AC4412 (1) BEXLEY Bex 13 BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Service For the Year 1948 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 1948 JOHN LANDON, M.R.C.S., L.R.C.P., D.PH. Medical Officer of Health Borough of Bexley. Mayor: Alderman J. Cronin, J.P Deputy Mayor: Councillor Mrs. E. Boswell, J.P HEALTH COMMITTEE. Chairman: Councillor F. H. Sampson. Vice-Chairman: Alderman Mrs. A. Welch. Alderman J. T. H. Ashmore, C.C. Alderman J. C. McLean, J.P., C.C. Alderman A. R. Potter, J.P. Councillor L. H. Bridges. Councillor J. Duffus. Councillor D. C. E. Gorringe. Councillor Mrs. M. Hall. Councillor Mrs. A. E. Lawrence. Councillor J. M. Pawson. Councillor P. E. Relph. PUBLIC HEALTH STAFF, 1948. 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. Assistant Medical Officer of Health Chief Sanitary Inspector, Public Cleansing Officer and Shops Acts Inspector. Deputy Chief Sanitary Inspector District Sanitary Inspectors ... John Landon, M.R.C.S., L.R.C.P., D.P.H. Mary Love, M.B., Ch.B., D.P.H., D.R.C.O.G. (resigned 3.6.48). § P. S. Robinson, M.R.C.S., L.R.C.P., D.R.C.O.G. *‡ R. J. Rayner, F.R.S.I. (retired 6.4.48). *† G. Hind, M.S.I.A. (appointed 7.4.48). *† J. T. Boocock. *† P. W. Willington. *† G. F. Lovegrove (appointed 17.3.48). *† W. B. Moses (appointed 17.3.48). Senior Health Visitor & §. Blythe (Mrs.),nee Ormandy. S.R.N S.C.M. and Health Visitor s Certificate. Health Visitors § N. Feeley (Miss), S.C.M. 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 Visitor's Certificate. § E. M. Gibson (Mrs.), S.R.N., S.C.M. and Health Visitor's Certificate. E. M. Martin (Miss), S.R.N., S.C.M. and Health Visitor's Certificate (resigned 14.3.48). F. P. Foster (Miss), S.R.N., S.C.M. and Health Visitor's Certificate (resigned 17.5.48). § Three Public Health Nurses. Matron of the Corporation Maternity Home, Lavernock Road, Bexleyheath. F. H. Hammond (Miss), S.R.N., S.R.F.N., S.C.M., Midwives' Teachers' Certificate (transferred to South-East Metropolitan Regional Hospital Board 5.7.48). 3 Chief Clerk M. Bentley (Miss). Senior Clerk G. A. Pearson. Clerks N. E. Broom (resigned 13.11.48). R. V. Hoad. § M. E. Leech (Miss) (Shorthand Typist). M. E. Smith (Miss) (Shorthand Typist). E. M. Williams (Miss) (resigned 4.7.48). E. Pearmine (Miss) (resigned 4.7.48). G. Webb (Mrs.) (Temporary— resigned 21.5.48). Consultant for Puerperal Keith Vartan, F.R.C.S., Pyrexia and for Ante-Natal M.R.C.O.G. Obstetric Complications. Dental Surgeon § K. Roberts, L.D.S., R.C.S., appointed 19.1.48. Public Analyst M. E. Monk, B.Sc., F.R.I.C. Other Staff § 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. § Transferred to Kent County Council 5.7.48. 4 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH To the Mayor, Aldermen and Councillors of the Borough of Bexley. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1948. The vital statistics for the year show that the health of the population of the Borough has been well maintained. The birth rate at 15.36 per thousand of the population, however, is lower than the rate for 1947 which was 18.72 and lower than the 1948 rate for England and Wales which was 17.9 as against 20.5 per thousand during the previous year. There can be little doubt that planned family limitation is an important feature of the present housing shortage which remains the most important single health problem not only in the Borough of Bexley but in the country as a whole. The death rate at 7.53 per thousand of the population is the lowest ever recorded in the Borough and compares favourably with a rate of 10.8 for England and Wales. It is interesting to note that the death rate for the Brampton Ward was as low as 5.3 per thousand and for the Falconwood Ward 6.4 per thousand, compared with a death rate of 9.9 for the Christchurch Ward and 8.1 per thousand for the St. Mary's Ward. The explanation would appear to be that, in the first two mentioned, the new housing estates which have been built in the past 30 years have tended to attract a younger population, while in the remaining two Wards, which contain some of the oldest property in the Borough, the age constitution of the residents is probably higher. This phenomenon has been noticed regularly since 1939 and is, therefore, worthy of mention. The infant mortality rate reached a new low level of 19.03 per thousand live births compared with a new low rate for England and Wales of 34 per thousand, and this favourable result is due, in part, to the fact that, in Bexley, there were no deaths in children under 2 years from gastro-enteritis and diarrhoea which took such a 5 heavy toll of infant life in the early part of the century. It is interesting, also, to record that the infant mortality rate among the 46 illegitimate births assigned to the Borough was nil, which argues a high standard of care among these children. Of the 25 infant deaths on which this rate was based, no fewer than 17 (68 per cent.) occurred during the first month of life (neo-natal deaths) and it may be that we are now approaching the irreducible minimum as far as present day knowledge is concerned. It may be, however, that further reduction will be achieved with a fuller knowledge of the causes of premature births and congenital deformities which are responsible for the great majority of neo-natal deaths. Much research is being done in regard to the importance of maternal infections during the early months of pregnancy and the incompatibility of the blood of mother and child (Rh. factor) which are thought to be responsible for a proportion of deaths during the first month of life. There were no deaths from diphtheria or measles, due, we believe in the case of the former, in a large measure, to the intensive campaign for immunisation which has been pursued in the Borough during the past 10 years. During the year, 4,467 children received booster doses of diphtheria prophylactic, with a view to keeping the level of immunity as high as possible. The maternal mortality rate (number of deaths of mothers resulting from childbirth for every thousand total births) was also nil and this can be taken as presumptive evidence that the ante-natal and obstetric services in the area worked well during the year. The death rate from tuberculosis was 0.42 per thousand of the population as against a rate of 0.51 per thousand for England and Wales. Although the rate for this disease has tended to be stationary during recent years, there are indications that, unless arrangements can be made to admit open cases to hospital and to relieve overcrowding among tuberculous families, the rate will rise in the near future. There can be no doubt that many children are being infected by their continued close proximity to adults suffering from this disease, and I am glad to say that the Housing Committee are alive to this danger and have, during the year, given high rehousing priority to such families, although much still remains to be done. 6 One of the most disquieting features of present day mortality statistics is the increased number of deaths from cancer and diseases of the heart and blood vessels. While insufficient is known of the causation of cancer to explain this phenomenon, it would appear that the increase in cardio-vascular diseases is probably related to the stresses and strains of life in the highly organised modern industrial state and the worry and anxiety which are an inseparable part of existence today. There is, of course, a fallacy in judging the health of an area solely by the mortality statistics. To get a complete picture information should also be available in regard to the incidence of sickness as distinct from deaths, and it is well known that to collect comprehensive statistics of sickness is not an easy task. At the present time the Medical Officer of Health has not the resources to carry out this important enquiry, but it is interesting to note that the Registrar General in the preface to the report issued bv the General Register Office on Sickness in the Population of England and Wales, 1944-1947, has stated that the measurement of sickness in relation to local populations is important and is of particular concern and interest to the Medical Officer of Health. It is to be hoped that this function will, in time, become an integral part of the work of the Health Department. Attention is drawn to the report on page 49 on the ocurrence of a mild outbreak of pemphigus at the Corporation Maternity Home and the steps that were taken to deal with it. It is felt that timely action may have prevented a more serious outbreak of a condition which is often difficult to control. One of the difficulties experienced during the year has arisen from the fact that, although the demolition of individual unfit houses has been dealt with in a number of cases, it has still not been possible to proceed with slum clearance in view of the problems which would be raised in the rehousing of the occupants. The question of the demolition of sub-standard houses and of proceeding with the implementation of the Lodge Lane Hutments Slum Clearance Scheme is one of the greatest importance from a health point of view and should not be delayed a day longer than is absolutely necessary. 7 On December 6th the use of the Bursted Wood Tip was discontinued and refuse disposal was confined to the Tip at East Wickham which should be able to meet the needs of the Borough for some years to come. The year 1948 was noteworthy in that on July 5th the Borough Council ceased to be a welfare authority and their maternity and child welfare services were transferred to the County Council. With them went the responsibility for ambulances, domestic helps and immunisation. The loss of local autonomy is keenly felt in view of the previous high standard of child care which had been achieved in the Borough and which is reflected in the vital statistics of the area. I wish to express my sincere thanks to the Chairman and Members of the Health Committee for their sympathetic help and encouragement and also to the members of the Health Department, both those remaining with us and those transferred to the County Council, for their devoted help and co-operation during the year. I am, Your obedient servant, JOHN LANDON, Medical Officer of Health. 8 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. Registrar General's Estimate midyear, 1948 88,920 New Dwellings Erected. Houses 334 Demolished Houses Rebuilt 286 Relative figures for previous years. Population—Mid-Year. 1931 (Census) 33,150 1938 (R.G.'s Estimate) 77,020 1939 80,110 1940 77,670 1941 72,080 1942 77,020 1943 76,740 1944 71,130 1945 75,040 1946 85,820 1947 87,670 New Houses Erected. 1,165 1,170 1,002 113 Nil 5 5 Nil 2 82+64 Demolished houses rebuilt. 199+216 rebuilt. Number of inhabited houses at end of 1948 (according to Rate Books) approximately 26,180 Rateable Value £617,055 Sum represented by a penny rate £2,450 Unemployment. Men Women Boys Girls Total December 31st, 1947 307 33 8 11 359 December 31st, 1948 258 59 11 7 335 Social Conditions and Amenities. The Borough of Bexley continues to be a healthy residential district and is specially favoured in that it has ample open spaces and recreational facilities for its inhabitants. Like other districts, however, that suffered severe bombing during the war, and whose population is tending all the time to increase, housing shortages, at present, constitute the main barrier to health for a relatively large number of its citizens. The housing programme is being accelerated as much as possible and it can only be hoped that, as the momentum increases, the housing position of the Borough will gradually reach the optimum standards for which the Council are striving. 9 The Corporation supplied the district with electricity until the date of transfer of this service to the London Electricity Board, 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 Gardeus .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 „ 10 GRAPH SHOWING RISE IN POPULATION SINCE 1911 11 SUMMARY OF VITAL STATISTICS England and Wales. 126 County Boro's and Great Towns including London. 148 Smaller Towns Resident Populations 25,000 to 50,000 at 1931 Census. London Administrative County. Borough of Bexley. Rates per 1,000 Civilian Population. Births- Live 17.9* 20.0 19.2 20.1 15.36 Still 0.42* 0.52 0.43 0.39 0.34 Deaths— All Causes 10.8* 11.6 10.7 11.6 7.53 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.02 0.02 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.01 — Tuberculosis 0.51 0.59 0.46 0.63 0.42 Influenza 0.03 0.03 0.04 0.02 0.03 Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 0.01 0.01 0.01 0.00 Pneumonia 0.41 0.38 0.36 0.54 0.35 Notifications (corrected) Typhoid Fever 0.01 0.00 0.01 0.00 — Paratyphoid Fever 0.01 0.01 0.01 0.01 — Cerebro-Spinal Fever 0.03 0.03 0.02 0.03 — Scarlet Fever 1.73 1.90 1.82 1.37 1.63 Whooping Cough 3.42 3.51 3.31 3.13 3.50 Diphtheria 0.08 0.10 0.09 0.10 0.02 Erysipelas 0.21 0.23 0.21 0.22 0.19 Smallpox — — — — — Measles 9.34 9.75 8.84 9.17 9.11 Pneumonia 0.73 0.84 0.60 0 57 0.28 Acute Poliomyelitis 0.04 0.05 0.04 0.04 0.07 Acute alitis 0.00 0.00 0.00 0.00 — Rates per 1,000 Live Births. Deaths All causes under one year of age 34† 39 32 31 19.03 Enteritis and Diarrhoea under two years of age 3.3 4.5 2.1 2.4 Rates per 1,000 Total (Live and Still) Births. Notifications (corrected) Puerperal fever and Pyrexia 6.89 8.90 4.71 7.34‡ 5.73 *Rates per 1,000 total population. †Per 1,000 related births. ‡in London Puerperal Fever alone was 0.61. A dash (—) signifies that there were no deaths. 12 Maternal Mortality in England and Wales. Rates per 1,000 Total (Live and Still) Births. No. 140 Abortion with Sepsis. No. 141 Abortion without Sepsis. No. 147 Puerperal Infections. Nos. 142-6, 148-50 Other Maternal Causes. 0.11 0.05 0.13 0.73 Abortion:—Mortality per million women aged 15-44 in England and Wales. No. 140 With Sepsis. No. 141 Without Sepsis. 9 4 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1948. The Register General's Estimate of resident population for mid-year is 88,920 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 687 679 1,366 Legitimate 665 655 1,320 Illegitimate 22 24 46 Birth Rate. Rate per 1,000 estimated resident population 15.36 The following relates to the Birth Rate during the past ten 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 ,, ,, 1946 ,, „ 19.75 ,, ,, 1947 „ „ 18.72 „ ,, Rate per 1,000 tor England and Wales, 1948 17.9 ,, ,, ,, ,, County Boroughs and Great Towns including London 20.0 ,, ,, ,, ,, Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 19.2 ,, ,, ,, ,, London Administrative; County 20.1 Forty-six illegitimate live births were registered against fifty-seven in 1947. 13 Stillbirths. Males Females Total Total 19 11 30 Rate per 1,000 total (live and still) births 21.5 The following relates to the Stillbirth Rate during the past ten years:— Year Rate per Thousand 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 1946 23.6 0.48 1947 21.5 0.41 Thirty Stillbirths registered during the year. This represents a rate of 0.34 per 1,000 population against 0.41 per 1,000 population in 1947. Rate per 1,000 for England and Wales 1948 0.42 ,, ,, ,, ,, County Boroughs and Great Towns including London 0.52 , ,, ,, ,, Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 0.43 „ ,, „ ,, London Administrative County 0.39 One Stillbirth was registered as illegitimate. Deaths. Males Females Total All causes 346 324 670 Death rate per 1,000 of estimated resident population 7.53 Number of women dying in, or in consequence of, childbirth: From Puerperal and Post Abortive Sepsis — — — From other Puerperal Causes — — — Death rate per 1,000 total (live and still) births — 14 Deaths of Infants under one year of age 13 13 26 Legitimate 13 13 26 Illegitimate — — — Death rate of Infants under one year of age: Total per 1,000 live births 19.03 Legitimate per 1,000 legitimate live births 19.7 Illegitimate per 1,000 illegitimate live births — Deaths from Measles (all ages) — — — ,, ,, Whooping Cough (all ages) — 1 1 ,, ,, Diarrhœa (under 2 years of age) — — — ,, ,, Cancer (all ages) 75 56 131 Death Rate of Country:— Rate per 1,000 for England and Wales, 1948 10.8 ,, ,, ,, ,, County Boroughs and Great Towns, including London 11.6 ,, ,, ,, ,, Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 10.7 ,, ,, ,, ,, London Administrative County 11.6 Death Rate of Area during last ten years:— 1938 7.84 per thousand 1939 7.98 „ ,, 1940 10.40 „ ,, 1941 9.68 ,, ,, 1942 8.73 ,, ,, 1943 9.21 „ ,, 1944 10.20 ,, ,, 1945 9.28 „ ,, 1946 8.55 ,, ,, 1947 9.17 „ ,, 15 BIRTHS AND STILLBIRTHS IN WARDS. The figures relate to live births and stillbirths notified but not necessarily registered up to the 5th July. Wards Live Births Stillbirths Christchurch 107 1 St. Mary's 160 7 Brampton 110 3 Danson 107 3 Falconwood 110 1 St. Michael's 143 2 Total 737 17 ANALYSIS OF NOTIFICATIONS OF LIVE AND STILLBIRTHS. Births notified from Institutions 556 Births notified by Midwives 197 Births notified by Doctors, etc. 1 Total 754 DEATHS AND DEATH RATE IN WARDS. The figures given relate to deaths occurring but not necessarily registered. Wards No. of Deaths Rate per 1,000 Population Christchurch 149 9.9 St. Mary's 129 8.1 Brampton 77 5.3 Danson 94 7.4 Falconwood 85 6.4 St. Michael's 131 7.5 Total 665 The rate for Bexley compares fairly with that for other parts of the country. The Registrar-General has not supplied a comparability factor for 1948; it is therefore impossible to work out the standardised rate which would be comparable with that of other parts of the country. 16 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1948. Causes of Death. M. F. Total All Causes 346 324 670 1 Typhoid and Paratyphoid Fevers — — — 2 Cerebro-spinal Fever — — — 3 Scarlet Fever — — — 4 Whooping Cough — 1 1 5 Diphtheria — — — 6 Tuberculosis of respiratory system 21 12 33 7 Other forms of tuberculosis 1 3 4 8 Syphilitic diseases 4 — 4 9 Influenza 3 — 3 10 Measles — — — 11 Acute poliomyelitis — — — 12 Acute infectious encephalitis — — — 13 Cancer of body cavity and Oesophagus (M.) and uterus (F.) 5 5 10 14 Cancer of stomach and duodenum 9 13 22 15 Cancer of breast — 12 12 16 Cancer of all other sites 61 26 87 17 Diabetes 1 2 3 18 Intracranial vascular lesions 30 48 78 19 Heart Disease 106 92 198 20 Other diseases of circulatory system 11 27 38 21 Bronchitis 15 10 25 22 Pneumonia 12 19 31 23 Other respiratory diseases 8 3 11 24 Ulcer of stomach or duodenum 2 2 4 25 Diarrhoea under two years — — — 26 Appendicitis — — — 27 Other digestive diseases 8 6 14 28 Nephritis 3 5 8 29 Puerperal and post abortive sepsis — — — 30 Other maternal causes — — — 31 Premature Birth 5 4 9 32 Congenital malformation, birth injuries and infant diseases 7 6 13 33 Suicide 4 1 5 34 Road traffic accidents 4 2 6 35 Other violent causes 1 2 3 36 All other causes 25 23 48 17 18 DEATHS IN ACE CROUPS IN 1948. These relate to deaths occurring in 1948 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 CO to 65 65 to 70 70 to 75 75 and over Deaths Registered during the year. Registrar General's figures ALL CAUSES. 665 25 2 — — — 8 5 5 5 4 11 18 21 31 35 54 54 69 84 231 670 1. Typhoid and Paratyphoid Fevers — 2. Cerebro-Spinal Fever — 3. Scarlet Fever — 4. Whooping Cough 1 1 1 5. Diphtheria — 6. Tuberculosis of Respiratory System 31 1 3 2 3 3 4 4 1 5 2 1 9 23 7. Other Tuberculous Diseases 4 1 1 1 1 4 8. Syphilitic Diseases 4 1 1 2 4 9. Influenza 3 1 1 1 3 10. Measles — 11. Acute Poliomyelitis — 12. Acute Infectious Encephalitis — 13 to 16. Cancer, Malignant Disease 131 2 9 4 12 10 22 17 16 21 18 131 17. Diabetes 3 \ 1 2 3 18. Intra-cranial vascular Lesions 78 1 1 1 4 7 10 7 14 33 78 19. Heart diseases 198 1 1 1 3 8 7 10 10 17 22 34 84 198 20 Other Diseases of Circulatory System 30 1 1 1 1 2 2 3 4 15 38 21. Bronchitis 25 1 1 3 1 3 16 25 22. Pneumonia 31 3 1 3 3 20 34 23. Other Respiratory Diseases 9 1 1 1 1 2 1 2 11 24. Ulcer of the Stomach or Duodenum 4 1 1 2 4 25. Diarrhoea (under 2 years of age) - 26. Appendicitis - 1 1 2 1 2 1 2 3 14 27. Other Digestive Diseases 13 1 1 1 2 3 8 28. Nephritis 8 29. Puerperal and Post-Abortive Sepsis - 30. Other Maternal Causes - 9 31. Premature Birth 9 9 32. Congenital Malformations, Birth Injury, Infantile Disease 11 11 13 33. Suicide 5 1 1 1 1 1 5 34. Road Traffic Accidents 6 1 2 1 1 1 6 35. Other Violent Causes 2 1 3 35. All Other Causes 59 2 3 1 1 1 1 1 4 3 3 4 3 32 48 19 INFANT MORTALITY, 1948. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1948 but not necessarily registered in that year. 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 1 Broncho-pneumonia 1 1 1 1 3 Acute Capillary Bronchitis 1 1 Congenital Malformation,Premature Birth, Birth Injury, etc. 9 2 11 3 1 15 Atelectasis 3 3 3 Foetal Endocarditis, Septicaemia 1 1 1 Neonatal Sepsis 1 1 1 Totals 13 3 1 17 5 i i i 25 The number of infants under one year of age who died during the year 1948 as shown by the table is 25. 17 of these deaths, that is 68 per cent., occurred in the neonatal period (within one month of birth). In 1947 the corresponding figure was 72.3 per cent. 20 26 were registered during the year giving an infantile mortality rate per 1,000 live births of 19.03. Rates over previous years have been:— 1938 35.1 per 1,000 live births 1939 40.1 ,, ,, ,, ,, 1940 45.4 ,, ,, ,, ,, 1941 35.4 ,, ,, ,, ,, 1942 32.7 ,, ,, ,, ,, 1943 26.01 ,, ,, ,, ,, 1944 31.37 ,, ,, ,, ,, 1945 33.9 ,, ,, ,, ,, 1946 29.5 ,, ,, ,, ,, 1947 28.6 ,, ,, ,, ,, Maternal Deaths. There were no maternal deaths during 1948. 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 ,, ,, ,, ,, ,, 1946 1.73 ,, ,, ,, ,, ,, 1947 1.19 ,, ,, ,, ,, ,, SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Isolation Hospital Accommodation. This had been available in the past at the Bow Arrow Hospital of the Dartford Joint Hospital Committee of which the Council was the largest contributing member. With the transfer of the Hospital to the Regional Hospital Board on 5th July, 1948, the Joint Hospital Committee became redundant and there is now no control of this Hospital by the Local Authority. 21 General Hospitals. Bexley Cottage Hospital. Outpatients 1,440 Outpatients Attendances 4,794 X-Ray examinations 614 AMBULANCE FACILITIES. Infectious Diseases. This ambulance service continued to be supplied by the Dartford Joint Hospital Committee until 5th July, 1948. Non-Infectious Diseases. The Borough Ambulance Service was transferred under the National Health Service Act, 1946, to the Kent County Council on July 5th and the following figures relate, therefore, to the first half of the year only. Cases Removed by Corporation Ambulances. Sickness 880 Accidents 90 Illness in Street 22 Maternity 347 Malicious calls — Ambulance not required 21 Collecting blood 1 Total 1,361 Mileage : Austin Ambulance—9,957, Talbot—2,342. Number of calls on Outside Ambulances. Crayford Ambulance 60 Sickness 39 Erith Ambulance 9 Accident 30 Sidcup Ambulance 41 Maternity 38 Not required 2 Blood 1 22 NATIONAL ASSISTANCE ACT, 1948. Action taken under Section 47. An application was made to a Court of Summary Jurisdiction on the 10th September, 1948, by the Bexley Borough Council for the removal of a resident of the Borough to suitable residential accommodation on the grounds that he was aged and infirm, was living in insanitary conditions, and was unable to devote to himself or receive from other persons proper care and attention. The Court, after the evidence, made an order for his removal to the West Hill Hospital from which he was subsequently transferred to a hostel for aged persons. Action under Section 50. The Borough Council undertook the burial of two residents who were without means and whose relatives could not be traced. 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 66 occasions and 63 post-mortem examinations were made. Five inquests were held. 23 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 — Tuesday, 10.30 a.m., Fridays, 2.30 p.m. Welling—Station Approach. Child Welfare Sessions — Mondays, Tuesdays and Thursdays, 2.30 - 4.30 p.m. Ante-natal Sessions — Mondays and Fridays, 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—Wroth am 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 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. Tuberculosis Dispensaries. At Overy Street, Dartford, and Bexley Road, Erith. Venereal Disease Clinics. At the County Hospital, West Hill, Dartford. 24 PROFESSIONAL NURSING IN THE HOME. Home nursing was provided for by three Nursing Associations in the area, namely:— Bexleyheath Services of two whole time Nurses. Bexley Service 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. MATERNITY AND CHILD WELFARE. Services transferred to Kent County Council July 5th, 1948. (a) Ante-natal Clinics. Average number of sessions weekly 8.6 Average attendances 14.9 (b) Post-natal Clinic. No. of post-natal examinations at Corporation Clinics 40 (c) Home Helps. No. of applications 57 No. cancelled or not proceeded with 1 No. of Homes attended 42 No. of attendances (days) 632 No. of applications transferred 24 No. of Cases being attended at transfer date 4 25 (d) Domestic Helps. No. of applications 62 No. cancelled or not proceeded with 4 No. of Homes attended 70 No. of attendences (days) 1,949 No. of applications transfered 1 No. of cases being attended at transfer date 23 (e) 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 1948. The denture supply service was again used to a considerable extent as the following table shows. Summary of Work for period ending July 5th, 1948. Expectant Mothers Nursing Mothers Children under 5 No. referred to and appointments made for Dental Clinic by a M.O. 176 58 170 No. found to be in need of treatment 116 13 86 No. who received treatment 116 12 86 No. made dentally fit 43 14 35 No. of treatments:— (a) Fillings— (1) In temporary teeth 176 (2) In permanent teeth 112 19 — (b) Teeth extracted 154 51 65 (c) Administrations of General anaesthesia 2 1 29 (d) Administrations of local anaesthesia 59 18 2 Patients supplied with dentures 7 8 — Dentures supplied 8 8 — Dentures repaired — 1 — No. of scalings and gum treatment, etc. 169 53 100 (f) 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 26 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. For the half-year, 29 premature births were notified. Special attention to these children was given by the Health Visitors and hot water bottles and other small equipment were provided when necessary. When the home conditions were not conducive to the proper care of these children the latter were admitted for an indefinite period to the Corporation Maternity Home where adequate facilities are available. The Town Ambulance Service was available for transport of these children. (g) Health Visitors and Clinics. The Health Visitors employed by the Council carried out a considerable body of work, details of which are given in the following tables (Figures relate to period ending July 5th, 1948):— Child Welfare Sessions. Bexleyheath Clinic. Total number of attendances 4,583 Average attendance 59.52 No. of children under one year 3,442 No. of children under one year (first time) 219 No. of children over one year 887 No. of children over one year (first time) 35 No. of children medically examined 803 27 Atten- Ante-natal Sessions. Mothers dances Bexleyheath Clinic 147 836 Bexley Clinic 66 361 Welling Clinic (Station Approach) 131 722 Wrotham Road Clinic 57 260 Falconwood Clinic 41 278 1781 attendances were made at Maternity Home. Bexley Clinic. Total number of attendances 3,063 Average attendance 57.79 No. of children under one year 1,963 No. of children under one year (first time) 113 No. of children over one year 958 No. of children over one year (first time) 29 No. of children medically examined 346 Welling Clinic (Station Approach). Total number of attendances 4,216 Average attendance 54.75 No. of children under one year 3,334 No. of children under one year (first time) 170 No. of children over one year 691 No. of children over one year (first time) 21 No. of children medically examined 604 Wrotham Road Clinic. Total number of attendances 3,193 Average attendance 63.86 No. of children under one year 2,187 No. of children under one year (first time) 175 No. of children over one year 815 No. of children over one year (first time) 16 No. of children medically examined 385 Falconwood Clinic Total number of attendances 2,554 Average attendance 49.11 No. of children under one year 1,916 No. of children under one year (first time) 135 No. of children over one year 486 No. of children over one year (first time) 17 No. of children medically examined 258 Births Registered. 1342 1943 1944 1945 1946 1947 1948 Live Births 1,469 1,384 1,498 1,413 1,695 1,641 1,366 Stillbirths 38 29 30 31 41 36 30 28 (h) Assisted Milk, etc. No. of families supplied with food free or at reduced cost 7 Approximate cost £5.1.11, No. of lbs. of dried milk at cost price 15,145 No. of lbs. of Virol, cod liver oil and malt 1,470 No. of Marmite cartons 5,524 Supply of Sheets for Expectant Mothers. No. of applications 109 No. of dockets 305 (i) Orthopaedic Treatment. The Council had an arrangement with Kent County Council whereby children under five years could attend for consultation and treatment at the Couuty Hospital, Dartford. An Orthopaedic Clinic has been established by the Kent County Council in the Borough for the care of school children and this was available for children under five years. No. of children attended first time 12 No. of children attended previously on the register 24 No. of total attendances made 72 No. of appliances recommended 1 (j) Child Life Protection. The Medical Officers and the Health Visitors Act as Child Life Protection Visitors under the Public Health Act, 1936. Children under nine years of age, who were nursed for reward or gain, were 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 18 (b) At 5th July 23 29 No. of children:— (a) At the beginning of the year 20 (b) At 5th July 25 No. of foster children who died Nil No. of inquests held Nil (k) Sunlight Clinic. No. of cases treated including any outstanding from previous year 150 No. of treatments 2,071 Diseases Treated. Knock-knees 2 General Atonia 3 General debility 114 Bowed legs 6 INSTITUTIONAL PROVISION FOR MOTHERS. (a) Maternity Home. (Transferred to Regional Hospital Board, July 5th, 1948, but Council continue supervision on an agency basis.) The Home continued as a training school for the State Certified Midwives Part II Examination. Priority admission was given to primiparæ, previous or expected abnormal cases, cases from overcrowded homes and unmarried mothers. Statistics. No. of patients in Home, 1st January, 1948 18 No. of patients admitted during 1948 715 No. of patients discharged during 1948 709 No. of patients died during 1948 nil No. of patients remaining, 31st December, 1948 24 No. of patient days 8,081 Average duration of stay in days 10.79 No. of cases delivered by nursing staff (midwives) 622 No. of cases delivered by doctors 90 No. of cases delivered before patients admitted to Home 3 No. of primiparæ 398 No. of multiparæ 314 30 Twin pregnancies 16 No. of calls on Consultant 10 No. of Cæsarean sections 5 No. of cases in which medical assistance was sought 95 No. of cases notified as Puerperal pyrexia 7 No. of cases of ophthalmia neonatorum — No. of cases of pemphigus neonatorum 8 No. of maternal deaths (after discharge) — No. of infant deaths 5 Causes — Premature 2 Mongolian 1 Cleft Palate 1 Unknown 1 No. of still births 18 Causes— Ante partum hæmorrhage 3 Obstructed labour 2 Congential heart 1 Locked twins Rh. factor 1 Toxaemia 2 Exomphalos 1 Hydrocephalus 1 Malformation 1 ? Cause 4 No. of cases sent to other Hospitals 9 No. of practitioners' private booked cases 90 Forceps deliveries 25 Feeding: Breast alone 611 Breast supplemented by artificial food 93 No. of babies born alive (including twins) 712 (b) Co-operation with General Practitioners. 90 of the 712 cases admitted to the Corporation Maternity Home during 1948 were general practitioners' cases. (c) Consultant Services. The consultant was called on 10 occasions to see patients in the Maternity Home. 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 63 Total 69 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 12 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 21 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 27 (c) No. of children notified under Section 7 (3):- (i) Under supervision at 5.7.48 19 (ii) Who died during the year — (iii) On whom inquests were held — Number of children adopted 5.7.48 13 32 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. List cf Adoptive Acts, etc., in force. Date Acts. Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 8 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 ,, 6—the whole ,, 10—Sec. 95 May 1909 Public Health Act, 1925, Part 2 Jan. 192(5 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; 33 moval of Offensive and Noxious Matters; Nuisances; 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, 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 1948 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 case 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: — 34 Bacteriological. No. of organisms per c.c. capable of growth on Agar at: 37° C. 22° C. 0-10 0-90 B. coli presumptive Absent in 100 c.c in all samples (ii) Drainage and Sewerage. Foul and surface water sewers were laid on housing site, John Newton Court, and sewer works commenced on Halcot No. 2 Housing Site. 2. Rivers and Streams. No serious case of pollution of rivers or streams was found during the year. CHIEF SANITARY INSPECTOR'S REPORT. Health Department, 14, Brampton Road, Bexleyheath. To the Mayor, Aldermen and Councillors of the Borough of Bexley. Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting my Annual Report as Chief Sanitary Inspector and Public Cleansing Officer to your Council for the year 1948. The report consists, as in previous years, of a tabulated record of work carried out. The year was marked by the retirement on April 6th of Mr. R. J. Rayner, who was Chief Sanitary Inspector for a period of 33 years. In consequence of this, I was appointed his successor and would like to record in my first Annual Report my appreciation of the help and advice Mr. Rayner gave me during my years of service under him. Other changes in the inspectorial staff were the appointments of Mr. Boocock as Deputy Chief Sanitary Inspector, and Mr. Lovegrove and Mr. Moses as District Sanitary Inspectors. When the latter two appointments were made, it was found possible to divide the area into four districts, and this has resulted in better supervision than has been possible for some years. 36 I wish to tender my thanks to the Chairman and members of the Health Committee for their help and support during the year, and to the Medical Officer of Health for his co-operation in all matters of environmental health. TABLE No. 1. Number of complaints received and investigated 596 Number of informal notices, letters, etc. 873 TABLE No. 2. Details of Inspection Work Carried Out. Inspections Re-inspections Houses inspected (all particulars recorded) 20 30 Houses inspected (defects only recorded) 543 1,800 Houses inspected (Housing Act, 1936, Overcrowding) 182 23 Houses inspected re Infectious Disease (including Scabies) 213 36 Factories with mechanical power 139 35 Factories without mechanical power 56 5 Schools 8 3 Refuse Tips 209 — Bakehouses 61 15 Outworkers 59 3 Meat Shops and Premises where food is prepared 1,456 113 Cowsheds and Dairies 33 15 Ice Cream Premises 201 24 Fried Fish Premises 162 11 Common Lodging Houses 18 — Tents, vans and Sheds 37 — Offensive Accumulations 75 64 Keeping of Animals 76 44 Rats 157 78 Verminous Premises 64 70 Insufficient Ashplace Accommodation 122 159 Drains Inspected 954 977 Drains Tested (water, smoke or colour) 90 18 Visits re Refuse Removals and Salvage 340 7 Miscellaneous Inspections 1,810 99 Food and Drugs Act re Samples 269 — Shop Acts, 1912-1936 559 33 Visits re Certificates of Essential Repairs 57 — 36 TABLE No. 3. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 57 Provided with sufficient ashplace accommodation 66 Provided with sufficient water supply 20 Houses Improved Internally— Dirty rooms cleansed 39 Walls and ceilings repaired 402 Dampness in rooms remedied 354 Defective floors repaired 78 Ventilation of rooms improved 23 Windows repaired 147 Coppers repaired 3 Stoves, fireplaces, etc., provided or repaired 25 Houses Improved Externally— Roofs repaired 155 Eaves, gutters and down spouts fixed or repaired 105 Yards paved or repaired 3 Chimney stacks repaired 13 Walls repointed or repaired 55 Miscellaneous repairs 188 Yards cleansed 4 Drainage— Drains cleansed or repaired 551 New drains constructed 1 New Gullies provided 6 Ventilation of drainage system improved 3 Inspection chambers built or improved 5 New sinks provided 2 Waste pipes provided or improved 22 Offensive accumulation removed 20 Nuisances from animals abated 1 Other nuisances abated 35 37 TABLE No. 4. Infectious Diseases. Cases removed to Isolation Hospitals 85 Houses visited including revisits 249 Rooms disinfected 40 Notices delivered to Education Authorities, etc. 507 Houses at which defective sanitary conditions were found 2 TABLE No. 5. Food Inspection. The following is a summary of unsound food surrendered. Beef lbs. 1,760½ Cake lbs. 2 Corned Beef „ l,281¾ Milk Powder „ 112 Corned Mutton ,, 120 Cake Flour pkts. 2 Meat Pastes ,, 4 Dates boxes 246 Ham 14¾ Meat tins 261 Mutton Fish „ 554 and Lamb 18 Milk „ 994 Kidneys 9½ Vegetables „ 656 Luncheon Meat 3½ Preserves „ 306 Poultry „ 243A Soup „ 153 Rabbits ,, 60 Fruit and Fruit Fish Paste ,, 4 Juices „ 376 Fish „ 1,752½ Meat and Veget Cheese „ 23½ ables ,, 2 Butter ,, 7 Pastes „ 413 Fats 4½ Bacon „ 14 Flour ,, 57 Mustard ,, 10 Sugar ,, 12 Beef Cubes ,, 8 Bacon „ 17¼ Pickles and Rolled Oats ,, 62 Sauces jars 1,191 Cereals ,, 77 Coffee bottles 4 Apples „ 105 Dried Egg tins 7 Dried Fruit „ 151½ ,, ,, pkts. 17 Tomatoes „ 10¾ Eggs 119 Fresh Peas ,, 42 Malt Loaves 18 Dried Peas ,, 12 Shrimps gals. 6 Cocoa Powder ,, 18 Miscellaneous tins 105 Confectionery 14½ 38 TABLE No. 6. 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 243 10 — Factories without mechanical power 130 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 373 12 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) 3 3 — — Overcrowding (S.2) Unreasonable temperature (S.3) Inadequate ventilation (S.4) Ineffective drainage of floors (S.6) Sanitary Conveniences (S.7)— Insufficient 1 1 — — Unsuitable or defective Not separate for sexes 14 15 — — 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 4 — — Total 21 23 — — 39 Closet Accommodation. With the exception of a few houses, all the closet accommodation in the Borough is on the water carriage system. Public Cleansing. Twelve cesspools were emptied a total of 22 times. Refuse Collection and Disposal. The collection and disposal of house refuse and the collection of salvage is the responsibility of the Health Committee, and the work is carried out by direct labour. During the early part of the year there was some delay in collection owing to weather conditions and sickness, but during the remaining months it was possible to maintain the period between collections at approximately one week. The position with regard to transport was eased by the fact that three S. & D. Dust Carts were delivered during the year, and a further two were placed on order for delivery during 1949. It was, however, still found necessary to use an open lorry for refuse collection, to the obvious disadvantage of both the loaders and the public. Six of the freighters in use are between 10 and 17 years old, and four of these were reconditioned during the year in the Council's Workshop. Three of the remaining six freighters were purchased in 1947 and three in 1948. In addition to this, two Karrier lorries were delivered during the year to replace worn out vehicles. All house and trade refuse collected in the area is disposed of by controlled tipping. This has for a number of years been carried out at Bursted Wood, but"early in December it was found impracticable to carry on at this site, and tipping was recommenced on the East Wickham site. The Council are at present acquiring further land adjoining the latter tip which will meet the needs of the area for a number of years. A Muir-Hill Dumper of 2 cu. yds. capacity was acquired for carting soil for covering the refuse. Salvage. Salvage is collected by means of trailers attached to the refuse collection vehicles, and seven new trailers were purchased during the year. Kitchen waste 40 is collected separately by means of some 400 communal bins placed in the streets, and these are emptied twice weekly. All kitchen waste is sent to the Woolwich Borough Council's Concentrator Plant at White Hart Lane. On the 1st April a bonus scheme was instituted, whereby the men engaged on refuse collection and disposal are paid 15 per cent, of the gross sales of salvage. This undoubtedly had the effect of stimulating the men's interest, and resulted in a considerable increase in the amount of salvage collected. The revenue from salvage sales during the year was £4,559 8s. 5d., made up as follows:— tons cwts. qtrs. £ s. d. Waste Paper 359 14 1 2,296 2 7 Textiles 35 1 0 614 14 7 Bones 5 3 1 13 3 Kitchen Waste 550 18 1 826 7 4 Ferrous Metals 19 1 1 41 2 9 Non-Ferrous Metals 1 11 1 55 3 1 Bottles and Jars 27 8 0 114 1 7 993 19 3 3,949 5 2 Waste Paper Collection Allowance 128 2 3 Kitchen Waste Collection Allowance 482 1 0 £4,559 8 5 RATS AND MICE (DESTRUCTION) ACT, 1919. INFESTATION ORDER, 1943, Rodent control of surface infestations in the area is carried out by one full time Rodent Operative, and the test baiting and treatment of sewers by men under the control of the Borough Engineer. The method used is that approved by the Ministry of Agriculture and Fisheries, namely prebaiting followed by poison. The prebaits used are chiefly sausage rusk and bread mash and the poisons zinc phosphide, arsenic and red squill. Infestations found during the year have chiefly been of a minor character, and a high percentage were in private dwellings where fowls, ducks, etc., were kept. 41 Number of premises treated during the year. Local Authority's premises 6 Business premises 17 Private dwellings 253 The Refuse Tip was also treated on 3 occasions. SHOPS ACT, 1912 to 1936. The following Closing Orders are in operation in 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 592 inspections were made under the Shops Acts, 1912-36, and no legal proceedings were instituted. I am, Ladies and Gentlemen, Yours obediently, G. HIND, Chief Sanitary Inspector. Swimming Pool. The only swimming pool in the Borough 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. 42 Results. No. of organisms per c.c. capable of growth on Agar at: B. coli presumptive 37° C. 22° C. Deep end 3-37 1-148 Absent Shallow end 3-336 2-38 Absent in all but one case. Eradication of Bed Bugs. Number of houses found to be infested:— (a) Corporation houses 11 (b) Other houses 11 Five privately owned houses were fumigated with Hydrogen Cyanide by private firms. The other infestations were dealt with by the Department by spraying, etc., the number of rooms dealt with in this manner being 45. 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. 43 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 — Westwood Lane Estate 76 — Carlton Road 16 — East Wickham— Glenmore Road 116 — Bexleyheath— Highland Road Estate and Pickford Road Estate (including bungalows) 306 — Cannon Road — 28 Alers Road 80 — Halcot Estate 200 — Bexley— Hartford Road Estate and Victoria Road Estate 54 — Royal Park Estate 58 — Midhurst Hill 20 — Newick Close 16 — Henfield Close 8 — 1,378 28 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) 563 (b) Number of inspections made for the purpose (including re-inspections) 2,393 (2) (a) Number of dwelling houses cluded under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 1925 to 1932 20 (b) Number of inspections made for the purpose (including re-inspections) 50 44 (3) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (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 408 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 368 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 repect of which notices were served requiring repairs 1 (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 91 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 81 (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 repect of which Demolition Orders were made 6 45 (2) Number of dwelling houses demolished in pursuance of Demolition Orders — Public Health Act, 1936. Section 75. Provision of Dustbins. Notices served requiring prevision of bins 15 Number complied with— (a) by Owners 8 (b) by Local Authority in default of Owners 4 Bins provided in. consequence of informal action 54 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:— Pasteurised Milk 16 Tuberculin Tested Milk 9 Supplementary Licences:— Pasteurised Milk 2 Tuberculin Tested Milk 1 No. of cowsheds in district 1 (b) Meat Inspection. The slaughterhouses in the area remained closed during the year. 46 (c) Adulteration of Food. Food and Drugs Act, 1938. The following table summarises the 244 samples taken during the year. Formal Informal Milk 68 2 Soups, Meat Extracts, Pastes, etc. 2 10 Condiments, Sauces, Spices, etc. 14 34 Butter and Margarine 10 1 Meat and Fish Pastes, etc. 1 6 Pudding or Cake Mixtures, Flour, etc. 12 8 Jellies, Custard Powders, etc. — 6 Patent Medicines, etc. 3 11 Beverages 8 7 Sausages, Sausage Meat, etc. 27 2 Miscellaneous 2 10 Legal Proceedings. The following legal proceedings were instituted during the year:— (1) Beef Sausages Adulterated 16% deficient Fined 10s. plus in meat £3 3s. 0d. costs. (2) Beef Sausages Adulterated 37% deficient Fined £3 plus in meat £3 3s. 0d. costs. (3) Beef Sausages Adulterated 32% deficient Fined £3 plus in meat £3 3s. 0d. costs. (4) Beef Sausages Adulterated 34% deficient Fined £20 plus in meat £3 3s. 0d. costs. (5) Beef Sausages Adulterated 44% deficient Fined £3 plus in meat £3 3s. 0d. costs. (d) Food Preparation Premises. During the year 1,569 visits were made to restaurants and premises where food is manufactured for sale. The following is a summary of various improvements carried out at these premises. Rooms cleansed 16 Walls, ceilings, floors, etc., repaired 6 Dampness remedied 2 Hot Water supply provided 1 Drains cleansed or repaired 2 Dirty yard cleansed 1 Offensive accumulation removed 1 Registration of Premises under Food and Drugs Act, 1938. No. of premises registered for:— Sale or Manufacture of Ice Cream 8 Sale of Ice Cream 63 Preparation of Sausages, etc. 42 47 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 146 cases were notified as compared with 123 the previous year. Of these 52 were isolated in Bow Arrow Hospital and in an L.C.C. Hospital and 93 were isolated at home. One case isolated in Bow Arrow Hospital was non-civilian. No. of deaths Nil Return cases from Hospital cases Nil Return cases from home nursed cases Nil Average length of stay in Hospital 25.3 days Diphtheria. Two cases were notified as compared with seven in the previous year. One case was isolated in Bow Arrow Hospital and one in an L.C.C. Hospital. There were no return cases and no deaths. Average length of stay in Hospital 76 days Immunisation Against Diphtheria. No. of children who completed full course up to 30.6.48. under 5 5-14 years At Clinics 621 15 By Doctors 8 1 In Schools 6 386 635 402 Total 1,037 No. of children who were given secondary injections (Booster) up to 30.6.48. At Clinics 154 In Schools 4,313 Total 4,467 48 Enteric Fever. There were no cases notified during the year. Puerperal Pyrexia. Eight cases were notified during the year, of which seven were from the Bexleyheath Maternity Home, where four were isolated and treated, and three cases were removed to Bow Arrow Hospital. One case was isolated and treated in the British Hospital for Mothers and Babies, Woolwich. Ophthalmia Neonatorum. There were no cases notified. Measles. 810 cases were notified. 6 cases were treated in hospital, 5 at Bow Arrow and 1 at the County Hospital, Farnborough. There were no deaths. Whooping Cough (Pertussis). 311 cases were notified, 8 of which were treated in hospital. There was 1 death. Acute Anterior Poliomyelitis and Polio-encephalitis. 6 cases were notified and all were treated in hospital. There were no deaths. Pemphigus. The following report was made to the Health Committee as a result of the occurrence of pemphigus at the Corporation Maternity Home:— I have to report that, on the 16th April, 1948, a baby at the Maternity Home developed a spot on the skin which was not, at the time, regarded as in any way serious. The mother and baby were, accordingly, discharged from the Home. On the 21st April, 1948, another child developed a small blister which raised the suspicion of pemphigus and the mother and baby were transferred to the Bow Arrow Hospital from which they were discharged three days later. Further very mild cases occurred on the 25th April, 1st May and the 3rd May all of which were transferred to Bow Arrow Hospital where the skin lesions rapidly cleared up. The total number of cases was eight. 49 Although the actual condition was extremely mild, one had to consider the possibility of the spread of infection and that further cases might have become more virulent than the earlier ones. Bearing in mind the history of outbreaks occurring in other institutions from time to time, which proved extremely difficult to overcome, it was decided to take a serious view of the matter. I, therefore, communicated with the Ministry of Health on the 4th May and Dr Manson one of the Medical Officers of the Ministry, came down on the 5th May to assist us in the investigation. Dr. Manson, in fact, spent the whole day at the Maternity Home with the Matron and myself and, after a very full examination of the position, it was decided to suspend admissions for the time being. The following action was also taken. 1. Nasal swabs were taken from all members of the staff. 2. Swabs were taken from a baby's spots. 3. As many mothers and babies were sent home as early as was conducive to safety. 4. Attendance at the homes of discharged babies by midwives from the Maternity Home was arranged where necessary. 5. All cases were followed up by Health Visitors. 6 Walls and floors at the Maternity Home were washed and re-sterilisation of cots, mattresses and equipment was carried out. 7. Arrangements were made for the provision of alternative accommodation for all booked cases. The results of the swabs showed that several members of the staff were nasal carriers of the particular germ which was capable of causing this condition. By an arrangement with the Central Public Health Laboratory at Colindale, special typing of the organism was carried out which showed that, in the case of one member of the staff, the organism taken from her nose was identical with that isolated from the baby's spot and, as there was a prima facie case that this might have been the origin of the trouble, the nurse in question was taken off duty. 50 By the 10th May, 1948, the Home was completely empty of patients. Local treatment of the noses of members of the staff was undertaken to get rid of the carrier condition and further swabs were taken from time to time. No further cases occurred in the Home and, following further consultation with the Ministry of Health, it was decided that it would be safe to resume admissions on the 18th May, 1948, and this was, accordingly, done. It is considered that, as a result of the action which was taken, it was possible to prevent the spread of this condition but further time will have to elapse before we can be quite sure that the trouble has been completely eliminated. I am indebted to the Matron and her staff and to the medical staff for so cheerfully submitting to the discomforts of swabbing and treatment and for their cooperation in all the measures necessary for the safety of the Home. I am indebted, also, to the Ministry of Health for their kind co-operation and to Dr. Cochrane, Surgeon Superintendent at the Dartford County Hospital who so very kindly arranged to take most of our cases and to other institutions who were also able to render us assistance. Scabies. 39 cases were notified. 30 patients and contacts had two treatments at the Corporation Cleansing Station and 13 had one treatment. 12 patients and contacts received treatment at home. 51 52 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 1947. DISEASE. Total cases notified CASES NOTIFIED AT ALL AGES—YEARS. Cases admitted to Hospital Total Deaths Under 1 1 to 3 3 to 5 5 to 10 10 to IS 15 to 25 25 and over Age unknown Smallpox — — — — — — — — — — — Scarlet Fever *146 — 13 24 83 19 4 3 — *53 — Diphtheria 2 — — 2 — — — — — 2 — Enteric Fever (including Typhoid and Paratyphoid) — — — — — — — — — — — Puerperal Pyrexia 8 — — — — — 6 2 — 3 — Pneumonia 25 1 1 2 2 2 1 16 — 6 31 Encephalitis Lethargica — — — — — — — — — — — Acute Poliomyelitis 6 1 — 2 — 1 — 2 — 6 — Ophthalmia Neonatorum — — — — — — — — — — — Erysipelas 17 — — — — — 1 16 — 1 — Cerebro-Spinal Fever — — — — — — — — — — — Dysentery — — — — — — — — — — — Measles 810 19 194 230 341 10 6 5 5 6 — Whooping Cough 311 24 73 79 115 9 2 8 1 8 1 Scabies 39 2 2 3 12 4 3 7 6 — — Acute Polioencephalitis — — — — — — — — — — — Totals 1364 47 283 342 553 45 22 59 12 85 32 * 1 Non-Civilian TUBERCULOSIS. During the year 92 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1947 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 — — — — — — 5—10 1 1 — 1 — — 1 — 10—15 2 1 — 3 — — 1 — 15—20 8 5 1 2 — 1 — — 20—25 8 5 1 — 1 2 — 1 25—35 12 5 1 — — 5 — 1 35—45 4 5 1 — 6 1 — — 45—55 6 4 2 2 3 2 — — 55—65 3 1 — — 4 1 — — 65 and upwards 3 3 — — 5 1 — — Totals 47 31 6 8 19 13 2 2 The number of non-notified Tuberculosis deaths was 15. 56 specimens of sputum were examined and reported upon by the County Laboratory. Pulmonary. Non-Pulmonary. Total M F M F No. on Register at commencement of year 389 299 58 63 809 No. on Register at end of year 412 299 68 68 875 Rehousing. 15 cases were referred to me by Tuberculosis Officer for rehousing and in nine cases the families were rehoused by the Housing Committee. 53 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1948 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h. Medical Officer of Health EXCEPTED DISTRICT OF BEXLEY WELFARE AND SCHOOL ATTENDANCE SUB-COMMITTEE Chairman: Alderman J. T. H. Ashmore, C.C. Vice-Chairman: Miss M. Woodward. His Worship the Mayor: Alderman Mrs. A. Welch Councillor D. C. E. Gorringe Councillor Mrs. M. Hall Alderman J. Cronin, J.P. Councillor Mrs. A. Lawrence Councillor J. D. Vergette Councillor A. W. Lanyon. Co-opted Mem hers: Miss D. C. Collins Revd. R. B. Wright. 0 STAFF 1948 Borough Education Officer W. E. D. Stephens, M.A. Deputy Borough Education Officer R. R. Sutton. School Enquiry Officers M. D. H. Garrett, R. W. Forbes, R. N. Harrison. Welfare Officer Mrs. E. Somerville. SCHOOL HEALTH SERVICE Medical Officer of Health John Landon, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officers Mary Love, M.B., CH.B., D.P.H., D.R.C.O.G. (Part time). (Resigned 3.6.48). P. S. Robinson, M.R.C.S., L.R.C.P., D.R.C.O.G. (Part time). Transferred to K.C.C. 5.7.48). Arthur James Dalzell-Ward, M.R.C.S., L.R.C.P., D.P.H. Robert Bruce Killoh, M.B., Ch.B., D.P.H. (Appointed 3.11.48). Ophthalmic Surgeon John Smallpeice, M.R.C.S., L.R.C.P., D.O.M.S. Roland M. Chambers, M.B.B.S., D.O.M.S. (as from 2.11.48). Aural Surgeon T. P. Gill, F.R.C.S. W. MacGregor, O.B.E., V.D., M.B. (as from 1.7.48). Orthopædic Surgeon K. F. Hulbert, F.R.C.S. Dental Officers T. C. Farmar, L.D.S. (Resigned 30.9.48). H. Wade, L.D.S. P. Middleton, L.D.S. (Part time as from 1.10.48). T. A. Hall, L.D.S. (Part time as from 6.10.48). Health Visitors Mrs. E. A. Bowman, S.R.N, and Health Visitor's Certificate. Miss K. P Hart, S.R.N, and Health Visitor's Certificate. Mrs. V. Waters, S.R.N., S.C.M. (Temporary). Mrs. A. E. Matthews, S.R.N., (Temporary—Appointed 3.11.48). Physiotherapist Miss R. Cheeseman, M.C.S.P., M.S.R. Speech Therapist Mrs. D. Rant, L.C.S.T. Dental Attendants Mrs. I. Birtchnell. Miss K. M. Dunkley. School Health Servce Clerk Miss M. C. A. Smith. General Clerks Miss C. E. Anderson. Miss E. Pearmine (appointed 5.7.48). 57 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1948. To the Chairman and Members of the Welfare and School Attendance Suh-Committee. Ladies and Gentlemen, I have the pleasure to present my Annual Report for the year 1948, during which period the work of the School Health Service was further consolidated. On the 30th September, 1948, one of the two dental surgeons resigned and it has not been possible, so far, to fill this vacancy owing to the greater incentives offered in private practice under the National Health Service Act, 1946. This has resulted in a serious limitation of the amount of dental work carried out during the latter part of the year, and at the time of writing there appears to be no solution to the problem which is indeed nationwide in its implications. It can be said, however, that all children needing emergency treatment have been given special priority although individual cases of difficulty have occurred. During the year, the number of Health Visitors was increased to four, but it is probable that a fifth will be required to deal with the considerable amount of work which is involved. The clerical section was increased to three and, with the provision of full office equipment, a complete overhaul was made of our recording system and office administration generally. There were no serious outbreaks of infectious disease at any of the schools due, at least in part, to the vigilance exercised by headteachers and their staffs particularly by arranging for the exclusion of all children with " colds " and sore throats. Clinic attendances have been heavy and once again the tendency for them to be used as consultative centres has been in evidence. Considerable work has been done during the year in the treatment of nasal catarrh and sinusitis. It is felt that many cases of bronchitis and even more serious lung conditions are due to the neglect of these conditions and treatment has consisted of repeated local applications under continuous medical supervision. Any success that may have been achieved 58 in this direction has depended, largely, on the hard work and interest of the Health Visitors, who have carried out the rather tedious treatments with enthusiasm. Good liaison has existed with the Paediatric Departments at the Farnborough and Dartford Hospitals and a number of cases have been referred for advice and treatment where this was thought to be necessary. Considerable use was made, during the year, of the Child Guidance Clinic provided by the Kent County Council and many cases of maladjustment, some of which were very severe, were referred to the Psychiatrist. The co-operation and interest of headteachers is of prime importance in these cases which raise educational problems of great difficulty, and I am happy to record that this has been readily forthcoming. Facilities for diphtheria immunisation have now been made available at all school clinics and considerable work was carried out during the year. In addition, a review of children requiring booster doses in infant and junior schools was carried out and 4,467 children were given booster doses while at school, a whole time Medical Officer being temporarily appointed for this purpose. There has recently been formed, in the Borough, a local group of the British Council for the Welfare of Spastics which will afford an opportunity for parents of such handicapped children to meet and exchange ideas and information relating to their care and upbringing. There are 18 spastic children in the Borough of Bexley, and it is important that they should be kept under constant supervision. In the case of children who are educable, a home tutor has been provided, in certain oases, by the Education Authority, and in one case sufficient progress has been made by the child to qualify him for admission to the St. Margaret's School, Croydon, which had rejected him a year before. I am glad to report that the Paediatric Department at the Farnborough Hospital will shortly be opening a centre for these children and arrangements have been made for a number of children from Bexley to be conveyed on several days a week for treatment and training. During the year Dr. Dalzell-Ward has given a number of lectures to Parent-Teacher Associations on a variety of subjects affecting the health of the school child. Such lectures provide an opportunity for group 59 health education and give parents a greater realisation of the scope and functions of the School Health Service and of child care in general. It has often been felt that the school health records in our possession have not been used sufficiently in the past from the point of view of fostering research into problems of child health. I have pleasure, therefore, in reporting that, in conjunction with the Kent Pediatric Society, an investigation is being made locally into the incidence and causation of positive health among school children, and in this matter we have the great advantage of the help and advice of Professor John Ryle of the Institute of Social Medicine at Oxford. The success of the School Health Service depends to a large extent on team work in which the Doctors, Health Visitors, Clerical Staff, Head Teachers, School Enquiry Officers and parents co-operate, and much of the work that is carried out cannot be recorded statistically. It is true to say, however, that as a result of co-operative action we have built up an "intelligence service" which ensures that full arid up-to-date information is available to us in regard to the health of the children. In this connection the work of the Health Visitors is of prime importance, as they are, in fact, the spearhead of the School Health Service as it is through their influence with parents that the best use can be made of the facilities which are provided. I wish to express my appreciation of the help and support which I have received during the year from the Chairman and Members of the Committee and from all members of the staff on whose industry and devotion to duty the success of this very personal service depends. I am, Mr. Chairman, Ladies and Gentlemen, Tour obedient servant, John Landon, Medical Officer of Health. 60 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Six County Secondary Schools with seven departments. Average number on Roll at 31st December, 1948 3,376 Twenty-three County Primary Departments. Average number on Roll at 31st December, 1948 6,901 One Nursery Class attached to Uplands Primary School. Average number on Roll 58 Bexley County Technical School for Girls. Average number on Roll: Bexley 755 Wilmington Annex 153 Total 11,243 Clinics. Minor Ailments. Welling—Little Danson, Dansington Road. Tuesday, 2-4 p.m. Wednesday, Friday and Saturday, 9.30-11 a.m. Doctor in attendance— Wednesday and Saturday. Bexleyheath—315, Broadway. Tuesday, 2-4 p.m. Monday, Wednesday, Friday and Saturday, 9.30-11 a.m. Doctor in attendance—Tuesday and Saturday. Bexley—Murchison Avenue. Tuesday, Thursday and Friday, 9.30-11 a.m. Doctor in attendance—Thursday. Dental. Welling—Little Danson, Dansington Road. Wednesday and Friday, 9.30-11 a.m., 2-4 p.m. Bexleyheath—315, Broadway. Thursday and Friday, 9.30-11 a.m., 2-4 p.m. Saturday, 9.30-11 a.m. Extraction Session—Friday morning. 61 Crayford—Woodside Road. Monday, Tuesday and Wednesday,9.30-11 a.m., 2-4 p.m. Sunlight CIinic. Bexleyheath—315, Broadway. Tuesday and Thursday, 10-12 noon. Specialist's Clinics. Ophthalmic. Welling—Little Danson, Dansington Road. Monday, 9.30-11 a.m., 2-4 p.m. Thursday, 9.30-11 a.m. Appointments made from Office. Orthopaedic. Welling—Station Approach. Wednesday, 9.30-11 a.m., 2-4 p.m. Thursday and Saturday, 9.30-11 a.m. Specialist in attendance 1st, 2nd and 3rd Wednesday at 10 a.m. Appointments made through County Medical Officer. Aural. Welling—Little Danson, Dansington Road. 1st and 5th Wednesday, 3rd Thursday, 1.30-4 p.m. Sessions increased to one per week (Tuesday morning) from 6.7.48. Appointments made from Office. Speech. Welling—Wrotham Road. Friday, 9.30-12 noon, 2-4 p.m. Appointments made through County Medical Officer. Child Guidance. Crayford—Woodside Road. Clinics held daily. Appointments made through County Medical Officer. 62 CO-ORDINATION. It has been our aim, during the year, to co-ordinate the work of the School Health Service with that of Maternity and Child Welfare with a view to ensuring continuity of supervision and treatment of children from birth to school leaving age. It was, therefore, a great help to have the School Health Service on a local basis so that the Medical Officers and Health Visitors in the child care services generally could exchange records and information to ensure the most efficient follow up of children when they pass from pre-school to school life. Periodic Medical Inspections. See Table 1. The successful carrying out of routine medical inspections was made possible by the excellent co-operation of Head Teachers and their staffs and it is true to say that this is now regarded as an integral part of the school curriculum. It is at these inspections that the greatest number of defects are discovered and where a great deal of information is obtained in regard to the school children by discussions with the parents. Generally speaking, it was found that entrants, 8-year-olds and 11-year-olds showed a uniformly high standard of personal hygiene. Clothing was good and clean and the incidence of skin diseases very low. In only a few cases was it necessary to record a defect in clothing or of footwear. The attendance of parents at routine medical inspections was good, being practically 100 per cent. in the case of entrants, but as might be expected there was a falling off in the case of senior children. There is no great change in the findings at routine medical inspections in the schools and the proportion of children classified as A, B and C remains roughly the same. Dental caries constitutes the principal cause of defect with Ear, Nose and Throat conditions remaining second on the list. Of the deformities, flat feet and genu valgum are decreasing in frequency and scoliosis is hardly ever seen. It is well worth reviewing the technique of routine examination from time to time and assessing its real value, as there is no doubt that few procedures can 63 become more automatic than this. The traditional methods of examination are sufficient for health assessment and the detection of defects with one or two simple additions which require no special apparatus and do not materially add to the time of examination. School Meals—1948. Average number of pupils in attendance:— Primary Schools 6,677 Secondary Schools 4,012 10,689 Average number of pupils taking meals daily: — Primary Secondary Free 136 170 Payment 3,043 2,636 3,179 2,806 Percentages. Primary Secondary (1) of numbers in attendance taking meals free 2% 4% (2) of numbers in attendance taking meals 47% 69% Percentage of total numbers taking meals 55 % Milk. Number of pupils taking Milk. Primary 6,233 Secondary 3,293 Total 9,526 Percentages. Primary 93% Secondary 79% Total 89% 64 Work of the Opthalmic Clinic. I am indebted to Mr. R. M. Chambers, the Specialist, for the following report: — During 1948, the work at this clinic was principally refractive. The absence of minor operative work was due, in part, to lack of instruments, difficulty in fitting-in general anaesthetics, and the fact that the days on which the clinic functioned, Thursdays and Fridays, left an interval of six days before which patients would be seen again, such a delay often being undesirable, especially in the treatment of inflammatory conditions. The provision of a Maddox Wing and Worth's Four Light apparatus has enabled more accurate prescribing and a satisfactory follow-up to be maintained. A number of cases were referred to ophthalmic hospitals for orthoptic treatment. This was sometimes a difficult decision to make in view of the strain imposed upon busy mothers by repeated journeys to London. There is an urgent need for such facilities in this area. The parents appear to have discharged a greater sense of responsibility to such measures as occlusion and home-exercises, though, occasionally, one still encounters the type that regards the School Medical Service as a deus-ex-machina, absolving them from any responsibility in the matter themselves. The delay in the provision of glasses after prescriptions have been submitted is very disturbing. Such delays introduce difficulties in prescribing the optimum corrections, especially for myopes. It has been my practice latterly to over-correct myopes, having due regard to the rate of change during previous years and to the probability of a four to six month delay in the provision of new glasses. A few unusual cases were seen and referred to ophthalmic hospitals for opinion and disposal. They included : — 1. High Myopia. Bilateral dislocated lenses—12.0 D. through aphakic segments—aged 8 years. 2. Congenital Retinal Folds in one eye. Seen by Professor Ida Mann and Mr. H. Ridley at Moorfields Hospital. 65 3. Congenital Macular colobomata. 4. Interstitial Keratitis. 5. Post Polar Cateract. 6. Infantile Glaucoma. I would like to record my satisfaction at the way the Ophthalmic Clinic has been administered by both clerical and nursing staff. Orthopaedic Clinic. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on the Orthopaedic Clinic: — Orthopsedic Clinics for school children have been held at Welling throughout the year, and a full attendance has been seen on every occasion—an average of between 40 and 50 patients being seen at each time. The minor disorders of the feet still predominate and there is plenty of scope for the establishment of a Chiropody Service for the treatment of these minor disabilities. Postural deformities form a second group of cases, and here the extension of school physical training instructors would materially ease the burden that still falls on the physiotherapist. Operations when necessary are now performed at the West Hill Hospital and the Southern Hospital, Dartford, and the bed situation has improved somewhat during the last year. The scheme for establishing a central clinic in the area for the treatment of spastics, is of vital importance and every encouragement should be given to this service. Dental Treatment. I am indebted to Mr. Wade, L.D.S., Dental Surgeon, for this report. In the age groups of 14-18 years there has been a very large increase of caries in upper incisor teeth and I am watching in the professional press for a like observation from other Boroughs. 66 I should have noted for your information that Mr. Dickson, the County Orthodontist, has paid several visits and selected many cases for treatment both for alignment of teeth and to cure mouth breathing. The design and execution of the appliance received from the County Laboratory as ordered by Mr Dickson have proved excellent and it was encouraging that the Medical Officer of Health found time to see many of these appliances actually in the patients' mouths. Mouth breathing still seems the chief cause of trouble with the orthodontic cases. The patients themselves have co-operated well in their rather trying ordeals of wearing oral appliances which many times hold their mouths open. I hold the view that much good work could be done if, say a few lectures could be given to parents concerning teeth and oral conditions generally as there can be no doubt that much ignorance remains with parents regarding these matters. In this connection I would like to suggest that the Senior County Dental Officer be approached to deliver these lectures. Cleanliness Inspections. (See Table V.) During the year the School Nurses carried out 24,282 examinations of children in Schools and 190 were found to have some infestation with vermin. In nearly all cases, the condition was cleared up by parents who were assisted, where necessary, by the School Nurses. The infestation rate is commendably low and speaks well for the standard of child care in the Borough. Physical Education. I am indebted to the Borough Education Officer for the following report. One of the most noticeable features in the physical education of the Borough Schools is the increasing desire of children to remove more clothing for physical education lessons. The cap-and-muffler lesson is, happily, not often seen. This is due, I feel, to the greater understanding and drive of the teaching staff, and to the greater knowledge of the parents, who see the value of movement unhampered by heavy clothes. 67 Bare-foot work is occasionally still regarded with suspicion, but on the whole, where the floors allow, it is realised that the sensitivity of the foot can be trained much more readily without shoes, and that it is not in this way that children catch cold. They are very soon warmed by the activity of the modern lesson. The design and improvisation of apparatus for "free exercise " is receiving constant consideration and experiments are being carried out in one or two schools in the Borough. Swimming. Bexley is unfortunate in that the only swimming bath available in the Borough is not covered in or heated and is consequently unusable for instruction during the greater part of the year. Arrangements have therefore to be made for pupils of the schools to use baths at Plumstead, Charlton, Eltham Park, Martens Grove in addition to the Danson Park pool. 11 Primary and 6 Secondary Schools took advantage of the opportunities thus provided. A few of the schools also continued swimming throughout the Winter season. The other schools in the Borough were prevented, in the main, by reasons of difficulty of access to the baths. Swimming certificates are issued to pupils completing successfully specified distances from 25 yards to half a mile, arranged by the Borough Bath Superintendent. Approximately •300 certificates were issued during 1948. 68 SCHOOL HEALTH SERVICES. Statistical Tables. Table I — Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. B. Other Inspections. C. Pupils found to require Treatment. Table II — A. Return of Defects found by Medical Inspection. B. Classification of the General Condition of Pupils Inspected during the year in the Age Groups. Table III — Group I. Minor Ailments. Group II. Defective Vision and Squint. Group III. Treatment of Defects of Nose and Throat. Group IV. Orthopaedic and Postural Defects. Group V. Child Guidance Treatment and Speech Therapy. Table IY — Dental Inspection and Treatment including Orthodontics. Table V — Infestation with Vermin. Table VI — Handicapped Children. 69 TABLE 1. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. — Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 1,211 Second Age Group 847 Third Age Group 948 Total 3,006 Number of other Periodic Inspections 967 Grand Total 3,973 B. — Other Inspections. Number of Special Inspections 4,097 Number of Re-Inspections 4,488 Total 8,585 C. — Pupils Found to Require Treatment at Periodic Medical Inspections. Group For defective vision (excluding squint) For any of the other conditions recorded in Table IIA Total individual pupils (1) (2) (3) (4) Entrants 7 215 218 Second Age Group 53 97 141 Third Age Group 60 130 177 Total (prescribed groups) 120 442 536 Other Periodic Inspections 82 147 213 Grand Total 202 589 749 70 TABLE II. A. — Return of Defects Found by Medical Inspection in the Year ended 31st December, 1948. Defect Code Defect or Disease No. PERIODIC INSPECTIONS SPECIAL INSPECTIONS No. of defects No. of defects Requiring treatment Requiring to be kept under observation, but not requiring treatment Requiring treatment Requiring to be kept under observation, but not requiring treatment 1 2 3 4 5 4. Skin 85 26 167 17 5. Eyes— a. Vision 202 69 66 4 b. Squint 32 48 9 – c. Other 34 12 124 7 6. Ears— a. Hearing 17 43 10 9 b. Otitis Media 15 33 82 19 c. Other 17 9 33 6 7. Nose or Throat 207 253 203 136 8. Speech 4 10 8 3 9. Cervical Glands 2 27 4 10 10. Heart and Circulation 19 34 10 18 11. Lungs 9 80 22 108 12. Developmental — a. Hernia 4 3 14 9 b. Other 1 — 1 2 13. Orthopaedic— a. Posture 19 24 3 8 b. Flat-foot 46 18 9 11 c. Other 118 73 25 15 14. Nervous system— a. Epilepsy — 7 — 5 b. Other 3 8 4 8 15. Psychological— a. Development 3 36 3 11 b. Stability — 20 41 37 16. Other 40 126 56 761 71 B. — Classification of the General Condition of Pupils Inspected during the Year in the Age Croups. Age Groups No. of Pupils Inspected A. (Good) B. (Fair) C. (Poor) No. % of col.2 No. % of col.2 No. % of col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 1211 354 29.23 820 67.71 37 3.05 Second Age Group 847 215 25.38 584 68.94 48 5.66 Third Age Group 948 228 24.05 671 70.78 49 5.16 Other Periodic Inspections 967 223 23.06 688 71.14 56 5.79 Total 3973 1020 25.67 2763 69.54 190 4.79 TABLE III.—Treatment Tables. Croup 1—Minor Ailments (excluding Uncleanliness, for which see Table V). (a) Number of Defects treated, or under treatment during the year. SKIN— Ringworm—Scalp— (i) X-Ray treatment — (ii) Other treatment 4 Ringworm—Body 60 Scabies 10 Impetigo 53 Other skin diseases 489 Eye Disease 302 (External and other, but excluding errors of refraction, squint and cases admitted to hospital.) Ear Defects 294 Miscellaneous 3,198 (e.g. minor injuries, bruises, sores chilblains, etc.). Total 4,410 (b) Total number of attendances at Authority's minor ailments clinics 14,598 72 Croup II—Defective Vision and Squint (excluding Eye Disease treated as Minor Ailments—Group I). No. of defects dealt with (1) Errors of Refraction (including squint) 1,177 (2) Other defect or disease of the eyes (excluding those recorded in Group 1) 14 Total 1,191 (3) No. of Pupils for whom spectacles were (a) Prescribed 565 (b) Obtained 204 Croup III—Treatment of Defects of Nose and Throat. Total number treated Received operative treatment— (a) for adenoids and chronic tonsillitis 144 (b) for other nose and throat conditions Received other forms of treatment 1 122 Total 267 Croup IV—Orthopœdic and Postural Defects. (a) No. treated as in-patients in hospital or hospital schools 14 (b) No. treated otherwise e.g. in clinics or out-patient departments 260 Croup V— Child Guidance Treatment and Speech Therapy. No. of pupils treated (a) under Child Guidance arrangements 60 (b) Under Speech Therapy arrangements 19 73 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 5,120 (b) Specials 627 Total (Periodic and Specials) 5,747 (2) Number found to require treatment 3,771 (3) Number actually treated 3,178 (4) Attendances made by pupils for treatment 6,750 (5) Half-days devoted to (a) Inspection 34 (b) Treatment 820 Total (a) and (b) 854 (6) Fillings: Permanent Teeth 1,630 Temporary Teeth 636 Total 2,266 (7) Extractions: Permanent Teeth 523 Temporary Teeth 4,273 Total 4,796 (8) Administration of general anaesthetics for extraction 914 (9) Other Operations (a) Permanent Teeth 1,203 (as above) (b) Temporary Teeth 691 Total (a) and (b) 1,894 Scalings 103 Cleaning 214 Polishing 210 Dressings Permanent Teeth 647 Temporary Teeth 691 Root Dressings 29 1,894 74 Attendances for mechanical appliances 358 Impressions Upper 47 Lower 37 Bites 20 Try-ins 7 Dentures Fitted—Upper 3 Appliances Fitted—Upper 22 Lower 1 Remakes— Upper 2 Repairs 4 Adjustments 168 TABLE V. Infestation with Vermin. (i) Total number of examinations in the schools by the school nurses or other authorised persons 24,282 (ii) Total number of individual pupils found to be infested 190 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) – (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) – 75 76 TABLE VI. Handicapped Children. In Special Schools In Maintained Prim, and Sec. Schools In Independent Schools Not in School Total Blind 1 – – — 1 Partially Sighted 4 1 1 – 6 Deaf 4 — — 1 5 Partially Deaf 1 1 — — 2 Delicate 9 35 — 2 46 Diabetic – – — — — Educationally Subnormal 18 58 — 8 84 Epileptic 2 ' — — — 2 Maladjusted 1 56 — — 57 Physically Handicapped 22 18 — 7 47 Speech Defects — 43 — — 43 Multiple Disabilities 5 8 — 7 20 Total 67 220 1 25 313 INDEX. ITEM PAGE Health Committee 2 Public Health Staff 3—4 STATISTICS AND SOCIAL CONDITIONS. Acreage 9 Population 9 Unemployment 9 Social Conditions and Amenities 9—10 Population Graph 11 Summary of Vital Statistics, 1948 12—13 Extracts from Vital Statistics— Births and Birth Rates, etc. 13 Stillbirths and Stillbirth Rates 14 Deaths and Death Rates 14—15 Births and Stillbirths in Wards 16 Deaths and Death Rates in Wards 16 Causes of Death 17 Deaths in Age Groups 18—19 Infantile Mortality 20 Maternal Deaths 21 GENERAL PROVISION OF HEALTH SERVICES. Isolation Hospital 21 General Hospitals 22 Ambulance Facilities 22 National Assistance Act, 1948 23 Public Mortuary 23 77 ITEM PAGE Clinics and Treatment Centres 24 Professional Nursing in the Home 25 Laboratory Facilities 25 Maternity and Child Welfare— Midwifery and Maternity Service— Ante-natal Clinics 25 Post-natal Clinics 25 Home Helps 25 Domestic Helps 26 Dental Treatment 26 Care of Illegitimate Children 26—27 Health Visitors and Clinics 27—28 Births Registered 28 Assisted Milk, etc. 29 Supply of Sheets for Expectant Mothers 29 Orthopaedic Treatment 29 Child Life Protection 29—30 Sunlight Clinic 30 Institutional Provision for Mothers— Maternity Home 30—31 Co-operation with General Practitioners 31 Consultant Services 31 Registration of Nursing Homes 31—32 Adoption of Children (Regulation) Act, 1939 32 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 33—34 Water Supply 34—35 Drainage and Sewerage 35 Rivers and Streams 35 Chief Sanitary Inspector's Report— Tables of Inspections and Improvements, etc. 36—38 Food Inspection 38 Tables—Factories Act, 1937 39 Closet Accommodation 40 Public Cleansing 40 Refuse Collection and Disposal 40 Salvage 40—41 Rats and Mice (Destruction) Act, 1919 41—42 Shops Acts, 1912—1936 42 78 ITEM PAGE Swimming Pool 42—43 Eradication of Bed Bugs 43 Camping Sites 43 Schools 43 HOUSING. Council Estates 44 Inspection of Dwelling Houses 44—45 Remedy of Defects without formal notice 45 Action under Statutory Powers 45—46 Public Health Act, 1936—Provision of Dust Bins 46 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 46 Meat Inspection 46 Adulteration of Food—Food & Drugs Act 47 Food Preparation Premises 47 Registration of Premises 47 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 48 Diphtheria 48 Diphtheria Immunisation 48 Enteric Fever 49 Puerperal Pyrexia 49 Ophthalmia Neanatorum 49 Measles 49 Whooping Cough 49 Acute Anterio Poliomyelitis and Polio-Encephalitis 49 Pemphigus 49—51 Scabies 51 Tables of Infectious Diseases Notified 52 Tuberculosis 53 79 ITEM PAGE SCHOOL HEALTH SERVICES REPORT, 1948. Welfare and School Services Sub-Committee 56 Staff 56—57 Schools 61 Clinics 61—62 Co-ordination— Periodic Medical Inspections 63 School Meals 64 Ophthalmic Clinic 65—66 Orthopa?dic Clinic 66 Dental Treatment 66—67 Cleanliness Inspections 67 Physical Education 67—68 Swimming 68 Statistical Tables 69—76 80