BEX 4 LIBRARY BOROUGH OF BEXLEY. Annual Report OF THE Medical Officer of Health, For the Year, 1938. GEO. F. BRAMLEY, M.D., Ch.B , D.P.H., Medical Officer of Health. Printed by T. W. Jenkins (T.U., 5-day week), 73-75, Broadway, Bexleyheath BOROUGH OF BEXLEY. Annual Report OF THE Medical Officer of Health, For the Year, 1938. GEO. F. BRAMLEY. M.D.. Ch.B., D.P.H., Medical Officer of Health. Borough of Bexley. Mayor: Alderman G. J. Buckingham, .J.P. Deputy Mayor: Councillor A. R. Potter, J.P. HEALTH COMMITTEE. Chairman: *Councillor A. R. Potter, J.P. Vice-Chairman: *Alderman G. A. Bock. *Alderman Mrs. A. Welch. Councillor D. E. Hayes. Councillor H. J. Bennett *Councillor Mrs. G. M. Hoad. Councillor R D. Binfield. Councillor G. M. Ranson. *Councillor Mrs. E. Boswell. Councillor W. Rose. *Councillor M. J. Corr. Councillor I. W. Wilson. "Slum Clearance Sub-Committee. 3 8 PUBLIC HEALTH STAFF. Medical Officer of Health, and Geo. F. Bramley, M.D., Ch.B., Superintendent of the Mater- D.P.H. nity and Child Welfare Services. Medical Superintendent Corporation Maternity Home. Assistant Medical Officer of Janet C. King, M.B., Ch.B., Health and Medical Officer D.P.H. (resigned 31.10.38). Corporation Maternity Home. Mary Love, M.B., Ch.B., D.P.H. (commenced 1.11.38). Chief Sanitary Inspector. R. J. Rayner, M.R.S.I., CertiPublio Cleansing Officer and ficate Inspection of Meat. Shops Acts Inspector. Senior Assistant Sanitary G. Hind, Certificate of Sanitary Inspector. Inspectors' Joint Board; Certificate Inspection of Meat. Assistant Sanitary Inspectors. 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 (resigned 5.2.38). J. T. Boocock, Certificate of Sanitary Inspectors' Joint Board; Certificate Inspection of Meat. A. V. Griffith, Certificate of Sanitary Inspectors' Joint Board (commenced 7.2.38). Health Visitors N. Feeley (Miss), C.M.B., and Health Visitor's Certificate. K. V. Birmingham (Miss), S.R.N., C.M.B., and Health Visitor's Certificate. 4 Health Visitors—con. N. M. Marshall (Miss), S.K.N., C.M.B., and Health Visitor's Certificate; Certificate of Sanitary inspectors' Joint Board. G. M. Froggatt (Miss), S.R.N., C.M.B., and Health Visitor's Certificate. D. G. Stanley (Miss), S.R.N., C.M.B., and Health Visitor's Certificate. J. Ormandy (Miss), S.R.N.. C.M.B., and Health Visitor's Certificate (appointed 1.5.38). Matron of the Corporation F. M. Hammond (Miss), S.U.N., Maternity Home, Lavernock F.R.N., C.M.B. Road. Bexleyheath. Clerks M. Bentley (Miss). G. F. Lovegrove, Certificate of Sanitary Inspectors' Joint Board. N. E. Broom. R. V. Hoad. M. J. Priestland (Miss). R. Milligan. M. J. Williams (Miss). Consultant for Puerperal J. V. O'Sullivan, MIX, Pyrexia and for Ante-natal M.R.C.P., F.R.C.S., and Obstetric Complications. M.C.O.G. (part-time). Dental Surgeon H. Wade. L.D.S. (part-time). Other Staff Two Food Sales Clerks (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 Road, Bexletheath, Kent. 15th May, 1939. To the Mayor, Aldermen and Councillors of the Borough of Bexley. Ladies and Gentlemen, I have to present to you the Annual Report on the health of the Borough and the work of the Health Department for the year 1938. So far as can he judged from material available, the health of the Borough is of a high comparative standard. The developments in the Health Services are detailed in the body of the report. Air Raid Precautions have demanded a large amount of attention during the year, and this has meant additional duties to a staff already fully occupied. I am deeply grateful to them for their loyal co-operation in all their duties and in the additional work Air Raid Precautions has brought to the Department. On behalf of this Department I wish to thank the Council for their guidance and other Departments of the Corporation for their assistance and co-operation. I am, Your obedient servant, GEO. F. BRAMLEY, Medical Officer of Health. 6 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. The Borough covers 4,869 acres, sub-divided into Wards as follows; — Brampton 509 acres Christchurch 746 „ St. Michael's 740 „ Falconwood 382 ,, Danson 640 „ St. Mary's 1,852 „ Population. Houses erected. Registrar General's Estimate (30.6.38)—77,020 Mid year. 1,170 1911 (Census) 16,000 1921 21,510 1931 33,150 1,082 1932 (R.G.'s Estimate) 37,610 1,165 1933 44,860 2,514 1934 52,030 3,832 1935 59,970 2,412 1936 69,247 2,034 1937 74,380 *1,373 * Minor alterations of Borough boundary. Number of inhabited houses (end of 1938, according to Rate Books), 22,480. Rateable Value, £578,180. Sum represented by a penny rate, £2,250. 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 industry 7 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. I am not aware of any conditions of occupation which are prejudicial to health within this Borough. Conditions of environment which are prejudicial to health obtain only in those houses which are now being demolished or are to be demolished under the Housing Acts. 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 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 twothirds has been here less than seven years. Unemployment. The following figures are kindly supplied by the Manager of the Bexleyheath Labour Exchange and show the numbers unemployed at the beginning and end of the year:— 8 [ Men Women Boys Girls Total[ January 3rd, 1938 741 222 75 96 1,134 December, 31st, 1938 878 301 100 132 1,411 As has been pointed out in previous reports, the larger proportion of the exchange register is made up of employees in the building trades. The weather conditions control the present numbers of unemployed and the severe weather at the end of the year is, therefore, probably reflected in the numbers of unemployed. It is noted, however, that the numbers have been rising each year, and the percentage unemployed of the total population is also rising. This feature is seen in the increasing amount expended by the Council in providing free milk for mothers and children over and above any increasing amount due to the adoption of a more liberal scale. I may be taking a pessimistic view and I have no special knowledge of trade conditions, nor have we for this Borough any Census report giving occupational figures for the present population, but I do anticipate further rises in the number of unemployed in the Borough and a further demand for free milk. Nutrition. There is no statistical or other evidence that malnutrition is increasing in the Borough or that the position in this Borough is worse than in similar areas in Greater London. From my remarks under this heading in the last Annual Report the impression may have been gathered that I was of the opinion that existing malnutrition was entirely due to ignorance of food values, and the nonprovision of a properly balanced mid-day meal for toddlers and school children. The food purchasing power of the family must be sufficient and is of paramount importance, and many families in the Borough suffer because of low and insufficient wages, but where the Health Services can help directly is in teaching mothers, and this service has been put into direct operation by cookery classes at the clinics where food values and so on are explained. 9 Social Amenities. The Corporation supplies the district with electricity, and the South Suburban Gas Company supplies gas. The following public open spaces have been provided by the Corporation : — 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 „ Halcot 21.00 ,, Wrotham Road 10.30 „ and other smaller open spaces giving a total of over 425 acres. The value of these "lungs" is, and will be, more appreciated as the remaining fields and orchards of the Borough become covered by more dwellings every year. 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, 1938. The Registrar General's Estimate of poulation for the mid-year of 1938 of 77,020 is used for the production of these figures. 10 11 0 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 Bex ley[ Rates per 1,000 Population. Births— Live 15.1 15.0 15.4 13.4 18.51 Still 0.60 0.65 0.60 0.48 0.81 Deaths— All Causes 11.6 11.7 11.0 11.4 7.84 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 O OO Smallpox 0.00 — 0.00 — O.OO Measles 0.04 0.05 0.03 0.06 O.O4 Scarlet Fever O.O1 O.O1 O.O1 O.O1 O O1 Whooping Cough 0.03 0.03 0.02 0.03 O.OO Diphtheria 0.07 0.07 0.06 0.05 O O1 Influenza 0.11 0.10 0.11 0.06 O.O6 Notifications— Smallpox 0.00 0.00 0.00 - - Scarlet Fever 2.41 2.60 2.58 2.05 1.99 Diphtheria 1.58 1.85 1.53 1.90 0.62 Enteric Fever 0.03 0.03 0.04 0.05 O.O1 Erysipelas 0.40 0.46 0.39 0.46 0.25 Pneumonia 1.10 1.28 0.98 O.98 0.38 Rates per 1,000 Live Births. Deaths under one year of age 53 57 51 57 35.1 Deaths from Diarrhoea & Enteritis under two years of age 5 5 78 3.6 13.1 3.5 Maternal Mortality— Puerperal Sepsis 0.89 0.7 Others 2.19 Not avail able — Total 3.08 0.7 Rates per 1.000 Total Births (i.e. Live and Still). Maternal Mortality— Puerperal Sepsis 0.86 0.67 Others 2.11 Not available — Total 2 97 0.67 Notifications— Puerperal Fever 14 42 18.08 12.51 3.53 Puerperal Pyrexia 15.46 17.47 12 [Births. Males. Females . Total.[ Live Births—Total 717 709 1,426 Legitimate 698 695 1,393 Illegitimate 19 14 33 Birth Rate. Birth Rate per 1,000 of the estimated resident population 18.51 The following statement relates to the birth rate during the past eight years: — 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 „ „ 1938 „ „ 18.5 „ „ Rate per 1,000 for England and Wales, 1938 15.1 ,, ,, ,, ,, County Boroughs and Great Towns, including London 15.0 ,, ,, ,, ,, Smaller Towns (Estimated populations 25,000 to 50,000 at Census 1931) 15.4 ,, ,, ,, ,, London Administrative County 13.4 Thirty-six illegitimate children were registered as against 28 for the year 1937. [Stillbirths. Males. Females. Total.[ Stillbirths—Total 31 31 62 ,, Rate per 1,000 total (live and still) births 41.66 Sixty-two stillbirths (31 males and 31 females) were registered during the year. This represents a rate of 0.81 per thousand population, against 0.71 per thousand in 1937. 13 Rate per 1,000 for England and Wales, 1938 0.60 ,, ,, ,, ,, County Boroughs and Great Towns, including London 0.65 ,, ,, ,, ,, Smaller Towns (Estimated populations 25,000 to 50,000 at Census, 1931) 0.60 Three stillbirths registered were illegitimate. [Deaths. Males. Females. Total[ All causes 304 300 604 Death rate per 1,000 of the estimated resident population 7.84 Number of women dying in, or in consequence of childbirth: From Puerperal Sepsis 1 1 From other Puerperal causes — — Rate per 1,000 total (live and still) births 0.67 Deaths of Infants under one year of age: [ Males. Females. Total[ Legitimate 29 15 44 Illegitimate 5 1 6 Death Rate of Infants under one year of age: Total per 1,000 live births 35.1 Legitimate per 1,000 legitimate live births 31.6 Illegitimate per 1,000 illegitimate live births 181.8 Deaths from Measles (all ages) 3 — 3 ,, ,, Whoopiug Cough (all ages) - - - „ ,, Diarrhoea (under 2 years of age) 4 1 5 ,, ,, Cancer (all ages) 45 48 93 14 Death Rate. The Death Bates for the area during the last eight years are as follows : — 1931 8.3 per thousand 1932 10.0 „ „ 1933 8.2 ,, ,, 1934 8.8 ,, ,, 1935 8.4 ,, ,, 1936 8.7 „ „ 1937 8.72 „ „ 1938 7.84 „ „ BIRTHS, BIRTH RATES, STILLBIRTHS IN WARDS. Estimated Population in Wards. Christchurch 14,199 St. Mary's 11,360 Brampton 13,135 Danson 11,492 Falconwood 12,682 St. Michael's 14,152 Total 77,020 The figures given relate to live births and stillbirths notified during 1938, but not necessarily registered during the year. Live Births. [Wards. No. of Births. Rate/1,000 Population.[ Christchurch 187 13.17 St. Mary's 200 17.6 Brampton 245 18.65 Danson 215 18.7 Falconwood 256 20.19 St. Michael's 279 19.15 Stillbirths. [Wards. No. of Stillbirths. Rate 1,000 Births (Live & Still).[ Christchurch 6 31.08 St. Mary's 4 19.6 Brampton 12 46.69 Danson 6 27.14 Falconwood 4 15.38 St. Michael's 13 44.52 15 DEATHS AND DEATH RATES IN WARDS. The figures given relate to deaths actually occurring during 1938, but not necessarily registered during the year. [Wards. No. of Deaths. Rate/1,000 Population.[ Christchurch 133 9.4 St. Mary's 104 9.2 Brampton 77 5.9 Danson 84 7.3 Falconwood 97 7.5 St. Michael's 104 7.3 The rate for Bexley again compares favourably with other parts of the country, the death rate over England and Wales being 11.6. 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 8.39. The figure 1.07 is the same as that supplied in each year since 1931, and it 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 1938. [Causes of death. M. F.[ All Causes 304 300 1 Typhoid and Paratyphoid Fevers — — 2 Measles 3 — 3 Scarlet Fever 1 — 4 Whooping Cough — - 5 Diphtheria 1 — 16 [Causes of death. M. F.[ 6 Influenza 2 3 7 Encephalitis lethargica — — 8 Cerebrospinal Fever 1 1 9 Tuberculosis of respiratory system 15 14 10 Other tuberculous diseases 1 1 11 Syphilis 1 — 12 General paralysis of the insane, tabes dorsalis 1 - 13 Cancer, malignant disease 45 48 14 Diabetes — 5 15 Cerebral Haemorrhage, etc. 11 20 16 Heart disease 81 88 17 Aneurysm 2 1 18 Other circulatory diseases 12 17 19 Bronchitis 2 7 20 Pneumonia (all forms) 17 14 21 Other respiratory diseases 3 4 22 Peptic Ulcer 8 2 23 Diarrhoea, etc. (under two years) 4 1 24 Appendicitis 3 3 25 Cirrhosis of liver — 1 26 Other diseases of liver, etc 2 2 27 Other digestive diseases 7 11 28 Acute and chronic nephritis 5 8 2,9 Puerperal sepsis — 1 30 Other puerperal causes — — 31 Congenital debility, premature birth, malformation, etc. 20 10 32 Senility — 6 33 Suicide 5 9 34 Other violence 21 10 35 Other defined diseases 29 19 36 Causes ill-defined or unknown 1 1 Special causes (include in No. 35 above(:- Small-pox — - Poliomyelitis — - Polioencephalitis — — Anthrax - — 17 18 DEATHS IN ACE GROUPS IN 1938. These relate to deaths occurring in 1938, but 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. 599 49 5 3 2 13 4 11 10 13 15 20 24 37 30 41 51 71 61 139 1 Typhoid and Paratyphoid Fevers - 2 Measles 2 1 1 3 Scarlet Fever - 4 Whooplng Cough - 5 Diphtheria 1 1 6 Influenza 3 1 1 1 7 Encephalitis Lethargica . 1 1 8 Cerebro-Spinal Fever 2 1 1 9 Tuberculosis of Respiratory System 29 2 2 4 5 4 1 4 4 2 1 10 Other Tuberculous Diseases 2 1 1 11 Syphilis 1 I 12 General Paralysis of the Insane, Tabes Dorsalis 1 1 13 Cancer, Malignant Disease 94 3 4 1 10 9 9 9 13 16 9 11 14 Diabetes 1 1 15 Cerebral Haemorrhage, etc. 29 1 1 I 4 2 1 2 5 3 9 16 Heart Disease 101 2 2 2 4 5 12 6 18 15 35 17 Aneurysm 1 1 18 Other Circulatory Diseases 78 1 1 2 1 2 6 4 13 19 29 19 Bronchitis 17 1 3 3 1 9 20 Pneumonia (all forms) 40 6 2 I 1 2 1 4 3 2 3 5 2 8 '21 Other Respiratory Diseases 8 1 1 1 2 1 2 22 Peptic Ulcer 8 1 1 1 2 2 1 23 Diarrhoea, etc. (under 2 years) 5 4 1 24 Appendicitis 8 1 2 1 2 2 25 Cirrhosis of Liver 1 1 26 Other Diseases of Liver . 1 1 27 Other Digestive Diseases 10 I I 1 1 2 I 2 1 28 Acute and Chronic Nephritis 14 1 2 1 1 3 2 3 1 29 Puerperal Sepsis I 1 30 Other Puerperal Causes 2 1 1 31 Congenital Debility. Premature Birth, Malformation, etc. 12 I 32 Senility 29 3 1 2,5 33 Suicide 7 1 1 2 2 1 34 Other Violence 2q 2 2 2 2 1 1 2 2 2 1 1 1 3 35 Other Defined Diseases 40 2 I 6 2 1 2 2 1 1 4 1 4 5 36 Causes ill-Defined or unknown 1 1 Special Causes (included above) Smallpox — Poliomyelitis -— Polioencephalitis — Anthrax – 19 D Infantile Mortality. DEATHS FROM 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 j to 4 weeks Total under month 1 to 3 months 3 to 6 months 6 to 9 months 9 to 12 months Total deaths under 1 year All causes. Accident 1 1 1 2 Broncho Pneumonia 4 1 1 6 Congenital malformation and Premature birth 21 1 1 1 24 2 26 Influenza 1 1 Meningitis 1 1 Eczema with secondary infection 1 1 Gastro Enteritis 2 2 4 Icterus Gravis 1 1 1 Subarachnoid Haemorrhage 1 1 1 Urinary Infection 1 1 Convulsions 1 1 1 2 Inanition 1 1 1 Intussusception 1 1 Malnutrition 1 1 Totals 25 1 1 2 29 11 5 4 — 49 20 Infantile Mortality. The number of infants under one year of age who died during the year 1937 as shown by the table is 49. Fifty were registered during the year giving an infantile death rate per thousand live births of 35.1. 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 1937 44.7 Twenty-nine of these deaths, that is 58 per cent., occurred in the neonatal period, that is within one month of birth. In 1937 and 1936 the corresponding figure was 57 per cent. 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 0.67, compared with 0.77 in 1937, and an average over the previous five years of 2.39, and 2.97 for England and Wales. Three deaths occured during the year, however, two of which were not registered until 1939, and will be recorded as against that year in the next Annual Report. With relatively small figures there is bound to be a certain amount of irregularity, but even such figures as we have, do appear to me to show a good standard of midwifery. In considering the evidence collected after these deaths for transmission to the Ministry of Health one can often see where a mistake has occurred, but it is a case of being wise after the event. In relation to the death which was registered in 1938, one wondered if this woman should ever have been allowed to become pregnant at all in view of her general health. 21 22 23 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Isolation Hospital Accommodation. Bow Arrow 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. Extensions and improvements at this Hospital are now almost completed. The cost of the extensions has been about £70,000, including central heating, furnishing, and new lodge. The accommodation includes two cubicle wards and provides 135 beds, and ground has been acquired to allow space for a growth up to 500 beds. Future extensions on the lines of providing more cubicle bed accommodation will provide the Borough with first class isolation hospital accommodation. The reduction in cross infection and number of days stay per patient has already been apparent since the cubicle blocks were opened, despite the fact that almost every type of infectious disease has been admitted, whilst previously only cases of reputed diphtheria and scarlet fever were accepted. The new Nurses Home was also completed at the Hospital during the year. Other Hospitals. 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. has not been discontinued. Cases of Puerperal Pyrexia are admitted to the Queen Charlotte's Hospital (Isolation Block) with the Authorities of which the Corporation has an agreement. 24 By the scheme required under the Local Government Act, 1929, the Corporation has now made an agreement with the London Comity Council for the latter to receive into isolation hospitals provided by them for cases of small pox, persons residing in this Borough who are suffering from small pox. The Corporation is required to pay a standing annual sum of £270, and when cases are admitted from the Borough, a daily maintenance charge per patient, subject to a minimum charge equal to the standing charge, the maintenance charge merging into the standing charge. The standing charge will vary according to the number of population. Patients cannot be admitted to the London County Council small pox hospitals until they have been verified by the Borough Medical Officer of Health. For babies suffering from ophthalmia neonatorum, the Corporation has an arrangement for admission of such cases to the L.C.C. St. Margaret Hospital, where mothers can be admitted with the babies if necessary. Corporation Maternity Home. This is situated in Lavernock Road, Bexleyheath, next to Bursted Wood open space, and provides 26 beds (including two isolation). It was opened in Mav, 1937. and has been running full since within six months after that date. General Hospitals. The Bexley Cottage Hospital now provides for 25 beds and one cot, and hopes are held that the further stages 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 Management Committee for 1938:— Total Patient Year. Total No. of In-patients. Out-patients. Days. 1928 1937 1938 156 528 608 242 615 647 2,815 6,105 6,238 25 The facilities ottered by the Woolwich War Memorial Hospital, the Miller Hospital, Greenwich, and other London Hospitals have again been taken advantage of by the residents within the Borough. The Kent County Council, through its Public Assistance Committee, maintains the County Hospital at Dartford (631 beds) available for certain portions of North West Kent. The relative proximity to London Hospitals is of great advantage for the obtaining of treatment especially where specialised or radium treatment for cancer is required, but a visit to any of the hospitals involves a bus or train journey and the cost of travelling severely handicaps many patients. The large growth of population in this and surrounding districts has not been accompanied by a corresponding growth of hospital accommodation. This has rendered the position acute and leads to reported overcrowding in the County Hospital, and whilst the provision of 300 additional beds has been approved, the Council has asked the Kent County Council that when consideration is duly given to the siting of further additional accommodation the claims of this area be considered and that land be acquired for this purpose whilst it is still available. In considering facilities for the treatment of chronic rheumatism the Council decided that such treatment in the present state of knowledge could most appropriately be arranged at a general hospital and, as the needs of this area were not adequately fulfilled, have asked the County Council to consider the needs of the area in relation to providing a general hospital in or near the Borough. 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 Small Pox, etc. 26 Non-Infectious Cases. The Corporation 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 Corporation 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 lied 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 1938. Sickness 546 Accidents 209 Maternity 208 Malicious calls 1 Ambulance not required 36 Total1,000 No. of calls on outside ambulances—60. Crayford Ambulance 39 Sidcup Ambulance 18 L.C.C. Ambulance 1 Erith Ambulance 2 Sickness 9 Accident 39 Maternity 12 This shows an increase of 50 per cent. in the use of the Corporation ambulance service over 1937, which was the first full year of operation. With the increasing calls on the secondary service, in which delay in arrival of the ambulance must occur, and because long distance calls have to be refused, the time is rapidly approaching when the Council will need to consider providing another ambulance. With the removal of the re-organised full-time Fire Brigades Department to the proposed new station in Glynde Road, where room for two ambulances will be 27 E provided, the transfer of the ambulance service to the Fire Brigades Department will give a more flexible staff and the ambulance will not need to turn out during the night without an attendant to assist the driver in moving cases. MORTUARY. The Public Mortuary, which is maintained by the Corporation, is situated on land at the south side of the Council Offices. During the year it was used on 51 occasions, and 41 post-mortem examinations were made. CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare Centres. Bexleyheath—315, Broadway. Child "Welfare Sessions—Mondays, Wednesdays, Thursdays, 2.30—4.30 p.m. Ante-natal Sessions—1st and 3rd Fridays in the month, 10.30 a.m. and 2.30 p.m. Welling—Station Approach. Child Welfare Sessions—Mondays, Tuesdays, Wednesdays and Thursdays, 2.30—4.30 p.m. Ante-natal Sessions—2nd and 4th Fridays in the month, 10.30 a.m. and 2.30 p.m. Bexley—Murchison Avenue. Child Welfare Sessions—Tuesdays and Thursdays, 2.30—4.30 p.m. Ante-natal Sessions—Wednesdays, 10.30 a.m. Maternity Home—Lavernock Road. Ante-natal Sessions—Tuesdays and Thursdays, 10.30 a.m. Post-natal Sessions—Thursdays, 11.30 a.m. 28 Dental Clinic—315, Broadway, Bexleyheath. Mondays and Wednesdays, 10 a.m. Sunlight Clinic—315, Broadway, Bexleyheath. Tuesdays and Thursdays, 9 a.m. 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 the 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. 29 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 as there is still too much reliance placed on swabs for the diagnosis of diphtheria, the postal delay 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. MATERNITY AND CHILD WELFARE. (i) Midwifery and Maternity Services. (a) Ante-natal Care. 729 expectant mothers attended the Corporation ante-natal clinics and received ante-natal medical care, equal to a percentage of 51.0 of the notified births aginst 43.4 for 1937. It is known that 312 other expectant mothers received ante-natal care at clinics attached to maternity hospitals to which they were admitted for confinement, and that 89 women received ante-natal care from their own doctors prior to admission to the Corporation Maternity Home, giving a total percentage of 79.2, as compared with 65.1 in 1937, who received ante-natal medical care. This increase is probably due to the new Midwives' service, and to that service we look for a higher percentage in future years. That the Midwives' service is not under the Corporation is a matter for regret, as under those conditions I am sure more midwives' cases would attend the centres. That there are still many independent midwives in the Borough is not the reason for only less than half midwives' cases attending ante-natal clinics, as many independent midwives do try to insist on their cases attending. Out of 122 births notified by county midwives in (he first 6 months of 1938, only 31 per cent. of the resnective mothers had attended the ante-natal clinics, and out of 68 notified by independent midwives 41 per cent, had attended. (b) Co-operation with General Practitioners. 90 of (he 479 cases admitted to the Corporation Maternity Home during 1938, the first full year of its opening, 30 were general practitioners' cases, and the doctors have welcomed the opportunity of doing midwifery under good conditions, which has no doubt been of benefit both to the patients and doctors concerned. (c) Consultant Services. Better use of these services has been made during 1938, especially through the cases admitted to the Maternity Home. The Consultant was called on one occasion for domiciliary consultation, and on three occasions to the Maternity Home for consultation with the doctor in charge of the case. To provide an ante-natal consultation clinic for use by patients to be admitted to the Home a monthl, clinic has been instituted since August, 1938, at the Maternity Home when the Obstetric Consultant attends and sees cases referred there from the ante-natal clinics or by general practitioners. This obviates the difficulty of the journey in sending women far advanced in pregnancy to the City of London Maternity Hospital out-patients' Department, and provides a full local ante-natal scheme. 1938. No. of consultation clinics 5 No. of cases seen 25 No. sent by general practitioners Nil (d) Maternity Accommodation. No alteration has been made during the year 1938. The Corporation Maternity Home has been booked to the maximum number of cases it could deal with without overcrowding. This means, in midwifery work, that all the beds may be occupied one week and several empty beds at another period, as the day of confinement cannot be forecast exactly. For the 24 available beds 42 cases per month are booked and although non-residents of the Borough are no longer taken, all the beds are usually booked up six months in advance. In 1938, 44 residents of the Borough could not be booked owing to lack of accommodation. Many mothers from this Borough are confined in the British Hospital for Mothers' and Babies', Woolwich, and the War Memorial Hospital, Shooters Hill. These institutions are booked up as soon as, or even earlier than, the Corporation Maternity Home, so that with the continued growth of the Borough, and the 31 demand for institutional confinement, the Council has agreed to include a scheme for the enlargement of the Home within the financial five-year programme of capital expenditure required in 1938 by the Ministry of Health. (e) Ante-natal Clinics. Five ante-natal sessions are held weekly and the sessions have averaged 15 attendances. (f) Post-natal Clinic. The post-natal session at the Maternity Home is for mothers confined there and others and 260 attendances were made in its first full year of working, 1938. Post-natal examinations are also made at the ante-natal sessions at the other clinics and 16 attendances were made. These totals represent a percentage of 19.3 against births notified; excluding mothers confined in other institutions and by private doctors, who make arrangements for post-natal examination, a percentage of 38.5 is obtained. The importance of these examinations and the future ease of the mother is not yet fully realised by the public, but as this is a new service, which will continue to grow, there is no need for despondency. (g) Home Helps. The need for this service is shown by the fact that 21 applications were approved, and 21 homes attended covering a period of 321 days in 1938, as compared with respective figures of 9, 9 and 126 in 1937. (h) Dental Treatment. During the year a dental scheme, provided and maintained by the Corporation for nursing and expectant mothers, and children under the age of five, was inaugurated. The accommodation provided consists of three rooms on the ground floor of the old Maternity Home, 315, Broadway, Bexleyheath, one as a waiting room, another equipped as a dental surgery, and a small recovery room for mouth cleansing. A part-time dentist is engaged on a sessional basis and a health visitor acts as Dental Attendant. Two weekly sessions are held and nursing or expectant mothers, and children under the age of 5 are referred as required by appointment on account of need of treatment, and treatment is provided, to secure dental fitness. 32 There are arrangements whereby patients may obtain dentures, which are fitted by the denial surgeon and obtained from a firm of mechanics at contract prices. An assessment scale, based on family income, is used, patients paying full cost or a proportion in accordance with income. Local and general anæsthesia is used, the latter being administered by the Assistant Medical Officer of Health. The service commenced in September, 1938, and the following is a summary of the work done in 1938:— Expectant Mothers. Nursing Mothers. Children under 5. Numbers referred to dental clinic by a Medical Officer 23 5 45 Numbers found to be in need of treatment 21 5 40 Numbers who received treatment 17 3 39 Numbers made dentally fit 3 — 27 Numbers of treatments:— (a) Fillings (1) In temporary teeth — — 12 (2) In permanent teeth 1 1 — (b) Teeth extracted 92 26 67 (c) Administrations of general anaesthesia 10 2 15 Patients supplied with dentures 1 – – Dentures supplied 2 — — (ii) (a) INSTITUTIONAL PROVISION FOR MOTHERS. Corporation Maternity Home, Lavernock Road, Bexleyheath. During the year the Home was approved by the Central Midwives' Board in respect of the second period of training under new section B of the Board's Rules. Four pupil midwives may be accepted at one time for a 33 period of six months for each. Three months will be spent in the Home and three months on the district. The Medical Officer of Health and the Matron have been approved by the Board as teachers for the second part of the certificate. The district training will be carried out by the local organiser of midwives, under the Kent County Council, who has been made an approved teacher. Two pupils will reside with the district organiser for a period of three months each, and will do district work under supervision. The pupil midwives will be given the opportunity of practice and attending, and nursing, not less than ten lying-in women in their own homes. Whilst on the district the pupils will attend the Ante-natal Clinics and the Child Welfare Clinics belonging to the Corporation. The Home has been affiliated with the Leeds Maternity Hospital and the Kingston County Hospital, from which institutions pupils who have passed the examination after the first period of training will be received. A scheme for a 96-hour fortnight for the staff was approved during the year, to come into operation on July 1st, 1939, when the first pupils arrive, and this necessitated the approval of an additional appointment of a staff nurse. The difficulty of obtaining staff is still acute and, until the new training rules of the Board have been developed and some solution to prevent the whole shortage of nurses throughout the country is found, there appears to be no hope of any other position. Under the New Rules of the Central Midwives' Board it is now necessary for a midwife to have taken a two weeks' course in instruction at a recognised institution in the administration of gas and air analgesia before being allowed to administer any type of analgesia. It was therefore agreed that Matron and the two Sisters be sent to the City of London Maternity Hospital for this course. They attended and duly obtained the necessary certificate. Statistics. No. of patients in Home 1st January, 1938 22 No. of patients admitted during 1938 477 No. of patients discharged during 1938 479 No. of patients died during 1938 Nil No. remaining 31st December, 1938 20 34 No. of patient days 7105 Average duration of stay 14.2 days No. of cases delivered by nursing staff (midwives) 387 No. of cases delivered by doctors 90 No. of primiparæ 291 No. of multiparæ 186 Twin pregnancies 6 No. of calls on Consultant—ante-natal 2 intra-natal Nil post-natal 1 No. of cases in which medical assistance was sought 104 No. of cases notified as Puerperal pyrexia 6 No. of cases of ophthalmia neonatorum Nil No. of cases of pemphigus neonatorum Nil No. of maternal deaths (after discharge) 1 No. of infant deaths 9 Causes—(1) Convulsions, prematurity 4 (2) Atelectasis of lungs 2 (3) Jaundice 1 (4) Abscess of liver 1 (5) Mongolism 1 No. of stillbirths 19 Causes—(1) Prolapsed Cord 1 (2) Anencephalic (twins) 2 (3) Toxæmia 3 (4) Breech with extended legs 2 (5) Unknown 8 (6) Premature 1 (7) Hydrocephalus 1 (8) Instrumental delivery 1 No. of cases sent to other Hospitals:— Ante-natal 6 Early intra-natal 4 Post-natal 5 No. of Borough cases 436 No. of out-district cases 41 No. of practitioners' private booked cases 90 Forceps rate 6.6% 35 Feeding. Breast alone 407 Breast supplemented by artificial food 49 Artificial food alone 27 No. of babies born alive (including twins) 483 (b) OTHER INSTITUTIONAL PROVISION FOR MOTHERS AND CHILDREN. No provision is made by the Corporation for children. Nine cases were sent to Queen Charlotte's Hospital for treatment of puerperal conditions through the Corporation's scheme. Twelve cases of complicated pregnancy or labour were sent to the City of London Maternity Hospital for admission through the Corporation's scheme. (iii) Health Visitors and Clinics. A further Health Visitor (bringing the total to six) was appointed during the year in order that the minimum quarterly visits to children under one, and halfyearly 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. Two Health Visitors each year are sent to the Winter School for Health Visitors held by the Women Public Health Officers' Association. The course lasts nine days. The number of visits made by the Health Visitors is shown in the table. The total number of visits was 13,249, including visits to ante-natal mothers. Ante-natal Sessions. Bexleyfreath—289 mothers made 973 attendances. Welling —297 mothers made 1,055 attendances. Bexley—86 mothers made 208 attendances. Maternity Home, Lavernock Road—44 mothers made all their attendances at the home. The total visits of mothers to be admitted was 1,590. 36 Infant and Child Welfare Sessions. Bexleyheath. Total number of attendances:— (a) By children under one year of age 6057 (b) By children between one and five years 2533 Average attendance 65 Number of children attending for the first time: (a) Under one year of age *381 (b) Between one and five years *118 Number of children medically examined 2811 Welling. Total number of attendances:— (a) By children under one year of age 8721 (b) By children between one and five years 3969 Average attendance 69 Number of children attending for the first time: (a) Under one year of age *525 (b) Between one and five *207 Number of children medically examined 4401 * These numbers do not include children who have previously attended a Centre in another district. Bexley. This Centre was opened in February, 1938, and is a new building erected at a cost of £2,100 in the middle of a newly developed and now almost built up area in the southern part of the Borough. The need for this Centre has been shown by the numbers attending. Some of the mothers attending the Bexley Clinic formerly attended at Bexleyheath, but the distance required to travel prevented any regularity of attendance. Some attendances are made by residents of the County Council Maternity and Child Welfare area, possibly balancing the number who attend County Clinics from part of Falconwood Ward. An arrangement is in force with the County Council to hold no hard and fast rule with regard to boundaries, except, of course, where assisted milk or dental treatment, etc., is concerned. The New Clinic is situated in Murchison Avenue on a pleasant site and well back from the road. The building provides a waiting room 20ft. x 21ft. with 37 Copyright] [Ed. J. Burrow & Co. Ltd. The Bexley Maternity and Child Welfare Centre, Murchison Avenue. 38 store room, food supply room and kitchenette on one side, and leading from the opposite side of the waiting room a toddlers' room 20ft. x 16ft. There are three inter-communicating rooms along the rear length of the building—weighing room, 20ft. x 16ft., nurses' consultation room 16ft. x 11ft., and doctors' room 9ft. x 15ft. There is a side entrance directly from the perambulator shed (13ft. x 29ft.), and the usual lavatory accommodation for adults, toddlers and staffs is provided. The floors are solid wood block and the building is very light and airy. It is heated by electricity throughout by tubular heaters. The whole accommodation provides for steady working without any overcrowding or hold-ups, and the pleasant surroundings are a great help to the children, mothers and staff. Total number of attendances:— (a) By children under one year of age 2122 (b) By children between one and five years 1523 Average attendance 81 Number of children attending for the first time: (a) Under one year of age 152 (b) Between one and five 141 Number of children medically examined 1150 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, and our thanks are hereby expressed. Births (Registered). 1938 1937 1936 1935 1934 Live Births 1,426 1,319 1,282 1,045 819 Stillbirths 62 53 42 27 25 The number of births notified from institutions was 959, by midwives 228, and bv parents and doctors, etc., 240. (iv) Assisted Milk Supply. During the year the number of families in which there was an expectant mother or children supplied with milk free or at half cost was 258, at an approximate cost of £962. This item is more than double that of 39 1937, due to the operation of the more generous scale, the seeking out of necessitous persons by the Health Visitors, and a larger number of unemployed, and as it encourages the further use of pasteurised and therefor safe milk, there can be no doubt that the return despite the high cost of milk will be well worth while. A reduction in the price of milk to families where there are children under the age of five, or where there is an expectant mother in the house, is overdue. Milk at reduced prices is supplied to school children and surely it is more necessary for the younger children and their mothers, and a simple scheme for its issue could quickly and easily be devised. At present there are few families with young children who can afford to buy the amount they should have. 14,4831bs. of dried milk were supplied at cost price for infants attending the Centres, and Virol and Cod Liver Oil to the extent of 2,364ilbs. were also sold. (v) Dental Treatment. Before the operation of the Corporation Dental Clinic, 87 children under the age of five years were referred to the Education Committee's Clinics for treatment. (vi) Orthopaedic Treatment. The Council has an arrangement with the Kent County Council whereby children under the age of five years 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 Orthopædic defects. Ninety-five children attended for the first time during 1938, and also made subsequent attendances. 28 children who were previously on the Register also attended. Three children were referred for in-patient treatment and two for X-ray treatment. 81 appliances were recommended and 894 attendances at the Orthopedic Clinics were made. In view of the distance to travel and the cost of fares, especially where frequent attendances for massage are required, it has been brought to the notice of the County Authority that a clinic held periodically in this Borough, with facilities for massage and remedial 40 exercises is desirable, and I understand that such a clinic is likely to be held at one of the schools where there is a gymnasium. Where Sunlight treatment is required, this is now given at the Clinic provided by the Borough. (vii) Child Life Protection. The Medical Officers and the Health Visitors are appointed Child Life Protection Visitors under the Public Health Act, 1936. 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 54 (b) At the end of the year 56 Number of children:— (a) At the beginning of the year 70 (b) At the end of the year 72 One foster child died during the year and an inquest was held. A boarding school which received children under the age of nine was exempted in accordance with provisions allowed by the Act. (viii) Records. It has always been the custom to forward copies of records of children on reaching the age of five years 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 three sterilised outfits were issued free of charge to applicants. (x) Compensation to Midwife for loss of case. No application was received. 41 (xi) Sunlight Clinic. Artificial sunlight treatment is now provided in a clinic on the ground floor of the old Maternity Home, 315, Broadway, Bexleyheath. It is available for children under the age of five and for nursing and expectant mothers. School children are treated when referred by the School Medical Officer, and a charge for treatment is paid by the Education Authority. A duotherapy ultra violet lamp is used and a Health Visitor with special training is in charge of the treatment under a Medical Officer. The clinic is at present open on two mornings in the week. Sundry ailments have been treated with benefit such as early rickets, general debility, and sub-acute rheumatism. Number of cases treated 41 Number of treatments 232 Number still being treated at end of year 28 Average number of treatments per patient 8 Diseases treated. No. Rickets Rheumatism General Debility Bronchitis 8 20 10 3 (xii) Ear and Eye Defects. Many children with chronic discharging ears have been seen at the centres and have been referred to their own doctors for treatment, but a large proportion were either not taken or soon ceased attending even when referred to hospital. In the latter case the travelling costs for repeated attendances were probably the deterrent. As the school authority provide a nurse with special experience in ear cases, who works under a consulting ear specialist, advantage has now been taken of this facility, and in necessitous cases the child with a discharging ear is referred to the clinic provided. Where children with eye defects such as squint are seen at the clinics, they are now referred to the School Ophthalmic Officer for diagnosis and treatment. The advantage of this scheme is that the child when reaching school age will have a continuity of treatment through the same specialist eye doctor. 42 43 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 I930 427 12 2 133 216 515 2805 3683 4144 1976 278 70 651 957 200 45.5 1931 5.6 18 2 100 206 561 3318 3565 4812 1921 361 96 699 944 242 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 !045 27 2 1O4 191 1070 3945 3809 9414 2502 571 55 546 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 1938 1426 62 §6 490 734 1298 4548 7967 ‡15792 ‡7476 1091 470 76.5 3886 729 49.0 * 2 for ⅔rds of year. † 4 for ⅔rds. of year. ‡ These figures relate to children attending and do not include visits to collect food for a child as in previous years. § 5 for ¼th. of year. This table shows how it has been possible to cover the work necessary with the increase in the child population. The number of expectant mothers visited shows a fall, due to the fact that if the Health Visitor knows the home, and the mother makes regular antenatal attendances, it has not always been necessary to make a call. The total number of child welfare clinic attendances has grown, and by the more frequent sessions now held, there has been no overcrowding. The better attendance of toddlers is gratifying and there is no difficulty in dealing with them at the ordinary child welfare sessions. (xiii) Special Classes. To further the educational aspects of the Maternity and Child Welfare Services, classes in needlework and cookery for expectant mothers, and mothers of children under the age of five, have been commenced. The classes are not exactly the same type as provided by the Education Authority and, being held in the afternoons when the mother can bring along her children with her to the clinic, where they can be looked after by voluntary workers, the mothers find no difficulty in attending. A part-time cookery instructress attends on one session per week and a series of demonstrations over three months is held at each of the three centres in turn. At these classes the mothers take turns in doing practical work under the demonstrator's supervision and undertake the subsequent clearing up. Two or three dishes are prepared and cooked, the cost of which is recovered by sale of the food to the mothers. The course covers the theory of cooking, marketing, food values, choosing of joints, fuel and food economy, food storage, choice and care of utensils, simple menu making, serving food, invalid cookery and toddlers' needs. Sewing classes under a sewing instructress are similarly held over three months at each of the three centres in turn. A definite lesson on some feature of sewing is put forward each week, and part of the session is devoted to the cutting out and making up of garments, especially those in which the mothers are interested, a special feature being renovated garments. 44 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. I. 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 Tan. 1899 Public Health Acts Amendment Act, 1907, Parts 8 and 9 Apr. 1909 Part 2—the whole ,, 4—Sees. 53 and 54 ,, 6—the whole ,, 10—Sec. 95 May 1909 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, Yans, Sheds and Similar Structures June 1921 Offensive Trades (Fish Frying) Dec. 1923 Parks and Pleasure Grounds June 1920 Lodging Houses (Housing Act, 1925) Sec. (i Jan. 1927 New Streets and Buildings May 1927 New Streets and Buildings Dec. 1931 Slaughterhouses Mar. 1934 Wireless Loudspeakers, Gramophones, etc. Nov. 1938 Fouling by Dogs of Footpaths July 1938 Baths, Wash-houses. Swimming Baths and Bathing Places Aug. 1938 45 (i) Water Supply. The Borough is supplied with water by the Metropolitan Water Board, and during the year a good and constant supply has been maintained. I am informed by the Clerk of the Board that— ' (a) No new public water supply has been instituted in this Borough during the past year. (b) A borehole has been sunk at Bexley, but no supply has yet been taken from it. A booster station has been constructed at Erith, but is not yet in actual use. (c) No important extensions of trunk mains have been laid. (d) No changes in the general scheme of supply to the Borough of Bexley took place during the year 1938. (e) Early in May, 1938, it was considered desirable to instal apparatus for chloramine treatment at one of the wells at Crayford, which affords part of the supply to Bexley. This treatment has been continuous since 9th May, 1938. The supply to Bexley has continued to maintain a high standard of purity.' Examinations of samples of water from piped supplies to houses in the district have been made on samples collected by the Sanitary Inspectors, with the following results: — Bacteriological. No. of organisms per c.c. capable of growth on Agar at: B. coli presumptive 37° 0. 22° C. *Present in 100 c.c. Absent in 90 c.c. Absent in 100 c.c. 0.24 0.74 *A-typical organism. Chemical (parts per 100,000). Total solid residue. Chlorine Ammonia Free Albuminoid. Nitrogen as Nitrites. Oxygen i hr. at 80°F, Absorbed 4 hrs. at Nitrites. 80°F. 38.5 2.55 0.0 0.003 0.2 0.08 0.156 Absent -2.8 -0.0017 -0.0083 46 The only houses without water delivered to a tap inside the house were under a demolition order throughout 1938 and were demolished early in 1939. (iii) Rivers and Streams. Information under this and the next two items has been provided by the Borough Engineer. A portion of the water course in East Wickham Valley has been eulverted in connection with the Corporation Housing Scheme in filenmore Road. The Rivers Cray and Shuttle are now under the control of the Kent Rivers Catchment Board, with whom close co-operation is maintained with regard to work affecting these rivers. (iv) Drainage and Sewerage. During 1938 the East Wickham Foul Drainage Scheme has been completed by the Council, this involving the construction of a Pumping Station at East Wickham to facilitate the drainage of East Wickham Valley and a part of Stevens' No. 6 Estate. The scheme also included the provision of a relief sewer from Upper Wickham Lane to the West Kent Trunk Sewer at Tanyard Lane, Bexlev, the total length of these sewers being approximately 4 miles. The Council has also constructed a surface water sewer through the tip site at East Wickham, and (in conjunction with the Woolwich Borough Council) a surface water sewer in Upper Wickham Lane and Lodge Hill, to drain the Hutments Site and a part of Stevens' No. 6 Estate. The total length of these sewers is approximately 1¼ miles. At Grlenmore Road six cesspools draining 24 houses have been abolished and the properties connected to the foul sewerage system. In addition to the above, private developers have laid approximately 1¾ miles of foul sewers, and approximately l½ miles of surface water sewers. Projected schemes for 1939 include the South Welling and Rochester Way Foul Sewer, and surface water sewers in Hook Lane and Rochester Way. 47 3. (i) Closet Accommodation. All the closet accommodation in the Borough is on the water carriage system. (ii) Public Cleansing. House refuse continues to be dealt with at Bursted Wood by controlled tipping and has been done without nuisance and in accordance with the advisory instructions issued by the Ministry of Health. The life of this Tip is limited, and as tipping has not been commenced in any other part of the Borough, the Council have taken cognizance of the fact and alternative methods of disposal are being considered to take effect when the contemplated levelling and terracing at Bursted Wood is completed. The levelled space will then he a valuable addition to open spaces and playing fields already provided. CHIEF SANITARY INSPECTOR'S REPORT. Health Department, 14, Brampton fto.U), Bexleyheath. To the Mayor Aldermen and Councillors of the Borough of Bexley. Ladies and Gentlemen, I submit herewith my Twenty-fourth Annual Report as Sanitary Inspector to vour Council, being for the vear 1938. The report consists, as on former occasions, of a tabulated record of the work carried out. 48 TABLE No. 1. Number of complaints received and investigated 418 ,, Statutory Notices served 9 ,, Statutory Notices complied with 6 ,, Informal notices, letters, etc. 632 TABLE No. 2. Details of Inspection Work carried out during the year. Number of Inspections s Re-inpections Houses Inspected Housing Acts (all particulars recorded) 455 2018 Houses Inspected (defects only recorded) 78 648 Houses Inspected (Housing Act, 1936, Overcrowding) 235 23 Houses Inspected re Infectious Disease 298 — Inspections—Factories 118 12 Outworkers 20 — Schools 10 — Refuse Tips 155 — Van Dwellers 8 — Bakehouses 42 16 Slaughterhouses 820 — Meat Shops and Premises where food is prepared 1399 Cowsheds and Dairies 42 6 Common Lodging House 10 — re Offensive Accumulations 75 84 re Keeping of Animals 33 27 re Rats 80 126 re Offensive Trades 148 — re Verminous Premises 56 66 re Insufficient Ashplace Accommodation 73 88 Drains Inspected 908 1112 Drains Tested (Water, Smoke or Grenade) 1854 — Housing Estate Visits— Inspections 175 — Re-inspections — 564 Miscellaneous Visits 1384 — Miscellaneous Inspections (including Refuse Removal, Conveniences) 2839 49 TABLE No. 3. Improvements effected and defective sanitary conditions remedied. With Notice Without Notice Houses— Provided with sufficient W.C. accommodation 221 Provided with sufficient ashplace accommodation — 168 Houses improved internally— Dirty rooms cleansed 9 151 Walls and ceilings repaired 21 154 Dampness in rooms remedied 2 123 Defective floors repaired 4 36 Ventilation of rooms improved 8 76 Windows repaired 13 96 Coppers repaired 1 13 Stoves, fireplaces, etc., provided or repaired 4 67 Houses improved externally— Roofs repaired 1 42 Eaves, gutters and down spouts fixed or repaired 1 69 Yards paved or repaired — 27 Yards cleansed — 8 Chimney stacks rebuilt or repaired — 32 Walls repointed or repaired 1 108 Miscellaneous repairs 5 135 Drainage- Drains cleansed or repaired — 560 New drains constructed — 10 New gullies provided — 9 Ventilation of drainage system improved 30 Inspection chambers built or improved 1 45 New sinks provided — 4 Waste pipes provided or improved — 121 Offensive accumulations removed 1 46 Nuisances from animals abated 1 8 Tents. Vans and Sheds, nuisances abated Other nuisances abated — 102 50 TABLE No. 4. Infectious Disease— Cases removed to Isolation Hospitals 184 Houses visited including re-visits 298 Rooms disinfected 266 Notices delivered to Educational Authorities, Royal Factories, etc. 575 Houses at which defective sanitary conditions were found and remedied 4 TABLE No. 5. Food Inspection. 5,139 carcases were inspected during the time of or after slaughter as follows:— Cattle 105 Sheep and Lambs 1,073 Pigs 3,755 Calves 206 Total 5,139 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 — 8 138 Pigs 1 124 1,160 Calves — — — Total weight 1,298 Diseases other than Tuberculosis. Cattle — 11 126 Sheep 2 4 58 Pigs 20 282 2,569 Calves 1 1 35 Total weight 2,788 400lbs. of shrimps; 601bs of Fruit; 321bs. Rabbits; and 841bs. of Fish were also condemned. 51 TABLE No. 6. Factories Act, 1937. 1. Inspections for Purposes of Provisions as to Health. Including Inspections made by Sanitary Inspectors. Premises. Number of:— Inspections. Written Notices. Prosecutions. 1 2 3 4 Factories with mechanical power 81 5 — Factories without mechanical power 127 — — † Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) † Electrical Stations should be reckoned as factories. Total 208 5 2. Defects Found. Particulars Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M Inspector. i 2 3 4 5 Want of cleanliness (S. 1) 7 8 — — Overcrowding (S. 2) Unreasonable temperature (S. 3) Inadequate ventilation (S. 4) Ineffective drainage of floors (S. 6) Sanitary Conveniences (S. 7)— Insufficient Unsuitable or defective 8 7 — — Not separate for sexes 1 Other Offences 1 — — (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry;it' Health {Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted ill the Third Schedule to the Factories Act. 1937.) Total 16 16 — — SHOPS ACTS, 1912 to 1936. The following Closing Orders are in operation within the area:— Bexley Urban District (Butchers) Mo. 6 Order, 1920. Bexley Urban District (Grocers and Provision Merchants) No. 7 Order, 1923. Bexley Urban District (Miscellaneous Trades) No. 8 Order, 1923. Approximately 830 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, 1912-36 873 252 No legal proceedings were instituted dnring the year. 1 am, Ladies and Gentlemen, Yours obediently, R.T. 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 Act, 1936. A few complaints have been received in the Department with respect to two chimneys in commercial areas liordering on residential areas, but these have been dealt with iu the main by use of appropriate fuel and improved methods of stoking. No smoke nuisance exists in the Borough except that caused by domestic chimneys, and no real hope of its solution can be anticipated except by the extended use of smokeless fuels or until the Englishman's love of the open fire changes. (vi) Swimming Pool. The only swimming pool in the 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 pool, a smaller one for children and another for 53 paddling. The water is kept pure by 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 0.12 Absent Shallow end 0.2 0.5 Absent (vii) Eradication of Bed Bugs. No alterations in the methods outlined in the report of 1987 have been made. No. of Corporation No. of other houses houses infested infested with bugs 3 with bugs 1 Disinfested 1 Disinfested 3 Result: Good. Results : 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. Corporation houses. Other houses. One room only 4 Three rooms only 4 Two rooms only 2 10 families were transferred from properties to be demolished, and their furniture, etc., was disinfested bv HCN in vans by a contractor. Visits by the Sanitary Inspectors are made at intervals after disinfestations to determine whether the treatment has been efficacious, and to instruct the tenant how to maintain freedom from vermin. (viii) Camping Sites. A camp site used by Rover Scouts and Woodcraft Folk, in Hall Place, was kept under observation, but was not used over such a period as to come within the operation of Section 269 of the Public Health Act, 1936. 54 SCHOOLS. There are now 29 Elementary Schools (including' six non-provided schools, and a day Technical School for Girls) in the Borough, and the sanitary conditions are satisfactory. The opening of the new Church of England School in Wrotham Road, Welling, has eased the overcrowding situation at Brampton Road School, and it is hoped that with the provision of a new school in Lodge Lane the difficulty will he solved. 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 74 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 910 Statistics for 1938. Total number of new houses erected during the year (including 50 Council Houses) 1170 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 533 (b) Number of inspections made for the purpose 3199 55 (2) (a) Number of dwelling-houses cluded under sub-head (1) above) which were inspected and recorded under the, Housing Consolidated Regulations, 1925 and 1932 455 (b) Number of inspections made for the purpose 2473 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be uufit for human habitation 400 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation133 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 119 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 8 (2) Number of dwelling-houses which were rendered fit after service of formal notices : (a) By owners 3 (b) By local authority in default of owners— B. Proceedings tinder Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1 (b) By local authority in default of owners — 56 C. Proceedings under Sections 11 and 13 of Housing; Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 18 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 19 D. 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 made fit in pursuance of Undertakings given 1 (4) Undertakings to discontinue usiug separate tenements for human habitation accepted 1 4. Housing Act, 1936—Fart IV—Overcrowding. 1936 1937 1938 A. (1) Number of dwellings overcrowded at the end of the year 89 45 33 (2) Number of families dwelling therein 89 45 33 (3) Number of persons dwelling therein 496½ 320½ 260 B. Number of new cases of overcrowding reported during the year 8 7 2 C. (1) Number of cases of crowding during the year relieved 23 51 14 (2) Number of persons concerned in such cases 158 375 85½ 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 Nil 57 Housing—Overcrowding. The 33 outstanding cases of overcrowding are receiving the attention of the Housing Committee, and 50 of the 96 houses (including bungalows for aged persons) to he erected in Glen more Road, Welling, for accommodation of overcrowded and other families were completed by the end of 1938. No. of overcrowded dwellings. Jan. 31st, 1936. Dec. 31st, 1937. Dec. 31st, 1938. Owner occupiers 16 6 5 Welling- Hutments (compulsory Purchase Areas) 20 12 12 Corporation 31 8 4 Private owners 37 19 12* * Four of these houses are the subject of demolition orders. Housing—General. Bexley (Lodge Lane Hutments) Clearance Area, 1937. A compulsory Purchase Order was made by the Council in May, 1938, affecting 294 hutments in the Clearance Area, aud including eleven reconditioned hutments and certain contiguous lands. An inquiry was held by the Ministry of Health in November, 1938, and the Order has been since confirmed, subject to 67 hutments being deemed unfit for human habitation, but only because of their bad arrangement. In respect of a further 52 hutments, a payment is to be made by the Council under Section 42, on the grounds ihat the properties have been well maintained. Bexley (East Wiekham Hutments) Clearance Areas Nos. 1,2,'3 (1937). In respect of these, Compulsory Purchase Orders have been made by the Council. Bexley (Princes Street, Bexleyheath) Clearance Order, 1938 I represented this area covering seventeen properties in February, 1938, and a Clearance Order was made on the 31st May, 1938. An inquiry was held by the Ministry of Health in November, 1938, and the Order was confirmed without modification. 58 Section E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The milk retailed for consumption in tlie area is railborne, pasteurised and bottled, except for one small supply by a producer retailer. Licences granted by the Council during 1938 under the Milk (Special Designations) Order, 1936, are as follows: — For the sale of: — Pasteurised Milk ... ... ... 29 licences " Tuberculin Tested " Milk ... ... 14 licences There is now only one cowshed in the district, and it is periodically inspected by the Sanitary Inspectors. The Council's Veterinary Inspector resigned during the year, and in view of the national change in veterinary inspection and the small amount of work now remaining in connection with dairy farms, no sticcessor was appointed. Samples of milk have been taken for bacteriological examination, and the results on the whole have been good. Any result which does not show a high standard is followed up and referred to the Medical Officer of Health of the district of origin. Further samples from the same distributor are taken and an improvement always noticed. (b) Meat Inspection. There are four 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. 59 Section F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Small Pox. No case of small pox was notified during the year. Scarlet Fever. During the year there were 154 notified cases of scarlet fever compared with 194 in the previous year. Of these, 118 were isolated in Bow Arrow Hospital, 33 at home, and 3 in other isolation hospitals. Home isolation continues to be encouraged, and the disease remains mild. There was one death associated with scarlet fever, the immediate cause being general peritonitis, gangrenous appendicitis and operation. Return cases from hospital cases: Nil. Return cases from home nursed cases: Nil Average length of stay in Hospital: 38 days. Diphtheria. Forty-eight cases were notified as compared with 59 in 1937, and there was only one death. This occurred in a child age four. None of these cases was isolated at home, 41 being admitted to Bow Arrow Hospital, and 7 to other isolation hospitals. The average number of days per patient in hospital was 32. 489 swabs were taken for bacteriological examination although on the whole, less reliance on, and waiting for, the laboratories report is taken, and where the practitioner is in doubt the case is usually sent to hospital or a second opinion sought. The Medical Officers of the Health Department are always available for consultation. Anti-toxin is supplied free by the Corporation, 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. 60 61 The following Table gives the particulars concerning the cases of Infectious Disease (other than Tuberculosis) notified in the area during the year. NOTIFIABLE DISEASES (other than tuberculosis) DURING THE YEAR, 1938. 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 154 3 3 12 17 83 19 6 10 1 121 1 Diphtheria 48 1 4 4 5 12 4 4 10 2 2 48 1 Enteric Fever (including Typhoid and Paratyphoid) 1 1 i Puerperal Fever 26 2 21 3 IO Pneumonia 29 1 1 3 4 2 4 8 6 3 31 Encephalitis Lethargica 1 1 Acute Poliomyelitis 1 1 Ophthalmia Neonatorum 2 2 2 Erysipelas 18 1 7 1 7 2 5 Cerebro-spinal Fever 3 1 1 I 3 2 Dysentery 2 1 I Totals 285 3 5 11 17 23 99 23 13 52 11 19 9 199 Immunisation against Diphtheria. 1938 was the first full year of operation of the scheme for immunisation against diphtheria and no modification of the procedure as outlined in the previous report has been made. At the time of writing however a scheme is being evolved to bring in more children from the junior and infant schools. T.A.M. is the prophylactic used. No. of children No. immunised by No. who failed immunised at Clinics. general to attend practitioners. for full course. One child previously immunised was in the County Hospital during an outbreak of diphtheria in the ward and was swabbed, and found to have a positive swab for diphtheria organisms. He was removed to the Isolation Hospital, but no clinical signs of diphtheria were present and further swabs were negative. Enteric Fever. One case was notified during 1938, and the particular infection was paratyphoid B. The actual source of infection was not traced, although it was suspected to be shell fish. There were no deaths. 1937 232 1938 872 57 134 5 27 Puerperal Pyrexia. Twenty-six cases were notified during the year as follows:— Isolated at:— Delivered at:— Queen Charlotte's Hospital 9 Patient's home 5 Maternity Home, Bexleyheath 2 Nursing Home, Bexley 1 Patient's home, Miscarriage 1 War Memorial Hospital, Shooters Hill 1 Same British Hospital for Mothers' and Babies', Woolwich 4 Same Maternity Home, Bexleyheath 4 Same General Lying-in Hospital 1 Same 62 Farnborough Hospital 1 Guys Hospital 1 Patient's home Same Greenwich Borough Council Maternity Home 1 Same Nursing Home, Bexley 1 Same Patient's home 3 Same Ophthalmia Neonatorum. Two cases were notified during the year. One was transferred from the City of London Maternity Hospital to the Royal London Ophthalmic Hospital, and the other was admitted through the Corporation's scheme to the St. Margaret's L.C.C. Hospital. The cases did well and recovered without injury to the eyes. Measles and Whooping Cough. 1938 was an epidemic year for measles and 430 cases were notified from schools. Two children died as compared with three in the 1936 epidemic, and it was felt that on the whole the epidemic was mild though several very ill cases were seen. Eleven cases were admitted to the Isolation hospital, either on account of the severity of the disease with or without complications or inadequate facilities in the home. Through the Corporation's scheme nursing provision for seven cases by the Bexley Nursing Fund was arranged. A supply of adult serum was obtained from donors on the staff of the Department and examined and put up in sterile ampoules of 10 c.c. each, after being tested for sterility by Messrs. Burroughs Wellcome, Ltd. The adult serum was issued to general practitioners on request. Eleven contacts, who were either debilitated or suffering from another disease were given 10 c.c.s each on the 4th to the 6th day after contact with a case or onset of rash in the first case. In five cases measles was entirely prevented, in five others a very mild attack of measles followed, as desired, and in the eleventh case, the child, aged 11 months, just recovering from whooping cough and bronchitis, measles and bronchopneumonia followed, but some benefit was given and the child recovered. None of these children has developed any untoward symptom since 63 Fourteen cases of whooping cough were notified from schools with 110 deaths as compared with 201 cases and 2 deaths in 1937. Two cases were admitted to the Isolation Hospital. Dysentery. Two cases were notified and there were 110 deaths. Cerebro-spinal Fever. Three cases were notified during the year, in each case after admission to a general hospital. One patient died, and on investigation the cases were apparently sporadic. A death of a child from cerebro-spinal fever in an unnotified case also occurred. TUBERCULOSIS. During the vear 91 cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1938 are contained in the following table:— New Cases Deaths Age Period Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. 0— 1 – – – – – – – – 1— 5 – – 1 1 – – 1 1 5—10 – 1 3 – – – – – 10—15 2 1 1 1 – – – – 15—20 4 2 – 2 1 1 – – 20—25 8 7 – 1 – 2 – – 25—35 16 8 – 2 3 6 – – 35—45 4 9 – – 3 2 – – 45—55 6 2 1 1 6 2 – – 55—65 6 1 – 1 2 1 – – 65 and upwards – – – – – – – – Totals 46 31 6 9 15 14 1 1 64 The number of non-notified tuberculosis deaths was two. 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. 245 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 carried out by the County, certain duties in connection therewith have to be done by the staff of your Health Department. Three families during the year in which there was a case of infectious tuberculosis where the patient could not have a bedroom to him or herself were recommended for consideration by the Housing Committee; and one family was rehoused. Disinfectants are provided for notified cases, and arrangements are made for the disinfection of premises, beddings, 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 183 152 41 46 422 Number on Register at the end of the year 225 187 45 56 513 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 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 65 culosis 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. DEATHS FROM CANCER BY ACE DISTRIBUTION. Birth to 15 15 & under 30 30 & 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 Total Nil 3 4 1 10 9 9 9 13 16 9 11 94 National Health Campaign. In co-operation with the Ministry of Health, Board of Education and the Central Council for Health Education, the Council took part in the above Campaign, which lasted from October 1937 to February 1938 inclusive, periods being given up to particular aspects of the Health Services. 38 16-sheet double crown posters, and 138 double crown posters were posted on hoardings, 276 posters were placed in waiting rooms, offices, classrooms, and clinics, and 418 mounted display cards were placed on shop and collecting office counters. Traffic notices were placed on Corporation vehicles, 2.400 folders were distributed at the Maternity and Child Welfare Centres, and 16,000 bookmarks were issued through the libraries. In a rapidly growing town with a large proportion of child population the Health services are well used and the effect of this campaign could, therefore, not be judged. 66 INDEX. Item. Page. Health Committee Public Health Staff 4— 5 Ambulance Facilities 26—28 Clinics and Treatment Centres 28—29 Corporation Maternity Home 25, 33—36 Closet Accommodation 48 Chief Sanitary Inspector's Report 48—53 Camping Sites 54 Deaths from Cancer by Age Distribution 66 Drainage and Sewerage 47 Eradication of Bed Bugs 54 General Hospitals 25—26 General Provision of Health Services for the Borough 24—26 Housing 55—58 Inspections 55 Action Taken 56—57 Overcrowding 57—58 General 58 Inspection and Supervision of Food 59 Milk Supply 59 Meat Inspection 59 Adulteration of Food 59 Institutional Provisions for Mothers 33—44 Assisted Milk Supply 39—40 Orthopedic Treatment 40—41 Child Life Protection 41 Records 41 Maternity Outfits 41 Compensation to Midwife for loss of case 41 Sunlight Clinic 42 Ear and Eye Defects 42 Table of Maternity and Child Welfare Work Done 43 Special Classes 44 Isolation Hospital Accommodation 24 List of Adoptive Acts, etc , and Byelaws in Force 45 Laboratory Facilities 30 Maternity and Child Welfare 30—33 Ante-natal Care 30 67 INDEX—continued. Item. Page. Co-operation with General Practitioners 30—31 Consultant Services 31 Maternity Accommodation 31—32 Ante-natal and Post-natal Clinics 32 Home Helps 32 Dental Treatment 32—-33 Mortuary 28 National Health Campaign 66 Prevalence of and Control over Infectious and Other Diseases 60—66 Smallpox 60 Scarlet Fever 60 Diphtheria 60 Table 61 Immunisation against Diphtheria 62 Enteric Fever 62 Puerperal Pyrexia 62—63 Ophthalmia Neonatorum 63 Measles 63 Whooping Cough 63 Dysentery 64 Cerebro-spinal Fever 64 Tuberculosis 64—66 Professional Nursing in the Home 29 Public Cleansing 48 Rivers and Streams 47 Schools 55 Statistics and Social Conditions of the Borough 7—23 Population 7, 11, and 14 Unemployment 8— 9 Nutrition 9 Social Amenities 10 Extracts from Vital Statistics 10—12 Births, Stillbirth, Death, etc., Bates 13—17 Deaths in Age Groups 18—19 Infantile Mortality 20—21 Maternal Mortality 21—23 Smoke Abatement 53 Swimming Pool 53—54 68