Journal rebind Co.Ltd. Unit 4 ??? ??? Grays Essex BEX 10 BOROUGH OF BEXLEY Annual Report OF THE Medical Officer of Health, For the Year 1945 and Statistical Report For Years 1939—44. GEO. F. BRAMLEY, M.D., Ch.B., D.P.H., Medical Officer of Health. Printed by T. W. Jenkins, Ltd. (T.U.), 73-75, Broadway. Bexleyheath. 68003 BOROUGH OF BEXLEY Annual Report OF THE Medical Officer of Health, For the Year 1945 and Statistical Report For Years 1939—44. GEO. F. BRAMLEY, M.D , Ch.B., D P.H., Medical Officer of Health. Borough of Bexley. Mayor: Alderman J. C. McLean, J.P. Deputy Mayor: Alderman J. T. H. Ashmore. HEALTH COMMITTEE. Chairman: Alderman Mrs. A. Welch. Vice-Chairman: Councillor A. S. Groome. Alderman A. R. Potter, J.P., C.C. Councillor F. H. Bond, J.P. Councillor Mrs. E. Boswell. Councillor W. Carter. Councillor M. J. Corr. Councillor J. DufFus. Councillor D. C. E. Gorringe. Councillor Mrs. M. Hall. Councillor Mrs. A. E. Lawrence. Councillor R. C. Swallow. PUBLIC HEALTH STAFF, 1945. Medical Officer of Health and Superintendent of the Maternity and Child Welfare Services. Medical Superintendent Corporation Maternity Home. Geo. F. Bramley, M.D., Ch.B., D.P.H. (Released for service in R.A.M.C. Hygiene Section for Civil Affairs 10/2/45). Assistant Medical Officer of Health and Medical Officer Corporation Maternity Home. Mary Love, M.B., Ch.B., D.P.H. (Acting M.O.H. from 10/2/45). Temporary Assistant Medical Officer of Health. Mary H. Westlake, M.B., D.P.H. commenced 29/1/45. Assistant Medical Officer at Maternity and Child Welfare Clinics (part-time temporary). Isobel Johnson, M.B., ES., Ch.B. Chief Sanitary Inspector, Public Cleansing Officer and Shops Acts Inspector. *‡ R. J. Rayner, F.R.S.I. Assistant Chief Sanitary Inspector. *† G. Hind. District Sanitary Inspectors *† F. W. Willington. *† J. T. Boocock. Assistant Sanitary Inspectors *† G. F. Lovegrove (on military service) Inspector. One Temporary Inspector. Senior Health Visitor J. Ormandy (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. Health Visitors . N. Feeley (Miss), S.C.M. and Health Visitor's Certificate. K. V. Birmingham (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. G. M. Blackmore (Mrs.), S.R.N., S.C.N, and Health Visitor's Certificate. D. G. Stanley (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. K. M. Miller (Miss), S.R.N., S.C.M. and Health Visitor's Certificate C. Darby (Miss), S.R.N., S.C.M. and Health Vistor's Certificate E. M. Gibson (Mrs.), S.R.N., S.C.M. and Health Visitor's Certificate. Matron of Corporation Maternity Home, Lavernock Road, Bexleyheath. F. H. Hammond (Miss), S.R.N., F.R.N., S.C.M. Midwive's Teachers' Certificate. 3 Chief Clerk M. Bentley (Miss). Clerks G. A. Pearson. ) N. E. Broom. R. V. Hoad. J R. A. Milligan (On Military Service but reported missing June 1944). M. .1. E. Hoad (Mrs.) Five Temporary Female Clerks. On Military Service. Consultant for Puerperal Pyrexia and for Ante-Natal and Obstetric Complications. J. V. O'Sullivan, M.D., M.R.C.P., F.R.C.S., M.C.O.G. (part-time). Dental Surgeon H. Wade, L.D.S., (part-time). On Military Service until 3/7/45. • Temporary Dental Surgeon H. Warner, L.D.S. (part-time). Resigned 30/6/45. Public Analyst F. W. Arnaud, F.T.C. (parttime). Other Staff Two Food Sales Clerks (parttime). One Disinfector and Mortuary Attendant (On Military Service until 12/11/45). One Temporary Disinfector and Mortuary Attendant. One Ambulance Driver. One Ambulance Driver (On * Military Service until October 1945). One Relief Driver (On Military Service). One Ambulance Driver (temporary). * Certificate for Inspection of Meat and other Foods, † Certificate of Royal Sanitary Institute and Sanitary Inspectors' Joint Board. ‡ Certificate of the Royal Sanitary Institute. PUBLIC HEALTH STAFF, 1939-1944. Medical Officer of Health and Superintendent of the Maternity and Child Welfare Services. Medical Superintendent Corporation Maternity Home. Geo. F. Bramley, M.D., Ch.B., D.P.H. Assistant Medical Officer of Health and Medical Officer Corporation Maternity Home. Mary Love, M.B., Ch.B., D.P.H. Assistant Medical Officer at M. & C. W. Clinics (part-time). Mary Anderson, M.R.C.S., L.R.C.P. (1939). 4 Assistant Medical Officer at M. & C. W. Clinics (part-time, temporary). Isabel C. Johnson, M.B., Ch.B. (1940-1942). Assistant Medical Officer at M. & C. W. Clinics (part-time, temporary). Beatrice Mary Kidd, M.B. (1943 resigned May 1944). Assistant Medical Officer at M. & C. W. Clinics (part-time, temporary). Charlotte Himsworth, M.B., B.S. (1943 resigned July 1944. Assistant Medical Officer at M. & C. w. Clinics (part-time, temporary). label C. Johnson, M.B., Ch.B. (Recommenced July 1944). Chief Sanitary Inspector, Public Cleansing Officer and Shops Acts Inspector. ‡ R. J- Rayner, F.R.S.I. Assistant Chief Sanitary Inspector. *† G. Hind. District Sanitary Inspectors *† F. W. Willington. *† J. T. Bocock. * A. V. Griffith (resigned 30/6/39). Assistant Sanitary Inspectors *†G. F. Lovegrove (Apptd. 1/7/39 Military Service 3/9/39). One temporary Assistant Sanitary Inspector appointed 1940. Health Visitors J. Ormandy (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. K. V. Birmingham (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. G. M. Froggatt (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. D. G. Stanley (Miss), S.R.N., S.C..M. and Health Visitor's Certificate. J. Darby (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. (Absent through sickness 1942 and 1943. Parttime Jan.-March 1944; Fulltime April 1944). K. M. Miller (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. E. M. Gibson (Mrs.), S.R.N., S.C.M. and Health Visitor's Certificate, appointed 9.2.42. N. M. Marshall (Miss), S.R.N., C.M.B. and Health Visitor's Certificate; Certificate of Sanitary Inspectors' Joint Board (resigned 14/1/39). N. Feeley (Miss), S.C.M. and Health Visitor's Certificate. 5 Matron of the Corporation Maternity Home, Lavernock Road, Bexleyheath. F. H. Hammond (Miss), S.R.N., F.R.N., S.C.M. Chief Clerk M. Bentley (Miss). Clerks G. F. Lovegrove (resigned 30/6/39). G. A. Pearson (on military service from January 1941). N. E. Broom (on military service from 3/9/39). R. V. Hoad (on military service from 3/9/39). M. J. Priestland (Miss). R. Milligan (on military service from May 1941. Reported missing June 1944). M. J. Knox (Mrs.) nee Williams (resigned 30/9/43). Three temporary Female Clerks. Two temporary Female Clerks (part-time). Consultant for Puerperal Pyrexia and for Ante-Natal and Obstetric Complications. J. V. O'Sullivan, M.D., M.R.C.P., F.R.C.S., M.C.O.G. (part-time). Dental Surgeon H. Wade, L.D.S., (part-time). (On military service from 1940). Temporary Dental Surgeon H. Warner, L.D.S. (part-time). Public Analyst F. W. F. Arnaud, F.I.C.* (parttime). Other Staff Two Food Sales Clerks (parttime). One Disinfector and Mortuary Attendant (on military service). One Disinfector and Mortuary Attendant (temporary). One Ambulance Driver. One Ambulance Driver and relief driver (on military service 1941). One Temporary Driver. * Certificate for Inspection of Meat and other Foods. † Certificate of Royal Sanitary Institute and Sanitary Inspectors' Joint Board. ‡ Certificate of the Royal Sanitary Institute. 6 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, 1945. In presenting the annual report for 1945 the opportunity has been taken of including' the statistical material from the department which lias not been presented to the Council during the years 1939 to 1944 iclusive. It is felt that this should now be placed in a composite form for the Council's information, for reference and for the normal work of the Health Department. A summary of vital statistics for 1945 follows on these opening remarks and is based on an estimation from the Registrar General of the population for midyear 1945 of 70,040. By the end of 1945 the population was 81,110. This is a return to the" pre-war figures as a result of the return of evacuees and men and women from the forces plus the natural increase in population. Despite 6 years of war conditions the general health of the Borough as compared with the rest of the country was good in 1945. The Infantile Mortality rate of 33.9 is quite comparable with the figure for 1944 of 31.37, but we know that a goal of 25 can be reached in this area. The stillbirth rate also compares favourably with that of England and Wales. The low death rate of 9 • 27 is due to the youth of the population, but is somewhat artifically raised by the number of air raid casualties early in tlie year. The birth rate shews a slight decrease on that of 1944, but is relatively high considering the extreme upset in domestic conditions during the VI and Y2 attacks in the late summer of 1944 and early months of 1945. The low notification rate for Diphtheria justifies the large amount of work which has been done in immunisation against Diphtheria since it first commenced in this Borough in 1937. Inoculation against whooping cough ceased during 1945 as it became impossible to obtain what is considered a suitable material but although the notification rate -is much lower than in the rest of the country I am not prepared to state categorically that the whooping cough vaccination campaign which resulted in a total of 4,703 children under the age of 5 being vaccinated since 1942, is the cause. There were no deaths in 1945 in connection with childbirth. 7 547 mothers were accommodated for their confinements in the Corporation Maternity Home during the year and it was not until towards the end of the year that shortage of nursing staff began to be felt. Until then the position had been favourable compared with most maternity units in the country. Clinic attendances rose again to pre-war levels, but the continued high pressure on the Bexleyheath Clinic means that provision in the Long Lane area for an additional Clinc cannot be long delayed. The needs for Cold Blow and Old Bexley are not so urgent until housing development in that area proceeds. The Day Nursery attendances continued to fall in the early months, but in the later months of the year 4 of the 6 nurseries had waiting list. Despite the fact that the 24 hour nursery was still well used in Welling throughout the year the Ministries of Health and Labour & National Service insisted on closing the night nursery in December. The collection of house refuse was again not maintained on a weekly basis owing to shortage of labour and three weeks, and longer, sometimes elapsed between collections. The controlled tips suffered from lack of suitable covering material and shortage of labour. There was a cricket infestation in one tip and the other was set on fire and burned for many months. With an easing of the labour situation in 1946 these difficulties will be overcome. During practically the whole of the year under review I was absent in the Army and I must express my appreciation of the way in which Dr. Love took over the duties at a difficult time and successfully began the change back to peace time working of the department. I have also to acknowledge the fullest help of the Health Committee and the Chief Officers of the other Departments. In thanking the staff of the Health Department for their excellent co-operation and hard work T wish to take the opportunity of welcoming back those members of the staff who have now returned from the Forces. G. F. BRAMLEY, Medical Officer of Health 8 SUMMARY OF VITAL STATISTICS, 1945. England and Wales. 126 County Boro's and Great Towns including London. 148 Smaller Towns Resident Populations 25,UU0 to 50,000 at 1931 Census. London Administrative County. Borough of Bexley. *Rates per 1,000 Civilian Population. Births– Live 10.1‡ 19.1 19.2 15.7 18.81 Still 0.46‡ 0.58 0.53 0.40 0.41 Deaths– All Causes. 11.4‡ 13.5 12.3 13.8 9.27 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.01 0.02 0.00 Diphtheria 0.02 0.02 0.02 0.01 0.01 Influenza 0.08 0.07 0.07 0.07 0.03 Smallpox – – – – – Measles 0.02 0.02 0.02 0.01 0.00 Rates per 1,000 Live Births. Deaths under one year of age 46† 54 43 53 33.9 Deaths from hœa and Enteritis under two years of age 5.6 7.8 4.5 7.6 3.53 Rates per 1,000 Civilian Population : Notifications– Typhoid Fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid Fever 0.01 0.00 0.01 0.00 0.01 Cerebro-Spinal Fever 0.05 0.05 0.05 0.06 0.04 Scarlet Fever 1.89 2.02 2.03 1.57 1.99 Whooping Cough 1.64 1.65 1.47 1.25 0.92 Diphtheria 0.46 0.52 0.56 0.31 0.28 Erysipelas 0.25 0.28 0.24 0.31 0.41 Smallpox 0.00 0.00 – 0.00 – Measles 11.67 10.89 11.19 9.03 6.01 Pneumonia 0.87 1.03 0.72 0.78 0.44 Rates per 1,000 Total Births (Live and Still). (a) Notifications :— Puerperal Fever 9.93 12.65 8.81 3.60 18.0 Puerperal Pyrexia ‡15.87 (b) Maternal .Mortality'—England and Wales:— Bexley No. 140 Abortion with Sepsis. No. 141 Abortion without Sepsis. No. 147 Puerperal Infections. Nos. 142-6 148-50 Other. 0.25 0.08 0.24 1.22 0.00 Abortion:—Mortality per million women aged 15-45—England and Wales:— No. 140 With Sepsis. .No. 141 Without Sepsis. Bexley. 18 6 0.00 *A dash (—) signifies that there were no deaths. †Per 1,000 related births. ‡Rates per 1.000 total copulation. 9 10 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. 1939 1940 1941 1942 1943 1944 1945 Area (acres) 4,869 4,869 4,869 4,869 4,869 4,869 4,869 Population. Registrar General's Estimate mid-year:— (a) Figure for calculating birth rates 80,110 77,670 72,080 77,020 76,740 71,130 75,040 (b) Figure for the calculation of death rates, etc. 78,880 – – – – – – New Houses. Erected 1,002 113 nil 5 5 nil 2 Number of inhabited houses according to rate books (estimated) 24,748 24,866 24,350 24,302 24,246 23,969 23,873 Rateable value £601,847 £603,611 £591,174 £597,392 £597,716 £593,103 £592.910 Sum represented by Penny Rate £2,350 £2,340 £2,200 £2,300 £2,400 £2,400 £2,350 Unemployment. 31st December—Men 712 151 21 66 57 24 122 Women 986 529 146 32 23 2 43 Boys 107 34 16 11 18 10 38 Girls 215 57 24 39 11 22 42 Total 1,620 771 207 148 109 58 245 Social Conditions. The above figures reflect movements of the population associated with air raids except the first evacuation of September, 1939. They also shew the amount of housing accommodation available. Because of Bexley's position sleeping in public shelters was fairly extensive in the winter 1939/40 and 1944 /45 (probably 5,000 people nightly at a maximum) but with almost eveiy house having its own garden, sleeping in Anderson shelters was more the rule. There is no evidence that general health suffered. With food shortages there was a well developed scheme for allotment holders and there is no doubt that in common with the rest of the country more fresh vegetables were consumed in the war years than previously. The Council sponsored the Holidays-at-Home Scheme from 1942 and a full use was made of the amenities especially those provided in the Parks. Scabies was to be more frequently found from 1940 and whether its increased existence was due to the greater communal life developed in war time or whether due to a phase in the cycle of this disease is not clear. Scabies has shewn no tendency to decrease during the years under review. In 1943 overcrowding began, not on the standards of the Housing Act, but chiefly in two or more families sharing accommodation often for convenience, because of absence of husbands in the Forces or a tendency to move out from Central London. Bexlev's population is young, there was relatively a higher proportion of husbands and young women in the Forces. The increase in the number of tuberculosis people on the Register is associated with the youth of the population and a high proportion of the population who stayed at home working long hours in factories and offices to and from which a moderately long journey had to be made daily. Bexley's social conditions during the war can be appreciated from the following summing up of its position and population. It was almost at the termindus of ' bomb alley,' its population had increased at the quickest rate from 1931 to 1939 of any population in England and Wales and comparable with the growth of Dagenham in the preceding decennial census period. It has the highest proportion of young married people in Kent. It is a modern working class dormitory Borough.. 11 12 EXTRACTS FROM VITAL STATISTICS. 1939 1940 1941 1942 1943 1944 1945 Births. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Total 747 676 632 647 601 544 727 742 707 677 786 712 728 685 Legitimate 730 660 620 636 585 529 706 726 674 659 750 685 695 650 Illegitimate 17 16 12 11 16 15 21 16 33 18 36 27 33 35 Total 1,423 1,279 1,145 1,469 1,384 1,498 1,413 Legitimate 1,390 1,256 1,114 1,432 1,333 1,435 1,345 Illegitimate 33 23 31 37 51 63 68 Birth Rate per 1,000 of Estimated resident population 17.76 16.46 15.88 19.07 18.03 21.06 18.81 Rate per 1,000 for— England and Wales 15.0 14.6 14.2 15.8 16.5 17.6 16.1 County Boroughs and Great Towns including London 14.8 16.0 14.7 17.3 18.6 20.3 19.1 Smaller Towns (estimated populations 25,000 to 50,000 at Census 1931) 15.6 15.7 16.4 18.4 19.4 20.9 19.2 London Administrative County 12.3 13.7 8.9 14.0 15.8 15.0 15.7 Stillbirths. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 18 23 20 12 21 14 28 10 17 12 15 15 12 19 Total 41 32 35 38 29 30 31 Rate per 1,000— Total Live and Stillbirths 28.0 24.4 29.6 25.2 20.5 19.0 21.4 Population 0.51 0.41 0.48 0.49 0.37 0.42 0.41 For England and Wales 0.59 0.55 0.51 0.54 0.51 0.50 0.46 For County Boroughs and Great Towns including London 0.59 0.64 0.58 0.66 0.63 0.64 0.58 For Smaller Towns (estimated populations 25,000 to 50,000 at Census 1931) 0.57 0.55 0.60 0.62 0.61 0.61 0.53 For london Administrative county 0.44 0.44 0.33 0.48 0.45 0.42 0.40 Number of stillbirth registered as illegitimate 1 – 2 2 1 – 4 1939 1940 1941 1942 1943 1944 1945 13 ??? Deaths. 1939 1940 1941 1942 1943 1944 1945 M F M F M F M F M F M F M F All Causes 346 284 426 382 374 324 372 301 378 329 382 344 333 363 Total 630 808 698 673 707 726 696 Death Bate per 1,000 of estimated resident population 7.98 10.40 9.68 8.73 9.21 10.2 9.27 Death Rate of Country—Bate per 1,000 for— England and Wales 12.1 14.3 12.9 11.6 12.1 11.6 11.4 126 County Boroughs and Great Towns including London 12.0 15.8 14.9 13.3 14.2 13.7 13.5 148 Smaller Towns (estimated populations 25,000 to 50,000 at Census 1931) 11.2 12.8 13.0 12.1 12.7 12.4 12.3 London Administrative County 11.0 17.8 16.3 13.9 15.0 15.7 13.8 Number of women dying in, or in consequence of, childbirth from Puerperal and Post Abortive Sepsis – – 1 1 1 – – From other Puerperal causes 1 1 2 1 1 2 – Rate per 1,000 total Live and Stillbirths 0.69 0.79 2.77 1.32 1.41 1.30 – M. F. M. F. M. F. M. F. M. F. M. F. M. F. Deaths of infants under 1 year of age 38 18 25 31 23 14 38 10 28 8 23 24 25 23 Total 56 56 37 48 36 47 48 Legitimate 38 17 24 31 22 14 36 10 26 8 21 23 22 21 Total 55 55 36 46 34 44 43 Illegitimate – 1 1 – 1 – 2 – 2 – 2 1 3 2 Total 1 1 1 2 2 3 5 Death Rate of infants under 1 year of age :— Total per 1,000 Live Births 40.1 45.4 35.4 32.6 26.01 31.37 33.9 Legitimate per 1,000 Live Births 40.3 45.5 35.5 32.1 25.5 30.66 31.97 Illegitimate per 1,000 illegitimate Live Births 31.2 43.4 30.0 54.0 39.2 47.61 73.5 Deaths from Measles, all ages – – – – – 1 1 – – 1 – – – – Total – – 1 1 1 – – Deaths from Whooping Cough 2 – – – 2 1 3 – 1 – – 2 – – Total 2 – 3 3 1 2 – Deaths from Diarrhœa (under 2 years of age) 1 3 3 2 1 – 2 1 2 1 4 – 4 1 Total 4 5 1 3 3 4 5 Deaths from Cancer (all ages) 49 48 45 40 53 48 62 48 57 61 48 53 53 65 Total 97 85 101 110 118 101 118 The Registrar General supplied a comparibility factor for the area in 1939 and 1940 by which the death rate of the area should be multiplied in order to make it comparable with other parts of the country, but for the years 1941-1945 no comparability factor was given owing to the movements of population. The figures were as follows: — 1939 1940 Comparability Factor 1.07 1.26 Standardised Death Rate 8.53 13.01 BIRTHS AND STILLBIRTHS IN WARDS. The figures relate to live births and stillbirths notified but not necessarily registered in the same year. LIVE BIRTHS. NUMBER OF BIRTHS. 1939 1940 1941 1942 1943 1944 1945 Christchurch 186 173 187 184 206 235 220 St. Mary's 239 229 172 247 237 244 228 Brampton 276 200 136 248 276 223 247 Danson 182 145 133 209 175 168 187 Falconwood 198 174 137 210 179 228 191 St. Michael's 310 261 209 307 300 286 300 Total 1391 1182 974 1405 1373 1384 1373 STILLBIRTHS. NUMBER OF BIRTHS. 1939 1940 1941 1942 1943 1944 1945 Christchurch 4 5 5 6 5 6 3 St. Mary's 4 5 2 2 8 4 2 Brampton 6 6 4 4 4 5 3 Danson 6 8 5 7 2 1 3 Falconwood 8 2 4 4 2 7 3 St. Michael's 8 7 9 8 4 4 13 Total 36 33 29 31 25 27 27 ANALYSIS OF NOTIFICATIONS OF LIVE AND STILLBIRTHS. Births notified from Institutions 881 723 632 934 959 1021 1033 Births notified by Midwives 459 406 344 461 398 356 341 Births notified by Doctors, etc 87 86 27 41 41 34 26 14 DEATHS IN WARDS. The figures given relate to deaths actually occurring but not necessarily registered. 1939 1940 1941 1942 1943 1944 1945 Wards. Christchurch 148 159 126 169 154 142 140 St. Mary's 94 132 100 100 123 135 126 Brampton 84 125 101 103 91 85 105 Danson 97 98 112 90 110 111 110 Falconwood 76 92 96 72 91 89 84 St. Michael's 128 182 150 145 137 164 127 Total 627 788 685 679 706 726 692 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1939. Causes of Death. M. F. All Causes 346 284 1. Typhoid and Paratyphoid Fevers — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough 2 — 5. Diphtheria — 1 6. Influenza 4 2 7. Encephalitis Lethargica 1 — 8. Cerebrospinal Fever — — 9. Tuberculosis of respiratory system 35 13 10. Other tuberculous diseases 4 0 11. Syphilis — — 12. General paralysis of the insane, tabes dorsalis — — 13. Cancer, malignant disease 49 48 14. Diabetes 4 4 15. Cerebral Haemorrhage, etc. 18 17 16. Heart disease 58 107 17. Aneursym 3 0 18. Other circulatory diseases 22 15 15 Causes of Death. M. F. 19. Bronchitis 8 5 20. Pneumonia (all forms) 20 11 21. Other respiratory diseases 9 5 22. Peptic Ulcer 8 0 23. Diarrhoea, etc. (under two years) 1 3 24. Appendicitis 1 1 25. Cirrhosis of Liver 1 0 26. Other diseases of liver, etc. 2 0 27. Other digestive diseases 10 4 28. Acute and chronic nephritis 6 4 29. Puerperal sepsis — — 30. Other puerperal causes — 1 31. Congenital debility, premature birth, malformation, etc. 21 13 32. Senility 4 3 33. Suicide 2 4 34 Other violence 19 5 35. Other defined diseases 34 17 36. Causes ill-defined or unknown 0 1 Special causes (included in No. 35 above) : — Small-pox — — Poliomyelitis — — Poliocencephalitis — — The years 1940/45 appear under a combined table under the new Registrar General's classification. 16 CAUSES OF DEATHS IN THE BOROUGH REGISTERED DURING 1940-1945. Causes of Death 1940 1941 1942 1943 1944 1945 M F M F M F M F M F M F All causes 426 382 374 324 374 305 378 329 382 344 333 363 1. Typhoid and Paratyphoid Fevers — — — — — — — — — — — — 2. Cerebro-Spinal Fever — — — 1 1 4 1 2 1 — — — 3. Scarlet Fever — — — — — — — — — — — — 4. Whooping Cough — — 2 1 3 1 — — 2 — — 5. Diphtheria 3 1 — — 1 1 — — — 1 — 1 6. Tuberculosis of Respiratory System 28 30 26 14 24 10 24 20 33 23 22 15 7. Other forms of Tuberculosis 5 3 6 7 4 7 2 2 2 2 5 3 8. Syphilitic Diseases 3 1 6 1 2 1 3 1 2 1 3 — 9. Influenza 3 1 1 — 1 — 4 8 — 2 2 — 10. Measles — — — 1 1 — — 1 — — — — 11. Acute Poliomyelitis — — 1 — 1 1 — — — — — — 12. Acute Infectious Encephalitis — — — — — 1 — — — — — — 13. Cancer of Body Cavity and (Esophagus (M) and Uterus (F) 7 3 4 4 4 2 4 8 5 6 2 11 14. Cancer of Stomach and Duodenum 7 6 11 7 13 5 11 11 6 10 10 11 15. Cancer of Breast 11 8 11 12 13 15 16. Cancer of all other sites 31 20 38 29 45 31 42 30 37 24 41 28 17. Diabetes 2 3 2 — 2 4 1 5 1 3 — 4 18. Intracranial Vascular Lesions 21 33 26 32 28 36 34 35 28 36 27 32 19. Heart Disease 89 93 76 80 87 86 80 78 100 68 78 107 20. Other Diseases of the Circulatory System 14 15 14 6 15 12 17 12 12 8 7 7 21. Bronchitis 26 20 20 21 23 13 26 17 19 9 27 14 22. Pneumonia 21 23 18 22 19 15 19 20 12 13 15 7 23. Other Respiratory Diseases 6 2 4 2 6 2 5 10 10 5 4 2 24. Ulcer of Stomach or Duodenum 16 1 5 1 8 3 10 2 8 1 8 2 25. Diarrhoea under 2 years 3 2 1 — 2 1 2 1 4 — 4 1 26. Appendicitis — — 4 3 4 1 2 3 2 — 1 2 27. Other Digestive Diseases 9 5 3 8 6 11 3 6 9 13 8 8 28. Nephritis 9 9 16 6 5 7 6 5 11 6 8 11 29. Puerperal and Post Abortive Sepsis — — — 1 — 1 — 1 — — — — 30. Other Maternal causes — 1 — 2 — 1 — 1 — 2 — — 31. Premature Birth 8 10 5 9 8 1 10 1 6 11 10 5 32. Congenital malformation ; Birth Injuries and Infant Diseases 8 9 10 2 23 3 12 3 10 6 8 12 33. Suicide 4 3 2 7 1 1 2 2 1 1 1 2 34. Road Traffic Accidents 9 1 5 — 7 1 2 2 6 — 6 2 35. Other Violent causes 63 63 32 23 3 4 11 5 35 48 12 20 36. All other causes 29 22 36 33 27 28 44 25 22 30 24 41 17 18 DEATHS IN AGE CROUPS IN 1939. These relate to deaths occurring in 1.939, but not necessarily registered in that year. Short List of Causes of Death in Use in General Register Office. Total 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. 627 60 4 2 1 2 6 2 12 11 12 21 15 22 26 35 44 50 59 71 164 1. Typhoid and Paratyphoid Fevers 2. Measles — 3. Scarlet Fever — 4. Whooping Cough 2 2 5. Diphtheria 1 1 6. Influenza 5 2 1 1 1 7. Encephalitis Lethargica 1 1 8. Cerebro-Spinal Fever — 9. Tuberculosis of Respiratory System 49 5 9 7 4 1 7 3 5 4 1 1 10. Other Tuberculous Diseases 5 1 1 1 2 11. Syphilis — 12. General Paralysis of the Insane, Tabes Dorsalis — 13. Cancer, Malignant Disease 95 1 1 2 4 4 7 9 12 12 11 15 17 14. Diabetes 5 1 1 1 1 1 15. Cerebral Haemorrhage, etc. 33 1 1 2 2 3 2 3 11 8 16. Heart Diseases 83 2 1 1 2 5 3 1 7 11 8 42 17. Aneurysm 1 1 18. Other Circulatory Diseases 109 4 2 7 11 17 20 48 19. Bronchitis 21 3 5 2 11 19 20. Pneumonia (all forms) 48 9 3 2 1 3 2 1 3 2 2 5 15 21. Other Respiratory Diseases 16 3 1 2 1 2 3 2 2 22. Peptic Ulcer 8 1 1 2 1 2 1 23. Diarrhoea, etc. (under 2 years) — 24. Appendicitis 3 1 1 1 25. Cirrhosis of Liver 1 1 26. Other Diseases of Liver 2 1 1 27. Other Digestive Diseases 9 6 1 1 1 28. Acute and Chronic Nephritis 18 1 1 2 2 1 2 1 1 2 3 2 29. Puerperal Sepsis — 30. Other Puerperal Causes 1 1 31. Congenital Debility, Premature Birth, Malformation, etc. 38 37 1 32. Senility 10 1 9 33. Suicide 6 2 1 1 1 1 34. Other Violence 19 1 2 1 3 3 1 1 1 1 2 1 2 35. Other Defined Diseases 40 2 1 1 1 3 3 1 4 1 5 2 7 2 1 6 36. Causes Ill-Defined or Unknown — Special Causes (included above) Smallpox — Poliomyelitis — Polioencephalitis — Anthrax — 20 DEATHS IN ACE CROUPS IN 1940. These relate to deaths occurring in 1940, but not necessarily registered in that year. Short List of Causes of Death in Use in General Register Office. Total 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. 788 51 8 5 2 2 10 11 18 12 29 32 35 41 48 38 57 65 65 87 172 1. Typhoid and Paratyphoid Fevers — 2. Cerebro-Spinal Fever 2 1 1 3. Scarlet Fever — 4. Whooping Cough — 5. Diphtheria 4 1 3 6. Tuberculosis of Respiratory System 49 1 8 2 6 7 4 7 5 2 3 2 2 7. Other Tuberculous Diseases 8 1 1 i 1 1 1 1 1 8. Syphilitic Diseases — 8a. General Paralysis of the Insane, Tabes Dorsalis 1 1 9. Influenza 4 1 3 10. Measles 11. Acute Poliomyelitis and Polioencephalitis — 12. Acute Encephalitis — 13 to 16. Cancer, Malignant Disease 83 1 1 2 7 4 7 12 12 9 14 14 17. Diabetes 6 1 1 1 1 1 1 17a. Aneurysm 3 1 1 1 18. Cerebral Haemorrhage, etc. 52 1 1 2 6 6 4 5 11 16 21 19. Heart Disease 149 1 1 1 2 2 2 1 3 6 9 13 22 18 68 20. Other Circulatory Diseases 61 1 1 2 1 4 3 5 3 9 13 21 21. Bronchitis 27 1 1 1 2 1 1 3 2 5 12 22. Pneumonia (all forms) 60 9 1 1 2 3 1 4 11 3 9 17 23. Other Respiratory Diseases 10 1 1 3 1 2 1 1 3 1 1 1 24. Peptic Ulcer 15 1 3 25. Diarrhoea, etc. (under 2 years) 2 1 1 2 1 26. Appendicitis — 1 1 1 1 1 1 1 4 4 27. Other Digestive Diseases 13 4 1 1 1 3 2 2 1 1 28. Nephritis 21 29. Puerperal Sepsis — 1 30. Other Maternal Causes 1 31 and 32. Cengenital Debility, Premature Birth, Malformation, etc 26 26 1 1 1 1 1 6 1 1 33. Suicide 7 3 1 2 7 8 6 14 14 16 17 16 15 8 4 2 3 1 34 and 35. Other Violence 136 2 1 2 1 2 1 2 2 2 4 2 3 4 2 3 36. Other Defined Diseases 36 6 36a. Causes Ill-Defined or Unknown 1 1 1 10 36b. Senility 11 22 DEATHS IN ACE CROUPS IN 1941, These relate to deaths occurring in 1941, but not necessarily registered in that year. Short List of Causes of Death in Use in General Register Office. Total 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. 385 35 5 5 4 3 2 12 14 16 16 18 30 31 32 52 36 46 83 69 176 1. Typhoid and Paratyphoid Fevers 2. Cerebro-Spinal Fever — 3. Scarlet Fever — 4. Whooping Cough 3 3 5. Diphtheria — 6. Tuberculosis of Respiratory System 42 1 1 1 2 7 5 4 3 3 3 4 2 4 1 1 7. Other Tuberculous Diseases 11 2 1 3 1 3 1 8. Syphilitic Diseases 6 2 2 1 1 9. Influenza 1 1 10. Measles — 11. Acute Poliomyelitis and Polioencephalitis _ 12. Acute Infectious Encephalitis 1 1 13 to 16. Cancer, Malignant Disease 97 2 10 9 8 11 6 16 16 19 17. Diabetes 1 1 18. Intra-Cranial Vascular Lesions 63 1 1 1 2 4 1 3 6 3 14 10 17 19. Heart Disease 148 1 3 3 7 10 4 12 26 18 64 23 20. Other Diseases of Circulatory System 19 1 1 4 2 3 8 21. Bronchitis 30 1 2 1 1 1 5 19 22. Pneumonia 57 8 2 1 2 1 1 2 1 1 1 1 3 4 4 8 3 14 23. Other Respiratory Diseases 9 1 1 2 1 1 1 2 24. Ulcer of the Stomach or Duodenum 4 1 1 1 1 25. Diarrhoea (under 2 years of age) 1 1 26. Appendicitis 7 1 1 1 1 1 1 1 27. Other Digestive Diseases 7 1 1 1 4 28. Nephritis 23 1 2 1 2 4 1 2 3 5 2 29. Puerperal and Post-Abortive Sepsis — 30. Other Maternal Causes 3 1 1 1 31. Premature Birth 8 8 32. Congenital Malformations, Birth Injury, Infantile Disease 8 8 33. Suicide 9 2 2 1 1 1 1 1 34. Road Traffic Accidents 3 1 1 1 35. Other Violent Causes 51 3 1 3 2 3 7 8 6 3 10 1 2 1 1 36. All Other Causes 73 3 1 1 1 1 2 4 3 3 2 6 2 3 3 1 3 7 3 24 24 DEATHS IN ACE CROUPS IN 1942. These relate to deaths occurring in 1942, but not necessarily registered in that year. Short List of Causes of Death in Use in General Register Office. Total 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. 679 48 6 3 2 2 6 5 9 6 13 17 24 27 32 39 54 69 74 83 160 1. Typhoid and Paratyphoid Fevers — 2. Cerebro-Spinal Fever 5 1 1 1 1 1 3. Scarlet Fever — 4. Whooping Cough 3 3 5. Diphtheria 2 2 6. Tuberculosis of Respiratory System 38 4 2 4 5 6 3 6 3 3 1 1 7. Other Tuberculous Diseases 9 1 1 2 2 2 1 8. Syphilitic Disease 3 1 1 1 9. Influenza 1 1 10. Measles 1 1 11. Acute Poliomyelitis 2 2 12. Acute Infectious Encephalitis 1 1 13 to 16. Cancer, Malignant Disease 116 3 2 4 8 11 16 16 19 21 16 17. Diabetes 5 1 2 1 1 18. Intra-Cranial Vascular Lesions 70 1 2 1 4 3 4 10 11 17 17 19. Heart Disease U66 1 2 2 2 6 3 6 14 19 18 25 68 25 20. Other Diseases of Circulatory System 21 1 1 4 5 4. 6 21. Bronchitis 22 1 1 1 2 1 1 3 2 1 9 22. Pneumonia 58 9 1 1 1 2 1 1 3 3 8 8 3 17 23. Other Respiratory Diseases 10 1 1 1 1 3 1 1 1 24. Ulcer of the Stomach or Duodenum 9 2 1 2 2 1 1 25. Diarrhoea (under 2 years of age) 4 3 1 26. Appendicitis 4 1 1 1 1 27. Other Digestive Diseases 13 1 1 1 1 1 2 1 1 1 3 28. Nephritis 12 1 1 1 1 1 2 2 3 29. Puerperal and Post-Abortive Sepsis 1 1 30. Other Maternal Causes 1 1 31. Premature Birth 9 9 32. Congenital Malformations, Birth Injury, Infantile Disease 23 20 1 1 1 33. Suicide 3 1 1 1 34. Road Traffic Accidents 8 1 1 1 1 1 1 1 1 35. Other Violent Causes 8 2 1 1 1 1 1 1 36. All Other Causes 51 1 2 1 1 1 3 3 1 2 2 5 2 2 5 4 16 26 DEATHS IN ACE CROUPS IN 1943. These relate to deaths occurring in 1943, but not necessarily registered in that year. Short List of Causes of Death in Use in General Register Office. Total 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. 706 36 6 5 1 2 6 2 15 9 8 19 24 25 39 35 51 66 72 87 197 1. Typhoid and Paratyphoid Fevers ... — 2. Cerebro-Spinal Fever 2 2 3. Scarlet Fever — 4. Whooping Cough 1 1 5. Diphtheria — 6. Tuberculosis of Respiratory System 45 1 1 1 7 3 5 7 4 3 4 4 1 2 2 7. Other Tuberculous Diseases 4 1 1 2 8. Syphilitic Diseases 4 1 1 1 1 9. Influenza 10 1 1 1 1 2 4 10. Measles 1 1 11. Acute Poliomyelitis — 12. Acute Infectious Encephalitis — 13 to 16. Cancer, Malignant Disease 121 1 2 3 3 3 14 10 12 17 19 19 18 17. Diabetes 3 1 1 1 18. Intra-Cranial Vascular Lesions 81 1 2 3 2 3 6 11 12 14 27 19. Heart Disease 162 1 1 1 1 1 3 2 4 4 7 17 14 27 79 27 20. Other Diseases of Circulatory System 25 1 2 1 4 1 4 4 8 21. Bronchitis 21 1 1 1 2 1 2 2 11 22. Pneumonia 54 5 2 2 1 1 3 1 2 5 7 6 19 23. Other Respiratory Diseases 19 1 1 1 1 3 7 1 2 1 1 24. Ulcer of the Stomach or Duodenum 10 2 1 2 2 1 1 1 25. Diarrhoea (under 2 years of age) — 26. Appendicitis 5 2 1 1 1 27. Other Digestive Diseases 10 2 1 1 1 3 2 28. Nephritis 15 1 2 1 2 1 1 3 4 29. Puerperal and Post-Abortive Sepsis 1 1 30. Other Maternal Causes 2 1 1 31. Premature Birth 13 13 32. Congenital Malformations, Birth Injury, Infantile Disease 9 9 33. Suicide — 34. Road Traffic Accidents 4 1 1 1 1 35. Other Violent Causes 6 1 1 1 1 1 1 36. All Other Causes 13 1 2 1 1 3 1 1 1 1 1 65 1 1 1 1 1 1 1 4 4 7 2 4 8 5 4 20 28 DEATHS IN ACE CROUPS IN 1944. These relate to deaths occurring in 1944, but not necessarily registered in that year. Short List of Causes of Death in Use in General Register Office. Total 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. 726 46 4 2 2 8 7 11 16 10 29 21 35 44 56 52 59 60 85 179 1. Typhoid and Paratyphoid Fevers — 2. Cerebro-Spinal Fever 1 1 3. Scarlet Fever — 4. Whooping Cough 2 1 1 5. Diphtheria 1 1 6. Tuberculosis of Respiratory System 54 4 6 4 9 3 5 10 6 a 1 1 1 1 7. Other Tuberculous Diseases 4 1 1 1 1 8. Syphilitic Diseases 3 1 1 1 9. Influenza 2 1 7 10. Measles 1 11. Acute Poliomyelitis — 12. Acute Infectious Encephalitis — 13 to 16. Cancer, Malignant Disease 101 3 1 2 1 2 13 15 8 10 16 11 19 17. Diabetes 4 1 1 1 1 18. Intra-Cranial Vascular Lesions 69 1 1 3 4 6 6 9 15 24 19. Heart Disease 174 2 2 2 3 5 6 2 5 13 19 19 31 65 29 20. Other Diseases of Circulatory System 23 1 2 4 1 3 12 21. Bronchitis 21 2 1 2 1 4 3 8 22. Pneumonia 31 3 1 1 1 1 1 2 1 3 5 1 3 8 23. Other Respiratory Diseases 24. Ulcer of the Stomach or Duodenum 11 8 1 1 2 2 1 2 1 1 3 1 3 1 25. Diarrhoea (under 2 years of age) 4 4 26. Appendicitis 2 1 1 27. Other Digestive Diseases 21 1 1 2 3 6 2 1 1 2 2 28. Nephritis 17 1 1 1 1 1 1 1 1 2 1 1 5 29. Puerperal and Post-Abortive Sepsis 30. Other Maternal Causes 3 1 1 1 31. Premature Birth 17 17 32. Congenital Malformations, Birth Injury, Infantile Disease 15 15 33. Suicide 2 1 1 34. Road Traffic Accidents 3 1 1 1 35. Other Violent Causes 83 1 1 1 1 3 4 4 10 4 14 7 11 4 7 2 5 4 36. All Other Causes 50 2 1 1 1 1 2 1 1 1 6 2 5 26 30 DEATHS IN ACE CROUPS IN 1945. These relate to deaths occurring in 1945, but not necessarily registered in that year. Short List of Causes of Death in Use in General Register Office. Total 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. 692 49 3 3 1 2 7 1 10 7 9 15 21 22 28 38 56 56 76 90 198 1. Typhoid and Paratyphoid Fevers — 2. Cerebro-Spinal Fever — 3. Scarlet Fever — 4. Whooping Cough — 5. Diphtheria 1 1 6. Tuberculosis of Respiratory System 39 3 2 4 5 6 3 1 3 5 3 2 2 7. Other Tuberculous Diseases 7 1 1 1 2 1 1 8. Syphilitic Diseases — 9. Influenza 3 1 1 1 10. Measles — 11. Acute Poliomyelitis — 12. Acute Infectious Encephalitis — 13 to 16. Cancer, Malignant Disease 116 1 1 4 8 11 13 17 12 18 31 17. Diabetes 3 1 1 1 18. Intra-Cranial Vascular Lesions 64 1 1 1 3 6 7 5 8 12 20 19. Heart Disease 188 1 1 1 1 1 4 4 6 8 14 15 19 32 81 31 20. Other Diseases of Circulatory System 16 1 1 1 2 3 4 4 21. Bronchitis '20 1 1 5 3 10 22. Pneumonia 41 6 1 1 1 1 1 2 4 7 7 10 23. Other Respiratory Diseases 11 1 1 1 1 1 1 2 2 1 24. Ulcer of the Stomach or Duodenum 9 1 1 3 1 1 2 25. Diarrhoea (under 2 years of age) . 5 5 26. Appendicitis 3 1 1 1 27. Other Digestive Diseases 15 2 1 1 2 3 2 4 28. Nephritis 21 1 1 1 1 3 5 1 6 2 29. Puerperal and Post-Abortive Sepsis 30. Other Maternal Causes — 31. Premature Birth 18 18 32. Congenital Malformations, Birth Injury, Infantile Disease 11 11 33. Suicide 4 1 1 2 34. Road Traffic Accidents 4 1 1 1 1 35. Other Violent Causes 33 2 1 2 1 1 1 3 1 3 2 2 4 2 1 3 1 3 36. All Other Causes 60 4 1 1 1 1 2 4 2 1 2 3 3 7 3 25 Infantile Mortality. 1939. 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 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 Whooping Cough 1 1 2 Accident 1 1 Broncho-pneumonia 1 1 2 2 4 1 9 Congenital Malformation, Premature Birth and Convulsions 25 4 1 30 1 1 5 37 Influenza 1 1 2 Gastro Enteritis 3 1 4 Purpura 1 1 Umbilical Infection 1 1 1 Urinary Infection 1 1 Intussusception 1 1 2 Totals 25 5 2 1 33 5 10 8 4 60 32 Infantile Mortality. 1940. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OP 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 Marasmus 1 1 War Operations 1 1 Broncho-pneumonia 1 1 5 2 1 9 Intracranial Haemorrhage and Convulsions 4 1 5 1 6 Congenital Malformation, etc. 2 1 3 1 4 Premature Birth and Inanition 17 1 18 18 Atelectasis of Lungs 2 2 2 Gastro Enteritis 1 1 1 1 4 Intussusception 1 1 Tuberculous Meningitis 1 1 Meningitis 1 1 1 1 3 Totals 25 3 2 — 30 10 5 3 3 51 33 Infantile Mortality. 1941. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. Causes of Death as Certified. Under 1 week 1 week and under 2 weeks 2 weeks and under 3 weeks 3 weeks and under 4 weeks Total under 1 month 1 month and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year Whooping Cough 2 1 3 War Operations 1 1 Broncho-pneumonia 6 2 8 Intracranial Haemorrhage 2 2 1 3 Congenital Malformation, etc 1 1 2 1 3 Premature Birth and Inanition 6 1 1 8 8 General Toxaemia, Pyelitis 1 1 Gastro Enteritis 1 1 Heart Failure 1 1 1 Suffocation 1 1 1 2 Meningitis 1 1 Convulsions— Spina Bifida 1 1 Convulsions— With Enlarged Thymus 1 1 Influenza 1 1 Totals 12 1 1 1 15 14 3 2 1 35 34 Infantile Mortality. 1942. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. Causes of Death as Certified. Under 1 week 1 week and under 2 weeks 2 weeks and under 3 weeks 3 weeks and under 4 weeks Total under 1 month 1 month and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year Whooping Cough 2 1 3 Broncho-pneumonia 1 1 2 5 2 1 10 Bronchitis 1 1 Intracranial Haemorrhage 4 4 1 1 6 Congenital Malformation, etc. 6 2 1 9 3 1 13 Premature Birth and Inanition 8 2 10 10 Gastro Enteritis 3 3 Meningitis 1 1 Convulsions 1 1 Totals 19 2 2 2 25 11 8 2 2 48 35 Infantile Mortality. 1943. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. Causes of Death as Certified. Under 1 week 1 week and under 2 weeks 2 weeks and under 3 weeks 3 weeks and under 4 weeks Total under 1 month 1 month and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months deaths under 1 year Whooping Cough 1 1 Measles 1 1 Cerebro-Spinal Fever 1 1 2 Broncho -pneumonia 2 1 3 2 5 Bronchitis 1 1 Congenital Malformation, Birth Injury, etc 5 1 1 7 1 8 Premature Birth and Inanition 13 13 2 15 Suffocation 1 1 Meningitis T.B. 1 1 Encephalomyelitis 1 1 Totals 20 1 2 23 6 2 4 1 36 36 Infantile Mortality. 1944. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. Causes of Death as Certified. Under 1 week 1 week and under 2 weeks 2 weeks and under 3 weeks 3 weeks and under 4 weeks Total under 1 month I month and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year Broncho-pneumonia 2 2 1 3 Whooping Cough 1 1 Bronchitis 1 1 2 Congenital Malformation, Birth Injury, etc. 9 1 10 4 1 15 Premature Birth and Inanition 16 1 17 17 Intussusception 1 1 Gastro Enteritis 1 3 4 Septicæmia 1 1 2 War Operations 1 1 Totals 25 4 — — 29 8 7 — 2 46 37 Infantile Mortality. 1945. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. Causes of Death as Certified. Under 1 week 1 week and under 2 weeks 2 weeks and under 3 weeks 3 weeks and under 4 weeks Total under 1 month 1 month and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year Broncho-pneumonia 1 1 2 3 1 6 Bronchitis 1 1 Premature Birth and Inanition 18 18 18 Mental Deficiency and Inanition 1 1 Miliary T.B. 1 1 Gastro Enteritis 1 1 1 2 1 5 Congenital Malformation, etc. 5 3 8 2 10 War Operations 1 1 Misadventure (asphyxiated under bedclothes) 1 1 2 Septicæmia 1 1 1 Infected Eczema 1 1 Septic Meningitis 1 1 Acute Lymphatic Leukaemia 1 1 Totals 24 4 — 2 30 10 4 4 1 49 38 Infantile Mortality. Year. Registered. Rate per 1,000 Live Births. Deaths in neonatal period, i.e., within one month of birth. Deaths. Percentage. 1939 56 40.1 33 55 1940 56 45.4 30 53 1941 37 35.4 15 42 1942 48 32.7 25 52 1943 36 26.01 23 63 1944 47 31.37 29 63 1945 48 33.9 30 61.2 Maternal Deaths. Year. Deaths. Puerperal Mortality Rate per 1,000 Live & Stillbirths. 1939 1 0.69 1940 1 0.79 1941 3 2.77 1942 2 1.32 1943 2 1.44 1944 2 1.30 1945 nil nil It will be noticed that in 1941 the mortality rate increased in comparison with that of 1940. This large variation is always liable to appear in local statistics due to a relatively small population as compared with the rest of the country. 39 SECTION B GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Isolation Hospital Accommodation. This has always been available at the Bow Arrow Hospital of the Dartford Joint Hospital Committee of which the Council is the largest contributent member. The policy of not sending in scarlet fever cases unless the clinical or home conditions require admission, has been followed. The shortage of nursing staff in the year 1945 has required that the necessity for any admission should be well scrutinised. General Hospitals. Bexley Cottage Hospital 1939 1940 1941 1942 1943 1944 1945 Patients Admitted 546 357 257 251 280 207 224 Patient Days 5019 4757 4581 5633 5126 4839 6225 Outpatient Attendances 674 668 728 748 3304 919 1093 X-Ray examinations Figures not available. 389 485 575 571 585 AMBULANCE FACILITIES. Infectious Diseases. This ambulance service has continued to be supplied by the Dartford Joint Hospital Committee. Non-Infectious Diseases. From 1944 and until the Civil Defence Services were disbanded a second ambulance for urgent cases was manned by that Service. Since July, 1945, two ambulances have been manned by Corporation staff. Agreements are still maintained with the neighbouring authorities except Erith Borough for mutual aid when cases require urgent removal and no Borough ambulance is available. 40 Cases removed by Corporation Ambulances. Cases. 1939 1940 1941 1942 1943 1944 1945 Sickness 666 623 611 974 974 1362 1144 Accidents 224 173 201 134 149 141 159 Illness in street 39 50 62 78 65 72 53 Maternity 227 283 255 416 473 622 549 Malicious calls 3 1 2 4 5 7 6 Ambulance not required 39 34 24 4 7 17 26 Air Raid Casualties — 10 — — — 6 — Collecting Blood — — — 15 1 1 1 Conveying children to Special School — — — 6 — — — Sitting Car Cases — — — — — — 3 Total 1198 1174 1155 1631 1674 2228 1941 No. of Calls on Outside Ambulances. Crayford Ambulance 82 107 114 208 173 51 87 Erith Ambulance — 4 10 50 59 1 — Sidcup Ambulance 12 6 1 19 16 14 47 L.C.C. Ambulance — — — 3 5 3 7 Total 94 117 125 280 253 69 141 Cases. Sickness 30 41 55 160 125 21 60 Accident 43 54 31 43 39 22 36 Maternity 19 22 39 77 81 25 42 Miscellaneous 2 — — — — — — Not required — — — — 8 1 3 Total Calls 1292 1291 1280 1911 1927 2297 2082 PUBLIC MORTUARY. The Public Mortuary, which is maintained by the Corporation, is situated on land at the south side of the Council Offices. 1939 1940 1941 1942 1943 1944 1945 No. of occasions used 42 48 38 34 44 39 80 No. of Post Mortem Examinations 37 42 29 31 37 35 71 No. of Inquests 2 6 2 3 9 5 17 41 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—Friday, 2.30 p.m. Welling-—Station Approach. Child Welfare Sessions — Mondays, Tuesdays and Thursdays, 2.30 - 4.30 p.m. Ante-Natal Sessions—Friday, 10.30 a.m. . Bexley—Murchison Avenue. Child Welfare Sessions — Tuesdays and Thursdays, 2.30 - 4.30 p.m. Ante-Natal Sessions—Wednesdays, 10.30 a.m. Welling—Wrotham Road (opened May, 1943). Child Welfare Sessions — Mondays and Tuesdays, 2.30 - 4.30 p.m. Ante-Natal Sessions — Wednesdays, 10.30 a.m. Welling—Falconwood Parade, The Green (opened April, 1944). Child Welfare Sessions—Wednesdays and Fridays, 2.30 - 4.30 p.m. Ante-Natal Sessions — Mondays, 10.30 a.m. with the exception of the first Monday in each month. Maternity Home—Lavernock Road. Ante-Natal Sessions — Tuesdays and Thurdays, 10.30 a.m. Post-Natal Sessions—Thurdays, 11.30 a.m. Dental Clinic—315, Broadway, Bexleyheath. Mondays, Tuesdays and Wednesdays, a.m. Sunlight Clinic—315, Broadway, Bexleyheath. Tuesdays and Thursdays, 9 a.m. School Clinics and Dental Clinics. Little Danson, Welling and Mayplace Road East, Bexleyheath. Doctor's Clinics are held at both the above places weekly as follows:— 42 3 sessions at Mayplace Road East, 1 of which is Asthma Clinic. 2 sessions at Little Danson ½ day of which is Asthma Clinic. Tuberculosis Dispensaries at Overy Street, Dartford and Bexley Road, Erith. Venereal Disease Clinics at the County Hospital, West Hill, Dartford. MATERNITY AND CHILD WELFARE. (i) Midwifery and Maternity Service. 1939 1940 1941 1942 1943 1944 1945 (a) Ante-Natal Care. Expectant mothers attended Clinics 638 484 745 981 859 926 851 Percentage of notified Births 45.9 39.8 74.2 68.0 60.7 65.6 60.8 No. of expectant mothers received ante-natal care at clinics attached to other Hospitals 364 249 135 382 386 334 358 No. of women received ante-natal care from own doctors 83 84 89 80 104 90 112 Total percentage 78.0 67.2 96.6 94.8 95.5 95.6 97.0 (b) Co-operation with General Practitioners. No. of General Practitioners cases admitted to Corporation Maternity Home 86 84 89 80 104 90 112 (c) Consultant Service. No. of Clinics 10 12 12 12 12 12 12 No. of cases seen 79 135 164 252 168 196 184 No. sent by General Practitioners 4 20 20 36 33 34 18 No. sent by Midwives 2 1 6 11 3 7 4 No. of calls for domiciliary visits 1 — — — — — 3 No. of calls to Maternity Home 11 8 11 18 .11 13 16 43 (d) Maternity Accommodation This is provided in the Corporation Maternity Home (26 beds) and during 1945 the Council made an agreement with the K.C.C. for payment for Bexley mothers admitted to the County Hospitals. Accommodation has become available again in the Memorial Hospital, Woolwich, and has continued to be available in the British Hospital for Mothers and Babies, Woolwich, and local Nursing Homes. A few births occur in the Inner London Hospitals. From the outbreak of war until mid 1944 part of the Borough only was scheduled as an evacuation area. Facilities were available under the K.C.C. Scheme for expectant mothers resident in this area to go to hostels and later to temporary Maternity Homes in Kent for their confinements. With the advent of the flying bomb the whole of the Borough was included in the Government Scheme and expectant mothers were then also evacuated in parties to safer areas for maternity accommodation under the L.C.C. Scheme. 1939 1940 1941 1942 1943 1944 1945 (e) Ante-natal Clinics. No. of Sessions (weekly) 5 5 5 6 6 7 7 Average attendance 24.0 12.0 13.7 18.4 21.3 17.0 15.0 (f) Post-natal Clinic. No. of attendances at Maternity Home 287 191 238 372 320 312 272 No. of Post-natal examinations at other clinics 10 29 10 19 22 40 112 (g) Home Helps. No. of applications 32 33 28 37 54 64 63 No. cancelled or not proceeded with 18 19 13 16 10 27 25 No. of homes attended 32 33 28 37 54 37 38 No. of attendances (days) 430 402 558 585 668 520 526 This essential service has varied in demand and supply, depending on air raid conditions and supply of labour. Supply of labour has always been difficult, but with Ministry of Health support the service is gradually being built up. 44  1939 1940 1941 1942 1943 1944 1945 (h) Dental Clinic No. referred to dental clinic by M.O.'s 428 386 469 415 426 278 346 No. found to be in need of treatment 422 386 350 375 318 278 346 No. who received treatment 394 341 292 375 318 276 331 No. made dentally fit 215 315 100 202 146 229 298 Number of treatments— (a) Fillings : (1) In temporary teeth 121 222 221 136 260 164 75 (2) In permanent teeth 114 212 192 204 452 409 537 (b) Teeth extracted 1633 1658 930 1233 1468 1064 857 (c) Administration of general anaesthesia 381 209 119 159 216 120 102 (d) Local anaesthesia 67 86 63 94 118 140 139 Patients supplied with dentures 39 67 52 58 70 67 84 Dentures supplied 73 102 95 103 127 118 129 No. of scalings and gum treatment — — 48 136 477 342 439 The number of dental sessions per week was increased to three in 1944 and the figures show a policy of conservation of teeth by the greater number of fillings and the reduction of extractions. (ii) Institutional Provision for Mothers. (a) Maternity Home. Since 1939 the staff has been on a 96 hour fortnight and despite all the difficulties of air raids the Home has carried on and now admits and deals with abnormal cases in view of the difficulties in obtaining admission for these cases to London Hospitals. Increased staff has been difficult to recruit but not until 1945 has the shortage been felt. The Home has continued as a training school for the State Ceritfied Midwives Part II examination. Priority admission is given to primiparae, previous or expected abnormal cases, cases from overcrowded homes and unmarried mothers. 45 Maternity Home Statistics. 1939 1940 1941 1942 1943 1944 1945 No. of patients in Home 1st January 20 22 19 22 17 27 25 No. of patients admitted during year 494 500 497 574 551 549 541 No. of patients discharged during year 490 502 493 567 536 551 547 No. of patients died during year — 1 1 1 2 2 — No. of patients remaining at 31st December 24 19 23 16 27 25 19 No. of patient days 7273 7306 7430 8171 7994 7636 8148 Average duration stay in days 14.7 14.61 14.94 14.41 14.50 13.91 15.55 No. of cases delivered by nursing staff (midwives) 408 403 400 465 443 441 420 No. of cases delivered by Doctors 86 94 97 102 107 108 121 No. of cases delivered before patients admitted — 3 — — 1 1 — No. of primiparæ 278 273 308 335 306 278 246 No. of multipart .216 227 189 232 245 271 295 Twin pregnancies 6 12 3 6 4 5 — No. of calls on Consultant— Ante-natal 4 5 9 15 11 12 15 Post-natal 7 2 1 1 — 1 — Intra-natal — 1 1 2 — — 1 No. of Cæesarean sections — — — 10 8 12 10 No. of cases medical assistance sought 70 80 72 109 116 100 97 No. of cases notified— Puerperal Pyrexia 8 7 14 11 12 18 23 Opthalmia Neonatorum — — — 1 2 1 1 Pemphigus Neonatorum — — — — — — — No. of Maternal Deaths (after discharge) 1 — 1 — — — — No. of infant deaths 11 7 5 7 8 6 8 Causes— (1) Prematurity 6 2 3 2 5 2 4 (2) Atelactasis of Lungs 1 — — — — 1 — (3) Jaundice 1 1 — — — — — (4) Asphyxia Pallids 1 1 — — — — — (5) Forceps 1 — — — — 2 — (6) Convulsions 1 1 — 1 — — — (7) Pneumonia — 1 — 1 1 — — (8) Toxaemia — — 1 — — — — (9) Intracranial haemorrhage — — 1 1 — — — (10) Congenital Heart Disease — — — 1 — — — 46  1939 1940 1941 1942 1943 1944 1945 (11) Erythroblastosis — — — 1 — — 1 (12) Congenital Malformation — 1 — — 2 1 2 No. of Stillbirths 12 11 17 10 11 15 10 Causes— (1) Toxaemia 1 2 5 — 2 — 3 (2) Breech 2 1 1 — 1 — 1 (3) Unknown 2 4 3 2 3 3 1 (4) Macerated 7 1 3 2 — 3 — (5) Instrumental — 2 3 — — — 1 (6) Prematurity — 1 1 3 2 2 — (7) Prolapsed Cord — — 1 1 1 1 — (8) Hydrocephalic — — — 2 — — — (9) Anencephalic — — — — 1 — — (10) Ante partum Haemorrhage — — — — 1 3 — (11) Malformed — — — — — 2 — (12) Transverse Lie — — — — — 1 — (13) Spina Bifida — — — — — — 2 (14) Caesarian Section — — — — — — 1 (15) Prolapsed arm — — — — — — 1 No. of Cases sent to Other Hospitals— Ante-natal 8 8 — — — — 3 Early Intral Natal — — — — — — — Post Natal — — — 1 4 1 3 Baby — — — 1 5 2 4 No. of Borough Cases 494 490 470 552 447 537 539 No. of out-district cases — 10 27 15 4 12 2 No. of practitioners' private booked cases 83 84 89 80 104 90 112 Forceps deliveries. Rate 3.9% 4.25% 5.83% 4.3% 3.3% 2.7% 2.9% Feeding. Breast alone 402 404 403 472 440 436 404 Breast supplemented by artificial Food 55 52 42 60 60 56 70 Artificial food alone 20 45 33 24 36 47 52 No. of babies born alive (including twins) 488 501 483 563 543 539 536 (b) Other Institutional Provision for Mothers. The County Council Home for convalescent mothers has been available but post natal homes have not held any attraction for mothers who have usually been unable to find any person to care for the baby in their absence. (c) Care of Illegitimate Children. Since 1944 stress has been laid on this subject and the Day Nursery and Maternity Home provisions were 47 the most concrete aids given to help the mother to stay with her child. Close co-operation between the Health Visitors and the Moral Welfare Workers of the Rochester Diocese has continued. The Council contributes to the residential care of the mother before the birth and mother and baby after birth in Institutions provided by the Diocesan Council. (iii) Health Visitors and Clinics. The marked increase in Ante-Natal attendances in 1941 necessitated the holding of regular weekly clinics at Bexleyheath instead of four per month and two clinics each week at Welling instead of four per month. The reason for additional attendances is probably and mainly due to the notice brought to the department of expectant mothers which began with the issue of clothing coupons to such mothers for the expected baby. This is a notification of pregnancy and advantage has been taken of it by the Health Visitors following up each expectant mother who applies for clothing coupons. The high clinic attendances have in the main continued and despite air raids and evacuation additional sessions have been held at Wrotham Road, Welling and The Green, Falconwood. At Wrotham Road the building used is a Public Gas Cleansing Station which is well adapted to Clinic work and at Falconwood a Co-operative Hall is used which is not very convenient but until building is recommenced it can be used. A Centre in Long Lane, Bexleyheath is required to relieve the Broadway Clinic. 48 1939 1940 1941 1942 1943 1944 1945 Ante-Natal Sessions. Maternity Home, Lavernock Road— Mothers 51 45 54 60 50 56 49 Attendances 1325 1252 1354 1664 1917 1322 1601 Bexleyheath Clinic— Mothers 211 117 241 310 313 284 253 Attendances 837 632 828 1433 1246 1202 1113 Bexley Clinic— Mothers 106 105 107 112 154 127 123 Attendances 473 487 466 695 715 772 652 Welling Clinic (Station App.)— Mothers 270 257 343 489 272 283 220 Attendances 1080 917 1114 1977 1609 1308 1062 Wrotham Road Clinic— Mothers — — — — 70 154 135 Attendances — — — — 348 716 672 Falconwood Clinic— Mothers — — — — — 24 71 Attendances — — — — — 159 303 Child Welfare Sessions. Bexleyheath Clinic. Total No. of attendances— (a) Under 1 year 5898 4680 4997 5806 6780 5993 6280 (b) Between 1-5 yrs. 2814 1991 2333 2609 2761 2373 2934 Average attendance 58 44 48 54 62 52 60 No. of children attending first time— (a) Under 1 year 380 380 417 455 376 432 460 (b) Between 1-5 yrs. 122 127 146 118 109 47 92 No. of children medically examined 2322 1864 1624 1659 2025 1871 1627 Welling Clinic. Total No. of attendances— (a) Under 1 year 8225 5400 5938 8856 9125 6033 5296 (b) Between 1-5 yrs. 3370 2777 2789 2757 2734 2029 2187 Average attendance 57 40 43 55 57 46 48 No. of children attending first time— (a) Under 1 year 560 489 525 651 388 342 337 (b) Between 1-5 yrs. 194 166 166 233 19 40 32 No. of children medically examined 3512 2624 2495 3036 3500 1756 1708 49  1939 1940 1941 1942 1943 1944 1945 Bexley Clinic. Total No. of attendances— (a) Under 1 year 3087 3199 2191 3078 3755 2983 3136 (b) Between 1-5 yrs. 1978 1563 1662 1983 2181 1636 1921 Average attendance 52 45 37 48 57 45 49 No. of childrend attending first time— (a) Under 1 year 209 215 167 216 174 223 193 (b) Between 1-5 yrs. 83 88 73 116 69 33 65 No. of children medically examined 1322 1418 1076 1155 1147 795 554 Wrotham Road Clinic. Total No. of attendances— (a) Under 1 year — — — — 1661 2533 3113 (b) Between 1-5 yrs. — — — — 743 1178 1205 Average attendance — — — — 45 38 42 No. of children attending first time— (a) Under 1 year — — — — 131 170 224 (b) Between 1-5 yrs. — — — — 21 54 51 No. of children medically examined — — — — 390 422 637 Falconwood Clinic. Total No. of attendances— (a) Under 1 year — — — — — 1698 3041 (b) Between 1-5 yrs. — — — — — 433 999 Average attendance — — — — — 30 39 No. of children attending first time— (a) Under 1 year — — — — — 131 192 (b) Between 1-5 yrs. — — — — — 17 13 No. of children medically examined — — — — — 306 586 Births Registered : Live Births 1423 1279 1145 1469 1334 1498 1413 Stillbirths 41 32 35 38 29 30 31 (iv) Assisted Milk, etc. No. of families supplied with Food free or at reduced cost 395 387 73 48 21 26 25 Approximate cost £1462 £1120 £98 £46/8 £39/10 £32/12 £54/4 Liquid Milk (gallons) — 8217½ 178 11¼ — — — No. of lbs. of Dried Milk at cost price 16129 18423 21303 30569 35189 28278 32670 No. of lbs. Of Virol, Cod Liver Oil and Malt, etc. 2860 2743 4209 3280 3057 1910 2084 Marmite cartons — — — — — — 1007 The National Scheme of the Ministry of Food accounts for the fall in cost to the Council of this Scheme since 1941. 50 Supply of Sheets for Expectant Mothers 1939 1940 1941 1942 1943 1944 1945 Since Nov., 1944— No. of applications — — — — — — 225 No. of dockets — — — — — — 649 (v) Orthopaedic Treatment. No. of children attended first time 40 39 36 27 25 20 55 No. of children previously on the Register 54 20 18 25 21 12 15 No. of Total attendances made 633 384 392 367 242 223 466 No. referred for inpatient treatment 3 1 2 1 1 1 1 No. referred for Ultra Violet light treatment 3 1 2 — — 6 11 No. of appliances recommended 37 39 19 20 22 16 50 The majority of these cases are mild diversions from the normal. The increase in 1945 may be due to the greater willingness of mothers to travel to Hospital to seek advice.  1939 1940 1941 1942 1943 1944 1945 (vi) Child Life tion No. of persons receiving children under 9 years for reward— (a) At beginning of the year. 56 32 38 37 43 27 12 (b) At the end of the year 32 38 37 43 27 12 22 No. of children— % (a) At beginning of the year. 72 40 45 43 49 32 16 (b) At the end of the year 40 45 43 49 32 16 25 No. of foster children who died 2 — — 1 — — — No. of inquests held 2 — — — — — — 51  1939 1940 1941 1942 1943 1944 1945 (vii) Maternity Outfits. No. of sterilised outfits issued 2 5 2 free 4 2 free 1 — — — (viii) Compensation to Midwives. No. of midwives received compensation for loss of booked maternity cases — — — 1 — 1 1 (ix) Sunlight Clinic. No. of cases treated including any outstanding from previous year 74 114 212 188 144 177 261 No. of treatments 950 1529 2149 2293 1756 1811 3495 No. still being treated at end of year 17 11 27 29 19 32 36 Average number of treatments per patient 13.0 12.2 10.1 12.2 12.1 12.0 12.0 Diseases Treated. Ante-natal acne 2 — — — 1 8 8 Ante-natal rheumatism 1 — — — — — — Sub-acute rheumatism (schoolchildren) 11 — — — — — — Rickets 13 21 11 13 11 19 12 Knock Knees 3 20 33 5 4 12 36 General Atonia 44 70 168 156 109 109 168 Anaemia — 1 — — — — — Asthma — 1 — — — — — Bronchitis — 1 — — — — — Flat Feet — — — 2 — — 5 Curved Legs — — — 12 19 29 32 (x) Ear and Eye Defects. Referred to Aural Clinic for chronic ear discharge 5 6 10 10 19 7 4 Referred to Ophthalmic Clinic for squint or other defect 9 20 32 25 16 13 2 Speech Clinic — — — — — — 2 52 (xi) Special Classes These were cookery and sewing classes for expectant and nursing mothers. Owing to difficulties associated with the war these were only held spasmodically up to June, 1944, and then discontinued.  1939 1940 1941 1942 1943 1944 1945 (xii) Provision of Insulin to Persons suffering from Diabetes. (M.O.H. Circular 2735). No. of patients supplied — — — — — 3 — Registration of Nursing Homes Public Health Act, 1946. (Authority of Registration transferred from Kent County Council to the Bexley Borough Council. 17/4/39.) 1939 1940 1941 1942 1943 1944 1945 No. of Homes on the Register at beginning of year 7 7 6 5 5 5 5 Number of patients provided for— Maternity — — 6 6 6 6 4 Others — — 50 45 45 44 52 Total — — 56 51 51 50 56 No. of Homes first registered during year 1 1 — — 1 — 2 Number of patients provided for— — — — — — — — Maternity — 1 — — — — 2 Others — — — — 7 — 17 Total — 1 — — 7 — 19 No. of Homes on the Register at end of year 7 6 5 5 5 5 6 Number of patients provided for— Maternity — 6 6 6 6 4 6 Others — 50 45 45 44 52 62 Total — 56 51 51 50 56 68 No. of inspections made during year — 13 6 10 13 10 11 No. cancelled on request of applicant 1 2 1 — 1 — 1 53 Adoption of Children (Regulation) Act, 1939. This Act came into force June, 1943. 1943 1944 1945 (a) No. of persons who gave notice under Section 7 (3) during the year 9 18 55 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 9 19 56 (c) No. of children notified under Section 7 (3) (i) Under supervision at end of year — 10 26 (ii) Who died during the year — — 1 (iii) On whom inquests were held — — 1 Number of children adopted during the year 1 16 33 PROFESSIONAL DOMICILIARY NURSING AND LABORATORY FACILITIES. War-Time Nurseries. Care of young children of women war workers. The attendances were good throughout the year. Four of the six nurseries had a waiting list by the end of the year. The 24 hour nursery had to cease its night service at the end of the year as the Ministry of Health and Labour and National Service were satisfied that it was no longer required to enable women to engage in industry on night shifts. But in the absence of Public Health Residential Nursery provision and the inadequacy of that supplied by the Public Assistance Committee it was continuing to fulfil a useful purpose and children in the 24 hour nursery were noticed to be progressing less well when they could only use the Day Nursery. Accommodation at the end of 1945 in the six nurseries was available for 318 children by day (Mondays to Saturdays) and 18 by night (Mondays to Fridays). Professional Nursing in the Home. Home Nursing is provided by three Nursing Associations in the area, namely, Bexleyheath, Bexley, Welling and East Wickham. These are very useful services and the nurses are to be complimented on their work. Laboratory Facilities. Pathological and bacteriological work for the area is carried out by the K.C.C. at the Public Health Department, County Hall, Maidstone. 54 NOTE- PACE 54. Sub Headings " Professional ??? in the Home," and " Laboratory Facilities/'' ??? appear Immediately under Heading " professional ??? Domiciliary Nursing and Laboratory Facilities ??? Average daily attendance per month. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Christchurch— Opened January, 1942 - 19.0 30.0 32.0 39.0 37.7 37.8 23.6 36.6 31.4 30.6 33. 0 1943 22.8 26.0 26.6 26.0 37.0 34.5 36.0 34.9 41.3 37.4 36.5 30.8 1944 32.9 31.8 34.4 34.8 37.9 33.09 23.4 21.6 24.8 31.4 30.9 30.7 1945 25.49 27.2 28.6 30.4 30.29 32.9 31.34 21.95 32.04 30.81 32 41 32.93 St Michael's— Opened January, 1942 __ 17.0 25.0 32.0 26.0 27.6 29.8 31.4 39.0 31.5 34.5 39.6 1943 39.3 43.75 42.1 42.5 49.5 49.6 57.6 50.5 57.8 56.3 54.7 49.7 1944 46.6 52.6 55.6 52.4 55.4 54.7 46.5 40.0 44.2 48.9 52.4 46.8 1945 33.9 41.0 47.6 52.05 52.45 55.7 54.0 51.35 57.15 59.1 65.73 49.15 St. Michael's (Nights)— Opened May, 1943 - __ _ 6.9 7.4 4.9 8.3 11.5 11.6 10.6 10.2 1944 12.2 11.09 12.4 12.8 15.1 16.4 15.8 15.9 16.3 15.6 17.3 15.8 1945 15.0 13.0 14.9 16.95 12.4 13.7 15.3 13.1 12.0 10.7 13.7 11.36 Brampton Opened October, 1942 _ - - - - - - 25.8 36.6 38.76 1943 40.6 54.7 57.1 53.5 50.8 56.1 59.2 60.8 66.0 60.9 52.2 47.9 1944 34.9 41.8 44.0 50.0 55.5 56.9 43.2 35.6 31.2 40.8 43.2 46.4 1945 33.3 46.35 47.32 51.25 57.2 61.7 55.91 57.1 53.41 56.34 51.59 44.38 Falconwood Opened November, 1942 - - - - - - - - - 27. 48 1943 27.0 42.08 38.7 42.0 31.8 51.5 46.9 46.0 53.0 58.8 56.0 42.63 1944 36.8 40.2 46.4 44.5 48.3 43.0 20.4 17.7 23.2 19.7 25.8 25.4 1945 21.67 24.2 28.8 29.4 22.1 34.1 53.7 42.3 43.51 44.3 48.54 56.16 St. Mary's Opened January, 1943 10.5 11.83 19.4 25.1 29.2 27.0 33.0 35.3 40.1 40.6 23.0 30.08 1944 29.1 35.1 33.4 35.9 34.3 31.0 27.2 14.3 13.0 22.5 27.0 23.2 1945 22.1 25.7 21.4 34.6 39.4 43.7 41.1 35.9 39.94 42.27 39.17 36.28 Okehampton— Opened January, 1944 15.6 30.1 31.6 28.4 35.3 35.5 26.1 14.4 16.9 26.7 32.0 28.7 1945 30.19 29.9 31.65 33.6 33.8 38.68 39.67 36.75 42.2 47.2 49.89 41.1 55 MATERNITY AND CHILD WELFARE WORK DONE. Year Registered No. of Health Visitors Visits made to Children 1 to 5 Centres (Children) %of Births Centres (ante-natal) Expectant Mothers Children Under 1 No. of Attendances First Attenders Live Births Still Births Attendance Expectant Mothers % of Births First Total First Total Under 1 1 to 5 Under 1 1 to 5 1939 1423 41 *7 447 691 1323 5142 9798 17210 8162 1149 399 80.7 3715 638 44.8 1940 1279 32 7 487 792 1108 4739 10277 13279 6331 1084 381 86.6 2036 584 44.8 1941 1145 35 7 518 855 797 3707 8635 13126 6784 1109 385 96.9 3762 745 63.1 1942 1469 38 7 636 1109 1440 4445 8242 17740 7349 1322 467 90.0 5769 981 65.0 1943 1384 29 7 716 975 1664 4444 5995 21321 8419 1069 368 76.5 5835 859 60.7 1944 1498 30 ‡8 604 865 1491 4163 5089 19240 7649 1298 191 84.9 5479 926 60.6 1945 1413 31 8 664 884 1519 4722 6174 20866 9246 1426 253 100.9 5403 851 58.9 56 *6 for 2 months. ‡7* for quarter of year. SECTION C. SAN STARY CIRCUMSTANCES OF THE BOROUGH. List of Adoptive Acts, etc., in force. Date Acts. Adopted. Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 Public Libraries Act, 1892-1919 Oct 1893 Private Street Works Act, 1892 Jan. 1899 Public Health Acts Amendment Act, 1907, Parts 8 and 9 Apr. 1909 Part 2—the whole „ 4—Sees. 53 and 54 May 1909 ,, 6—the whole „ 10—Sec. 95 Public Health Act, 1925, Part 2 Jan. 1926 Slaughter of Animals Act, 1933 Jan. 1934 Byelaws. Wireless Loudspeakers, Gramophones, etc. Jan. 1939 Fouling by Dogs of Footpaths July 1938 Baths. Wash-houses, Swimming Baths and Bathing Places Aug. 1938 Parks and Pleasure Grounds May 1939 Building June 1939 Defacing of Pavements Nov. 1939 Deposit of Litter to the Detriment of Public amenities ,, Deposit of Dangerous Substances ,, Organs ,, Loitering at Church Doors ,, Indecent Language, etc ,, Noisy Hawking Touting ,, Noisy Animals ,, Violent Behaviour, etc. on School Premises ,, Nursing Homes June 1940 The Byelaws relating to: Cleansing of Earth Closets and Cesspools; Common Lodging Houses; Hop Pickers' and Fruit Pickers' Lodgings; Cleansing of Privies; Removal of Offensive and Noxious Matters; Nuisances; 57 Offensive Trades (Fish Frying); Tents, Vans, Sheds, and Similar Structures; Lodging (Housing Act, 1925) Sec. 6; New Streets and Buildings adopted 1927; New Streets and Buildings adopted 1931 and Slaughterhouses; lapsed in 1940 as under the Borough Charter of 1937 all Byelaws then in existence had to be re-made within three years of October, 1937. Application was made to the Ministry of Health for renewal of certain of the lapsing Byelaws which it was deemed necessary to have in effect, but in view of the war the Minister refused to sanction the proposed Byelaws put forward. So far it has been possible to continue sanitary work without these Byelaws, but if a difficult offender is met it is not possible to forecast how a remedy for the nuisance or defect can be obtained where such is not covered in the general legislation. 1. (i) Water Supply. The supply to the Bexleyheath district is a mixture of water from Wilmington, Darenth, Wansunt, Crayfiord, Bexley and Deptford AVells, and Thames-derived filtered water. All the water is chlorinated as it leaves the works. Bacteriological analyses are made five times per week of all supplies and consistently satisfactory results have been obtained. In the case of Bexley the water is also tested before chlorination but owing to the conditions of treatment at the other stations this is not possible. Water derived from the Thames is sampled at each stage of the purification process. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically. None of the supplies is plumbo-solvent. The examination of samples of water from piped supplies to houses at least monthly has given the following results:— Bacteriological. No. of organisms per c.c. capable of growth on Agar at— 1939 1940 1941 1942 1943 1944 1945 37°C. 0-28 0-7 0-2 0-6 0-4 0-2 0-5 22°C. 0-30 0-60 0-2 0-87 0-8 0-4 0-158 58 B.coli presumptive 1939 1940 1941 1942 1943 1944 1945 Absent in c.c. 100 100 100 100 100 100 90 Absent in c.c. 70 80 Present in c.c. *80 *90 †lOO * A—typical organism, † Further test proved that these were not typical B.coli. Satisfactory water. (ii) Drainage and Sewerage. During the war years very little new drainage or sewerage work was carried out. Repairs were carried out to a number of sewers damaged by enemy action. The following is a summary of new work during the years 1939-1945. 1939— South Welling and Rochester Way. 11/3 miles foul sewer. Rochester Way between Westwood Lane and Curren Avenue and Hook Lane, Welling. Surface water sewers laid. Sewers laid by private developers. Foul sewers— 2.21 miles. Surface water sewers 2.66 miles. 1940— South Welling and Rochester Way. Sewer scheme completed. Oakhouse Road. New surface water sewer. Marwood Close, Welling. Surface water sewer relaid. 1942— Bellegrove Road, Welling. 1,061 feet of foul sewer relaid. 1945— East Wickham, near Council's Controlled Refuse Tip. Approx. 37 yds. 15 ins. diameter. Surface water sewer laid. 59 2. Rivers and Streams. During- the years under review only one serious case of river pollution was found. This was due to debris from a bombed dockside warehouse being tipped near the River Cray just before it entered the Borough. The tipping was stopped and the channels cleared. 3. (i) Closet Accommodation. With few exceptions the whole of the closet accommodation in the area is on the water carriage system. (ii) Public Cleansing. No. of cesspools emptied:— 1939 1940 1941 1942 1943 • 1944 1945 11 9 8 5 4 5 10 Refuse Collection and Disposal. The work of collection and disposal of house refuse was seriously affected during the war years owing to the difficulty in obtaining the necessary labour. A large proportion of the men engaged on this work prior to the war were either called up or directed to other employment, with the result that it was found impossible to maintain a regular collection. In addition to this, the collection of salvage added to the work of the department. Kitchen waste is collected by means of street bins, which are cleared twice weekly. All refuse is disposed of by controlled tipping at two tips. CHIEF SANITARY INSPECTOR'S REPORT. Health Department, 14, Brampton Road, Bexleyheath . To the Mayor Aldermen and Councillors of the Borough of Bexley. Ladies and Gentlemen, I submit my Annual Report as Sanitary Inspector to your Council for the year 1945. The report consists of a tabulated record of the work carried out. Tabulated records are also included for the six years 1939 to 1944. 60 TABLE No. 1. 1939 1940 1941 1942 1943 1944 1945 No. of complaints received and investigated 457 335 506 427 399 282 410 No. of informal notices, letters, etc. 461 374 462 554 480 304 418 TABLE No. 2. Details of Inspection Work Carried Out. Houses inspected (all particulars recorded) 622 - - 34 9 15 14 Houses inspected (defects only recorded) 946 671 504 904 739 522 645 Houses inspected (Housing Act, 1936, Overcrowding) 108 154 17 278 448 129 199 Houses inspected re Infectious Disease (including Scabies) 374 204 146 425 771 531 499 Inspections. Factories with mechanical power 62 31 190 70 173 192 120 Factories without mechanical power 47 60 92 51 114 102 62 Schools 20 83 29 15 11 — 5 Refuse Tips 161 295 246 261 207 165 179 Van Dwellers 30 — — — — — — Bakehouses 56 38 68 83 82 63 41 Slaughterhouses 721 140 3 5 — — 6 Meat Shops and Premises where food is prepared 1224 1700 2016 2126 1957 1895 1864 Cowsheds and Dairies 55 36 107 62 110 38 37 Ice Cream premises — 71 65 113 — — 18 Fried Fish premises 250 188 278 297 330 192 231 Common Lodging House 12 24 20 19 16 23 15 Tents, Vans and Sheds — — — 12 9 8 5 Re Offensive accumulation 87 72 56 51 67 41 46 Re Keeping of Animals 69 73 133 107 77 50 40 Re Rats 322 184 779 491 1084 952 815 Re Verminous premises 110 90 244 186 160 139 140 Re Insufficient Ashplace Accommodation 141 62 99 242 151 45 165 Re Smoke Observations 84 — — — — — - Drains inspected 1023 1685 3031 2145 1407 1378 1830 Drains tested (water, smoke or grenade) 69 18 50 54 33 11 16 Visits re refuse re- moval and salvage 2755 932 1518 1812 1476 1035 1054 Miscellaneous Inspec- tions 2491 3391 3356 3169 2274 3010 Food and Drugs Act re samples 69 228 253 273 263 224 254 Removal of unnecessary railings - - - 949 142 - - Shops Acts 1912-1936— No. of inspections and re-inspections 1340 1075 769 857 1065 292 313 61 TABLE No. 3. Improvements effected and defective sanitary conditions remedied. 1939 1940 1941 1942 1943 1944 1945 Houses— Provided with sufficient w.c. accommodation 73 48 90 78 27 30 47 Provided with sufficient ashplace accommodation 62 28 27 52 63 16 41 Provided with sufficient water supplv — — 19 — — — — Houses Improved Internally— Dirty rooms cleansed 176 56 21 11 27 - 4 Walls and ceilings repaired 124 28 42 63 60 36 86 Dampness in rooms remedied 166 141 53 63 66 32 61 Defective floors repaired 31 11 20 9 47 19 28 Ventilation of rooms improved 94 14 23 6 6 7 — Windows repaired 96 15 37 3 22 2 9 Coppers repaired 18 5 8 2 4 — 1 Stoves, fireplace, etc., provided or repaired 59 22 41 12 17 9 16 Houses Improved Externally— Roofs repaired 64 29 38 15 18 17 9 Eaves, gutters and down spouts fixed or repaired 86 38 15 16 14 7 19 Yards paved or repaired 29 4 18 . 2 — — — Chimney stacks repaired 28 — — — 2 2 — Walls repointed or repaired 93 19 13 — 2 1 1 Miscellaneous repairs 115 18 60 5 5 6 10 Yards cleansed 1 — — — — — — Drainage— Drains cleansed or repaired 378 492 863 837 562 576 681 New drains constructed 25 7 7 — — — 10 New gullies provided 14 2 4 1 — — 1 Ventilation of drainage system improved 24 14 9 2 5 3 2 Inspection chambers built or improved 14 14 16 7 10 10 6 New sinks provided 13 4 1 2 1 — 2 Waste pipes provided or improved 7 9 12 9 7 6 4 Offensive accumulation removed 15 10 23 19 7 21 2 Nuisances from animals abated 6 5 6 3 1 2 I Tents, Vans and Sheds, nuisance abated — 82 — — — — — Other nuisances abated 101 21 78 207 179 40 51 Verminous premises 15 — — — — — — 62 TABLE No. 4. 1939 1940 1941 1942 1943 1944 1945 Infectious Diseases. Cases removed to Isolation Hospitals 252 99 108 210 204 98 113 Houses visited including revisits 374 204 146 425 771 531 499 Rooms disinfected 379 144 76 44 58 53 83 Notices delivered to Education Authorities, etc. 967 243 102 259 367 550 512 Houses at which defective sanitary conditions were found 6 1 4 7 — — — TABLE No. 5. Food Inspection. The following is a summary of animals slaughtered at the slaughter-houses in the area during the years 1939 and 1940. 1939 1940 Cattle 103 9 Sheep and Lambs 718 4 Pigs 3223 785 Calves 250 14 Total 4293 812 Details of meat condemned in connection with the above. 1939 Weight in lbs. 1940 Weight in lbs. Tuberculosis— Cattle 428 Pigs 1354 435 Calves 74 35 Total 1856 470 63 Other Diseases— 1939 1940 Weight in lbs. Cattle 286 15 Sheep and Lambs 38 - Pigs 1806½ 3603| Calves 195 - Total 2325½ 3618½ The slaughter-houses were all closed during 1940, and with the exception of an occasional emergency slaughter, have not been used since. Summary of Unsound Food surrendered 1939-1945. From the Meat Depot— 1939 1940 1941 1942 1943 1944 1945 Beef 67 613¾ 11411 858 390 396 1488½ Mutton and Lamb 271 1204 542½ — 52 108 62 Pork — — 5 — 141 502 90 Veal — — 8 51 - - Offal 1684½ 11332¼ 2307½ 19½ 12½ 386 280 Tinned Meat - - - 3312 10128¾ — 4143¼ From Shops, Stores, etc.— 1939 12 lbs. Beef. 175 lbs. Fish. 12 lbs. Mutton and Lamb. 49 lbs. Mushrooms. 25 lbs. Offal. 1x6 lbs. Tin Jellied Veal. 27 lbs. Rabbits. 750 Tins Fish and Fruit. 15 lbs. Poultry. 1940 227½ lbs. Beef. 26 lbs. Bacon. 74 lbs. Mutton and Lamb. 10 lbs. Butter. 5¾ lbs. Pork. 30 lbs. Corned Beef. 6 lbs. Veal. 4 lbs. Tinned Brisket. 65½ lbs. Offal. 5½ bags Vegetables. 40 lbs. Rabbits. 1 Barrel Dripping. 448 lbs. Fish. 64 1941 76 lbs. Meat. 27 Tins Milk. 514 lbs. Fish. 75 Tins Fish. 184 lbs. Sausage Meat. 36 Tins Fruit and Vegetables 28 lbs. Cooked Meat. 2,593 Rabbits. 12 lbs. Bacon. 20 Boxes Milts. 77¾ lbs. Cheese. 5 Meat Pies. 168 lbs. Corned Beef. 4 Jars Pickles, etc. 273 lbs. Butter. 2 lbs. Jam. 328 lbs. Cake. 51 lbs. Pearl Barley. 42 lbs. Dried Apricots. 350 lbs. Potatoes. 7 Tins Meat. 1942 57½ lbs. Beef. 273 Tins Meat. 48 lbs. Offal. 15 Tins Corned Beef. 889 lbs. Fish. 227 Tins Fish. 25 lbs. Butter. 24 Tins Meat and Vegetables. 10½ lbs. Lard. 812 Tins Vegetables. 30¼ lbs. Bacon. 70 Tins Soup. 15 lbs. Sausage. 517 Tins Milk. 298 lbs. Jam, Marmalade, etc. 305 Tins Fruit. 18 lbs. Haricot Beans. 197 Tins Coffee. 89 lbs. Tomatoes. 19 Jars Pickles, etc. 6 lbs. Sugar. 829 Eggs. 15 lbs. Oranges. 7 Meat Pies. 510¾ lbs. Flour. 12 Cakes. 1 lb. Rice. 1 Bottle Horlicks. 30 lbs. Bread. 1943 259½ lbs. Meat. 1,060 Tins Milk. 12 lbs. Sausages. 89 Tins Preserves. 2,002 lbs. Fish. 8 Tins Coffee, etc. 25½ lbs. Bacon. 34 Tins Egg Substitute. 346¼ lbs. Cheese. 640 Eggs. 37 lbs. Fats. 2 Cases Rabbits. 439 Tins Meat. 107 Packets Cereals. 444 Tins Fish. 7½ lbs. Cereals. 511 Tins Fruit. 1 Packet Cake Mixture. 979 Tins Vegetables. 5 Jars Fish Paste. 125 Tins Soups. 5 Jars Pickles, etc. 1944 72 Tins Soup. 178 Stone Fish. 126 Tins Beans. 355 Tins Canned Fish. 854 lbs. Dried Beans. 50 Tins Fruit. 285 Tins Meat. 28 lbs. Fresh Fruit. 16 Sets of Cow heels. 129 Tins Vegetables. 52 lbs. Sausage Meat. 65 1944—continued. 349 Tins Milk. 452 lbs. Butter and Margarine 110 Jars & Tins Jam and 8 Bottles Spreads. Marmalade. 28 lbs. Cake. 5 Jars Pickles. 298 lbs. Rabbit. 455 Eggs. 22 lbs. Sugar. 155 Packets Cereals. 4 lbs. Sultanas. 12 lbs. Flour. 50 lbs. Apple Rings. 8½ lbs. Rice. 2 Tins Paste. 195 lbs. Cheese. 144 Tins Barley Powder. 123 lbs. Bacon. 72 Packets Pudding Mixture. 1945 30 lbs. Beef. 459 Eggs. 137 lbs. Mutton and Lamb. 285 Tins Meat. 78 lbs. Pork. 723 Tins Fish. 1,702 lbs. Fish. 705 Tins Milk. 210 lbs. Dates. 441 Tins Vegetables. 15 lbs. 10 ozs. Bacon. 168 Tins Soups. 60 lbs. Rabbits. 5 Tins Meat and Vegetables. 452½ lbs. Tea. 5 Tins Fruit. 172½ lbs. Cheese. 130 Tins Preserves. 155 lbs. Flour. 48 Jars Pickles. 120 lbs. Butter & Margarine. 340 Tins Cake Mixture. 2 lbs. Lard. 38 Packets 130 lbs. Rice. 134 Tins 114 lbs. Peas and Beans. 103 Packets Cereals. 14 lbs. Lentils. 6 lbs. 69 lbs. Pearl Barley. 19 Jars Pastes. 840 lbs. Potatoes. 4 Packets Dried Egg. 5½ lbs. Barley Sugar. 7 Packets Chocolate Spread. 317 lbs. Dried Fruit. 2 Packets Gravy Powder. Foodstuffs damaged by enemy action. A considerable amount of time was spent by the Inspectors during 1944 and 1945 in dealing with foodstuffs at stores which had suffered damage through enemy action. The following table shows the amounts of foodstuffs surrendered from this cause. 1944 4 tons. 19 cwts. 3713 Tins, bottles, jars and packets. 1945 9 cwts. 62 lbs. 3410 Tins, bottles, jars and packets. 66 TABLE No. 6. 1939. Factories Act, 1937. 1. Inspections for Purposes of Provisions as to Health. Including Inspections made by Sanitary Inspectors. Premises. 1 Number of:— Inspections. 2 Written Notices. 3 Prosecutions. 4 Factories with mechanical power 68 3 — Factories without mechanical power 97 2 — *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 165 5 — 2. Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.l) 21 15 — — 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 4 4 — — Not separate for sexes Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 6 5 - - Total 31 24 — — 67 TABLE No. 6. 1940. 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 61 3 — Factories without mechanical power 68 1 — *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 129 4 — 2. Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.l) 7 11 — — Overcrowding (S.2) 1 1 — — Unreasonable temperature (S.3) Inadequate ventilation (S.4) Ineffective drainage of floors (S.6) Sanitary Conveniences (S.7)— Insufficient Unsuitable or defective Not separate for sexes 6 6 — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 3 2 - - Total 17 20 — — 68 TABLE No. 6. 1941. 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 246 4 — Factories without mechanical power 104 — — *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 350 4 — 2. Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.l) 17 14 — — Overcrowding (S.2) Unreasonable temperature (S.3) 1 1 1 — Inadequate ventilation (S.4) Ineffective drainage of floors (S.6) Sanitary Conveniences (S.7)— Insufficient Unsuitable or defective Not separate for sexes 10 10 — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 4 4 1 - Total 32 29 2 — 69 TABLE No. 6. 1942. 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 149 5 — Factories without mechanical power 55 — — *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 204 5 — 2. Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.l) 19 16 — — Overcrowding (S.2) Unreasonable temperature (S.3) Inadequate ventilation (S.4) Ineffective drainage of floors (S.6) Sanitary Conveniences (S.7)— Insufficient 1 Unsuitable or defective Not separate for sexes 11 11 - - Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 1 1 - - Total 32 28 — — 70 TABLE No. 6. 1943. 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 224 3 — Factories without mechanical power 145 — — *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 369 3 — 2. Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.l) 21 19 — — Overcrowding (S.2) Unreasonable temperature (S.3) Inadequate ventilation (S.4) Ineffective drainage of floors (S.6) 1 1 — — Other nuisances 4 4 — — Sanitary Conveniences (S.7)— Insufficient Unsuitable or defective Not separate for sexes 17 16 — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) Total 43 40 — — 71 TABLE No. 6. 1944. 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 192 4 — Factories without mechanical power 102 — — *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 294 4 — 2. Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.l) 13 13 — — Overcrowding (S.2) Unreasonable temperature (S.3) Inadequate ventilation (S.4) Ineffective drainage of floors (S.6) Other nuisances 1 — — — Sanitary Conveniences (S.7)— Insufficient 1 - - - Unsuitable or defective Not separate for sexes 11 10 - - Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) Total 26 23 — — 72 TABLE No. 6. 1945. Factories Act, 1937. 1. Inspections for Purposes of Provisions as to Health. Including Inspections made by Sanitary Inspectors. Premises. 1 Number of:— Inspections. 2 Written Notices. 3 Prosecutions. 4 Factories with mechanical power 157 3 — Factories without mechanical power 66 — — *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 223 3 — 2. Defects Found. Particulars. 1 Number of Defects. Number of Prosecutions. 5 Found. 2 Remedied. 3 Referred to H.M. Inspector. 4 Want of cleanliness (S.l) 13 15 — — Overcrowding (S.2) Unreasonable temperature (S.3) Inadequate ventilation (S.4) Ineffective drainage of floors (S.6) Other nuisances 3 3 — — Sanitary Conveniences (S.7)— Insufficient 1 — — — Unsuitable or defective 4 4 — — Not separate for sexes 1 — — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) Total 22 22 — — I am, Ladies and Gentlemen, Yours obediently, R J RAYNER, Chief Sanitary Inspector. 73 Swimming Pool. Samples of water were taken from time to time, and the results of bacteriological examination have been satisfactory on each occasion. At the outbreak of war the pool buildings were adapted for use as a mortuary for civilian war dead and for decontamination purposes. During the period of the flying bomb raids the pool was closed to the Public. Eradication of Bed Bugs. 1939 1940 1941 1942 1943 1944 1945 No. of Corporation Houses infested with bugs 11 3 — 2 1 2 3 No. of Corporation Houses disinfested 11 3 — 2 1 2 3 No. of other Houses infested with bugs 22 11 17 19 6 7 4 No. of Houses disinfested 22 11 17 19 6 7 4 No. of rooms in Corporation Houses— 1 room only 10 1 1 8 — — — 2 rooms only 2 2 — 3 — — — 3 rooms only 3 2 — — — — — No. of rooms in other Houses— 1 room 1 5 6 1 1 1 4 2 rooms 2 2 4 4 1 3 1 3 rooms 2 3 — 2 — 2 2 4 rooms — — — — 2 — 2 Families transferred to Council Houses from properties to be demolished. Furniture disinfested with HCN. 113 — — — — — — No. of Houses disinfested with HCN by private firms — 8 14 15 7 9 4 Camping Sites. One camping site used by Rover Scouts and the Woodfolk Craft in Hall Place has been kept under observation, but has not been used at any time over such a period as to come within the operation of Section 269 of Public Health Act, 1936. Schools. There are 24 County Modern and County Primary Schools, six non-provided schools, and a Day Technical School, for Girls in the Borough, and the sanitary conditions are satisfactory. 74 75 SECTION D. — HOUSING. 1939 1940 1941 1942 1943 1944 1945 The following particulars relate to the houses built by the Council on the various Estates and still occupiable :— Welling—Welling Estate 428 428 408 408 408 408 408 East Wickham—Glenmore Road 92 116 114 114 114 114 114 Bexleyheath—Highland Road Estate 88 88 305 305 305 305 305 Pickford Road Estate, including Bungalows 266 266 Bexley—Hartford Road Estate 18 18 53 53 53 53 53 Victoria Road Estate 36 36 Total 928 952 880 880 880 880 880 Total number of new houses erected during the year 1002 113 Nil 5 5 Nil 2 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) 209 216 107 260 196 127 253 (b) Number of inspections made for the purpose 1568 671 504 941 748 537 659 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 1925 to 1932 82 — — 12 3 14 4 (b) Number of inspections made for the purpose 622 — — 34 6 15 14 (3) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 — — 11 — — 1 (4) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 208 154 107 188 154 91 158 76 HOUSING (cont.) 1939 1940 1941 1942 1943 1944 1945 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 153 157 103 147 146 74 148 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 2 — — — — — — (2) Number of dwelling houses which were rendered fit after service of formal notices : (a) By owners 1 — — — — — — (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 — — 1 1 4 2 6 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners — — 1 2 3 1 (b) By local authority in default of owners — — — — — — — C. Proceedings under Section 11 and 13 of Housing Act, 1936— (1) Number of dwelling houses in respect of which Demolition Orders were made — — — — — — — (2) Number of dwelling houses demolished in pursuance of Demolition. Order 33 — 2 — — — — 77 HOUSING (cont.) 1939 1940 1941 1942 1943 1944 1945 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 1 — — — — — — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — — — — — — — 4. Housing Act, 1936. Part IV. Overcrowding. A. (1) Number of dwellings overcrowded at the end of the year 28 24 23 21 23 25 29 (2) Number of families dwelling therein 29 24 23 21 23 25 29 (3) Number of persons dwelling therein 228 193 185½ 171½ 184 195½ 215 B. Number of new cases of overcrowding reported during the year 6 1 1 — 6 2 4 C. (1) Number of cases of overcrowding relieved during the year 9 5 2 2 4 — — (2) Number of persons concerned in such cases 80 41 17 14 29 — — 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 Nil Nil Nil Nil The position to the 31st December, 1945, was :— Owner Occupiers 4 4 4 4 5 5 5 Welling Hutments (Compulsory Purchase Areas) 12 12 10 10 10 12 13 Corporation 2 — — — — — — Private Owners 10 8 8 7 8 8 11 SECTION E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The milk retailed for consumption in the area is railbourne, pasteurised and bottled, except for one small supply by a producer retailer. Licences granted by the Council under Milk Special Designations Order, 1936: — 1939 1940 1941 1942 1943 1944 1945 Pasteurised Milk 29 29 26 16 27 21 21 Tuberculin Tested Milk 16 16 15 13 13 12 10 Supplementary Licences— Pasteurised Milk — — — — — 1 2 Tuberculin Tested Milk — — — — — 1 1 No. of cowsheds in district 1 1 1 1 1 1 1 (b) Meat Inspection. During most of the period covered by this Report the slaughter-houses in the area were closed with the exception of an occasional emergency slaughter. In 1940 the distribution of meat from Smithfield was decentralised' and one of the Regional Depots was situate in this area. This has meant that a considerable amount of the Inspectors time has been spent in inspecting meat which was distributed from the Depot to this and adjoining areas. Damage was caused by enemy action to several meat shops in the area, but fortunately the amount of meat affected was not large. 78 (c) Adulteration of Food. Food and Drugs Act, 1938. The following table shows the number of samples taken during the year under review: — Year No. of samples. Adulterated. Formal. Informal Formal. Informal. 1939 32 2 — — 1940 201 28 6 2 1941 175 78 2 — 1942 175 98 4 3 1943 158 105 3 — 1944 125 99 1 — 1945 141 113 — — Legal Proceedings. 1939. Nil. 1940. (1) Coffee. Adulterated 34.8% chicory. Case dismissed. Vendor pleaded warranty. (2) Coffee. Adulterated 35.0% chicory. Case dismissed. Vendor pleaded warranty (3) Milk. Adulterated 13.6% deficient in fat. Fined £1 and £2 2s. 0d. costs. (4) Milk. Adulterated 36% deficient in fat. Fined £1 and £1 1s. 0d. costs. (5) Milk. Adulterated 26.7% deficient in fat. Fined £3 and £2 2s. 0d. costs., (6) Milk. Adulterated 19% deficient in fat. Fined £2 and £2 2s. 0d. costs. 1941. (1) Beef Sausages. Contained 320 parts phur dioxide per million. Fined £2 and £2 2s. 0d. costs. (2) Beef Sausages. Contained 172.9 parts sulphur dioxide per million. Fined £2 and £2 2s. 0d. costs. 79 1942. (1) Curry Powder. Contained 98 parts lead per million. Case dismissed. 1943. (1) Drinking Chocolate. Contained 14% of Carbonate of- Lime. Case against vendor dismissed. Supplier fined £10 and £2 2s. 0d. costs. (2) Pork Sausages. Contained 121.6 parts of sulphur dioxide per million. Total Pines, £30 0s. 0d. and £4 4s. 0d. costs. 1944. (1) Sausage Meat. Contained 229.5 parts phur dioxide per million. Fined £4 and £2 2s. 0d. costs. 1945. Nil. Registration of Premises under the Food and Drugs Act, 1938. No. of premises registered: — 1939 1945 Sale or manufacture of Ice Cream 13 13 Sale of Ice Cream 55 63 Preparation of Sausages, etc 40 43 80 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 1939 1940 1941 1942 1943 1944 1945 Scarlet Fever. No. notified 284 59 76 217 377 203* 150 No. isolated in Bow Arrow Hospital 185 44 47 121 148 72 45 No. isolated in other Hospitals 4 — — 5 6 2 2 No. isolated at home 95 15 20 51 223 129 103 Return cases from Hospital cases 2 1 2 4 8 3 2 Return cases from home nursed cases — — — — 4 1 1 Average length of stay in Hospital (days) 41.7 28.4 26.6 26.8 27.7 25.9 26.04 No. of deaths — — — — — — — * 1 non-civilian. Scarlet Fever has been mild through the war vears. The peak of incidence was reached in 1943. Previous high number of cases were noticed 1920/1/2, 1926, 1933/4. 1939 1940 1941 1942 1943 1944 1945 Diphtheria. No. notified 29 25 15 21 21 5 21 No. isolated in Bow Arrow Hospital 26 24 15 18 17 5 21 No. isolated in other Hospitals 1 — — 2 — — — No. isolated at home 2 1 — 1 4 — — No. of deaths 1 4 — — — 1 1 Average No. of days in Hospital 42.9 31.6 34.8 37.2 38.3 41.0 49.3 No. of swabs taken for bacteriological examination 303 138 120 25 84 13 804 No deaths have occurred in immunised children. No peaks of incidence have been reached since 1934. Immunisation commenced in 1937. Previous peaks of incidence were noted in 1921/2/3, 1926, 1928 and 1930. These facts speak for themselves. 81  1939 1940 1941 1942 1943 1944 1945 Diphtheria Immunisation. No. of children immunised at Clinics 939 2222 2692 2880 1882 794 1661 No. of children immunised by General Practitioners 107 209 205 216 85 59 63 No. of children who failed to have full course 7 45 49 88 99 42 6 Booster doses — — — — — 171 224 Total No. of children immunised at age of 15 at end of year 2327 4802 7410 10931 12823 13430 13473 Percentage of children under 15 by end of each year 13.7% 32.9% 51% 63.1% 69.3% 72% 72.75% No. of children immunised who developed Diphtheria — — — — 7 — 11 Enteric Fever. No. of cases notified 4 11 2 — 1 — l Puerperal Pyrexia. No. of cases notified 12 9 18 23 18 24 26 No. of cases isolated at Maternity Home, Bexleyheath 8 7 15 11 12 17 22 No. of cases isolated at Other Hospitals 2 1 1 1 2 1 Bow Arrow Hospital 1 1 1 9 3 4 2 Patients Home 1 — 2 2 2 1 1 Ophthalmia Neonatorum. No. of cases notified 1 — 1 7 2 4 2 No. of cases treated at home 1 — — 4 — — — No. of cases treated in Hospital i — 1 3 2 4 2 (a) Vision was unimpaired 1 — 1 7 2 4 2 (b) Vision was impaired — — — — — — — (c) Vision was lost — — — — — — — (d) The patient died — — — — — — — (e) The patient was still under treatment at the end of the year — — — — — — — (f) The patient removed from the district — — — — — — — (g) Classification under the above heads cannot be made (details of these cases should be attached) — — — — — — — 82  1939 1940 1941 1942 1943 1944 1945 Measles. No. of cases notified 3 25 1122 537 823 342 451 No. of cases treated in Hospital 1 6 16 6 6 9 11 No. of deaths — — 1 1 1 — — The previous measles epidemic was in 1938, and the epidemic expected in 1940 did not materialise. In 1941, however, the epidemic began with two cases in the first week of the year, and the number of cases rose gradually to a peak by the third week in June, with a slight remission two weeks after the school Easter Holiday which covered the two weeks ending the 10th and 17th April. After the peak in July the number of cases notified fell rapidly and the last case was notified in the last week in August. Measles serum for prophylaxis etc. is supplied on application by the Kent County Council to General Practitioners for contacts, but the number of requests for this serum has been small. 1939 1940 1941 1942 1943 1944 1945 Whooping Cough. No. of cases notified 18 6 388 147 108 214 69 No. of cases treated in Hospital 11 — 12 12 1 3 — No. of deaths 2 — 3 3 1 — — No. inoculated against Whooping Cough— scheme commenced in 1942 — — — 1296 1595 763 1049 Cases occurring in inoculated children — — — — 7 24 13 Vaccination against this disease of children under the age of 5, i.e. in the vulnerable years, was commenced in 1942. The material used was a concentrated vaccine, two injections at 4 weeks interval. This became unobtainable during 1945 and the Scheme was temporarily suspended In individual outbreaks in vaccinated day nursery children there was not enough evidence to state that these children had benefited. On the other hand, there were no deaths from this disease in 1944 and 1945. The question of the value of this vaccine must still be kept open. 83  1939 1940 1941 1942 1943 1944 1945 Dysentery. No. of cases notified 2 — 1 3 12 6 23 Treatment of Typhus Fever. In view of the possibility under war conditions of typhus fever being introduced into this country consideration was given to schemes for the isolation of cases of typhus fever and it was agreed to co-operate with the County Council in this matter and after a period the County Council made a scheme whereby the first eight cases in the County would be admitted to London County Council hospitals and thereafter and to the extent that accommodation was available at Bow Arrow Hospital, the County Coucil making arrangements for other cases of infectious disease during this period to be taken to other infectious diseases hospitals. 1939 1940 1941 1942 1943 1944 1945 Cerebro-Spinal Fever. No. of cases notified 1 12 5 11 5 — 3 No. of deaths — 2 1 5 1 — — No. of deaths nonnotified cases — — — — 2 — — Acute Anterior Poliomyelitis. No. of cases notified 4 — — 1 — — 2 No. of deaths — — — 2 — — — Food Poisoning. No. of cases notified — 9 6 10 11 5 — 84 85 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 1939. 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 285 1 3 10 17 22 162 51 8 7 1 3 — 190 — Diptheria 30 1 1 5 5 5 5 5 — 3 — — — 28 1 Enteric Fever (including Typhoid and Paratyphoid) 4 — — — — 1 1 1 — — 1 — — 4 — Puerperal Pyrexia 12 — — — — — — — — 12 — — — 3 1 Pneumonia 22 2 1 — — — — — 2 6 2 5 4 5 31 Encephalitis Lethargica 1 — — — — — — 1 — — — — — 1 1 Acute Poliomyelitis 4 — — — — 2 1 — — 1 — — — 4 — Ophthalmia Neonatorum 1 1 — — — — — — — — — — — — — Erysipelas 16 — — — — — — — — — 7 6 3 5 — Cerebro-Spinal Fever 1 — 1 — — — — — — — — — — 1 — Dysentery 2 — — — — — 1 — — — 1 — — — — Measles 2 — — — 1 — 1 — — — — — — 1 — Whooping Cough 5 — 2 1 — 2 — — — — — — — 2 2 Totals 385 5 8 16 23 32 171 58 10 29 12 14 7 252 36 86 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 1940. 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 20 15 to 20 to 35 35 to 45 45 to 65 65 and over Smallpox — — — — — — — — — — — — — — — Scarlet Fever 59 1 1 4 3 4 19 13 7 5 1 1 — 44 — Diptheria 26 — — 1 3 3 8 3 4 4 — — — 25 4 Enteric Fever (including Typhoid and Paratyphoid) 11 — — — — — 5 3 2 1 — — — 9 — Puerperal Pyrexia 9 — — — — — — — — 8 1 — — 2 — Pneumonia 36 — 1 3 — — 3 1 3 4 4 13 4 4 44 Encephalitis Lethargica — — — — — — — — — — — — — — — Acute Poliomyelitis — — — — — — — — — — — — — — — Ophthalmia Neonatorum — — — — — — — — — — — — — — — Erysipelas 13 — — — — — — — 1 2 1 6 3 — — Cerebro-Spinal Fever 12 — 2 1 — — 2 1 2 3 1 — — 11 2 Dysentery — — — — — — — — — — — — — — — Measles 25 3 2 — 2 4 7 3 2 1 1 — — 6 — Whooping Cough 6 2 — 2 1 — 1 — — — — — — — — Totals 197 6 6 11 9 11 45 24 21 28 9 20 7 101 50 87 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 1941. 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 76 2 — 5 7 11 30 8 3 6 4 — — 47 — Diptheria 15 — — — 1 1 4 2 3 2 2 — — 15 — Enteric Fever (including Typhoid and Paratyphoid) 2 — — — — — — 1 — 1 — — — 2 — Puerperal Pyrexia 18 — — — — — — — 2 9 7 — — 1 — Pneumonia 40 — 7 1 4 1 5 1 1 4 4 10 2 7 40 Encephalitis Lethargica — — — — — — — — — — — — — — — Acute Poliomyelitis — — — — — — — — — — — — — — — Ophthalmia Neonatorum 1 1 — — — — — — — — — — — 1 — Erysipelas 15 — — — — — — — — 2 4 4 5 2 — Cerebro-Spinal Fever 5 — — — 1 — 1 — 1 1 1 — — 5 1 Dysentery 1 — — — — — — — 1 — — — — — — Measles 1122 22 85 102 1ll 113 642 28 8 10 1 — — 16 1 Whooping Cough 388 25 27 40 52 47 182 6 — 5 1 2 1 12 3 Totals 1583 50 119 148 176 173 864 46 19 40 24 16 8 108 45 88 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 1942. 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 216 1 3 11 15 21 136 15 7 7 — — — 125 — Diptheria 21 — 1 — 2 — 6 3 2 6 1 — — 21 2 Enteric Fever (including Typhoid and Paratyphoid) — — — — — — — — — — — — — — — Puerperal Pyrexia 23 — — — — — — — 2 19 2 — — 11 — Pneumonia 47 1 1 2 — 5 10 5 1 5 5 9 3 3 34 Encephalitis Lethargica 1 — — — — — — — — — — 1 — — 1 Acute Poliomyelitis 8 — — 1 1 — 2 — — 2 2 — — 8 1 Ophthalmia Neonatorum 7 7 — — — — — — — — — — — 3 — Erysipelas 21 — — — — — — — 1 4 3 11 2 6 1 Cerebro-Spinal Fever 11 1 1 1 1 1 2 1 — — 1 1 1 11 5 Dysentery 3 — — — — — — — — 1 1 1 — — — Measles 532 11 33 51 61 73 283 14 3 2 1 — — 6 — Whooping Cough 147 16 15 21 22 18 51 — 1 2 1 — — 12 — Totals 1037 37 54 87 102 118 490 38 17 48 17 23 6 206 44 89 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 1943. 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 1 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Smallpox — — — — — — — — — — — — — — — Scarlet Fever 377 1 2 13 29 33 219 55 6 13 7 — — 154 — Diptheria 21 — — — — 1 12 3 2 2 1 — — 17 — Enteric Fever (including Typhoid and Paratyphoid) 1 — — 1 — — — — — — — — — 1 — Puerperal Pyrexia 18 — — — — — — — — 17 1 — — 3 — Pneumonia 76 2 2 1 1 1 13 2 4 10 11 21 8 11 39 Encephalitis Lethargica — — — — — — — — — — — — — — — Acute Poliomyelitis — — — — — — — — — — — — — — — Ophthalmia Neonatorum 2 2 — — — — — — — — — — — 2 — Erysipelas 21 — — — — — 1 — — 1 7 11 1 2 — Cerebro-Spinal Fever *5 1 — — — — 2 — *1 *1 — — — 4 1 Dysentery 12 — 2 — — 3 1 1 1 1 2 1 — 3 — Measles 823 25 57 62 121 91 403 45 12 4 3 — — 6 1 Whooping Cough 108 13 6 10 16 17 42 — — 2 — 2 — 1 1 Scabiesf 129 1 2 1 4 2 18 18 19 32 14 17 1 — — Totals 1593 45 71 88 171 148 711 124 45 83 46 52 10 204 42 *Two of these cases were non-civilian. †Disease made notifiable as from 1st November. 1943. 90 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 1944. 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 204 — 6 5 17 17 117 26 5 10 1 — — 74 — Diphtheria 5 — — — — 1 3 — 1 — — — — 5 1 Enteric Fever (including Typhoid and Paratyphoid) — — — — — — — — — — — — — — — Puerperal Pyrexia 24 — — — — — — — — 23 1 — — 5 — Pneumonia 58 4 1 1 3 2 6 1 5 10 6 14 5 8 25 Encephalitis Lethargica — — — — — — — — — — — — — — — Acute Poliomyelitis — — — — — — — — — — — — — — — Ophthalmia Neonatorum 4 4 — — — — — — — — — — — 4 — Erysipelas 27 — — 1 — — — — — 3 4 13 6 — — Cerebro-Spinal Fever — — — — — — — — — — — — — — — Dysentery 6 — — — 3 — 2 — — — 1 — — 2 — Measles 342 7 28 32 31 45 137 30 19 10 2 1 — 9 — Whooping Cough 214 24 26 13 22 32 81 4 2 4 3 3 — 3 2 Scabies 492 3 8 6 10 5 83 65 69 107 75 52 9 — — Totals 1376 42 69 58 86 102 429 126 101 167 93 83 20 110 28 91 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 1945. 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 150 — 4 9 8 8 85 24 6 5 — — 1 47 — Diphtheria 21 — — — 2 1 8 6 — 2 2 — — 21 1 Paratyphoid Fever 1 — — — — — — — — 1 — — — 1 — Puerperal Pyrexia 26 — — — — — — — 2 22 2 — — 3 — Pneumonia 33 1 1 4 1 1 4 3 1 — 3 7 7 8 22 Encephalitis Lethargica — — — — — — — — — — — — — — — Acute Poliomyelitis 2 — — — — — — — — 1 1 — — 2 — Ophthalmia Neonatorum 2 2 — — — — — — — — — — — 2 — Erysipelas 31 — — — — — — — — 2 4 22 3 3 — Cerebro-Spinal Fever 3 1 — — — — 1 1 — — — — — 3 — Dysentery 23 — 2 1 3 — 6 1 2 5 2 1 — 3 — Measles 451 18 61 70 64 41 171 15 7 3 — 1 — 16 — Whooping Cough 69 10 9 8 10 4 21 1 2 2 1 1 — — — Scabies 339 2 8 8 5 9 45 41 46 88 49 31 7 4 — Totals 1151 34 85 100 93 64 341 92 66 131 64 63 18 113 23 Scabies. Notifiable from 1/11/1943, 1943 1944 1945 Number of cases notified 128 492 339 Treated at Cleansing Station (includes contacts) 728 980 811 Number referred for further treatment 6 — — Malaria. One case in 1944 notified—treated in a military hospital. Terminal Disinfection. It had been the custom that after certain infectious diseases, either when the case was removed to hospital or the period of isolation was ended, the bed and bedding was removed to the infectious disease hospital for steam disinfection and an employee of the Health Department sprayed the room or rooms last occupied by the infectious person with a solution of formalin. Owing to the call up of employees to the Forces and increased costs it was decided in 1941 to dispense with terminal disinfection except of the room and bedding following cases of smallpox, plague or typhus fever and the bedding of cases of cholera, typhoid and enteric fevers. The whole question of discontinuing terminal disinfection is a matter of educating the public, as the public has during the past forty or more years been led to expect disinfection. An Inspector calls at each house from which a case of infectious disease has been notified and gives instructions with regard to the airing and scrubbing of the room after the patient has been removed. 92 TUBERCULOSIS. 1939 1940 1941 1942 1943 1944 1945 No. of cases notified 102 79 105 120 127 112 105 No. of specimens of sputum 328 212 213 41 57 55 51 No. of families referred for rehousing 2 8 1 – 6 1 6 No. on Register at beginning of year 513 562 376 456 455 617 667 Pulmonary— Male 225 245 167 201 24 1 283 308 Female 187 206 143 179 212 236 253 Non-pulmonary— Male 45 52 31 38 44 42 45 Female 56 59 35 38 48 56 61 No. on register at end of year 562 376 456 545 617 667 715 Pulmonary— Male 245 167 201 214 283 308 332 Female 206 143 179 212 236 253 269 Non-pulmonary— Male 52 31 38 44 42 45 53 Female 59 35 38 48 56 61 61 In 1941 a review was made of the cases on the register with the assistance of the Tuberculosis Officer and those cases were removed which were lost sight of or had been cured through other agencies than the public medical services. A review is due again now. 93 TUBERCULOSIS. 1939. Particulars relating to the same, and also to the deaths which occurred during 1939 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 – – – – – 5—10 1 1 2 2 – – – – 10—15 – 2 – 1 – – – – 15—20 6 5 1 – 4 1 1 – 20—25 10 5 2 – 7 3 – – 25—35 17 10 1 5 2 2 – – 35—45 10 3 2 – 6 2 – – 45—55 4 3 – – 5 1 – – 55—65 6 – – – 2 2 – – 65 and upwards – 1 – – – – – – Totals 54 31 9 8 26 11 1 – TUBERCULOSIS. 1940. Particulars relating to the same, and also to the deaths which occurred during 1940 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 – – – – – – 1 1—5 1 1 – 1 – – 1 – 5—10 – – – 1 – – – – 10—15 1 – 2 – 1 – 1 – 15—20 5 6 – – 4 4 – 1 20—25 6 8 1 1 1 1 – – 25—35 13 11 3 – 8 5 – 2 35—45 5 4 – 1 8 3 1 – 45—55 2 2 – – 6 1 – – 55—65 – 2 – – 1 2 – – 65 and upwards 1 – – – 2 2 1 – Totals 35 34 6 4 31 18 4 4 The number of non-notified tuberculosis deaths was 16. 94 TUBERCULOSIS. 1941. Particulars relating to the same, and also to the deaths which occurred during 1941 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 1 – 1 2 1 5—10 – 1 2 1 – – 1 – 10—15 – 2 3 – – 1 1 2 15—20 4 7 1 2 1 1 1 – 20—25 10 4 3 2 4 4 – 2 25—35 10 12 – 1 5 4 – – 35—45 9 7 – 1 3 4 – – 45—55 7 2 – — 6 1 – – 55—65 8 – – – 5 1 – – 65 and upwards 1 1 – – 2 – – Totals 50 37 10 8 26 17 5 5 The number of non-notified tuberculosis deaths was 13. TUBERCULOSIS. 1942. Particulars relating to the same, and also to the deaths which occurred during 1942 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 – 2 – 1 – – – 1 5—10 2 2 – 1 – – – – 10—15 1 – – 1 – – – – 15—20 14 8 – 2 6 – – 1 20—25 11 11 – 4 – 1 1 2 25—35 10 10 – – 2 5 – – 35—45 10 7 1 1 5 4 – – 45—55 11 1 1 – 7 – – –. 5&—65 5 1 – 1 4 – – – 65 and upwards 1 – – – – – – – Totals 65 42 2 11 24 10 1 4 The number of non-notified deaths was 7. 95 TUBERCULOSIS. 1943. Particulars relating to the same, and also to the deaths which occurred during 1943 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 2 – – – – – – – 5—10 3 – – 2 1 – – – 10—15 2 4 – – – – – – 15—20 9 13 – 3 1 6 – – 20—25 9 7 – – 3 1 – 1 25—35 15 12 – 3 5 3 – – 35—45 17 2 1 – 4 2 – – 45—55 12 4 – – 5 2 – – 55—65 3 1 – 1 1 2 – – 65 and upwards 1 1 – – – – – – Totals 73 44 1 9 20 16 – 1 The number of non-notified tuberculosis deaths was 8. TUBERCULOSIS. 1944. Particulars relating to the same, and also to the deaths which occurred during 1944 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 2 – – – – – – – 5—10 1 2 2 1 – – – – 10—15 1 3 1 – – – – – 15—20 12 9 1 1 1 1 – – 20—25 11 1 – 1 3 3 – – 25—35 11 11 2 1 9 4 – \– 35—45 8 6 – – 3 4 – – 45—55 14 2 – – 6 3 1 – 55—65 6 1 – – – – – – 65 and upwards 1 – – – – – – – Totals 67 35 6 4 . 22 15 1 – The number of non-notified tuberculosis deaths was 16, 96 TUBERCULOSIS. 1945. Particulars relating to the same, and also to the deaths which occurred during 1945 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 – 1— 5 1 1 1 1 – – – – 5—10 – 1 1 1 – – – 1 10—15 – – 1 – – – – – 15—20 10 7 3 2 2 2 – – 20—25 5 7 4 1 1 2 – – 25—35 10 10 2 – 3 2 – 1 35—45 15 3 1 2 2 3 1 – 45—55 6 1 1 1 4 1 – – 55—65 6 – – – 5 – – – 65 and upwards – – – – – 1 – – Totals 53 30 14 8 17 11 2 2 The number of non-notified tuberculosis deaths was 12. 97 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1939. This report of the Medical Officer of Health is confined to essential and urgent matters in accordance with the Ministry of Health Circular 2067 of the 19th July, 1940. The Registrar General's figures for 1939 have not yet been received, but from information in the possession of the Department, 1939 can be classed as a healthy vear. There was an increase in the incidence of Scarlet Fever up to the middle of the year, but following the outbreak of war very few cases were notfied as with the other infectious diseases. Developments were held up for various reasons, but the calls of civil defence on all members of the staff and the calling up of two clerks and an assistant sanitary inspector at the outbreak of war placed a great strain on the resources of the staff. Complaints generally fell off with the declaration of war and housing work came to a standstill, but the Department had additional work in dealing with matters of evacuation, arrangements for decontamination of clothing and material, disposal of war dead, and decontamination of foodstuffs. Food and Drugs Act, 1938, came into operation in this area on the 31st October, 1939, and sampling was commenced. Maternity and Child Welfare. From the outbreak of war the clinics opened as previously, and mothers were advised to bring children at less frequent intervals to prevent large numbers being present at one time, and so with smaller attendances the Health Visitors were able to concentrate more on home visiting. At the Maternity Home there were more admissions as women who had booked for other institutions which closed at the outbreak of war were admitted where possible, and owing to the difficulty of getting ante-natal and abnormal intra-natal cases into a maternity hospital some of these cases were dealt with at the Home under the care of the Consultant Obstetrician. GEO. F. BEAMLEY, M.D., Ch.B., D.P.H., Medical Officer of Health. 98 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1940. The report this year is again confined to essential and urgent matters in accordance with Ministry of Health Circular 2,314 of the 26th March, 1941. A sunmary of vital statistics is appended, from which it will be seen that the general health of the Borough has been maintained at a high standard despite the conditions of over-crowding when the majority of the population spent many of the night hours in air raid shelters in the last four months of the year. Some evidence was forthcoming, however, that some persons were not bathing and changing their underclothes as frequently as before, and this was seen by an increased number of cases of scabies. This, I understand, has been fairly general throughout the country. The Registrar General's estimate of population for mid-year is 77,670 compared with 80,110 for 1939. There has been a slight fall in the birth rate which is only to be expected in view of the several conditions brought about by the war. There has been an increase in the death rate, largely due to deaths due to war operations, but even after the application of the comparability factor the death rate compares favourably with the rest of the country. The Corporation Maternity Home has been fully occupied throughout the year and maternity and child welfare clinic sessions held regularly, although smaller attendances have been encouraged especially at the child welfare sessions. There has been no curtailing of health visiting, in fact there has been an increase in the number of home visits made, and the only restriction in the whole of the maternity and child welfare services throughout the year was the discontinuation of special classes in cookery and sewing. The bye-laws affecting sanitation, as with other byelaws, lapsed in October, 1940, three years after the Incorporation of the Borough as required in the Borough Charter. Application was made to the Ministry of 99 Health for the renewal of certain of the lapsing bye-laws which it was deemed necessary to have in effect, but in view of the war the Minister refused to sanction the proposed bye-laws put forward. So far it has been possible to continue sanitary work without these bye-laws, but if a difficult offender is met it is not possible to forecast how the remedy for the nuisance or defect can be obtained where such is not covered in the general legislation. The water supply, despite temporary dislocation due to war damage, has been maintain and a pure and wholesome water has been forthcoming after a few hours on practically all occasions. Regular weekly collections of house refuse have been seriously interfered with owing to the call-up of workmen and the difficulty in replacing them and owing to dislocations in traffic movements from time to time. The longest period between collections has not, however, ex- ceeeded fourteen days. The incidence of scarlet fever and diphtheria was lower in 1940 than in any previous recorded year in this district. Immunisation against diphtheria was pushed vigorouslv throughout the year and by the end of the year the percentage of the peace time child population inoculated under the age of 11 was about 38. Many more children require to be immunised and all the publicity that can, should be given to this vital procedure. Of 4.611 children immunised in this Borough from the commencement of the scheme up to the end of 1940 not one has developed diphtheria. During the second and third weeks of June nine cases of Para-typhoid B Fever came to my notice. This was at a time when there was a prevalence of this disease in other parts of the county, and, although many investigations were made, the cause was not found. It must be assumed, however, that there had been some infection of some foodstuff at this time, and with the increased handling of unwrapped foods and the employment of more women in shops, with frequent changes in staff, such outbreaks can only be prevented by all persons who are handling food frequently washing their hands both before and during the period they are working. 100 The increased duties placed upon the staff with the many dislocations which occurred during the year, including the necessary vacation of the Health Department Offices for several weeks, placed a severe strain on everyone concerned, but the work of the health services was not discontinued, and I am indebted to members of the Council and to the whole of the members of my staff and the officers of other departments for their assistance and co-operation. GEO. F. BRAMLEY, M.D., Ch.B., D.P.H,. Medical Officer of Health. 101 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1941. The report is again restricted in accordance with Ministry of Health Circular 2604 of the 24th March 1942. A summary of vital statistics is appended from which it will be seen that the general health of the Borough has been maintained at a high standard. The birth rate again shows a slight fall which is usual in war time. The death rate is slightly raised over pre-war years, but lower than in 1940. The infantile mortality rate is the lowest ever recorded in this Borough, and the reduction appears to be chiefly due to a reduction in the deaths under one month, that is in the neonatal mortality rate, which is usually taken as a reflection upon the ante-natal care, and in this connection it is interesting to note that more mothers than ever attended the Corporation Ante-Natal Clinics where in fact 74% of the expectant mothers of the Borough were seen, and it is known that 96% of expectant mothers received ante-natal medical care. These figures compare with approximately 45% and 67% in 1940. The large increase in the number of expectant mothers attending ante-natal clinics necessitated holding additional sessions and additional work upon your full-time Medical Officers which was not easilv fitted in having regard to their additional war-time duties in connection with Civil Defence etc., but it was not deemed an opportune time to come to the Council for an additional Medical Officer, especially in view of the shortage of doctors throughout the country. The Corporation Maternity Home has been fully occupied again and there has been greater responsibility on all members of the staff in view of the absence of beds in the London hospitals for abnormal cases. Accommodation at the Home was booked up six or seven months ahead and it will be an urgent post-war duty on the Council or other hospital authority to provide additional maternity institutional accommodation for this area. 102 During the year there was a gradual change in outlook from one of passive defence to active production which led to the call of women to war work including women with young children. The Council therefore took the step of adopting the principle of providing wartime day nurseries. I have no doubt that the Council as a Welfare Authority have taken on a further responsibility with regard to the care of children under the age of five which will be carried on in the years of peace. With regard to infectious disease, measles in numbers led the field, but the epidemic was of a mild character; whooping cough was also prevalent and the most fatal of the infectious diseases. There were no deaths from diphtheria but the immunisation campaign went forward well chiefly due in my opinion to the interest taken in this matter by the Ministry of Health and their wireless propaganda. By the end of the year 7,410 children had been immunised since the commencement of the scheme and not one of these has developed diphtheria. The Corporation ambulance service continues very actively, but more calls had to be transferred to outside ambulances owing to the Corporation ambulance being out when required. One of the Council's first duties after the war will be the provision of a second ambulance. The waiting list for dental treatment for nursing and expectant mothers and children under the age of five steadily increased until it became necessary to do less conservative treatment and arrange for more extractions. With the return of dental surgeons to civil life from the Services after the war it will be possible and necessary to increase the number of dental sessions. During the year terminal disinfection after cases of infectious diseases such as scarlet fever and diphtheria was discontinued, and the opportunity it taken here of stating, for the purpose of reassuring any who may have looked upon this as a step likely to increase the incidence of infectious disease, that the number of cases of these diseases, as will be seen in the summary of vital statistics, has continued at a very low figure. 103 During the year the Council considered reports on scabies and the head and body louse, and made arrangements for the full use of the Disinfecting Station. The work of the Sanitary section of the department has also been increased with new types of responsibility in view of the changing conditions of the war and mode of living. The water supply despite temporary dislocations due to war damage in the early part of the year has been maintained and a pure and wholesome water has been available continously. The collection of house refuse fell very much in arrear due to the shortage of labour, but with the institution of the system of street bins for twice weekly collection of waste food for pig feeding, the household dustbin despite the fact that it has not been emptied for periods up to three weeks should no longer be a source of nuisance even without its lid. I have to record my indebtedness to the Council, other departments, and every member of the Health Department for the full assistance which they gave me throughout a very busy year. GEO. F. BEAMLEY, M.D., Ch.B., D.P.H., Medical Officer of Health. 104 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1942. The report is again restricted in accordance with the Ministry of Health Circular 2773 of the 10th March, 1943. A summary of vital statistics is appended, from which it will be seen that the general health of the inhabitants of the Borough has been maintained at a high standard. The birth rate is the highest recorded since 1923 and the number of births the highest ever recorded in this area. Some reasons for the high rate are—(a) the population of the Borough is young, (b) the first children being borne as a result of the high number of marriages in the first years of the war, (c) the decision of parents to have children rather than wait an indefinite period until after the war, (d) the better economic position of the working population, (e) the large number of husbands in the Forces stationed in this country, (f) the return to valuation of family life with less outside attractions, (g) a decision to rear a child rather than work in a factory. It is interesting to note in view of the present day demand for maternity beds that there was a 50% increase of births in institutions but only a 30% increase of births in private houses. The infantile mortality rate (32.7) is the lowest ever recorded in this district and should be compared with the rate of 111 in 1915 when child welfare first began in Bexley and the rate of 78 in 1917 the third year of the last war. The death rate is the lowest of the war years, and is low when it is realised that it is calculated upon the population which does not include the healthiest and most virile men and women who are now in the Forces. There are still many preventable deaths and there is no cause for complacency. Diphtheria was the cause of two deaths, both in non-immunised children. Reference to the cycle of epidemics of this disease would lead one to expect a high rise in the number of cases by 1942, but this did not occur and I know of no other cause than that 63% of the children of the Borough were immunised against diph- 105 theria by the end of 1942. If the remaining children ' were immunised, diphtheria as a cause of death could be excluded. There were three deaths from whooping cough during the war and, apart from cerebro-spinal fever and tuberculosis, whooping cough is the biggest killer of the infectious diseases. Permission was obtained during the year from the Ministry of Health to commence an immunisation scheme against whooping cough. A vaccine has been prepared which is given at the same time as the diphtheria prophylactic mixed in the same syringe, thus necessitating no additional injections. The scheme was commenced in July and was offered to parents with children under the age of five. Bv the end of the year 1,296 children had been given the two doses and of these children 2 only developed whooping cough during the year, whilst 145 unprotected children of all ages contracted the disease. The Borough had been very lightly affected by the countrywide epidemic of cerebro-spinal fever prior to 1942, but during the year the number of cases was comparable with those throughout the rest of the country, and there were five deaths despite the big reduction in the fatality of this disease since the use of the sulphonamide drugs. An expected increase in the number of cases of scarlet fever occurred, but the disease continues to be mild, and there were no deaths. The policy of home isolation where possible was continued and there is no evidence to show that this policy causes any increase in the incidence. Almost half the number of cases were isolated at home. From these there were no return cases, but there were four from hospital isolated cases. The increased birth rate meant a busy year in the child welfare centres and a record total of attendances and of new attenders. Approximately 90% of the children born in 1942 attended the clinics at least once. Two thirds of the expectant mothers attended the antenatal clinics, and practically all the rest attended clinics at maternity hospitals outside the Borough or their own doctors. The attendances for post-natal examinations showed a marked increase and this service which is intended to minimise suffering in later years is deservedly becoming more popular. 106 Full co-operation has been maintained with the Ministry of Food in the isue from the clincs of cod liver oil and orange juice for children under five, and cod liver oil for expectant mothers, and with the Board of Trade, in the issue of supplementary clothing coupons for expectant mothers. Two war-time day nurseries were opened in January, which were an immediate success and the Council decided to provide a further three, raising the total accommodation to 240. Allowing for absentees this permits of 300 children on the registers. At the time of writing this report one of the nurseries has been enlarged by 18 places, also to provide accommodation for 18 children at night whilst their mothers are working and a sixth nursery is being prepared for 60 children and consideration is being given to provide accommodation for a further 100 children whose mothers will be in part time employment. However much we may be convinced that the place for the young child is at home with its mother there is no doubt that the childs place is in a nursery, so long as the mother goes out to work. In any case the scheme for Daily Minders was a failure in this Borough as although there were several initial registrations to take children the housewives pratically all withdrew their applications after giving the matter futher thought, as they no doubt realised that looking after children is difficult work and their household goods would be wearing away very quickly with other people's children in their homes. Slum clearance and housing development has continued in abeyance but there are many signs that the post-war problem in this respect will be very different from those of pre-war years and that very extensive works will be urgently necessary. Many houses in the Borough are now occupied by two families, a mother with children whose husband is in the Forces letting off two rooms to a family in similar circumstances, but in view of the low standard of the Housing Act, 1936, there is no evidence of more overcrowding. Treatment of scabies commenced in the new year and 475 persons were treated at the Cleansing Station, but until sufferers present themselves earlier for diagnosis and treatment and realise that infection is an accident and not a disgrace there does not seem to be much hope of eradicating the disease. 107 During the year accommodation for patients suffering from typhus in the event of the disease being introduced into the country was considered and the Borough Council came to an arrangement with the County Council for the admission of cases in the first instance to London County Council Hospitals and later to Bow Arrow Hospital. The demand for maternity accommodation has again exceeded supply and the Maternity Home has continued to work with an average of two midwives short of requirements which has placed a severe strain on the rest of the staff. The Ministries of Health and Labour and National Service are now reviewing the question of shortage of midwives throughout the country and it is hoped that a solution will soon be found. As a partial solution the Council agreed during the year to employ non-resident midwives at the Home. The Borough Ambulance had a 50% increase in calls and there was a 100% increase in calls on outside ambulances and in view of this increased use and the increased number of mechanical breakdowns the Council resolved to purchase an additional ambulance. The Sanitary Inspectors made an increased number of visits to various properties, food shops, etc., but their work has been made more difficult in view of the shortage of materials and labour in getting repairs carried out, and difficulty has been experienced with regard to collection and disposal of house refuse, and a weekly collection has not yet been found possible. It has been found necessary to spend a large amount of time inspecting foodstuffs both canned and otherwise in various bulk food stores. I wish to take this opportunity of thanking the Council and officers of all departments for their assistance and especially to all the members of the Health Department for the way in which they have cheerfully and ungrudgingly in effort dealt with the new and additional work of the depratment. GEO. F. BRAMLEY, M.D., Ch.B., D.P.H.. Medical Officer of Health. 108 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1943. The report is again restricted in accordance with the Ministry of Health Circular 10/44 of the 15th February, 1944. A summary of vital statistics is appended. Compared with the rest of the country, and with previous reports, the health of the inhabitants of the Borough has been maintained at a high standard. The low infantile mortality rate (26.01) is an outstanding fact and most gratifying. It is 6.59 below that of last year which was up to then the lowest ever recorded in this Borough. It has been stated recently that a goal of 25 for the infantile mortality rate of greater London might well be aimed at in the next ten years, so that to stabilise or reduce the 1943 record in Bexley there can be no relaxation and indeed only intensification of the activities of Maternity and Child Welfare. The low infantile mortality rate is accompanied by a low stillbirth rate. An equally outstanding and gratifying fact is that there was no death from diphtheria in 1943, when by December 31st, 70% of children under the age of 15 were immunised and to this must be given the credit. With varying phases of human resistance and bacterial infectivity there may be a change in this relationship, but so far as present evidence goes a high immunisation rate will mean a low diphtheria rate. Immunisation is a continuous process and the parents of children approaching one year old should take advantage of the facilities offered, as although diphtheria is now becoming an uncommon disease relaxation of the immunisation campaign would only lead to the old conditions with the disease taking a big toll of child life as the diphtheria germ is still with us. Scarlet fever was common during the year, but did not reach the levels of the previous epidemic cycles in 1920-22, 1926 and 1933. The disease was, however, very 109 mild with no deaths. From home isolated cases there were less than 2% of return cases, as against over 5% from Hospital isolated cases. Inoculation against Whooping Cough was continued and appears to be justifying the campaign as only 9 children of the 2891 inoculated since the scheme began in July, 1942, have contracted the disease. The influenza epidemic at the end of the year was mild and Bexley appeared to come off very lightly so far as deaths were concerned. The assistance of Voluntary Organisations was freely given in a Scheme organised to give domestic and nursing assistance and to assist with shopping where the adults of a household were incapacitated. The Ministry of Health gave stimulus to the Home Help Scheme during the year and the scheme suggested was substantially the same as had been in operation in the Borough since 1936, but with a 50% increase in applications and the inability of the Ministry of Labour to find suitable persons to act as Home Helps, the local service has not been easy to maintain. The scheme is restricted by legislation to homes in which there is a nursing or expectant mother or child under the age of five, but there are many homes where domestic assistance is urgently required outside the restriction, but we are unable to help. With the increase in illegitimate births the suggestions of the Ministry of Health to make provision for the mother and her child have been put into operation so far as they are applicable, and arrangements sought with the County Council where joint efforts would be more applicable and economical, for example, in residential nursery accommodation not only for the illegitimate child but for children whose mothers need to be admitted to hospital; the only accommodation in this part of the county is very limited and supplied by the Public Assistance Committee. The services of the Rochester Diocesan Council in the provision of hostels has been appreciated and arrangements made for contributions per case. The rise in illegitimacy should not necessarily be attributed to a lowering of moral standards, but it must be appreciated that opportunity for marriage to 110 legitimise an expected birth is very often impossible in war time. In peace time in England and Wales 20% of first births were legitimised by marriage after conception. By the end of the year four day nurseries were in operation in the Borough and one 24 hour nursery. There was a waiting list of 75 children for admission. The Okehampton Nurery for 60 children was in course of erection and a nursery in Bellegrove Road, Welling, proposed, as the Ministry of Labour required provision for children of mothers in part-time employment. During the year there was no accommodation available for children whose mothers were in part-time employment. The nurseries have continued to serve an essential purpose with obvious benefit physically and mentally to the children in them. With nursing supervision the physical side of children in nurseries has always been well catered for and with further development during the year of the educational side the role of the nursery is assuming its proper proportions. The continued high birth rate with large clinic attendances has necessitated increased ante-natal and child welfare sessions and the Council agreed to the use of adaptable premises in Wrotham Boad and Falconwood. The provision of clinic accommodation in these areas was held up by the outbreak of war but could not be postponed any longer. This additional service is appreciated as judged by attendances. It was also necessary to increase the dental sessions as the waiting list was becoming alarmingly big. The housing position becomes more acute but as new houses cannot be provided before the end of the war, the Council have before them schemes for post-war housing. I estimate that at least 500 new houses are required in the Borough for the rehousing of families living in houses not fit for habitation or overcrowded as judged by the Housing Act, Standards in addition to 618 houses required for rehousing of families still living in areas scheduled under Slum Clearance before the war. With the addition of houses required for married couples living with parents and new marriages a big programme lies ahead. 111 The number of new cases of scabies coming to my notice did not diminish during the year and many contacts were not being treated as the disease was not notifiable in the Borough. The necessary power was obtained therefore for the diseases to be notifiable as from the 1st November. Since then all notified cases and contacts have been followed up to see that they obtained treatment either at the Cleansing Station, or at home under the patient's own doctor. 129 cases were notified in the two months and during the year 728 cases and contacts attended for treatment at the Cleansing Station. The bathing and treatment is given by Civil Defence personnel and for this and help in other activities of the Health Department we are deeply indebted to them. An event of Public Health importance in the Borough during the year was the setting up of the Tuberculosis After Care Committee. A band of very energetic voluntary workers has commenced work on a very large task. As Tuberculosis is as much an economic calamity in the average household as a medical problem the work of the After Care Committee will go far to mitigate its evils and thereby prevent its spread. I have to thank the members of the Council and officers of other departments for their helpful consideration and express my indebtedness to all members of the Health Department. GEO. F. BEAMLEY, M.D., Ch.B., D.P.H., Medical Officer of Health. 112 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1944. In accordance with the Circular 49/45 of 19th March, 1945, the annual report is again restricted. Publication of population figures are, however, permitted and the estimation given by the Registrar Greneral for the Mid-Year 1944 in the Borough of Bexley is 71,130. This shows a decrease of over 5,000 on the previous year, but can be explained by the exodus of mothers and children when flying bombs commenced. A summary of vital statistics is appended. It is gratifying to note that, despite continuation of wartime conditions, the general health of the Borough, as compared with the rest of the country, was good. The death rate in the Borough was 10.2 per 1,000 population as compared with 11.6 for England and Wales and 15.7 for the Administrative County of London. The birth rate (21.06) was the highest since 1923, but as estimates are made on population and the midyear population for 1944 was low, it will not be surprising if a smaller figure is shown in 1945. The still birth rate (0.42) remained at a comparatively low level. The infantile mortality rate (31.37), though low in comparison with the rest of the country, was higher than that of last year which was the lowest on record. This increase was due mainly to the early death of premature and malformed babies, 25 having died in 1944 as against 18 in 1943. The concern of the Ministry of Health at the loss of premature babies is shewn by their issue of circulars relating to the care of these babies. As far as war-time conditions would allow their suggestions have been adopted in this Borough and every endeavour is being made to reduce deaths from this cause. Maternity Home. 549 cases were admitted during the year, abnormal cases again being included. Many applications for admissoin had to be refused owing to 113 shortage of beds. A suggestion came from the Ministry that patients, staff and Home might be evacuated because of enemy action, but practically all the mothers were averse to leaving their own homes and the scheme did not materialise, so further protective measures against enemy action were provided at the Home. The staff worked under considerable pressure and once again had the worry of numerous alerts and the moving of patients to and from protected wards; the loyalty evoked by Matron helped them to carry through. The Registrar General gives the Maternal Mortality for the Borough of Bexley as 1.30 per 1,000 live births as against 1.93 for the country in general. Both Infant Welfare Sessions and Ante-Natal Clinics started at The Green, Falcon wood, during the year and proved of benefit to residents in the area. Attendances at all the Clinics decreased owing to enemy action. Evacuation. During the time this District in common with others, was suffering from the effects of the flying bombs, the services of the Medical side of the Health Department in conjunction with those of the Kent County Council's School Medical Service, were called upon in connection with the medical examination of evacuees before they were listed for removal to reception areas. This entailed a considerable amount of work as the Evacuation Officer had to arrange for the removal of some thousands of persons in a very short time. Voluntary assistance was given in connection with these medical examinations and I wish to express my thanks to those who gave of their time and help in this matter. An increase in the number of Dental Sessions made it possible to have cases treated without undue delay, and this treatment should prove of great benefit to the health of the expectant and nursing mothers and their young children. Early in the year an additional Day Nursery was opened in Okehampton Crescent. This has helped to relieve the neighbouring Nurseries where there are always more names on the Register than available places. 114 A seventh Nursery which was nearing completion was badly damaged by a flying bomb. The Ministry decided not to complete this Nursery, and with alteration of war conditions its need became less apparent. The Home Help Scheme which has been in operation in the Borough since 1936 is restricted by legislation to homes in which there is a nursing or expectant mother or child under the age of 5 years. Towards the end of 1944 the Ministry of Health issued a Circular empowering the Council as a Welfare Authority to extend the Home Help Scheme to sick and infirm persons whether through old age or otherwise. There is a need for this service, but shortage of supply of reliable workers has made inauguration of the Domestic Help Scheme difficult. During the year 5 cases only of Diphtheria were notified, of these one child died. This child had not been immunised. It is hoped that with the greater stabilization of the child population in the Borough the campaign against this disease may be facilitated and that soon no child will pass its first birthday without having received protective inoculation. A booster dose is also recommended when the child reaches the age of 5, that is, when school life is due to commence and it will be mixing with many new playfellows. During the year 853 children were immunised, but a further 42 failed to complete their course. The percentage in the Borough in 1944 of children under the age of 5 who had been immunised was 73. We must not be satisfied until every child has been given the protection which scientists have made possible. 206 cases of Scarlet Fever were notified during the year. The disease was again mild in character and no deaths occurred, but of 214 cases of Whooping Cough, 2 proved fatal, both of these having been complicated with pneumonia and neither having been inoculated against the disease. Measles figures were higher than for any other infectious disease, but of the 342 cases notified there were no deaths. Scabies became notifiable on 1st November, 1943, and during 1944 492 cases were notified. This in an in- 115 fection with a long incubation period and notification greatly facilitates the early treatment of contacts and should result in the condition being kept under control. We have again to thank members of the Civil Defence for their help in treatment of this condition. Notification of tuberculosis was high. An increase in available beds in Sanatoria and post-war private houses should help in the fight against this disease. Flying Bombs and Rockets during the year increased the already acute shortage of houses in the Borough. The Council have a very big problem to face in rehousing families living in houses not fit for human habitation or overcrowded as judged by the Housing Act Standards. Despite war damage in the Borough a good and constant water supply was maintained by the Metropolitan Water Board. I am informed by the Clerk of the Board that: — (a) No new source of public water supply has been instituted in the Borough of Bexley during 1944; (b) There have been no extensions of trunk mains; (c) No changes in the general scheme of supply to the Borough of Bexley took place during the year. The supply has been satisfactory as to quantity. (d) The water supply to Bexley has been maintained at a high level of bacterial purity. Collection and Disposal of House Refuse. During the latter end of the year great difficulty was experienced in the collection and disposal of house refuse. The labour shortage was very acute and in common with other areas over the whole of the country the period between the collections was longer and less regular. This opportunity is taken of thanking the Council and Officers of other departments for their helpful cooperation during the year. There is also special appreciation for help given by members of the Health Department. MARY LOVE, M.B., Ch.B., D.P.H., Acting Medical Officer of Health. 116 INDEX Item. Page. Health Committee 2 Public Health Staff 3—6 STATISTICS AND SOCIAL CONDITIONS. Summary of Vital Statistics, 1945 9 Acreage 10 Population 10 Unemployment 10 Social Conditions 11 Extracts from Vital Statistics— Births and Birth Rates, etc. 12 Stillbirths and Stillbirth Rates 12 Deaths and Death Rates 13—14 Births and Stillbirths in Wards 14 Deaths in Wards 15 Causes of Death 15—17 Deaths in Age Groups 18—31 Infantile Mortality 32—39 Maternal Deaths 39 GENERAL PROVISION OF HEALTH SERVICES. Isolation Hospital 40 General Hospitals 40 Ambulance Facilities 40—41 Public Mortuary 41 Clinics and Treatment Centres 42—43 117 Item. Page. Maternity and Child Welfare— Midwifery and Maternity Service— Ante-natal Care 43 Co-operation with General Practitioners 43 Consultant Services 43 Maternity Accommodation 44 Ante-natal Clinics 44 Post-natal Clinics 44 Home Helps 44 Dental Clinic 45 Institutional Provision for Mothers— Maternity Home 45—47 Other Institutional provision for Mothers 47 Care of Illegitimate Children 47—48 Health Visitors and Clinics 48—50 Assisted Milk, etc. 50 Supply of Sheets for Expectant Mothers 51 Orthopaedic Treatment 51 Child Life Protection 51 Maternity Outfits 52 Compensation to Midwives 52 Sunlight Clinic 52 Ear and Eye Defects 52 Special Classes 53 Provision of Insulin to persons suffering from Diabetes 53 Registration of Nursing Homes 53 Adoption of Children (Regulation) Act, 1939 54 Professional Nursing in the Home 54 Laboratory Facilities 54 Day Nurseries 54—55 Maternity and Child Welfare Table 56 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 57—58 Water Supply 58—59 Drainage and Sewerage 59 Rivers and Streams 60 Closet Accommodation 60 Public Cleansing 60 Refuse Collection and Disposal 60 118 Item. Page. Chief Sanitary Inspector's Report— Tables of Inspections and Improvements, etc. 61—63 Food Inspection 63—66 Tables—Factories Act, 1937 67—73 Swimming Pool 74 Eradication of Bed Bugs 74 Camping Sites 74 Schools 74 HOUSING. Inspection of Dwelling Houses 75 Remedy of Defects without formal Notice 76 Action under Statutory Powers 76—77 Overcrowding—Housing Act, 1936, Part IV 77 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 78 Meat Inspection 78 Adulteration of Food—Food & Drugs Act 79—80 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 81 Diphtheria 81 Diphtheria Immunisation 82 Enteric Fever 82 Puerperal Pyrexia 82 Ophthalmia Neonatorum 82 Measles 83 Whooping Cough 83 Dysentery 84 Treatment of Typhus Fever 84 Cerebro-spinal 84 Acute Anterio Poliomyelitis 84 Food Poisoning 84 Tables of Infectious Diseases Notified 85—91 Scabies 92 Malaria 92 Terminal Disinfection 92 Tuberculosis 93—97 Annual Reports for 1939—44 as submitted to Ministry of Health 98—116 119