Pasteurised Milk 19 licences " Tuberculin Tested " Milk 12 licences There are now only two cowsheds in the district, and they are periodically inspected by the Sanitary Inspectors. The Council's Veterinary Inspector examines all the cows in the district and reports every month. Two farms were inspected and reported upon, and no cases of tuberculosis were found. The cleanliness of the milk is good, as judged by bacteriological reports on samples taken both on delivery and at the farms. (b) Meat Inspection. There are six registered and one licensed slaughterhouses in the district. The whole of the animals slaughtered in the district for human consumption are examined at the time of or immediately after slaughter and all meat shops are visited at busy periods of the week. Regular inspections of premises where foodstuffs other than meat are prepared and retailed have also been made. Particulars with regard to the number of animals inspected and meat condemned is shown on Table 5 of the Chief Sanitary Inspector's report. Adulteration of Food. Chemical and Bacteriological Examination of Food. The administration of the Acts of Parliament relating to the above is carried out by the Kent County Council. 56 57 The following' Table gives the particulars concerning the cases of Infectious Disease (other than Tuberculosis) notified in the area during the year. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFIABLE DISEASES (other than tuberculosis) DURING THE YEAR, 1937. DISEASE Total cases notified. CASES NOTIFIED AT ALL AGES—YEARS Cases admitted to Hospital Total Deaths Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Smallpox Scarlet Fever 194 1 4 12 9 1O 112 17 5 16 8 149 2 Diphtheria 59 1 I 3 5 21 13 3 II 1 59 3 Enteric Fever (including Typhoid and Paratyphoid) - Puerperal Fever 1 1 1 Puerperal Pyrexia 10 8 2 10 Pneumonia 41 2 1 3 2 10 2 2 6 3 5 5 44 Encephalitis Lethargica 1 1 1 Acute Poliomyelitis 6 1 1 2 2 6 Ophthalmia Neonatorum 2 2 1 Erysipelas 20 2 1 2 3 4 8 5 Cerebro-spinal Fever - - Dysentery 8 1 1 2 1 2 1 1 1 Totals 342 7 7 16 13 19 148 36 11 45 19 15 6 238 50 Small Pox. No case of Small Pox was notified during the year. Scarlet Fever. During the year there were 194 notified cases of scarlet fever compared with 189 in the previous year. Of these, 143 were treated in Bow Arrow Hospital, 6 at other isolation hospitals and 45 at home. Home isolation continues to he encouraged in the present day mild case where the home conditions are satisfactory and no occupant in the house is directly employed on a dairy farm, or other branch of the milk trade, etc. There were two deaths from scarlet fever, one an unnotified case dying in the County Hospital from nephritis, and, therefore, at some presumably long date after the infection. The other case died from malignant scarlet fever in Bow Arrow Hospital. Return cases from Hospital cases: 3. Return cases from home nursed cases: 1. Average length of stay in Hospital: 58 days. Admitting that the more serious type of cases go to Hospital, one cannot refrain from drawing attention again to the fact: that wherever home isolation is possible scarlet fever patients will be better off nursed at home until cubicle isolation or some similar procedure or preliminary quick typing of cases is adopted for scarlet fever cases admitted to hospital. Diphtheria. Fifty-nine cases were notified as against fifty cases in 193G, but the number of deaths (three) remains the same. Fifty-six were isolated in Bow Arrow Hospital, and three at home. The type of disease is severe and calls for early serum treatment and admission to hospital. The report on a swab m a suspicious case should not be waited for, but serum should be given, or the case sent to hospital. This especially obtains in this area where swabs have to be sent by post to Maidstone, entailing an extra day's delay in obtaining a report. The Health Committee has had under consideration the provision of a local laboratory for dealing with such things as swabs for diphtheria orsranisms and no doubt such facilities are needed, but I 58 should be sorry to see more use made of swabs, as even with a local laboratory, no report could be given in under 15 hours, and with severe diphtheria of the gravis type every hour's delay in the administration of serum means added risk to life. Anti-toxin is supplied free by the Council, and one is pleased to note that the Medical Practitioners use it in the very early stages of the disease. This anti-toxin can be obtained by any Medical Practitioner at the Health Department, 14, Brampton Road, Bexleyheath, during office hours, and after office hours, an emergency supply can be procured from the Bexley Cottage Hospital. 424 swabs were forwarded to the County Laboratory for bacteriological examination. The average length of stay in Isolation Hospitals during 1937 has been as follows: — Diphtheria Patients 42 days Immunisation against Diphtheria. In February 1937 the Council approved a scheme for immunisation against diphtheria and sessions have been held weekly at the Welling Clinic and fortnightly at the Bexleyheath Clinic after child welfare sessions. Yen' little propaganda has been used beyond display of notices at the child welfare clinics, advice by the medical officers and health visitors, and a letter to the parents of children as they become eight months old. The material used has been T.A.M. (Burroughs Wellcome) and three fortnightly injections of 1 c.c. have been given, the reactions noted have been negligible. Smaller doses with four or five injections have been used where a child has a history of asthma, hay fever, etc. Schick testing has not been carried out, and until a simple test is devised which will give better and more information that the Schick, there appears to be no need for its use. Besides involving more pricks for the child to bear, no more information can be given to the parent than one already knows after having given 3x1 c.c. injections of T.A.M. The after history of so many inoculated children throughout the country is now well known, and the fact that one knows that the machinery for production of anti-toxin has been initiated is deemed sufficient. 59 Immunising material is supplied free to private practitioners so that they may inoculate children whose parents wish their own doctor to give the injection, the doctor making his own arrangements with the parents for his fee. The material is provided for children living in the Borough on receipt of the name, age and address of the child. No. of children immunised during 1937 at Clinics. No. immunised by general practitoners. No. who failed to attend for full course. 232 57 5 Enteric Fever. No case was notified during the year. Puerperal Fever and Puerperal Pyrexia. One case of Puerperal Fever was notified during the year and was isolated at Queen Charlotte's Hospital Isoation Block. This case followed a miscarriage, and the patient recovered. Ten cases of puerperal pyrexia were notified during the year as follows:— Isolated at:— Delivered:— British Hospital for Mothers and Babies, Woolwich 3 Same County Hospital Dartford 1 Patients' home Queen Charlotte's 1 Maternity Home, Bexleyheath Maternity Home, Bexleyheath 3 Same War Memorial Hospital, Shooters Hill 1 Same Patient's home 1 Same There were no deaths. 60 It should he noted that, owing to the operation of the Public Health Act, 1936, the number of notified cases of Puerperal Fever relates to the first 39 weeks of the year only. Cases occurring afterwards are classed with Puerperal Pyrexia and included accordingly. Ophthalmia Neonatorum. Two cases were notified during the year. One was mild and nursed at home, the other severe and admitted through the Council's scheme to St. Margaret's L.C.C. Hospital. Both did well and recovered without any injury to the eyes. Measles and Whooping Cough. These diseases are not notifiable in this area, but cases among school children are notified to me by the Head Teachers, and the homes are visited by the Health Visitors to ascertain if there are any children under five in the homes. Inquiries are made as to whether the younger children have had or now have the disease. A report is made, also, on the adequacy of the isolation and nursing of the case if there is 110 doctor in attendance. By this method it is impressed upon the parents that these diseases are dangerous to children under five and that special care is required. 1937 was the non-epidemic year for measles, and only four cases were notified from the schools. There were 110 deaths. I11 preparation for the epidemic year of 1938. the Council agreed to a scheme for the collection of human adult measles serum, and issue for use, by general practitioners, for prevention and alleviation of cases of measles, and to the principle of providing Hospital accommodation for cases of measles (and whooping cough), which could not be nursed at home owing to home difficulties or complications. The completion in the autumn of the cubicle blocks at Bow Arrow Hospital provided the necessary bed accommodation. The nursing associations of the district were also approached to provide home nursing for necessitous cases 61 which might need it, and could appropriately he kept at home. The Bexley Nursing Fund agreed to assist in this matter, and the Corporation pay 1s. per visit for one case, or 6d. per visit per case for more than one case in the home at the same time, where the arrangements are approved by the Medical Officer of Health. 201 cases of whooping cough were notified from the schools and there were two deaths. Both were children under six months of age who developed bronchopneumonia as a complication. Dysentery. One death certified as due to this cause relates to an infant who died in the County Hospital early in the year. The Sonne Dysentery Epidemic. On the 28th of October, a General Practitioner informed me that he was attending, in this district, many cases of acute diarrhoea associated in some cases with vomiting and a slight rise in temperature. The cases recovered after three or four days. I ascertained from other practitioners that similar cases were occurring throughout the whole of the Borough, and on communicating with other areas and the Ministry of Health found that the epidemic was not localised to this Borough, butoccurring throughout the country. General practitioners were written to and asked to supply the Department with the names and addresses of any similar cases for investigation by the Department, and it was suggested that swabs from stools should be sent for bacteriological examination. The practitioners responded and in all 68 cases were investigated by the Department, and 34 stools were sent for examination. The number of cases in the district was probably many hundreds, as only a few called in their doctors; for example many children were seen at the Child Welfare Clinics, and an attack of diarrhoea and vomiting was only mentioned by the mother as a passing feature. The mildness of the disease is further evidenced by the fact that no deaths were certified as due to Dysentery during the outbreak in the Borough although persons of all ages were affected including an old person who was frail and also suffering from another disease. Amongst those investigated, all ages were affected including one breast fed baby. 62 Age 0-1 1-5 5-10 10-15 15-25 25-55 55-65 65- No age obtained. Cases 26 12 84 26 41 6 From 34 of the above cases, stools were examined with the following results:— No pathogenic organisms found 26 Sonne Dysentery organism present 7 Bacillus Morgani present 1 It does not seem certain that the last named organism will cause diarrhoea, but it is commonly found after or in association with such cases. The Sonne Dysentery organism having been found in several cases it can he assumed that the epidemic, was due to it as it is notoriously a difficult organism to trace, and often disappears from the fæces and bowel at an early stage. In four instances amongst the investigated cases, two or more of the family suffered from the disease and the infectivity appeared to be high. It was soon obvious that cases were appearing amongst the customers of every retail and wholesale food or milk distributor in the area, and the only common factors were air and water. The epidemic was late in the year when flies were not about, and this method of spread could be ruled out. Samples of drinking water were obtained, but there was no evidence that the organism was being transmitted by that means. If the transmission were by air then the method would presumably be by droplet infection. The disease is a bowel infection, and has never been considered to be transmitted by other means than by food or milk or water, and there has been no evidence to the contrary. One would, in fact, have expected to find evidence of spread through school, workplace or travel contact, etc., but such was not always the case. One is driven, therefore, to the supposition that spread occurred by food substances and in view of the widespread epidemic and the well known fact of the repeated handling of such foods as bread, provisions, 63 greengrocery, sweets and other unwrapped foods, not only in the retail stores, but in the places of manufacture or production by persons who may have been suffering from a mild attack of diarrhoea, this supposition receives support. The facilities for washing of hands are not universal in these places, nor are they always used where provided. One factor to be borne in mind is that the germ causing this disease is always with us, and many casas of diarrhoea are due to this organism, and so given a set of circumstances of temperature, climate, susceptibility of the population, etc., an epidemic of this disease will occur. In the prevention of further attacks one makes a plea for greater cleanliness in the handling of food both before it reaches the home and afterwards. 1. Food should be handled as little as possible. 2. Food should be protected from flies. 3. The hands should be washed, always, immediately after using the lavatory. (Germs live in excreta.) 4. The hands should always be washed and scrubbed before handling food, whether for oneself or for others. (During an epidemic a certain number of persons may become infected without suffering.) 5. All unpasteurised milk and water from doubtful sources should be boiled. 6. Bread and bought cakes, if not wrapped, should be baked again lightly or toasted, especially in epidemic times. 7. Butter, margarine, and cheese should be purchased only in packets. 8. Bought salads should be washed thoroughly, soaked in weak chlorinated water (Milton may be used) for an hour, and washed thoroughly again in boiled water. 9. No food should be eaten out of the house unless it is known that all these precautions are being taken conscientiously. 64 TUBERCULOSIS. During- the year 101 cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1937, are contained in the following table:— Age Period New Cases Deaths Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. 0— 1 - - - - - - - - 1— 5 - 1 1 1 - - - - 5—10 1 1 4 - 1 - - - 10-15 1 — 2 1 - - - - 15—20 2 5 1 - 2 - - - 20-25 7 9 1 - - 1 - - 25—35 19 11 - - 4 2 — 1 35-45 9 7 - - 5 3 - - 45—55 9 4 - - 3 3 - - 55-65 1 2 - 1 - - - - 65 and upwards - - - - - - - - Totals 49 40 9 3 15 9 - 1 The number of non-notified tuberculosis deaths was seven. In spite of this, tuberculosis is well notified in this area. In many unnotified cases, however, the doctor is under the impression that the case has already been notified. It must be again pointed out that this does not remove the necessity for re-notification. 265 specimens of sputum were examined and reported upon by the Staff of the County Laboratory. It has been previously stated that the Kent County Council is responsible for the administration of the Tuberculosis Scheme, but in addition to the work carrier out by the County, certain duties in connection therewith have to be done by the staff of your Health Department. 65 During the year the Council agreed to rehouse any family in which there was a case of infectious tuberculosis where the patient could not have a bedroom to him or herself. Disinfectants are provided for notified cases, and arrangements are made for the disinfection of premises, bedding, etc., following removal of patients to Sanatoria, and also after fatal cases. The following statement shows the number of cases on the Notification Register for the district at the beginning and at the end of the year. Pulmonary. Non-pulmonary. Total. M. F. M. F. Number on Register at the commencement of the year 155 124 35 44 358 Number on Register at the end of the vear 183 152 41 46 422 The increase in the number of cases on the register and of the notifications is not a real rise of incidence in the area, but due to the growth of the population, and the number of inward transfer of cases to the area. Also, it must be realised that the population in this area is young, and tuberculosis is more a disease of the young —including both children, young men and young women. No action was required to be taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, relating to persons suffering from pulmonary tuberculosis employed in the milk trade or under Section 62 of the Public Health Act, 1925, relating to the compulsory removal to a hospital of persons suffering from tuberculosis. Cancer. Disinfection is carried out if required after death from cancer. Facilities for diagnosis and treatment of cancer are available at the local Cottage Hospital and at the Voluntary General and Special Hospitals in the Metropolitan Area. 66 Deaths from Cancer by age distribution are shown below:— Birth to 5 years 5 & under 10 10 & under 35 35 & under 40 40 & under 45 45 & under 50 50 & under 55 55 & under 60 60 & under 65 65 & under 70 70 & under 75 over 75 Nil I Nil 3 2 6 7 17 8 16 11 14 Influenza. In common with the rest of the country there was a sudden epidemic of influenza in the beginning of the year. It was of a relatively mild type although 18 deaths were registered with influenza as the cause or associated with the cause. Posters advising avoidance of crowded places, etc., were issued, but where so many of the population journey to and from work in overcrowded trains and buses, one wonders how far this advice could be followed. Preventation of Blindness. Section 176 of the Public Health Act, 1936, and the Ministry of Health Circular 1621 on the Prevention of Blindness were considered by the Council, and in view of the fact that the Kent County Council is the local authority for the Blind Persons Act, and have, therefore, a comprehensive scheme for ascertaining and dealing with persons deemed blind within the Act, and that the local Education Authority covers the preventive aspect foxschool children, and that the Kent County Council have adopted the scheme of notification referred to in the Circular, it was resolved that the Bexley Corporation continue to maintain the blindness prevention service for children under school age, and ante-natal and nursing mothers, but that the Kent County Council be asked to carry out the service for the remainder of the population. Anthrax. One case of anthrax (malignant pustule of the neck) occurred during the year, and the patient died. The patient was a nursery garden labourer, who had been carrying sacks of guana, Indian bone meal, coarse bone meal, shoddy wool waste and corysant fertiliser. Samples of these materials, any of which may have contained the anthrax spores, were examined by the 67 stry of Health's laboratory, but the results were negative. It is interesting to note that this area was for many years a market gardening area, but no previous ease of malignant pustule appears to have been reported, though opportunities for infection must have been frequent. Persons dealing with such materials were advised to wear clean white mufflers, so that any soiling would be quickly noticed and the muffler changed, and infecting material not nibbed into the skin. Malaria. One case was notified of a patient who had suffered from malaria, induced for therapeutic purposes, and liable to relapses of the disease. No relapses occurred whilst she remained in the Borough. Acute Anterior Poliomyelitis. Six cases were notified during the year. One was notified in April and the remainder during August. No contact was traced between the cases except that one case had been in contact with the sister of another case. In no family was there more than one case although there Were other children in all the families except one. All were admitted to Hospital and at the end of the year all continued with orthopsedic treatment in Hospital. 68