44412 (1) BEXLEY BEX11 Borough of bexley Annual Report of the Medical Officer of Health For the Year 1946 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h. Medical Officer of Health borough of bexley Annual Report of the Medical Officer of Health For the Year 1946 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h. . Medical Officer of Health BOROUGH OF BEXLEY Mayor : Councillor Mrs. E. Boswell, J.P. Deputy Mayor : Alderman J. C. McLean, J.P., C.C. 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 L. H. Bridges. Counpillor J. D. Vergette. Councillor J. Duffus. Councillor D. C. E. Gorringe. Councillor Mrs. M. Hall. Councillor Mrs. A. E. Lawrence. Councillor R. C. Swallow. PUBLIC HEALTH STAFF. 1946: Medical Officer of Health and Superintendent of the Maternity and Child Welfare Services. Medical Superintendent Corporation Maternity Home. Assistant Medical Officer of Health and Medical Officer Corporation Maternity Home. Temporary Assistant Medical Officer of Health.. Assistant Medical Officer at Maternity and Child Welfare Clinics (part-time temporary) Assistant Medical Officer of'Health Chief Sanitary Inspector, Public Cleansing Officer and Shops Acts Inspector. Assistant Chief Sanitary Inspector District Sanitary Inspectors Assistant Sanitary Inspector Senior Health Visitor Health Visitors Geo. F. Bramley, M.D., Ch.B., D.P.H. In R.A.M.C. Hygiene Section for Civil Affairs until 23.4.46 (resigned 7.8.46). John Landon, M.R.C.S., L.R.C.P., D.P.H. (appointed 1.12.46). Mary Love, M.B., Ch.B., D.P.H. (acting M.O.H. until 22.4.46). Mary H. Westlake, M.B., D.P.H(resigned 23.8.46). Isobel Johnson, M.B., Ch.B. (resigned 2.5.46). B. S. Robinson, M.R.C.S., L.R.C.P. (appointed 25.11.46). *‡R. J. Rayner, F.R.S.I. *†G. Hind. *†F. W. Willington. *†J. T. Boocock. *†G. F. Lovegrove (on Military Service until 7.1.46). One temporary Inspector (resigned 15.2.46). J. Ormandy (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. 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.M. and Health Visitor's Certificate. D. G. Stanley (Miss), S.R.N., S.C.M. and Health Visitor's Certificate. R. 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 Visitor's Certificate. E. M. Gibson (Mrs.), S.R.N., S.C.M. and Health Visitor's Certificate. 4 Matron of Corporation Maternity Home, Lavernock Road, Bexleyheath. Chief Clerk Senior Clerk Clerks Consultant for Puerperal Pyrexia and for Ante-Natal and Obstetric Complications. Dental Surgeon Public Analyst Other Staff F. H. Hammond (Miss), S.R.N., S.R.F.N., S.C.M., Midwives' Teachers' Certificate. M. Bentley (Miss). G. A. Pearson (on Military Service until 27.5.46). N. E. Broom (on Military Service until 11.2.46). R. V. Hoad (on Military Service until 11.3.46). Five Temporary Female Clerks. J. V. O'Sullivan, M.D., M.R.C.P., F.R.C.S., F.R.C.O.G. (part-time). H. Wade, L.D.S. (part-time). F. W. Arnaud, F.I.C. (part-time). (Resigned 31.3.46). H. E. Monk, B.Sc., F.R.I.C. (appointed 1.4.46). Two Food Sales Clerks (part-time). * Certificate for Inspection of Meat and Other Foods. † Certificate of Royal Sanitary Institute and Sanitary Inspectors' Joint Board, ‡ Certificate of the Royal Sanitary Institute. 5 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. To the Mayor, Aldermen and Councillors of the Borough of Bexley. Mr. Mayor, Ladies and Gentlemen, The year 1946 witnessed the beginning of the transition from war to peace. The strain of bombardment of the civilian population was lifted and the re-integration of family life, greatly disturbed by the war, was assisted by the return of evacuated children and by an acceleration in the rate of demobilisation of the Armed Forces. On the other hand, this was, of itself, productive of many difficulties. In particular, the housing shortage resulting from bombing, and the suspension of new building during the war was considerably aggravated and remains at the present time the most serious of the many social problems which beset us. Difficulties in the process of re-settlement in civilian life inevitably occurred as a result of the enforced separation, over a number of years, of husband and wife and children and parents. The shortage of food and other commodities remained so that in many ways the stern discipline of the war-time years was continued. It is remarkable, therefore, in view of these factors, to be able to report that the general health of the community, as evidenced by the vital statistics of the area, remained good. The infantile mortality rate, that sensitive index of social conditions, was 29.5 per 1,000 live births, the lowest recorded in the Borough, with the exception of that for the year 1943 when the rate was 26.01. The birth rate of 19.75 per 1,000 of the population continued to reflect the higher rates experienced during the war and it is too early yet to say whether this represents the beginning of a real reversal of the fall in the birth rate, which began as long ago as 1870, or whether it can be explained entirely by the boom in war-time marriages. The answer to this question is anxiously sought by those who see in the decline of the birth rate a threat to the survival of our national institutions. 6 The death rate of 8.55 per 1,000 is the lowest rate achieved in the Borough since the outbreak of the war and compares favourably with the rate for England and Wales, which is 11.5. Generally speaking, the health services of the Borough were well maintained during the year and there is ample evidence from the statistics relating to Clinic attendances that the Maternity and Child Welfare Services, in particular, are now accepted by the residents of the Borough as an important factor in the day to day business of rearing healthy children. There can be little doubt that this is due, in no small measure, to the painstaking educational work undertaken, over many years, by the Health Visitors. The year under review was notable for the passage into law of the National Health Service Act, 1946. Containing as it does the promise of a considerable expansion and coordination of the health services of the country in the years to come, it is a measure to be welcomed. Its immediate effect, on the other hand, so far as the County Districts are concerned, will be to transfer to the County Councils many health functions, particularly those relating to Maternity and Child Welfare, which have been exercised with distinction by many local authorities for many years. It is earnestly to be hoped that, in working out the details of the new services, an adequate degree of delegation to these authorities, or groups of authorities, will be made so that local initiative and experience shall be retained in the new order of things. Towards the end of 1946 Dr. Bramley, who had been Medical Officer of Health for the Borough since 1936, relinquished his appointment on being appointed as Deputy Medical Officer of Health to the Kent County Council. I am sure he would wish to join with me in expressing thanks to the members of the Health Department for their loyal help and support during the year, and to the members of the Health Committee for their unvarying help and encouragement. I am, Your obedient servant, JOHN LANDON, Medical Officer of Health. 7 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. New Dwellings Erected. Registrar General's Houses 62 Estimate mid-year, 1946 85,820 Flats20 Demolished Houses Rebuilt 64 Relative figures for previous years. Po pulation—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1,165 1938 (R.G.'s Estimate) 77,020 1,170 1939 80,110 1,002 1940 77,670 113 1941 72,080 Nil 1942 77,020 5 1943 76,740 5 1944 71,130 nil 1945 75,040 2 Number of inhabited houses at end of 1946 (according to Rate Books) approximately 24,592 Rateable Value £597,438 Sum represented by a penny rate £2,425 Unemployment. Men Women Boys Girls Total December 31st, 1945 122 43 38 42 245 December 31st, 1946 336 38 19 10 403 Social Conditions and Amenities. The year 1946 saw what was virtually the end of the Government Evacuation Scheme and the demobilisation of His Majesty's Services. This meant in effect the re-establishment of family life very much disturbed by the war. It also emphasised housing shortages due to bombing and to the continued stoppage of new housing construction. The relief from bombing and the anxieties of war have compensated, to a certain extent, for the shortage of food and other consumable commodities and the general health has been generally maintained at a good level as the statistics of the Borough will show. 8 The population has tended to rise still further and it is thought that it is now reaching saturation point which may be in the neighbourhood of 90,000. The last population census was held in 1931 and this would have been repeated in 1941 had it not been for the war. It is hoped that a new census will be embarked upon in the near future, as this would shed much light not only on the size of the population of the Borough but also on certain aspects of its social structure. The Corporation supplies the district with electricity, and the South Suburban Gas Company supplies gas. The following public open spaces have been provided by the Corporation :— Bexley Wood 26.00 acres Bursted Wood (part of) 22.00 „ Danson Park 210.00 „ Eastcote Gardens 1.00 „ Hall Place Park 85.50 „ Hudson Road Playing Ground 1.60 „ Hurst Recreation Ground 3.50 „ Oxleas Close .13 „ Palmar Gardens 1.30 „ Parkhurst Gardens .70 „ Riverside Walk Recreation Ground . 10.50 „ Russell Park 13.00 „ Sheldon Sports Ground 7.66 „ Shoulder of Mutton Green (L.C.C.) . 3.86 ,, St. Mary's Recreation Ground 10.86 „ Total 397.61 „ Facilities for outdoor games are provided in many of these open spaces, including the large Swimming Pool in Danson Park, opened in July, 1936. Land acquired for Public Open Spaces, but not yet open to Public :— Brampton Park Recreation Ground 4.21 acres Bursted Wood (part of) 8.47 „ Ivy Cottage 6.50 „ The Green, Bexleyheath 1.10 The Green, Welling 1.80 „ Woodlands Farm 6.06 „ Stevens Park 10.30 „ East Wickham House Grounds 6.80 „ Total 45.24 „ 9 10 SUMMARY OF VITAL STATISTICS. England and Wales 126 County Boro's and Great Towns including London 148 Smaller Towns (Resident Pop. 25,000-50,000 at 1931 Census) London. Administrative County Borough of Bexley *Rates per 1,000 Civilian Population. Births— Live 19.1 ‡ 22.2 21.3 21.5 19.75 Still 0.53 ‡ 0.67 0.59 0.54 0.48 Deaths— All Causes 11.5 ‡ 12.7 11.7 12.7 8.55 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Scarlet Fever 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.02. 0.02 0.02 0.01 Dihtheria 0.01 0.01 0.01 0.01 0.01 Influenza 0.15 0.13 0.14 0.12 0.03 Smallpox 0.00 0.00 . 0.00 — — Measles 0.00 0.01 0.00 0.01 — Rates per 1,000 Live Births. Deaths under 1 year of age 43† 45 37 41 29.5 Deaths from Diarrhoea and Enteritis under 2 1 years of age 4.4 6.1 2.8 4.2 3.5 Rates per 1,000 Civilian Population. Notifications— Typhoid Fever 0.01 0.01 0.01 0.01 0.01 - Paratyphoid Fever 0.02 0.02 0.01 0.01 0.01 Cerebro Spinal Fever 0.05 0.05 0.04 0.06 0.03 Scarlet Fever 1.38 1.51 1.33 1.42 1.18 Whooping Cough 2.28 2.48 2.05 2.22 0.69 Diphtheria 0.28 0.32 0.31 0.24 .0.08 Erysipelas 0.22 0.25 0:22 0.27 0.31 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 3.92 4.73 3.70 7.35 4.17 Pneumonia 0.89 1.02 0.74 0.75 0.43 * A dash (—) signifies that there were no deaths, † Per 1,000 related births. ‡ Rates per 1,000 total population. 11 Rates per 1,000 Total Births (Live and Still)— (a) Notifications— England and Wales 126 County Boro's and Great Towns including London 148 Smaller Towns' (Resident Pop. 25,000-50,000 at 1931 Census) London Adminisstrative County Borough of Bexley Puerperal Fever 8.50 10.35 7.63 1.62 8.06 Puerperal Pyrexia ‡9.68 (b) Maternal Mortality in England and Wales— No. 140 Abortion with Sepsis No. 141 Abortion without Sepsis No. 147 Puerperal Infections Nos. 142-6, 148-50 Other 0.13 0.06 0.18 1.06 Abortion—Mortality per million women aged 15-45 in England and Wales— No. 140 With Sepsis No. 141 Without Sepsis 11 5 ‡ Including Puerperal Fever. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1946. The Registrar General's Estimates of resident 'population for mid-year 1946 is 85,820, and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 906 789 1,695 Legitimate 877 758 1,635 Illegitimate 29 31 60 Birth Rate. Rate per 1,000 estimated resident population 19.75 12 The following relates to the Birth Rate during the past eight years :— 1938 Birth Rate 18.5 per thousand 1939 „ 17.76 „ „ 1940 ., „ 16.46 „ „ 1941 „ „ 15.88 „ „ 1942 „ „ 19.07 „ „ 1943 „ „ 18.03 „ „ 1944 ,. „ 21.06 „ „ 1945 „ „ 18.81 „ „ Rate per 1,000 for England and Wales, 1946 19.1 „ „ „ „ County Boroughs and Great Towns including London 22.2 „ „ „ „ Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 21.3 „ „ „ „ London Administrative County 21.5 Sixty illegitimate' live births were registered against 68 in 1945. Stillbirths. Males Females Total Total .. 24 17 41 Rate per 1,000 total (live and still) births 23.6 The following relates to the Stillbirth Rate during the past eight years :— Rate per Thousand. Year Total Live and Still Births Population 1938 41.66 0.81 1939 28.0 0.51 1940 24.4 0.41 1941 29.6 0.48 1942 25.2 0.49 1943 20.5 0.37 1944 19.0 0.42 1945 21.4 0.41 Forty-one Stillbirths registered during the year. This represents a rate of 0.48 per 1,000 population against 0.41 per 1,000 population in 1945. 13 Rate per 1,000 for England and Wales, 1946 0.53 „ „ „ „ County Boroughs and Great Towns including London 0.67 „ „ „ „ Smaller Towns (estimated population 25,000 to 50,000 at Census 1931) 0.59 „ „ „ „ London Administrative County 0.54 Four stillbirths were registered as illegitimate. Deaths. Males Females Total All causes 389 345 734 Death rate per 1,000 of estimated resident population 8.55 Number of women dying in, or in consequence of childbirth : From Puerperal and Post Abortive Sepsis — 1 1 From other Puerperal Causes — 2 2 Death rate per 1,000 total (live and still) births 1.73 Deaths of Infants under one year of age 28 22 50 Legitimate 27 19 46 Illegitimate 1 3 4 Death rate of Infants under one year of age : Total per 1,000 live births 29.5 Legitimate per 1,000 legitimate live births 28.13 Illegitimate per 1,000 illegitimate live births 66.7 Deaths from Measles (all ages) — — ' — „ „ Whooping Cough (all ages) 1 1 „ „ Diarrhoea (under 2 years of age) 4 2 6 „ „ Cancer (all ages) 85 56 141 14 Death Rate of Country :— Rate per ],000 for England and Wales, 1946 11.5 „ „ „ „ County Boroughs and Great Towns, including London 12.7 „ „ „ „ Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 11.7 „ „ „ „ London Administrative County 12.7 Death Rate of Area during last eight years 1938 7.84 per thousand 1939 7.98 „ „ 1940 10.40 „ „ 1941 9.68 „ „ 1942 8.73 „ „ 1943 9.21 „ „ 1944 10.2 „ „ 1945 9.28 „ „ BIRTHS AND STILLBIRTHS IN WARDS. The figures relate to live births and stillbirths notified but not necessarily registered in the same year. Wards Live Births Stillbirths Christchurch 235 6 St. Mary's 272 . 3 Brampton 310 10 Danson 237 6 Falconwood 247 8 St. Michael's 346 4 Total 1,647 37 ANALYSIS OF NOTIFICATIONS OF LIVE AND STILLBIRTHS. Births notified from Institutions 1,255 Births notified by Midwives 413 Births notified by Doctors, etc. 16 Total 1,684 15 DEATHS AND DEATH RATES IN WARDS. The figures given relate to deaths occurring but not necessarily registered. No. of Deaths Rate per 1,000 Population Christchurch 162 10.8 St. Mary's 140 9.5 Brampton 97 6.9 Danson 109 9.0 Falconwood 99 7.6 St. Michael's . 128 7.5 Total 735 ' The rate for Bexley compares fairly with that for other parts of the country.' The Registrar-General has not supplied a comparability factor for 1946 ; it is therefore impossible to work out the standardised rate which would be comparable with that of other parts of the country. CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1946. Causes of Death. M. F. Total All Causes 389 345 734 1 Typhoid and Paratyphoid Fevers — — 2 Cerebro-spinal Fever — — — 3 Scarlet Fever — — — 4 Whooping Cough 1 — 1 5 Diphtheria 1 — 1 6 Tuberculosis of respiratory system 19 17 36 7 Other forms of tuberculosis 5 — 5 8 Syphilitic diseases 3 . — 3 9 Influenza 2 1 3 10 Measles — — — 11 Acute poliomyelitis — — — 12 Acute infectious encephalitis — — — 16 Causes of Death. M. F. Total 13 Cancer of body cavity and Oesophagus (M.) and uterus (F.) 9 6 15 14 Cancer of stomach and duodenum 18 10 28 15 Cancer of breast — 15 15 16 Cancer of all other sites 58 25 83 17 Diabetes 1 3 4 18 Intracranial vascular lesions 34 55 89 19 Heart disease 90 88 178 20 Other diseases of circulatory system 12 10 22 21 Bronchitis 18 16 34 22 Pneumonia 14 21 35 23 Other respiratory diseases 3 8 11 24 Ulcer of stomach or duodenum 13 2 15 25 Diarrhoea under two years 4 2 6 26 Appendicitis 2 1 3 27 Other digestive diseases 6 6 12 28 Nephritis 13 9 22 29 Puerperal and post abortive sepsis — 1 1 30 Other maternal causes — 2 2 31 Premature Birth 9 7 16 32 Congenital malformation, birth injuries and infant diseases 9 10 19 33 Suicide 3 1 4 34 Road traffic accidents 6 3 9 35 Other violent causes 9 2 11 36 All other causes 27 24 51 17 18 DEATHS IN AGE GROUPS IN 1946. These relate to deaths occurring in 1946 but not necessarily registered in that year. Short List of Causes of Death in use in General Registrar's 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 Deaths Registered during the year. Registrar General's figures ALL CAUSES. 735 50 2 2 I 6 7 8 14 11 25 18 36 38 53 55 84 99 226 734 1 Typhoid and Paratyphoid Fevers — 2 Cerebro-spinal Fever — 3 Scarlet Fever — 4 Whooping Cough 1 1 1 5 Diphtheria 1 1 1 6 Tuberculosis of Respiratory System 34 3 1 6 4 8 4 2 1. 1 2 2 36 7 Other Tuberculosis Diseases 7 1 1 1 3 1 5 8 Syphilitic Diseases 3 1 2 3 9 Influenza 3 1 1 1 3 10 Measles — 11 Acute Poliomyelitis — 12 Acute Infectious Fncephalitis — 13 to 16 Cancer Malignant Diseases 144 \ \ \ 4 9 15 12 20 24 26 34 141 19 17 Diabetes 4 1 1 2 4 18 Intra-Cranial Vascular Lesions 89 1 2 6 7 4 11 21 34 89 19 Heart Disease 176 1 1 1 1 10 5 11 9 24 29 84 128 20 Other Diseases of Circulatory System 18 1 1 2 2 4 2 6 22 21 Bronchitis 28 1 1 2 2 1 2 5 14 34 22 Pneumonia 42 10 1 1 2 1 1 1 1 1 3 2 18 35 23 Other Respiratory Diseases 13 1 3 1 1 2 1 1 1 1 1 11 24 Ulcer of the Stomach or Duodenum 16 1 2 5 3 3 1 1 15 25 Diarrhoea (under 2 years of age) 6 6 6 26 Appendicitis 3 1 1 1 3 27 Other Digestive Diseases 12 1 2 1 1 1 3 2 1 12 28 Nephritis 22 1 1 1 1 5 3 2 3 5 22 29 Puerperal and Post-abortive Sepsis 1 1 1 30 Other Maternal Causes 2 2 2 31 Premature Birth 17 17 16 32 Congenital Malformations, Birth Injury, Infantile Disease 16 12 1 1 1 1 19 33 Suicide 4 1 1 1 1 4 34 Road Traffic Accidents 9 1 1 1 1 1 3 1 9 35 Other Violent Causes 11 1 2 3 1 2 2 11 36 All Other Causes 53 1 1 1 1 1 6 2 3 2 2 3 4 3 23 51 INFANT MORTALITY, 1946. 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 Gastro Enteritis 4 1 2 1 8 Congenital malformation and Premature Birth 24 3 2 29 29 Broncho-pneumonia 1 1 2 3 3 9 Bronchitis 1 1 Acute Meningitis. 1 1 Whooping Cough. 1 1 Misadventure 1 1 24 4 2 — 30 7 5 7 1 50 The number of infants under one year of age who died during the year 1946 as shown by the table is 50. Thirty of these deaths, that is 60 per cent., occurred in the neo-natal period (within one month of birth). In 1945 the corresponding figure was 61.2 per cent. Fifty were registered during the year, giving an infantile mortality rate per 1,000 live births of 29.5. Rates over previous years have been :— 1938 35.1 per 1,000 live births 1939 40.1 „ „ „ „ 1940 45.4 „ „ „ „ 194135.4 „ „ „ „ 1942 32.7 „ „ „ „ 1943 26.01 „ „ „ „ 1944 31.37 „ „ „ „ 1945 33.9 „ „ „ ,, 20 Maternal Deaths. Three were registered during the year, giving a puerperal mortality rate of 1.73 per 1,000 live and stillbirths. Rates over previous years have been :— 1938 0.67 per 1,000 live and stillbirths 1939 0.69 „ „ „ „ „ 1940 0.79 „ „ „ „ „ 1941 2.77 „ „ „ „ „ 1942 1.32 „ „ „ „ „ 1943 1.44 „ „ „ „ 1944 1.30 „ „ „ „ „ 1945 nil „ „ „ „ „ It will be seen that 58 per cent. of infantile deaths were due to congenital malformation and premature birth. Comparatively little is known of the causes of these conditions but recent research has provided striking evidence that one of the factors causing congenital malformation may be virus infections of the mother, for example, by German Measles, during the early months of pregnancy. This information may, one day, make possible, to some extent, the prevention of malformation by the protection of the expectant mother against these infections. It is believed that premature births may be due to certain nutritional factors affecting both mother and child. It is clear, however, further marked reductions in the infantile mortality rate will depend on the results of further research on the causation of these conditions. SECTION B.—GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Isolation Hospital Accommodation. This has been available at the Bow Arrow Hospital of the Dartford Joint Hospital Committee of which the Council is the largest contributing 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 1946 has made it necessary for any admission to be well scrutinised. Genera! Hospitals. Bexley Cottage Hospital. Patients admitted during the year 190 Patient Days 4,159 Outpatient Attendances 1,214 X-Ray examinations 527 21 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 neighbouring authorities for mutual aid when cases require urgent removal and no Borough ambulance is available. Cases Removed by Corporation Ambulances. Sickness 1,381 Accidents 175 Illness in Street 71 Maternity 729 Malicious calls 1 Ambulance not required 47 Collecting blood 1 Total 2,405 Mileage : Austin Ambulance—17,778. Talbot—6,368. Number of calls on Outside Ambulances. Crayford Ambulance 101 Erith Ambulance 1 Sidcup Ambulance 37 L.C.C. 2 Sickness 40 Accident 43 Maternity 49 Not required 9 PUBLIC MORTUARY. The Public Mortuary which is maintained by the Corporation, is situated on land at the south side of the Council Offices. During the year it was used on 49 occasions, and 41 postmortem examinations were made. Eight inquests were held. 22 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. 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. 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 Thursdays, 10.30 a.m. Post-natal Sessions—Thursdays, 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 were held at both the above places weekly as follows :— Three sessions at Mayplace Road East, one of which is Asthma Clinic. Two sessions at Little Danson, one-half day of which is Asthma Clinic. 23 Tuberculosis Dispensaries. At Overy Street, Dartford and Bexley Road, Erith.. Venereal Disease Clinics. At the County Hospital, West Hill, Dartford. PROFESSIONAL NURSING IN THE HOME. Home nursing is provided for by three Nursing Associations in the area, namely :— Bexleyheath Services of two whole time Nurses. Bexley Services of one whole time Nurse. Welling District .. Services of three whole time Nurses. These are very useful services to the district, and the untiring manner in which the Committees and helpers of the Associations carried out their arduous duties in this connection during the year is greatly appreciated. The nurses are again to be complimented on the work that they have done in the homes of the patients. LABORATORY FACILITIES. Pathological and bacteriological work for the area is carried out by the Kent County Council at the Public Health Department, County Hall, Maidstone. A small laboratory, chiefly for the examination of nose and throat swabs will be established as soon as the necessary equipment is available and should greatly facilitate the early diagnosis of nasal and faucial diphtheria. MATERNITY AND CHILD WELFARE. (i) Midwifery and Maternity Services. (a) Ante-natal Care. 922 expectant mothers attended Corporation Ante-natal Clinics which equals a 54.7 percentage of notified births as compared with 60.8 per cent. for 1945 ; 565 other expectant mothers received ante-natal care at clinics attached to hospitals to which they were admitted for confinement; 95 women received ante-natal care from their own doctors prior to admission to Corporation Maternity Home, giving a total of 93.4 per cent. as compared with 97.0 per cent. in 1945 who received ante-natal care. 24 (b) Co-operation with General Practitioners. 128 of the 638 cases admitted to the Corporation Maternity Home during 1946 were general practitioners' cases. (c) Consultant Services. The consultant was called on nine occasions to see patients in the Maternity Home. 1946. Monthly Sessions. No. of consultation clinics 12 No. of cases seen 171 No. sent by general practitioners 35 No. sent by midwives 2 (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. (e) Ante-natal Clinics. Average number of sessions weekly 7.4 Average attendances 16.9 (f) Post-natal Clinic. No. of attendances at Maternity Home 298 No. of post-natal examinations at other Corporation Clinics 70 (g) Home Helps. No. of applications 139 No. cancelled or not proceeded with 25 No. of Homes attended 95 No. of attendances (days) 1,712 (h) Domestic Helps. No. of applications 25 No. cancelled or not proceeded with 3 No. of Homes attended 28 No. of attendances (days) 603 (i) Dental Treatment. The provisions for dental treatment of nursing and expectant mothers and children under five years of age instituted in 1938, were continued during 1946. The denture supply service was again used to a considerable extent as the following table shows. 25 Summary of Work done in 1946. Expectant Mothers Nursing Mothers Children under 5 No. referred to and appointments made for Dental Clinic by a M.O. 438 73 189 No. found to be in need of treatment. 274 45 160 No. who received treatment 262 43 138 No. made dentally fit 162 68 96 No. of treatments :— (a) Fillings— 226 (1) In temporary teeth — — (2) In permanent teeth 362 100 — (b) Teeth extracted 397 98 174 (c) Administrations of General anaesthesia 23 14 71 (d) Administrations of local anaesthesia 151 31 9 Patients supplied with dentures 34 34 — Dentures supplied 47 48 — No. of scalings and gum treatment 400 53 143 (ii) INSTITUTIONAL PROVISION FOR MOTHERS, (a) Maternity Home. The Home has continued as a training school for the State Certified Midwives Part II Examination. Priority admission is given to primiparæ, previous or expected abnormal cases, cases from overcrowded homes and unmarried mothers. Statistics. No. of patients in Home, 1st January, 1946 .19 No. of patients admitted during 1946 637 No. of patients discharged during 1946 636 No. of patients died during 1946 Nil No. of patients remaining, 31st December, 1946 20 No. of patient days 8,354 Average duration of stay in days 13.11 No. of cases delivered by nursing staff (midwives) 496 No. of cases delivered by doctors 139 No. of cases delivered before patients admitted to Home 2 No. of primiparæ 293 No. of multiparas 344 Twin pregnancies 12 26 No. of calls on Consultant—ante-natal 5 post-natal 2 intra-natal 2 No. of Cæsarean sections 8 No. of cases in which medical assistance was sought 97 No. of cases notified as Puerperal pyrexia 9 No. of cases of ophthalmia neonatorum Nil No. of cases of pemphigus neonatorum Nil No. of maternal deaths (after discharge) 2 No. of infant deaths 7 Causes—Marasmus (twins) 2 Atelectasis 1 Maternal toxaemia (premature) 1 Ante-partum haemorrhage (premature) 1 Congenital malformation 1 Prematurity 1 No. of stillbirths 16 Causes—Anencephalic 2 Hydrocephalic 2 Forceps (1 from District, 1 post-maternity) 2 Placenta Prævia ? Cause 2 Breech from District 1 Accidental haemorrhage 2 Prematurity 3 No. of cases sent to other Hospitals :— Baby 3 Post-natal 4 Intra-natal 1 No. of Borough cases 617 No. of out-district cases 20 No. of practitioners' private booked cases 128 Forceps deliveries 30 Feeding. Breast alone 527 Breast supplemented by artificial food 59 Artificial food alone 42 No. of babies born alive (including twins) 633 (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. 27 (c) Care of Illegitimate and Premature Children. Since 1944 stress has been laid on this subject and the Day Nursery and Maternity Home provisions were 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. During the year 1946, 57 premature births were notified.. Special attention to these children is given by the Health Visitors and hot water bottles and other small equipment are provided when necessary. When the home conditions are not conducive to the proper care of these children the latter are admitted for an indefinite period to the Corporation Maternity Home where adequate facilities are available. The Town Ambulance Service is available for transport of these children. (iii) Health Visitors and Clinics. The eight Health Visitors employed by the Council carried out a considerable body of work during the year, details of which are given in the following tables :— Ante-natal Sessions. Mothers Attendances Maternity Home, Lavernock Road 45 1,938 Bexleyheath Clinic 279 1,465 Bexley Clinic 137 770 Welling Clinic (Station Approach) 244 1.087 Wrotham Road Clinic 133 790 Falconwood Clinic 84 482 Child Welfare Sessions. Bexleyheath Clinic. Total number of attendances 10,155 Average attendance 67.58 No. of children under one year 7,069 No. of children under one year (first time) 488 No. of children over one, year 2,545 No. of children over one year (first time) 53 No. of children medically examined 1,807 28 Bexley Clinic. Total number of attendances 5,249 Average attendance 51.46 No. of children under one year 3,122 No. of children under one year (first time) 213 No. of children over one year 1,848 No. of children over one year (first time) 66 No. of children medically examined 713 Welling Clinic (Station Approach). Total number of attendances 8,520 Average attendance 57.57 No. of children under one year 6,136 No. of children under one year.(first time) 404 No. of children over one year 1,903 No. of children over one year (first time) 77 No. of children medically examined 1,433 Wrotham Road Clinic. Total number of attendances 4,752 Average attendance 47.52 No. of children under one year 2,896 No. of children under one year (first time) 234 No. of children over one year 1,570 No. of children over one year (first time) 52 No. of children medically examined 562 Falconwood Clinic. Total number of attendances 4,451 Average attendance 44.07 No. of children under one year 3,212 No. of children under one year (first time) 187 No. of children over one year 1,044 No. of children over one year (first time) 8 No. of children medically examined 634 Births Registered. 1941 1942 1943 1944 1945 1946v Live Births 1,145 1,469 1,384 1,498 1,413 1,695 Stillbirths 35 38 29 30 31 41 29 (iv) Assisted Milk, etc. No. of families supplied with food free or at reduced cost 37 Approximate cost £81 14 0 No. of lbs. of dried milk at cost price 41,485 No. of lbs. of Virol, cod liver oil and malt 3,450¼ No. of Marmite cartons 4,518 Supply of Sheets for Expectant Mothers. No. of applications 326 No. of dockets 968 (v) Orthopaedic Treatment. The Council has an arrangement with Kent County Council whereby children under five years can attend for consultation and treatment at the County Hospital, Dartford. An Orthopaedic Clinic is being established by the Kent County Council in the Borough for the care of school children and this will be available for children under five years. No. of children attended first time 17 No. of children attended previously on the register 23 No. of total attendances made 257 No. referred for in-patient treatment — No. referred for ultra violet light treatment 2 No. of appliances recommended 6 (vi) Child Life Protection. The Medical Officers and the Health Visitors are appointed Child Life Protection Visitors under the Public Health Act, 1936. Children under nine years of age, who are nursed for reward or gain, are periodically visited in their respective homes. The particulars regarding the number of foster parents and nurse children on the Council's register are as follows:— No. of persons receiving children under nine years for reward : (a) At beginning of the year 22 (b) At the end of the year 19 30 No. of children:— (a) At beginning of the year 25 (b) At the end of the year 21 No. of foster children who died — No. cf inquests held (vii) Compensation to Midwives. No. of midwives received compensation for loss of booked maternity cases 1 (viii) Sunlight Clinic. No. of cases treated including any outstanding from previous year 227 No. of treatments 2,809 No. still being treated at end of year 16 Average number of treatments per patient 12 Diseases Treated. No. Ante-natal acne 2 Rickets 10 Knock-knees 33 General Atonia 18 General debility123 Flat feet 2 Bowed legs 39 (ix) Ear and Eye Defects. No. Referred to Aural Clinic for chronic ear discharge 1 Referred to Ophthalmic Clinic for squint or other defect 5 Speech Clinic 1 Registration of Nursing Homes. Public Health Act, 1946. (Authority of Registration transferred from Kent County Council to the Bexley Borough Council—17.4.39.) No. of Homes on the Register at beginning of year 6 No. of patients provided for:— Maternity 6 Others 62 Total 68 31 No. of Homes first registered during year — No. of patients provided for:— Maternity — Others — Total — No. of Homes on the Register at end of year 6 No. of patients provided for:— Maternity 6 Others 63 Total 69 No. of inspections made during year 21 No. cancelled on request of applicant — Adoption of Children (Regulation) Act, 1939. This Act came into force in June, 1943. (a) No. of persons who gave notice under Section 7 (3) during the year 43 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 44 (c) No. of children notified under Section 7 (3) (i) Under supervision at end of year 16 (ii) Who died during the year 1 (iii) On whom inquests were held Number of children adopted during the year 27 DAY NURSERIES. The Day Nurseries were closed on 30th June, 1946. Average Attendances—Monthly. January February March April May June Christchurch 26.39 31.45 34.71 34.80 28.5 20.2 St. Michael's 40.69 46.45 51.37 . 51.9 50.1 44.8 Brampton 37.64 36.5 35.66 39.2 33.69 25.9 Falconwood 40.38 54.8 48.28 46.8 28.6 29.3 St. Mary's 34.86 39.45 40.61 40.9 31.6 20.9 Okehampton 35.38 38.6 37.85 46.7 42.4 28.7 The average attendances are calculated on the Monday to Friday attendances only. 32 33 MATERNITY AND CHILD WELFARE WORK DONE. Year Registered No. of Health Visitors Visits made to :— Centres (Children) % of Births Centres (Ante-natal) Expectant Mothers Children under 1 Children 1 to 5 No. of Attendances First Attenders Attendances No. of Expectant Mothers % of Births Live Births Still 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 1059 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 9245 1426 253 100.9 5403 851 58.9 1946 1695 41 8 692 996 1912 5371 7033 23961 9166 1526 256 90.0 6532 922 53.9 * 6 for 2 months, † for quarter of year. SECTION C: SANITARY CIRCUMSTANCES OF THE BOROUGH. List of Adoptive Acts, etc., in force. Acts. Date Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 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 May 1909 „ 4—Sees. 53 and 54 „ 6—the whole „ 10—Sec. 95 Public Health Act, 1925, Part 2 .. Jan. 1926 Slaughter of Animals Act, 1933 Jan. 1934 Bye-laws. 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 Nov. 1939 Deposit of Dangerous Substances Nov. 1939 Organs Nov. 1939 Loitering at Church Doors Nov. 1939 Indecent Language, etc. Nov. 1939 Noisy Hawking Nov. 1939 Touting Nov. 1939 Noisy Animals Nov. 1939 Violent Behaviour, etc., on School Premises Nov. 1939 Nursing Homes June 1940 The Bye-laws 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; Offensive 34 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 Bye-laws 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 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 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, Crayford, Bexley and Deptford Wells, and Thames-derived filtered water. All the water is chlorinated as it leaves the works. There have been no new sources of supply instituted in the Borough during 1946, nor any extension of trunk mains and the general scheme of supply is the same as the previous year. Bacteriological analyses are made five times per week of all supplies and consistently satisfactory results have been obtained. In the cases of Bexley, Wansunt and Deptford, 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 :— 35 Bacteriological. No. of organisms per c.c. capable of growth on Agar at : B. coli presumptive 37° C. 22° C. 0-40 0-250 Present in 100 c.c. B. Coli (presumptive) absent in 90 c.c. Further tests showed that these were not typical B. coli. (ii) Drainage and Sewerage. The Borough Engineer has supplied me with details of drainage work carried out during 1946 as follows :— The old 9-in. surface water sewer in Alers Road and Brook Lane was replaced by a new 15-in. and 18-in. sewer to accommodate the surface water discharge from the Council's Alers Road Housing Scheme and the surrounding drainage area. A new 15-in. x 18-in. surface water sewer was laid from Hurst Road to the River Cray to provide an outfall for the Council's proposed Hurst Place Housing Scheme (approximately one-third of a mile). A new 7-in. foul sewer was laid to connect the properties in Bournewood Road and Alliance Road to the Council's East Wickham Pumping Station. These properties were originally drained into the Metropolitan Borough of Woolwich. Foul and surface water sewers were laid on the Westwood Lane and Alers Road Housing Schemes. 2. Rivers and Streams. No serious case of pollution of rivers or streams was found during the year. 3. (i) Closet Accommodation. All the closet accommodation in the Borough is on the water carriage system. (ii) Public Cleansing. Eight cesspools were emptied a total of 23 times. One cesspool was abolished and the property concerned connected to the main sewage system. Refuse Collection and Disposal. The work of collection and disposal of house refuse was seriously affected during the early part of the year owing to the difficulty in obtaining the necessary labour, and at one time the period between collections was from two to three weeks. Later in the year, however, with the demobilisation of men from the Forces, additional labour became available, and this enabled a considerable improvement to be made. The loaders were provided with aluminium skeps for collecting purposes, and this also resulted in a more frequent collection, so much so that towards the end of October it was possible to say that a weekly collection was being carried out. In common with all Local Authorities the plant for collecting refuse has, during the war, and also since hostilities ceased, been used to the limit of its capacity and renewal in the form of new vehicles has been impossible. The Council are attempting to replace the present machines as and when possible and three S.D. Freighters were ordered during the year. None of these, however, had been delivered at the end of the year. The collection of salvage was continued during the year, and the income from sales" of materials amounted to £3,009. There are approximately 400 bins in the streets for the reception of kitchen waste and these are cleared twice weekly. This waste is disposed of at the Concentrator Plant in the Woolwich area. House and trade refuse collected in the area is disposed of by controlled tipping. 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 Thirty-second Annual Report as Sanitary Inspector to your Council for the year 1946. • The report consists, as on former occasions, of a tabulated record of work carried out. 37 TABLE No. 1. Number of complaints received and investigated 438 Number of informal notices, letters, etc. 595 TABLE No. 2. Details of Inspection Work Carried Out. Inspections - Re-inspections Houses inspected (all particulars recorded) 3 2 Houses inspected (defects only recorded) 393 808 Houses inspected (Housing Act, 1936, Overcrowding) 173 21 Houses inspected re Infectious Disease (including Scabies) 372 245 Inspections. Factories with mechanical power 98 19 Factories without mechanical power 14 2 Schools 12 — Refuse Tips 79 — Bakehouses 24 12 Slaughterhouses 4 — Meat Shops and Premises where food is prepared 949 314 Cowsheds and Dairies 26 9 Ice Cream premises 31 2 Fried Fish premises 72 1 Common Lodging Houses 5 — Tents, Vans, and Sheds 7 — Re Offensive Accumulations 39 17 Re Keeping of Animals 29 1 Re Rats 298 394 Re Verminous premises 52 85 Re Insufficient Ashplace Accommodation 190 151 Drains Inspected 1,104 1,075 Drains Tested (water, smoke or grenade) 39 — Visits re Refuse Removal and Salvage 869 — Miscellaneous Inspections 2,012 207 Food and Drugs Act re Samples 232 — Shops Acts, 1912-1936 121 — Visits re Certificates of Essential Repairs 1,128 — 38 TABLE No. 3. Improvements effected and defective sanitary conditions remedied. Houses- No. Provided with sufficient w.c. accommodation 49 Provided with sufficient ashplace accommodation 90 Provided with sufficient water supply 26 Houses Improved Internally— Dirty rooms cleansed 6 Walls and ceilings repaired 47 Dampness in rooms remedied 92 Defective floors repaired 25 Ventilation of rooms improved 3 Windows repaired 11 Coppers repaired — Stoves, fireplace, etc., provided or repaired 13 Houses Improved Externally- Roofs repaired 38 Eaves, gutters and down spouts fixed or repaired 32 Yards paved or repaired 2 Chimney stacks repaired 4 Walls repointed or repaired 4 Miscellaneous repairs 27 Yards cleansed 2 Drainage— Drains cleansed or repaired 631 New drains constructed 2 New gullies provided 1 Ventilation of drainage system improved 10 Inspection chambers built or improved 9 New sinks provided 1 Waste pipes provided or improved 11 Offensive accumulation removed 8 Nuisances from animals abated - Tents, Vans and Sheds, nuisance abated - Other nuisances abated 28 39 TABLE No. 4. Infectious Diseases. Cases removed to Isolation Hospitals 62 Houses visited including revisits 617 Rooms disinfected 79 Notices delivered to Education Authorities, etc. 304 Houses at which defective sanitary conditions were found 1 40 TABLE No. 5. Food Inspection. The following is a summary of unsound food surrendered from the Meat Depot, Shops, Stores, etc. Meat Depot. Beef lbs. 456 Corned Beef „ 2,306¾ Offal " 18 Lamb " 28 Pork 54 Shops and Stores, etc. Beef lbs. 697½ Meat tins 130 Mutton and Lamb " 37 Fish " 469 Corned Beef " 254¼ Milk „ 759 Sausage Meat " 31 Vegetables „ 495 Luncheon Sausage, etc. " 8½ Soups „ 153 Meat and Vegetables „ 49 Chitterlings " 238 Fats " 315 Fruit „ 98 Meat Pie " 6 Preserves „ 257 Poultry " 64 Pickles jars 15 Fish " 4,536 Sauces bots. 33 Bacon " 222 Pastes tins and jars 10 Cheese " 110 Puddings tins 4 Sugar " 140 Fish Cakes 32 Dried Peas, Beans, Lentils, etc. " 140 Miscellaneous Items jars 12 pkts. 22 Cereals " 56 Flour lbs. 438 Bread " 118 Biscuits „ 15 Beverages " 4 Dried Fruit „ 170 Egg Powder " 112 Syrup „ 112 Chocolate " 56 Jelly " 72 Eggs 139 TABLE No. 6. Factories Act, 1937. 1. Inspections for Purposes of Provisions as to Health. (Including Inspections made by Sanitary Inspectors). Number of:— Premises 1 Inspections 2 Written Notices 3 Prosecutions 4 Factories with mechanical power 151 6 — Factories without mechanical power 18 — — *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 169 6 — 2. Defects Found. Particulars Number of Defects Number of. Prosecutions Found Remedied Referred to H.M. Inspector 2 3 4 5 Want of cleanliness (S.l) 8 8 — — Overcrowding (S.2) — - - - Unreasonable temperature (S.3) — - - - Inadequate ventilation (S.4) - - - — Ineffective drainage of floors (S.6) -. - - - Other nuisances 2 2 - - Sanitary Conveniences (S.7)— Insufficient 2 1 - - Unsuitable or defective 6 6 - - 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 18 18 — 41 SHOPS ACTS, 1912 to 1936. The following Closing Orders are in operation within the area:- Bexley Urban District (Butchers) No. 6 Order, 1920 Bexley Urban District (Grocers and Provisions Merchants) No. 7 Order, 1923. Bexley Urban District (Miscellaneous Trades) No. 8 Order, 1923. The Bexley Hairdressers and Barbers Shops Closing Order, 1946. There were approximately 750 shops on the Council's Register at the end of the year. During the year 121 inspections were made under the Shops Acts 1912-36 and no legal proceedings were instituted. 1 am, Ladies and Gentlemen, Yours obediently, R. J. RAYNER, Chief Sanitary Inspector. Swimming Pool. The only swimming pool in the area open to the public is in Danson Park and is owned by the Council. The layout includes three open-air pools, one large for adults and two small pools for children. Showers and foot baths are provided for the pre-cleansing of bathers. The water is kept pure by continuous filtration and sterilisation with chlorine and ammonia gases. Samples of water have been taken by this department from time to time and the results of bacteriological examinations have been satisfactory on each occasion. Results. No. of organisms per c.c. capable of B. coli growth on Agar at : presumptive 37° C. 22° C. Deep end 0 0 Absent Shallow end 0 0 . Absent 42 Eradication of Bed Bugs. No. of Corporation houses found to be infested with bugs 5 No. of Corporation houses disinfested 5 No. of other houses found to be infested with bugs 8 No. of houses disinfested 8 No. of rooms in No. of rooms in Corporation houses— other houses— 1 room only — 1 room only 1 2 rooms only 2 2 rooms 1. 3 rooms only 1 3 rooms 2 4 rooms — No. of houses disinfested with HCN by private firms 5 CAMPING SITES. A camping site used by Rover Scouts and Woodcraft Folk in Hall Place was not used over such a period as to come within the operation of Section 269 of the 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. SECTION D.—HOUSING. The following particulars relate to the houses built by the Council on the various Estates and still occupiable :— Houses Flats Welling— Welling Estate 428 — East Wickham— Glenmore Road 116 — Bexleyheath— Highland Road Estate and Pickford Road Estate (including bungalows) 306 — 43 Bexley— Houses Flats Hartford Road Estate and Victoria Road Estate 54 — Westwood Lane 7 — Cannon Road — 20 911 20 Total number of new houses erected during the year 7 20 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) 396 (b) Number of inspections made for the purpose. 1,206 (2) (a) Number Of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 1925 to 1932 3 (b) Number of inspections made for the purpose 5 (3) Number of dwelling houses to be in a state so dangerous or injurious to .health as to be unfit for human habitation 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 301 2. Remedy of Defects during the year without service of Formal Notice. Number of defective dwelling houses rendered fit in consequence pf informal action by the Local Authority or their officers 225 44 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) Number of dwelling houses which were rendered fit after service of formal notices : (a) By owners- (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 14 (2) Number of dwelling houses in which defects were remedied after service of formal notices- (a) By owners 10 (b) By local authority in default of owners- C. Proceedings under Sections 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 Orders D. Proceedings under Section 12 of the Housing Act, 1936— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 45 4. Housing Act, 1936. Part IV. Overcrowding. A. (1) Number of dwellings overcrowded at the end of the year 47 (2) Number of families dwelling therein 64 (3) Number of persons dwelling therein 328 B. Number of new cases of overcrowding reported during the year 21 C. (1) Number of cases of overcrowding relieved during the year 3 (2) Number of persons concerned in such cases 22½ D. Any cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding SECTION E.—INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The milk retailed for consumption in the area is railborne, pasteurised and bottled except for one small supply by a producer retailer. Licenses granted by the Council under Milk Special Designations Order, 1936:- Pasteurised Milk 20 Tuberculin Tested Milk 10 Supplementary Licences:— Pasteurised Milk 3 Tuberculin Tested Milk 1 No. of cowsheds in district 1 (b) Meat Inspection. The slaughterhouses in the area remained closed during the year. The Meat Depot, which was opened as a distributing centre for Bexley and certain adjoining areas in 1940, was closed on 6th April, 1946, and meat is now distributed from Smithfield direct. A total of 1,263 visits were made to meat shops and other premises where food is prepared or sold. 46 (c) Adulteration of Food. Food & Drugs Act, 1938. The following table summarises the 236 samples taken during the year. Formal Informal Milk 93 1 Dried Milk — 3 Soups, Meat Extracts, Pastes, etc. 4 10 Sausages 2 — Fats 4 1 Condiments, Sauces, etc. 8 10 Beverages 3 6 Flavourings 1 7 Spices, etc. 6 11 Patent Medicines, etc. 4 12 Wines and Spirits 5 — Pudding or Cake Mixture, etc. 8 2 Jellies, Custard Powders, etc. 3 6 Dried Fruits 2 — Miscellaneous 8 16 151 85 No legal proceedings were instituted during the year. In one case a sample purchased as ground cloves was found to consist of mixed spice. This was obviously a genuine mistake, and the vendor withdrew the article from sale. A sample of ground ginger was found to be of inferior quality, but a further sample taken at a latter date was genuine. Registration of Premises under Food and Drugs Act, 1938. No. of premises registered for:- Sale or Manufacture of Ice Cream 14 Sale of Ice Cream 52 Preparation of Sausages, etc. 44 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 102 cases were notified as compared with 150 in the previous year. Of these, 32 were isolated in Bow Arrow Hospital and two in other Infectious Disease Hospitals and 68 were isolated at home. One case notified was noncivilian. There were no deaths. Return cases from hospital cases Nil Return cases from home nursed cases 6 Average length of stay in hospital 29.3 days 47 Diphtheria. Eight cases were notified as compared with 21 in the previous year, one case was fatal in an adult aged 25 years. All crises were removed to Bow Arrow Hospital. There were no "return cases." One case notified was non-civilian. The average length of stay in hospital 46.8 days Immunisation against Diphtheria. Immunisation in relation to Child Population. Age at 31.12.46 No. Immunised Estimated MidYear Population, 1946 Number of children who had completed a full course of immunisation at any time up to 31.12.46 Under 1 1 2 3 4 5-9 10-14 Total under 15 66 985 1,458 992 1,179 5,367 4,451 14,198 7,440 12,610 Diphtheria Notifications and Deaths in relation to Immunisation. Age at date of Notification No. of Cases No. of cases included in previous column in which the child had completed a full course of immunisation Deaths Under 1 - — — 1 1 1 — 2 — — - 3 - — — 4 2 1 — 5—9 1 1 — 10—14 — — — Totals 4 3 — Children Immunised during 1946. Number under 5 years of age 1,265 Number between 5 years and under 15 years (school children) 76 Total 1,341 Number of children given secondary injection (Booster doses), 173. On the Registrar-General estimate of child population of 20,050 the percentage of children under 15 years immunised against Diphtheria is 70.85. 48 Enteric Fever. One case of Typhoid Fever and one case of Paratyphoid Fever were notified during the year. Both were removed to L.C.C. Hospitals. Puerperal Pyrexia. Fourteen cases were notified during the year of which nine were from the Corporation Maternity Home where eight were isolated and treated. Two cases were removed to Bow Arrow Hospital, one to County Hospital, Farnborough, and one to an L.C.C. Hospital and two were isolated at home. Ophthalmia Neonatorum. Two cases were notified, one'was removed to White Oak Hospital and the other was treated at home. Analysis of Cases.- (a) Vision was unimpaired 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) — Measles. 358 cases were notified. Four were removed to Hospital, two to Bow Arrow Hospital, and two to other hospitals. There were no deaths. Whooping Cough (Pertussis). Fifty-nine cases were notified. None of these was removed to hospital. There was one death. Deaths attributable to this disease average over a thousand per annum in England and Wales. Given a potent vaccine a reduction of the attack rate to about one-third and a substantial reduction in mortality may well be expected. In the past many vaccines have been put on the market without much regard to their potency as a • result of the many technical difficulties involved. At the present time considerable research is taking place in an endeavour to produce the perfect immunising agent and field tests on a large scale are taking place in many districts. 49 Future progress in pertussis immunisation will, therefore, depend on the evolution of a really satisfactory vaccine and on the development of a " field " test, comparable with the Schick test in diphtheria immunisation which could be used for assessing immunity in inoculated children. Systematic immunisation in the Borough was abandoned, in 1945 owing to our not being able to obtain a suitable vaccine, but the position is being watched. At the present time, pertussis immunisation is given by local practitioners to individual delicate children or those subjected to particular risk. Dysentery. Fifteen cases were notified, one case was treated in Hospital. Cerebro-Spinal Fever. Three cases were notified and two were treated in hospital and one at home. There were no deaths. Acute Anterior Poliomyelitis. One case was notified which was removed to Bow Arrow Hospital, and subsequently transferred to County Hospital, Dartford. Food Poisoning. One case of food poisoning was notified during the year. This was treated at home. Scabies. 339 cases were notified during the year. 560 patients and contacts had two treatments at Corporation Cleansing Station and 146 had one treatment. Benzyl Benzoate has been invariably used in treatment. Malaria. Four cases of Malaria were notified. One case was " Induced " treated at Horton Emergency Hospital. Two cases contracted "Abroad " treated in Hospital. One case contracted England and Wales treated in Hospital. 50 51 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 1946. DISEASE Total cases notified Under 1 CASES NOTIFIED AT ALL AGES—YEARS Cases admitted to Hospital Total Deaths 1 to 3 3 to 5 5 to 10 10 to 15 15 to 25 25 and over Age unknown Smallpox Scarlet Fever *102 1 9 21 42 14 11 4 34 Diphtheria †8 1 2 1 2 2 - 8 1 Enteric Fever (including Typhoid and Paratyphoid) 2 1 1 2 Puerperal Pyrexia 14 6 8 4 Pneumonia 37 1 1 1 3 3 4 24 3 35 Encephalitis Lethargica Acute Poliomyelitis 1 1 1 Ophthalmia Neonatorum 2 2 Erysipelas 27 26 1 3 Cerebro-spinal Fever 3 1 1 1 2 Dysentery 15 % 2 1 1 3 8 1 Measles 358 13 82 79 164 9 7 4 4 Whooping Cough 59 3 15 16 25 Scabies 339 1 17 12 43 34 70 110 52 Totals 967 21 128 132 281 61 104 187 53 62 36 * 1 Non-civilian Scarlet Fever. t 1 Non-civilian Diphtheria. TUBERCULOSIS. During the year 119 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1946 are contained in the following table:- Age Period New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0—1 - - - - - - - — 1—5 - 2 1 - - - 1 - 5 — 10 1 2 - 2 - - - - 10—15 - 1 - - - - 1 - 15 — 20 6 6 2 1 2 - - 1 20 — 25 11 17 - - - 2 - - 25 — 35 18 9 - 2 5 5 2 1 35 — 45 14 4 2 - 6 6 - - 45 — 55 5 2 - - l 2 1 - 55 — 65 4 2 - 1 2 1 - 1 65 and upwards 4 - - - 2 - - - Totals 63 45 5 6 18 16 5 3 One case of Non-respiratory T.B. died of other causes. The number of non-notified tuberculosis deaths was 11. Sixty-five specimens of sputum were examined and reported upon by the County Laboratory. Rehousing. Fifteen cases were referred to me by the Tuberculosis Officer for rehousing. In six cases the families were rehoused through the Housing Committee, and one case was rehoused by another Authority, seven accepted for rehousing awaiting suitable accommodation, and one case was accepted but died before accommodation could be offered. The following statement shows the number of cases on the Notification Register for the district at the beginning and end of the year. Pulmonary. Non-Pulmonary. Total. No. on Register at M F M F commencement of year 332 269 53 61 715 No. on Register at end of year 370 290 56 65 781 52 INDEX ITEM PAGE Health Committee 3 Public Health Staff 4—5 STATISTICS AND SOCIAL CONDITIONS Acreage 8 Population 8 Population Graph 10 Unemployment 8 Social Conditions and Amenities 8—9 Summary of Vital Statistics, 1946 II—12 Extracts from Vital Statistics— Births and Birth Rates, etc. 12—13 Stillbirths and Stillbirth Rates 13—14 Deaths and Death Rates 14—15 Births and Stillbirths in Wards 15 Deaths and Death Rates.in Wards 16 Causes of Death 16—17 Deaths in Age Groups 18—19 Infantile Mortality 20 Maternal Deaths 21 GENERAL PROVISION OF HEALTH SERVICES. Isolation Hospital 21 General Hospitals . 21 : Ambulance Facilities 22 Public Mortuary 22 j Clinics and Treatment Centres 53—24 53 ITEM PAGE Professional Nursing in the Home 24 Laboratory Facilities 24 Maternity and Child Welfare— Midwifery and Maternity Service— Ante-natal Care 24 Co-operation with General Practitioners 25 Consultant Services 25 Maternity Accommodation 25 Ante-natal Clinics . 25 Post-natal Clinics 25 Home Helps 25 Domestic Helps 25 Dental Treatment 25—26 Institutional Provision for Mothers— Maternity Home 26—27 Other Institutional provision for Mothers Care of Illegitimate Children 28 Health Visitors and Clinics 28—29 Assisted Milk, etc. 30 Supply of Sheets for Expectant Mothers 30 Orthopaedic Treatment 30 Child Life Protection 30—31 Compensation to Midwives 31 Sunlight Clinic ■■ 31 Ear and Eye Defects ■■■ 31 Registration of Nursing Homes 31—32 Adoption of Children (Regulation) Act, 1939 32 Day Nurseries 32 Maternity and Child Welfare Table 33 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 34—35 Water Supply 35—36 > Drainage and Sewerage 36 Rivers and Streams 36 . Closet Accommodation 36 Public Cleansing ■■■ 36 Refuse Collection and Disposal 37 54 ITEM PAGE Chief Sanitary Inspector's Report— Tables of Inspections and Improvements, etc. 38—40 Food Inspection 40 Tables—Factories Act, 1937 41 Shops Acts, 1912—1936 42 Swimming Pool 42 Eradication of Bed Bugs 43 Camping Sites 43 Schools 43 HOUSING. Council Estates 43—44 Inspection of Dwelling Houses 44 Remedy of Defects without formal Notice 44 Action under Statutory Powers 45 Overcrowding—Housing Act, 1936, Part IV 4.6 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 46 Meat Inspection 46 Adulteration of Food—Food & Drugs Act 47 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 47 Diphtheria 48 Diphtheria Immunisation 48 Enteric Fever 49 Puerperal Pyrexia 49 Ophthalmia Neonatorum 49 Measles 49 Whooping Cough 49—50 Dysentery 50 Cerebro-spinal Fever 50 Acute Anterio Poliomyelitis 50 Food Poisoning 50 Scabies .• 50 Malaria 50 Tables of Infectious Diseases Notified 51 Tuberculosis 52 55 Printed by CHAS. F. THORN & SON (T.U. all Depts.) 60-64, WELLINGTON STREET, WOOLWICH, S.E.18.