BEX 14 BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Service For the Year 1949 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 1949 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h. Medical Officer of Health Borough of Bexley. Mayor: Alderman Mrs. A. Welch, J.P. Deputy Mayor: Alderman J. Cronin, J.P. HEALTH COMMITTEE. Chairman: Councillor J. M. Pawson. Vice-Chairman: Councillor M. J. Corr. Alderman R. G. Broomfield. Councillor W. Carter. Alderman J. C. McLean, J.P. Councillor J. Duffus. Alderman Mrs. A. Welch, J.P. Councillor A. E. Fairman. Councillor L. H. Bridges. Councillor S. W. Tinham. PUBLIC HEALTH STAFF, 1949. Medical Officer of Health John Landon, M.R.C.S., L.R.C.P., D.P.H. (Joint appointment with Borough of Erith and U.D. Crayford from 1.4.49). Chief Sanitary Inspector, Public Cleansing Officer and Shops Acts Inspector. *† G. Hind, M.S.I.A. Deputy Chief Sanitary Inspector *† J. T Boocock. District Sanitary Inspectors *† F. W. Willington. *† G. F. Lovegrove. *† W. E. Moses Chief Clerk M. Bentley (Miss). G. A. Pearson (appointed 13.9.49). Senior Clerk G. A. Pearson (to 12.9.49). Clerks R. V. Hoad. M. E. Smith (Miss) (Shorthand Typist). E. M. Lawrence (Mrs.) (temporary from 21.11.49). Public Analyst M. E. Monk, B.Sc., F.R.I.C. * Certificate for Inspection of Meat and other Foods. † Certificate of Royal Sanitary Institute and Sanitary Inspectors' Joint Board. 3 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 1949. The year under review was the first complete year during which the National Health Service Act, 1946, was in operation and the present report contains no reference to the Part III Services transferred to the Kent County Council as Local Health Authority, with the exception of certain statistics supplied by the County Medical Officer. It soon became clear that, although much had been lost, the greater part remained and the year has been one of considerable activity. However, to meet the altered circumstances, the Councils of the Boroughs of Bexley and Erith and the Urban District of Crayford decided to appoint a Joint Medical Officer of Health as from the 1st April, 1949. It is believed that this arrangement has worked smoothly, although there has been some duplication of effort. To meet this the three Councils found it convenient to take joint action in certain health matters which affected them in common. In the early part of the year, the Councils of Erith and Crayford entered into an agreement with the Bexley Council for the joint use of the latter's Cleansing Station and, later in the year, it was decided to take joint action, also, in connection with a Clean Food Campaign for the combined area. Certain health education lectures given by the Medical Officer of Health were also undertaken by him for the combined district and the advantage of this was seen in the size of the audiences which was very satisfactory indeed. The vital statistics of the Borough have again been satisfactory, indicating that the health of the population has been well maintained. The birth rate at 14.02 per thousand of the population was lower than the rate for 1948, which was 15.36. When one considers that the rate for 1947 was 18.72 per thousand it is evident that there has been no reversal in the locality of the 4 tendency of the birth rate to fall which has been noticed during the past 40 years. The local birth rate was lower than the birth rate for England and Wales as a whole, which was 16.7 per thousand. The death rate at 8.15 per thousand of the population must be compared with a rate of 7.53 per thousand in 1948. For the first time for a number of years, the Registrar General has supplied us with a comparability factor which enables us to adjust the local death rate to make it comparable with that of other parts of the country and the adjusted death rate is 9.7 per thousand compared with an adjusted death rate of 11.7 for England and Wales. The infant mortality rate was 24 per thousand live births during 1949 compared with a record low rate of 19.03 per thousand during 1948; the rate compares well, however, with that for England and Wales which was 32 per thousand live births during 1949, a new low rate for the country as a whole. Once again, there were no deaths from infantile diarrhoea which indicates that there has, in recent years, been a great improvement in hygiene in the home and, for this, credit is in large measure due to the educational work of Health Visitors and others in the clinics and in the homes of the children. The maternal mortality rate was 0.78 per thousand total births (live births and still births) and although this is an increase on a rate of nil for 1948, it may still be regarded as satisfactory. The still birth rate increased from 21.5 in 1948 to 31.0l in 1949. There were no deaths from diphtheria, measles or scarlet fever and this is now becoming a regular feature of our health statistics. There was, in fact, only one case of diphtheria notified during the year. When one recalls that not so many years ago large numbers of children died from these diseases, there is reason for satisfaction in the present state of affairs. During 1949, 131 new cases of tuberculosis were notified as compared with 92 in 1948. It is not certain whether this increase is due to a higher infection rate or to better means of ascertainment, including mass radiography, but it can be stated quite definitely that tuberculosis is not decreasing, if indeed it is not actually on the up-grade. The death rate from this disease during 1949. was much the same as that for 1948, namely, 0.44 per thousand of the population. 5 During 1949, the three Councils referred to above embarked upon a joint Clean Food Campaign which, at the time of writing, has made considerable progress. A Food Traders' Guild has been formed, Codes of Practice are being formulated, and it is intended to issue clean food certificates to those traders who comply with the Codes of Practice which have been formulated. A comprehensive health education programme has been worked out with a view to bringing this important matter to the notice of the general public, who, it is hoped, will come to expect and demand the higher standards of food production and handling which we hope to achieve. Under the aegis of the Kent Paediatric Society, an investigation was commenced during 1949 into the incidence and causation of Health among school children of 10 to 11 years of age attending maintained schools in the Borough of Bexley". The definition of Health is that adopted by the World Health Organisation, namely, that Health denotes soundness of body, mind and personality. A great deal of work has already been carried out and, in due course, a report will be published which should be of considerable interest both locally and over a wider field. The housing position remains much as it was during 1948 and I should like to express my appreciation of the co-operation which we have received from the Housing Committee, particularly in regard to the re-housing of tuberculous families. Much prominence is being given, nowadays, to the problems of old people, many of whom require admission to hospitals. During the year a number of such cases were dealt with by the Health Department and it was possible to assist in obtaining their admission to hospital. The Woolwich Group Hospital Management Committee are doing everything in their power to increase accommodation in their hospitals for elderly persons and the position may be expected to improve. Attention is directed to that part of the report of the Chief Sanitary Inspector dealing with refuse disposal. The present land being used for this purpose at the Ivy Cottage site at East Wickham will provide tipping space for a period of something over 9 years, and there appears to be no other land in the area suitable for the disposal of refuse. 6 It is with great regret that I have to record the death of Miss Bentley who, for 30 years, was Chief Clerk of the Health Department. Her loss was deeply felt by her many colleagues and friends in the Borough. I wish to express my sincere thanks to the Members of the Health Committee for their help and encouragement and to the members of the Health Department for the excellent work which they carried out during the year. I am, Your obedient servant, JOHN LANDON, Medical Officer of Health. 7 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. New Dwellings Erected. Registrar General's Estimate midyear, 1949 89,270 Houses 138 Demolished Houses Rebuilt 73 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1,165 1938 (R.G.'s Estimate) 77,020 1,170 1939 80,110 1,002 1940 77,670, 113 1941 72,080 Nil 1942 77,020 5 1943 76,740 5 1944 71,130 Nil 1945 75,040 2 1946 85,820 82 + 64 rebuilt. 1947 87,670 199+ 216 rebuilt. 1948 88,920 334 + 286 rebuilt. Number of inhabited houses at end of 1949 (according to Rate Books) approximately 25,668 Rateable Value £623,628 Sum represented by a penny rate £2,580 Unemployment. Men Women Boys Girls Total December 31st, 1948 258 59 11 7 335 December 31st, 1949 210 55 15 17 297 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. 8 The Corporation supplied the district with electricity until the date of transfer of this service to the London Electricity Board, and the South Eastern Gas Board supplies gas. The following public open spaces have been provided by the Corporation:— Bexley Woods 26.00 acres Brampton Park Recreation Ground 4.21 „ Bursted Wood 30.47 „ Danson Park 210.0U ,, East Wickham Land 6.80 ,, Eastcote Gardens 1.00 „ Hall Place Park 171.32 „ Hudson Road Playing Ground 1.60 „ Hurst Recreation Ground 3.50 „ Ivy Cottage 6.50 ,, Oxleas Close .13 „ Palmar Gardens 1.30 „ Parkhurst Gardens .70 ,, Playground off Broadway (Proposed) 1.16 „ Riverside Walk 10.50 „ Russell Park 13.25 „ Rutland Shaw, Bexley 2.90 „ Sheldon Sports Ground 7.66 „ Shoulder of Mutton Green (L.C.C.) 3.86 „ Sports Stadium (Proposed) 7.03 „ Steeple Avenue and Danson Mead 1.50 „ * Stevens Park 9.55 „ St. Mary's Recreation Ground 12.86 „ The Green, Bexleyheath 1.10 ,, The Green, Welling 1.80 „ Total 536.70 „ * Reserved under agreement with J. Stevens—freehold, still to be acquired. Facilities for outdoor games are provided in many of these open spaces, including the large Swimming Pool in Danson Park, opened in July, 1936. 9 GRAPH SHOWING RISE IN POPULATION SINCE 1911 10 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 16.7(a) 18.7 18.0 18.5 14.02 Still 0.39(a) 0.47 0.40 0.37 0.45 Deaths- All Causes 11.7(a) 12.5 11.6 12.2 8.15 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Whooping Cough 0.01 0.02 0.01 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.45 0.52 0.42 0.52 0.44 Influenza 0.15 0.15 0.14 0.11 0.06 Smallpox 0.00 0.00 — — — Acute Poliomyelitis and Polioencephalitis 0.01 0.02 0.02 0.01 Pneumonia 0.51 0.56 0.49 0.59 0.44 Notifications (corrected) Typhoid Fever 0.01 0.01 0.01 0.01 — Paratyphoid Fever 0.01 0.02 0.01 0.01 — Cerebro-Spinal Fever 0.02 0.03 0.02 0.02 — Scarlet Fever 1.63 1.72 1.83 1.46 1.51 Whooping Cough 2.39 2.44 2.39 1.70 2.14 Diphtheria 0.04 0.05 0.04 0.07 0.01 Erysipelas 0.19 0.20 0.19 0.17 0.18 Smallpox 0.00 0.00 0.00 0.00 — Measles 8.95 8.91 9.18 8.54 6.71 Pneumonia 0.80 0.91 0.65 0.55 0.21 Acute Poliomyelitis 0.13 0.13 0.12 0.18 0.11 Acute Polioencephalitis 0.01 0.01 0.02 0.01 — Food Poisoning 0.14 0.16 0.14 0 19 0.09 Rates per 1,000 Live Births. Deaths All causes under one year of age 32(b) 37 30 29 24 Enteritis and Diarrhoea under two years of age 3.0 3.8 2.4 1.7 Rates per 1,000 lotal (Live and Still) Births. Notifications (corrected) Puerperal fever and Pyrexia 6.31 8.14 5.30 6.82 3.1 (a) Rates per 1,000 total population. (b) Per 1,000 related live births. A dash (—) signifies that there were no deaths. 11 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 0.11 0.71 Abortion:—Mortality per million women aged 15-44 in England and Wales. No. 140 with Sepsis. No. 141 Without Sepsis. 8 4 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1949. The Registrar General's Estimate of resident population for the mid-year is 89,180 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 650 600 1,250 Legitimate 633 587 1,220 Illegitimate 17 13 30 Birth Rate. Rate per 1,000 estimated resident population 14.02 The following relates to the Birth Bate during the past ten years:— 1939 Birth Rate 17.76 per thousand 1940 „ „ 16.46 „ 1941 „ „ 15.88 „ 1942 „ „ 19.07 „ 1943 „ „ 18.03 „ 1944 „ „ 21.06 „ 1945 „ „ 18.81 „ 1946 „ „ 19.75 „ 1947 „ „ 18.72 „ 1948 „ „ 15.36 „ Rate per 1,000 for England and Wales, 1949 16.7(a) „ „ „ „ County Boroughs and Great Towns including London 18.7 „ „ „ „Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 18.0 „ „ „ „ London Administrative County 18.5 (a) Rate per 1,000 Total Population. 12 Thirty illegitimate live births were registered against forty-six in 1948. Stillbirths. Males Females Total Total 22 18 40 Rate per 1,000 total (live and still) births 31.01 The following relates to the Stillbirth Rate during the past ten years:— Rate per Thousand Year Total Live and Still Births Population 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 1948 21.5 0.34 Forty Stillbirths were registered during the year. This represents a rate of 0.45 per 1,000 population against 0.34 per 1,000 population in 1948. Rate per 1,000 for England and Wales, 1949 0.39(a) „ „ „ „ County Boroughs and Great Towns, including London 0.47 „ „ „ „ Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 0.40 „ „ „ „ London Administrative County 0.37 One Stillbirth was registered as illegitimate. 13 (a) Rates per 1,000 Total Population. Deaths. Males Females Total All causes 371 356 727 Death rate per 1,000 of estimated resident population 8.15 Number of women dying in, or in consequence of, childbirth: From Puerperal and Post Abortive Sepsis — From other Puerperal Causes 1 Death rate per 1,000 total (live and still) births 0.78 Deaths of Infants under one year of age 15 15 30 Legitimate 14 14 28 Illegitimate 1 1 2 Death rate of Infants under one year of age: Total per 1,000 live births 24 Legitimate per 1,000 legitimate live births 22.95 Illegitimate per 1,000 illegitimate live births 66.67 Deaths from Measles (all ages) — — — „ „ Whooping Cough (all ages) — 1 1 „ „ Diarrhoea (under 2 years of age) — — — ,, ,, Cancer (all ages) 57 71 128 Death Rate of Country: — Rate per 1,000 for England and Wales, 1949 11.7(a) „ „ „ „ County Boroughs and Great Towns, including London 12.5 „ „ „ „ Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 11.6 „ „ „ „ London Administrative County 12.2 14 (a) Rate per 1,000 Total Population. Death Rate of Area during last ten years: — 1939 7.98 per thousand 1940 10.40 „ „ 1941 9.68 „ „ 1942 8.73 „ „ 1943 9.21 „ „ 1944 10.20 „ „ 1945 9.28 „ „ 1946 8.55 „ „ 1947 9.17 „ „ 1948 7.53 „ „ 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 164 10.94 St. Mary's 117 7.22 Brampton 116 8.01 Danson 115 9.19 Falconwood 73 5.49 St. Michael's 142 8.01 Total 727 The rate for Bexley compares favourably with that for other parts of the country. The Registrar-General has supplied a comparability factor for 1949. The standardised death rate which allows for comparison with other parts of the country is 9.70. 15 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1949. Causes of Death. M. F. Total All Causes 371 356 727 1 Typhoid and Paratyphoid Fevers — — — 2 Cerebro-spiual Fever — — — 3 Scarlet Fever — — — 4 Whooping Cough — 1 1 5 Diphtheria — — — 6 Tuberculosis of respiratory system 22 11 33 7 Other forms of tuberculosis 3 3 6 8 Syphilitic diseases 2 2 4 9 Influenza 3 2 5 10 Measles — — — 11 Acute poliomyelitis — — — 12 Acute infectious encephalitis — — — 13 Cancer of body cavity and Oesophagus (M.) and uterus (F.) 4 8 12 14 Cancer of stomach and duodenum 8 8 16 15 Cancer of breast — 16 16 16 Cancer of all other sites 45 39 128 17 Diabetes 2 1 3 18 Intracranial vascular lesions 29 47 76 19 Heart Disease 109 100 209 20 Other diseases of circulatory system 31 16 47 21 Bronchitis 21 14 35 22 Pneumonia 16 23 39 23 Other respiratory diseases 4 2 6 24 Ulcer of stomach or duodenum 8 3 11 25 Diarrhoea under two years — — — 26 Appendicitis 1 — 1 27 Other digestive diseases 4 9 13 28 Nephritis 5 4 9 29 Puerperal and post abortive sepsis — — — 30 Other maternal causes — 1 1 31 Premature Birth 4 6 10 32 Congenital malformation, birth injuries and infant diseases 8 7 15 33 Suicide 2 7 9 34 Road traffic accidents 8 2 10 35 Other violent causes 5 3 8 36 All other causes 27 21 48 16 INFANT MORTALITY, 1949. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1949 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 1 Broncho-pneumonia ... 1 1 1 2 4 Congenital Malformation, Premature Birth, Birth Injury, etc. 14 14 1 1 16 Atelectasis 6 6 6 General Peritonitis Gangrene of small bowel Volvulus of mid gut 1 1 1 Asphyxia neonatorum Atelectasis Placenta Praevia 1 1 1 Erythroblastosis Foetalis Prematurity 1 1 1 Totals 22 2 24 1 1 4 30 The number of infants under one year of age who died during the year 1949 as shown by the table is 30. 24 of these deaths, that is 80 per cent., occurred in the neonatal period (within one month of birth). In 1948 the corresponding figure was 68 per cent. 17 3D were registered during the year giving an infantile mortality rate per 1,000 live births of 24. Rates over previous years have been:— 1939 40.1 per 1,000 live births 1940 45.4 „ „ „ „ 1941 35.4 „ „ „ „ 1942 32.7 „ „ „ „ 1943 26.01 „ „ „ „ 1944 31.37 „ „ „ „ 1945 33.9 „ „ „ „ 1946 29.5 „ „ „ „ 1947 28.6 „ „ „ „ 1948 19.03 „ „ „ „ Maternal Deaths. There was 1 maternal death during the year giving a maternal mortality rate of 0.78 per 1,000 live and stillbirths. Rates over previous years have been:— 1938 0.67 per 1,000 live and stillbirths 1939 0.69 „ „ „ „ „ 1940 0.79 „ „ „ „ „ 1941 2.77 „ „ „ „ „ 1942 1.32 „ „ „ „ „ 1943 1.44 „ „ „ „ „ 1944 1.30 „ „ „ „ „ 1945 nil „ „ „ „ „ 1946 1.73 „ „ „ „ „ 1947 1.19 „ „ „ „ „ 1948 Nil „ „ „ „ „ 18 SECTION B. CENERAL 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. Patients suffering from infectious disease are now admitted to hospitals controlled by the Woolwich and Dartford Hospital Management Committees. General Hospitals. Provisions made by S.E. Metropolitan Regional Hospital Board. AMBULANCE FACILITIES. The provision of these facilities now rest with the Kent County Council as Local Health Authority. NATIONAL ASSISTANCE ACT, 1948. Action taken under Section 47. It was not necessary during the year under review to take statutory action under this Section. 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 62 occasions and 48 post-mortem examinations were made. 14 inquests were held. 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. 19 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 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 — 20 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. List cf Adoptive Acts, etc., in force. Acts. Date Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 Public Libraries Act, 1892-1919 Oct 1893 Private Street Works Act, 1892 Jan. 1899 Public Health Acts Amendment Act, 1907, Parts 8 and 9 Apr. 1909 Part 2—the whole May 1909 „ 4—Sees. 53 and 54 „ 6—the whole „ 10—Sec. 95 Public Health Act, 1925, Part 2 Jan. 1926 Slaughter of Animals Act, 1933 Jan. 1934 Byelaws. Wireless Loudspeakers, Gramophones, etc. Mar. 1939 Fouling by Dogs of Footways 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 „ Nursintr Homes June 1940 Sale of Contraceptives in Slot Machines Dec. 1949 The Byelaws relating to: Cleansing of Earth Closets and Cesspools: Common Lodging Houses; Hop Pickers' and Fruit Pickers' Lodgings; Cleansing of Privies; Removal of Offensive and Noxious Matters; Nuisances; 21 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 Bexley district is derived from several sources, namely, "Wilmington, Darenth, Wansunt, Crayford, Bexley and Deptford wells, and Thames-derived filtered water. All the water is chlorinated as it leaves the works. Bacteriological analyses are made five times per week of all supplies and, as in 1948, completely satisfactory results have been obtained. In the case of the well supplies the water is sampled both before and after chlorination. Water derived from the River Thames is sampled at each stage of the purification process. Tanks to provide an adequate period of contact of the chlorine with the water are now in operation at Wilmington, Crayford, Bexley and Deptford. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically. The examination of samples of water from piped supplies to houses at least monthly has given the following results:— Bacteriological. No. of organisms per c.c. capable of growth on Agar at: B. coli presumptive Absent in 100 c.c in all samples 37° C. 22° C. 0-16 0-12 22 (ii) Drainage and Sewerage. The following foul and surface water sewers were laid during the year:— Halcot No. 2 Estate— 393 lin yds. 7" Foul Sewer. 30 lin yds. 18" S.W. Sewer. Sutherland Avenue— 90 lin yds. 9" S.W. Sewer. Wickham Street— 267 lin yds. 15" Foul Sewer (relaying sewer). Townley Road— 283 lin yds. 9" S.W. Sewer. 168 lin yds. 12" S.W. Sewer. 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 1949. The report consists mainly of a tabulated record of work carried out by the Sanitary Inspectors. TABLE No. 1. Number of complaints received and investigated 550 Number of informal notices, letters, etc. ... 805 23 TABLE No. 2. Details of Inspection Work Carried Out. Inspections Re-inspections Houses inspected (all particulars recorded) 29 51 Houses inspected (defects only recorded) 404 1,617 Houses inspected (Housing Act, 1936, Overcrowding) 178 22 Houses inspected re Infectious Disease (including Scabies) 387 140 Factories with mechanical power 143 49 Factories without mechanical power 57 7 Schools 5 — Refuse Tips 344 — Bakehouses 94 23 Outworkers 59 — Food Shops and Premises where food is prepared 1,965 101 Cowsheds and Dairies 81 5 Ice Cream Premises 269 20 Fried Fish Premises 244 9 Common Lodging Houses 32 — Tents, Vans and Sheds 15 — Offensive Accumulations 81 45 Keeping of Animals 155 57 Rats 152 100 Verminous Premises 68 69 Insufficient Ashplace Accommodation 101 109 Drains Inspected 1,121 1,001 Drains Tested (water, smoke or colour) 91 10 Visits re Refuse Removals and Salvage 605 — Miscellaneous Inspections 1,639 173 Food and Drugs Act re Samples 303 — Shop Acts, 1912-1936 1,235 23 24 TABLE No. 3. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 57 Provided with sufficient ashplace accommodation 40 Provided with sufficient water supply 19 Houses Improved Internally— Dirty rooms cleansed 120 Walls and ceilings repaired 508 Dampness in rooms remedied 161 Defective floors repaired 44 Ventilation of rooms improved 24 Windows repaired 121 Coppers repaired 1 Stoves, fireplaces, etc., provided or repaired 54 Houses Improved Externally— Roofs repaired 125 Eaves, gutters and down spouts fixed or repaired 91 Yards paved or repaired 10 Chimney stacks repaired 21 Walls repointed or repaired 64 Miscellaneous repairs 103 Drainage— Drains cleansed or repaired 585 New drains constructed 15 New Gullies provided 6 Ventilation of drainage system improved 5 Inspection chambers built or improved 15 New sinks provided 8 Waste pipes provided or improved 10 Offiensive accumulation removed 17 Nuisances from animals abated 5 Other nuisances abated 6 TABLE No. 4. Infectious Diseases. Cases removed to Isolation Hospitals 63 Houses visited including revisits 527 Rooms disinfected 50 Notices delivered to Education Authorities, etc. 366 Houses at which defective sanitary conditions were found Nil 25 TABLE No. 5. Food Inspection. The following is a summary of unsound food surrendered. Beef lbs. l,200 3/4 Meat tins 174 Corned Beef 9 9 486 3/4 Fish 9 9 448 Corned Mutton 9 9 24 Milk 9 9 757 Sausage Rusk 9 9 12 Vegetables 9 9 572 Sausage Meat 9 9 10 Preserves 9 9 224 Mutton and Lamb 99 4,006 Soup 9 9 97 Fruit and Fruit Juices 9 9 270 Luncheon Meat 9 9 4 Poultry 9 9 120½ Pastes 9 9 49 Rabbits 9 9 7 3/4 Fruit Puddings 9 9 2 Offal 9 9 32 Black Pudding 9 9 6 Dried Egg 9 9 3 Fish 9 9 2,373 Apple Puree jars 317 Cheese 99 147½ Soup pkts 174 Fats 9 9 44 Sweet Fats 5 Flour 9 1 120 Cereals 64 Suet 9 9 20 Eggs 207 Bacon 9 9 48½ Crumpets 88 Cereals 9 9 4 Rolls 42 Pearl Barley 9 9 448 Steak Pies 3 Figs 9 9 33 Fish Cakes 36 Vegetable Rusk 9 9 5 Pickles & Sauces— bottles & jars 390 Peel 9 9 6 Confectionery 9 9 75 3/4 Miscellaneous Items 63 Cake 9 9 15½ 26 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 297 3 — Factories without mechanical power 135 1 — "Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) *Electrical Stations should be reckoned as factories. 13 — — Total 445 4 — 2. Defects Found. Particulars. 1 Number of Defects. Number of Prosecutions. 5 Found. 2 Remedied. 3 Referred to H.M. Inspector. 4 Want of cleanliness (S.l) 4 4 — — 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 11 9 — — Not separate for sexes Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 2 2 — — Total 18 16 — — 27 Closet Accommodation. With the exception of a few houses, all the closet accommodation in the Borough is on the water carriage system. Public Cleansing. Eight cesspools were emptied a total of 21 times. Refuse Collection and Disposal. During the year two S. & D. Dust Carts were purchased to replace two of the old freighters, and an order was also placed for two further vehicles for deliverv in 1950. A weekly collection of refuse was reasonably well maintained during the year, although there was some delay on one or two occasions due to weather conditions and sickness. All refuse collected was disposed of by controlled tipping at the Ivy Cottage Site at East Wickham. Further land is being acquired adjoining this tip, but before tipping can be carried out it will be necessary to culvert a stream running through the valley. It is intended to level off this valley in order to provide playing fields, and will provide tipping space for a period of something over 9 years. So far as I am aware, there is no other land in the area suitable for the disposal of refuse, and the Council will be faced with this problem in a few years time. A muledozer was acquired during the year for dealing with refuse at the tip, and this has provided a very useful asset in the efficient disposal of refuse. Salvage. In common with many other Local Authorities, some difficulty was experienced towards the end of the year in the disposal of waste paper, and for a time the merchants restricted the sales to a maximum of 5 tons per week. This resulted in a large stock of waste paper accumulating at the Depot, but early in 1950 this restriction was removed and the whole of the stock was sold. Kitchen waste is collected by means of some 425 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. 28 The revenue from salvage sales during the year was £5,226 Is. 2d. made up as follows: — Tons cwts. qtrs. £ s. d. Waste Paper 452 7 0 2,818 16 7 Textiles 45 4 2 705 10 2 Bones 16 2 4 16 2 Kitchen Waste 629 5 0 1,321 5 2 Ferrous Metals 42 4 1 92 10 10 Non-Ferrous Metals 2 8 2 68 3 3 Bottles and Jars 4 17 1 13 3 8 Miscellaneous 2 0 0 1 0 0 1,179 3 0 5,025 5 10 Waste Paper Collection Allowance (Ceased 30.6.49.) 27 11 3 Kitchen Waste Collection Allowance (Ceased 30.4.49.) 173 4 1 5,226 1 o RATS AND MICE (DESTRUCTION) ACT, 1919. INFESTATION ORDER, 1943. The Council employ one full-time Rodent Operative for the treament of surface infestations, and the test haiting and maintenance treatment of sewers is carried out by men under the control of the Borough Engineer. The cost of disinfestation work carried out at business premises is charged to the occupiers, but the Council give a free service to private dwelling houses. Infestations found during the year were mostly of a minor character, and a good proportion were at private houses where fowls, ducks, etc., were kept. Number of premises treated during the year. Local Authority's premises 9 Business premises 15 Private dwellings 282 One treatment was carried out at Bursted Wood Tip during the year, but periodic inspections of the refuse tip at East Wickham have not shown any evidence of infestation. 29 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 1,258 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. Results. (Maximum and minimum numbers of organisms.) No. of organisms per c.c. capable of B. coli growth on Agar at: presumptive 37° C. 22° C. Deep end 2 - 38 2 - 24 Absent Shallow end 0 - 136 3 - 375 Absent 30 Eradication of Bed Bugs. Number of bouses found to be infested:— (a) Corporation bouses 12 (b) Other bouses 11 All infestations were dealt with by the Department by spraying, etc., and the results obtained were satisfactory. Camping Sites. A camping site used by Rover Scouts and Woodcraft Folk in H all 1 lace w as 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. 31 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 118 — Carlton Road 16 — Dovedale Close 14 — East Wickham — Glenmore Road 116 — Bexleyheath — Highland Road Estate and Pickford Road Estate (including bungalows) 306 Cannon Road — 28 Alers Road 84 — : 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 — : Rye Close and Extension 38 — : Glenhurst Avenue 22 — : 1,498 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) 433 (b) Number of inspections made for the purpose (including re-inspections) 2,101 (2) (a) Number of dwelling houses cluded under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 1925 to 1932 29 32 (b) Number of inspections made for the purpose (including re-inspections) 80 (3) Number of dwelling bouses to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 (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 351 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 ... 280 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 — (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners 1 (b) .By local authority in default of owners — B. Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 48 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 59 (b) By local authority in default of owners — 33 C. Proceedings under Sections 11 and 13 of Housing Act, 1936— (1) Number of dwelling bouses in repect of which Demolition Orders were made — (2) Number of dwelling houses demolished in pursuance of Demolition Orders 7 D. Proceedings under Section 12 of the Housing Act, 1936— (1) Number of Closing Orders made 2 Public Health Act, 1936. Section 75. Provision of Dustbins. Notices served requiring provision of bins 7 Number complied with— (a) by Owners 1 (b) by Local Authority in default of Owners 3 Bins provided in consequence of informal action 36 34 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The milk retailed for consumption in the area is all pasteurised and bottled, with the exception of a small quantity produced by a producer retailer. Licences granted by the Council under Milk Special Designations Order, 1936 to 1946, and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. Dealers' Licences: — Pasteurised Milk 16 Tuberculin Tested Milk 9 Sterilised Milk 20 Supplementary Licences: — Pasteurised Milk 4 Tuberculin Tested Milk 3 Sterilised Milk 3 No. of cowsheds in district 1 (b) Meat Inspection. The slaughterhouses in the area remained closed during the year. (c) Adulteration ot Food, Food and Drugs Act, 193s. The following table summarises the 251 samples taken during the year. Formal Informal Milk 48 — Soups, Meat Extracts, etc. 6 4 Meat and Fish Pastes, etc. — 2 Pudding or Cake Mixture, Flour, etc 3 4 Jellies, Custard Powders, etc. 5 4 Patent Medicines, etc. 8 7 Beverages 7 8 Sausages, Sausage Meat, etc. 16 2 Fruit and Fruit Juice 8 9 Cream of Tartar — 1 Malt and Chocolate Spread 2 3 Cereals 7 — Spaghetti 1 — Vita Crunch — 1 Sweets 3 3 Cake 3 7 Lime Flavour Compound — 1 Yeast — 1 Cocktail Cherry — 1 35 Formal Informal[/$$$] Milk Food Half Cream — 2 Dry Ginger Ale — 1 Cooking Fat 2 — Meat Pies 4 — Vermicelli 1 — Lemonade Powder 1 — Gelatine 1 1 Ground Ginger 1 1 Full Cream Condensed Milk — 4 Lentils 1 — Fish — 1 Ice Cream — 13 Beer, Wines and Spirits 5 2 Potato Crisp — 2 Baking Powder 1 — Fruit Salt I — Saccharin — 1 Artificial Cochineal Colouring — 1 Condiments, Sauces, Spices, etc. 8 17 Miscellaneous 2 2 No legal proceedings were instituted during the year, (d) Food Preparation Premises. During the year 2,066 visits were made to restaurants, food shops and premises where food is manufactured for sale. The following is a summary of various improvements carried out at these premises. Hot water supply provided or improved 26 Sinks provided 2 Floors, walls, ceilings, etc., repaired 5 Rooms cleansed 9 W.C. accommodation improved 2 Water closets cleansed or repaired 1 Drains cleansed or repaired 12 Dirty yards cleansed 1 Accumulation of refuse removed Accommodation for storage of refuse improved 3 Nuisance from animals abated 1 Registration of Premises under Food and Drugs Act, 1938. No. of premises registered for: — Sale or Manufacture of Ice Cream Sale of Ice Cream 93 Preparation of Sausages, etc 42 48 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. 36 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fewer. During the year 135 cases were notified as compared with 146 the previous year. Of these 45 were isolated in Bow Arrow Hospital and other Hospitals and 90 were isolated at home. No. of deaths Nil Return cases from Hospital cases 1 Return cases from home nursed cases 1 During' the past 15 years the character of this disease has changed from one of considerable severity to one characterised by its extreme mildness. The acute stage is, nowadays, in most cases, short and unaccompanied by high pyrexia and complications are in most cases mild or completely absent. Scarlet fever can now be disregarded as an important cause of acute endocarditis and acute nephritis which, in the past, were frequently encountered. Diphtheria. One case was notified as compared with two in the previous year, and was isolated in Bow Arrow Hospital. There were no return cases and no deaths. The following figures on Immunisation and Vaccination have been supplied by the County Medical Officer: — 37 38 Immunisation against Diphtheria and Vaccination against Smallpox, 1949. The following is a return of (A) the number of children resident in the Borough of Bexley who were immunised against diphtheria and (B) the number of persons who were vaccinated against smallpox, during the year ended 31st December, 1949:— (A) Diphtheria Immunisation. Year of Birth 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 Total Primary Inoculations 163 1017 100 43 23 58 65 26 25 11 12 8 2 1 1554 Reinforcing Inoculations — — — — 68 649 464 136 83 109 117 92 2 3 2 1725 (B) Vaccination. Age at 31st December, 1949 Under 1 1 to 4 5 to 14 15 or over Total Number Vaccinated 442 284 34 45 805 Number Re-Vaccinated — 3 10 100 113 Immunisation against Diphtheria, 1949. The following is a return of the number of children resident in the Borough of Bexley under the age of 15 years on 31st December, 1949, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1935). Year of Birth 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 Total 954 1068 1082 1178 1117 1018 991 1080 1163 1249 1123 1069 1293 1140 164 15,689 Enteric Fever. There were no cases notified during the year. Puerperal Pyrexia. Four cases were notified during the year, of which three were from the Bexleyheath Maternity Home, where they were isolated and treated. One case was isolated and treated in the British Hospital for Mothers and Babies, Woolwich. Ophthalmia Neonatorum. There were no cases notified. Measles. 598 cases were notified. 3 cases were treated in hospital, 1 at Bow Arrow and 2 in other Hospitals. There were no deaths. Whooping Cough (Pertussis). 191 cases were notified, none of which were treated in hospital. There was 1 death but the case was not notified. Acute Anterior Poliomyelitis. 10 cases were notified and 7 were treated in hospital. There were no deaths. Scabies. 26 cases were notified. 53 patients and contacts had two treatments at the Corporation Cleansing Station and 23 had one treatment. Food Poisoning. During the year 8 cases of mild food poisoning occurred apparently as a result of the ingestion of Shellfish obtained from sources on the Thames Estuary. Posters were displayed drawing the attention of the public to this danger. 39 40 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 1949. 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 15 15 to 25 25 and over Age unknown Smallpox __ Scarlet Fever 135 11 23 89 9 — 3 — 45 — Diphtheria 1 1 1 — Puerperal Pyrexia 4 4 Pneumonia 19 3 1 i 14 — 4 — Acute Poliomyelitis 10 3 2 — 2 i 2 — 7 — Erysipelas 16 — — — 2 14 — 3 — Malaria 1 1 — Pood Poisoning 8 I 7 Measles 598 17 119 165 278 11 4 4 3 — Whooping Cough 191 16 46 54 64 5 1 5 — — — Scabies 26 1 — 1 5 5 3 8 3 — — Totals 1009 34 183 246 437 32 13 61 3 63 1 TUBERCULOSIS. During the year 131 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1949 are contained in the following table: — Age Period New Cases Deaths llespiratory Noil Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. 0—1 — — — — — — — — 1— 5 2 1 — — — — — — 5—10 1 2 3 — — — 1 — 10—15 1 3 — 1 1 — — — 15—20 11 12 1 1 2 1 — — 20—25 11 12 — — 1 2 — — 25—35 15 17 — — 5 3 — — 35—45 12 5 — 1 2 3 2 — 45—55 9 — — 1 o — — 1 55—65 6 — — — 5 — — 1 65 and upwards 1 2 — — 1 2 — 1 Totals 69 54 4 4 22 11 3 3 The number of non-notified Tuberculosis deaths was 8. Pulmonary. Non-Pulmonary. Total MP M F No. on Register at commencement of year 412 299 67 67 845 No. on Register at end of year 454 329 68 69 920 Rehousing. 4 cases were referred to me by Tuberculosis Officer for rehousing and in two cases the families were rehoused by the Housing Committee. 41 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1949 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: Councillor J. M. Pawson. Vice-Chairman: Miss M. Woodward. Alderman R. G. Broomfield Councillor A. P. Charlton Councillor M. J. Corr Councillor H. A. Fergusson Councillor A. W. Lanyon Councillor A. S. Masey Co-opted Members: Miss D. C. Collins Revd. H. Charleston STAFF 1949 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 Assistant Medical Officers Ophthalmic Surgeon Aural Surgeon Orthopaedic Surgeon Dental Officers Orthodontist Health Visitors Physiotherapist Speech Therapist Dental Attendants School Health Service Clerk General Clerks John Landon, M.R.C.S., L.R.C.P., D.P.H. Arthur James Dalzell-Ward, M.R.C.S., L.R.C.P., D.P.H. (Resigned 31.12.49). Robert Bruce Killoh, M.B., Ch.B., D.P.H. (Part time). Nora Kelly, M.B., B.Ch., B.A.O., D.C.H. (Part time) (Appointed 9.5.49). Roland M. Chambers, M.B.B.S., D.O.M.S. W. MacGregor, O.B.E., V.D., M.B. K. F. Hulbert, F.R.C.S. H. Wade, L.D.S. P. Middleton, L.D.S. (Part time) (Resigned 26.3.49). T. A. Hall, L.D.S. (Part time). Gordon Charles Dickson, L.D.S. 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). Miss R. Cheeseman, M.C.S.P., M.S.R. Mrs. D. Rant, L.C.S.T. Mrs. I. Birtchnell. Miss K. M. Dunkley. Miss M. C. A. Smith. Miss C. E. Anderson. Miss E. Pearmine. 45 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1949. To the Chairman and Members of the W elf are and School Attendance Sub-Committee. Ladies and Gentlemen, I have the pleasure to present my Annual Report for the year 1949, during which period the work of the School Health Service was fully extended. The position in regard to the provision of dental services did not improve owing to our inability to replace the dentist who resigned on the 30th September, 1949. An attempt was made in the latter part of the year to try and deal, to some extent, with the serious limitation in the amount of dental work being carried out by enlisting the help of private dental practitioners and this was done with some success. Briefly speaking, eight private dentists agreed to devote a proportion of their time to the treatment of school children, either at the school clinics or at their private surgeries, as a gesture which recognised the principle that children are among the urgent priority classes for dental treatment. Although this scheme has now been terminated owing to a number of factors outside our control, a considerable amount of dental work was carried out and the thanks of the Committee for Education have been sent to the dentists concerned for their generous and public-spirited action. Towards the end of the year, the second of the County Mobile Dental Units took up its headquarters at the Murchison Avenue Clinic where it stayed for a period of approximately 6 months and carried out a considerable amount of work for the children living in the Old Bexley district of the Borough. The position in regard to the provision of spectacles for school children tended to improve during the year, partly as a result of the slowing down of the initial rush on the part of the public to obtain glasses and partly to improved organisation on the part of the supplying opticians who have been most co-operative in dealing with urgent cases. During the year, in spite of the small incidence of acute anterior poliomyelitis (infantile paralysis) in the Borough, the Ear, Nose and Throat surgeons of the Woolwich and Dartford Hospital Management 46 tees again agreed to suspend operations for the removal of tonsils and adenoids and although opinions differ as to the stage at which this precaution should be taken, it is generally felt that it is better to err on the side of safety even though this may mean some dislocation of the hospitals' admission lists. There were no serious epidemics during the year and the health of the school children has, on the whole, been satisfactory. It is generally agreed that the standards of clothing and cleanliness among the children is very high in the Borough and there is a great deal of evidence that maternal care as well as the high level of employment are responsible for this. It is appropriate, also, to point to the low incidence of skin infections among the children, although some difficulty has been experienced in regard to plantar warts. This has not assumed serious proportions, however, owing to the co-operation of Head Teachers and others concerned in giving suitable attention to foot cleanliness and the careful supervision and disinfection of plimsolls used in physical training classes. Attention is drawn to the report of Mr Hulbert, the Orthopaedic Surgeon, on page 53, in which he states that the principal obstacle to the relief of the very large waiting lists is due to lack of accommodation at the Station Road Clinic, and that steps should be taken to find larger premises where the size of classes for exercises could be increased. During the year, Dr. R. Bruce Killoh has given several series of lectures on medical biology, including anatomy and physiology, personal environmental and sex hygiene, to senior pupils of the Bexleyheath County Modern Boys School. These lectures are important and it is, largely, due to limitations of staffing and time that we are not able to do more in regard to health education in schools. It is, however, an ideal which must be constantly borne in mind. Once again, during the year it was possible to admit a large number of children to convalescent homes and open air schools and for these valuable facilities I acknowledge with thanks the help which we received from the Education Department. One result, not altogether beneficial either from the point of view of child health or the National Exchequer, of the increased interest taken by the public in matters of health, is the exaggerated importance placed by the 47 public on the need for vitamin supplements for their children. While these have an undoubted place in prevention and treatment, it must from time to time be emphasised that the best source of vitamins is a carefully balanced diet which includes fresh fruit and vegetables and the body-building foods like butter, eggs, meat and fish. At the school clinics considerable quantities of vitamin supplements are distributed under careful medical supervision and it is, often, necessary to curb the avidity of the public demand for such preparations. Attention is drawn to the foreword to the Health Committee section of this Report, in which further information is given in regard to the investigation which is being carried out on the health of school children. The demand for child guidance treatment is on the increase and a very large number of cases was referred to the Crayford Clinic. I should like to express my appreciation of the co-operation and help received from Dr. E. Wellisch, Psychiatrist, who kindness in seeing urgent cases at very short notice has been a great help The success of the School Health Service depends on team work in which a large number of workers participate and once again it is my pleasant duty to record the help and co-operation which I have received from all concerned. Finally, 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, from the Borough Education Officer, and from all members of the staff whose painstaking attention to the details of their tasks is ultimately responsible for any success which the School Health Service has achieved during the year. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, John Landon, Medical Officer of Health. 48 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Six County Secondary Schools with seven departments. Average number on Roll at 31st December, 1949 3,410 Twenty-three County Primary Departments. Average number on Roll at 31st December, 1949 6,912 One Nursery Class attached to Uplands Primary School. Average number on Roll 44 Bexley County Technical School for Girls. Average number on Roll: Bexley 800 Wilmington Annex 190 Total 11,356 Clinics. Minor Ailments. Welling—Little Danson, Dansington Road. Tuesday and Wednesday, 2-4 p.m. Monday 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—Friday. Dental. Welling—Little Danson, Dansington Road. By appointment. 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. Cravford—Woodside Road. Monday, Tuesday and Wednesday,9.30-11 a.m., 2-4 p.m. 49 Sunlight Clinic. Bexleyheath—315, Broadway. Tuesday and Thursday, 10-12 noon. Specialist's Clinics. Ophthalmic. Welling—Little Danson, Dansington Road. Monday, 2-4 p.m. Thursday and Friday, 9.30-11 a.m., 2-4 p.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 and 3rd Wednesday at 10 a.m. Appointments made through County Medical Officer. Aural. Welling—Little Danson, Dansington Road. Tuesday morning, 9.30-11 a.m. 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. 50 CO-ORDINATION. In spite of the transfer of the Maternity and Child Welfare Services from the local Council to the Kent County Council, a satisfactory degree of co-ordination of effort between the School Health Service and the Infant Welfare Services has been maintained as a result of the co-operative attitude of all members of the Staff concerned. Periodic Medical Inspections. See Table 1. The successful carrying out of routine medical inspections was made possible by the excellent cooperation 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. School Meals—1949. Average number of pupils in attendance:— Primary Schools 6,541 Secondary Schools 3,803 10,344 51 Average number of pupils taking meals daily:— Primary Secondary (1) Free 141 176 (2) Payment 2,957 2,513 3,098 2,689 Total 5,787 Milk. Number of pupils taking Milk. Primary 6,273 Secondary 2,835 Total 9,108 Work of the Opthalmic Clinic. I am indebted to Mr. R. M. Chambers, M.B., B.Sc., D.O.M.S., for the following report:— During the year 2,516 clinical examinations were made. A total of 1,630 children were seen ranging in age from a few months to sixteen years. The majority (1,618) had some degree of refractive error of which sixty-five per cent. required correction. There were 202 cases of squint of whom 60 received orthoptic treatment and 30 required surgery in addition. Convergence deficiency accounted for 51 cases of asthenopia, the majority of whom were relieved of symptoms by exercises at home. Among the myopic series 12 cases of ciliary spasm were found who responded to intensive cycloplegia. Happily, I saw only 2 cases of malignant myopia both of whom were entered for special schools. In 14 myopes, fine pigmentation of the macula was observed though central vision was not materially diminished. Among the non-refractive conditions, there were:— 7 cases of congenital ptosis, referred for surgery. 3 ,, ,, congenital nystagmus of central origin. 1 ,, „ persistent hyaloid artery. 17 ,, ,, migraine. 1 ,, ,, Homer's syndrome secondary to tuberculous cervical adenitis. 2 ,, ,, Albinism associated with very poor vision. 25 ,, „ Blepharitis. 30 ,, ,, Conjunctivitis. These last two groups responded satisfactorily to treatment at the Clinic. 52 I feel that some guidance in the form of printed circulars giving advice to parents of myopic children might be desirable. The attendances have been very satisfactory apart from the inevitable drops during high days and holidays and the parents in the vast majority of cases appear to take a keen interest in the investigation of their children provided they are told the reasons for them and are enrolled as partners in the general scheme. Orthopaedic Clinic. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on the Orthopædic Clinic:— The Orthopaedic clinics have continued throughout the year on the first and third Wednesday morning of the month at the Welling Clinic and an average of between fifty and sixty patients have been seen at each session. In spite of this there is still an enormous waiting list and patients are not being seen for several months. This is a very serious situation and attempts have been made to remedy it but the principal obstacle seems to be lack of accommodation and it is essential that steps should be taken in the immediate future to find a larger room where sessions can be held more frequently and where classes for exercises can be given more easily than at present. The size of the classes for exercises is now limited by the size of the rooms and lack of accommodation for changing, etc. As a result of this situation a lot of patients are not being seen until they are almost due to leave school by which time, of course, such things as remedial exercises are getting too late and I cannot emphasize too much the importance of attending to this situation. The type of case has not altered this year and defects of posture still occupy by far the greater part of our time. Some of the burden could be eased by providing remedial exercises in the schools to a larger extent than is possible at the moment. In conclusion I would like to pay a tribute to the work of Miss Cheeseman, who has carried out her work with skill and efficiency throughout the year. Aural Clinic. I am indebted to Mr. W. Macgregor, O.B.E., M.B., D.L.O., for the following report on the Aural Clinic:— There appears to be slightly more sinusitis in children in the Welling district than in other areas in which 53 I work. Most of the cases in which the adenoids have already been removed appear to be improved by injections against allergic disorders. The Clinic provides a most suitable place for treatment of catarrhal deafness by inflation but those cases of deafness and deaf mutism which require special schooling still have to wait too long before they receive attention. The need for more lip reading and speech therapy centres is very great. An Ear, Nose and Throat Clinic always works better when in close relation with the corresponding department in a hospital and the liaison still available at Erith District Hospital is a great help. The outbreak of poliomyelitis in 1947 and 1949 had a disastrous effect upon the waiting list for tonsillectomy and, personally, I feel that operating should only stop when a particularly violent outbreak occurs, but I think that parents of the children should be informed that there is some slight added risk of contracting the disease after operation. Only a few parents decide against operation at that time and the vast majority are quite agreeable for the treatment to be carried out. Finally, local doctors appear to think that admission for tonsillectomy can be more easily arranged through the School Clinics, but, as you know, this has only been possible through the co-operation of Dr. Mitman at Joyce Green Hospital where they have a relatively small waiting list. Dental Treatment. I am indebted to Mr. Dickson, L.D.S., Orthodontist, for the following report:— I have attended Little Danson School Clinic at approximately fortnightly intervals during 1949 for the purpose of holding pure orthodontic sessions. Inevitably, a small proportion of conservative dentistry and exodontia has associated itself with these sessions but the main purpose has been the correction of abnormalities of the permanent dentition. The response to treatment has, in the main, been entirely satisfactory but despite careful selection a small proportion (say 5%) of patients and parents, though keen enough for treatment until they get it, do not return after their appliance has been fitted — a corollary of a free service. 54 Orthodontic treatment is, probably, the most soughtafter form of dentistry and this has recently been more so since the Dental Estimates Board have brought in "payment by results" and the dental surgeons in the General Dental Service been thus discouraged from accepting such patients. My attendance there is still insufficient to keep up with the flow of patients and a waiting list exists. The figures for my patients are in your possession and Mr. Wade will doubtless comment on my visits to 315, Broadway so I will not mention these items. In conclusion, I would like to say that the general condition of the mouths of many of the patients shows evidence of neglect from an early age—in many cases sufficient to make orthodontic treatment quite unsuitable. I am indebted to Mr. Wade, L.D.S., Dental Surgeon, for this report:— I have to submit again my short report upon the work of the Dental Clinics. The year, as you will know, has been a very full one and Maternity and Child Welfare work has been added. Gingivitis, often found in pregnancy, has been treated with success with penicillin and has proved far superior to the other methods which can now be said to be out-of-date. One case of Osteomyelitis of the maxilla in a child of five years was suspected and admitted to hospital where, it is believed, the condition was confirmed. A case of suspected incipient hypertrophic gingivitis in a girl of 13 years of age was found and was given suitable treatment. The evidence of carious upper incisors in the 16-17 age group reported last year appears to have moderated in the same group in the year under review. The age group 16-17 of 1949, in regard to the matter, is still however, of much professional interest. The flow of new cases requiring orthodontic treatment continues and the County Orthodontist has paid regular visits advising parents and designing appliances for necessary corrections. The acute shortage of dental officers is still being felt. 55 The Dental Mobile Unit almost completed the treatment of Hurst Road School and this has been a great relief to the dental services. As in the past I have received every assistance in the running of the clinics and to you, personally, I again express my thanks. Cleanliness Inspections. (See Table V.) During the year the School Nurses carried out 22,146 examinations of children in Schools and 477 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. In all the Schools in the Borough increased care and attention is being given to Physical Education. In the Secondary Schools, in spite of limited playingfield accommodation, games and athletics form part of the school curriculum and are also, of course, practised very extensively out of school hours. Many parents will have seen with pleasure and admiration the high standard of the agility work of both boys and girls, and the delightful but energetic types of dance which form an increasingly important part of girls' Physical Education. In the Primary Schools the emphasis is on agility work on individual or group lines, usually out of doors, and on movement to music. The economy measures brought in by the Kent Education Committee at the request of the Ministry of Education have resulted in a severe cut in the provision of Physical Training clothing (including shoes). Nevertheless, at many Primary Schools every child changes into shorts, singlet and rubber shoes, for every period of Physical Education. Where conditions permit, bare-foot work, which has very great advantages from a physical education point of view, is encouraged. In spite of the severe reduction in expenditure on new equipment, the Bexley Committee for Education has set aside a considerable sum to provide during the year 1950-51, at a number of Primary Schools, sets of climbing and agility apparatus especially made to the design of the County Physical Education advisers. 56 The high standard of the Physical Education in the Borough's schools was brought home to the public in striking fashion when in the summer of 1949 a team of girls from the County Technical School was selected to represent English Secondary Schools at the Lingiad at Stockholm. Swimming. During the year 1949 schools in the Borough again took advantage of the facilities available for swimming. Twelve Primary departments and seven Secondary departments used the Charlton Park, Eltham Park, Plumstead and Danson Baths. A total of 416 swimming certificates were issued during the year. 57 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. Orthopsedic and Postural Defects. Group V. Child Guidance Treatment and Speech Therapy. Table IV — Dental Inspection and Treatment including Orthodontics. Table V — Infestation with Vermin. Table VI — Handicapped Children. 58 TABLE 1. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. — Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 1,713 Second Age Group 1,050 Third Age Group 1,235 Total 3,998 Number of other Periodic Inspections 1,532 Grand Total 5,530 B. — Other Inspections. Number of Special Inspections 4,987 Number of Re-inspections 4,722 Total 9,709 C. — Pupils Found to Require Treatment at Periodic Medical Inspections. Group (1) For defective vision (excluding squint) (2) For any of the other conditions recorded in Table IIA (3) Total individual pupils (4) Entrants 18 304 269 Second Age Group 68 156 192 Third Age Group 105 338 367 Total (prescribed groups) 191 798 828 Other Periodic Inspections 94 223 279 Grand Total 285 1,021 1,107 59 TABLE II. A. — Return of Defects Found by Medical Inspection in the Year ended the 31st December, 1949. Defect Code Defect or Disease No. 1 PERIODIC INSPECTIONS SPECIAL INSPECTIONS No. of defects No. of defects Requiring treatment 2 Requiring to be kept under observation, but not requiring treatment 3 Requiring treatment 4 Requiring to be kept under observation, but not requiring treatment 5 4. Skin 92 75 214 42 5. Eyes— a. Vision 285 189 76 2 b. squint 22 65 8 1 c. Other 53 15 87 6. Ears— a. Hearing 71 26 32 5 b. Otitis Media 29 32 31 8 c. Other 10 20 34 7 7. Nose or Throat 272 440 239 104 8. Speech 10 18 20 1 9. Cervical Glands 6 81 6 3 10. Heart and Circulation 50 64 40 15 11. Lungs 15 173 85 39 12. Developmental — a. Hernia 5 5 25 2 b. Other 1 84 11 9 13. Orthopaedic— a. Posture 58 61 12 3 b. Flat-foot 149 67 16 6 c. Other 175 196 81 26 14. Nervous system— a. Epilepsy 6 7 3 b. Other 2 16 36 9 15. Psychological— a. Development 1 27 14 5 b. Stability 1 78 72 17 16. Other 51 259 253 292 60 B. — Classification of the General Condition of Pupils Inspected during the Year in the Age Croups. Age Groups (1) No. of Pupils Inspected (2) A. (Good) B. (Fair) C. (Poor) No. (3) % of col. 2 (4) No. (5) % of col. 2 (6) No. (7) % of col. 2 (8) Entrants 1713 473 27.6 1176 68.7 64 3.7 Second Age Group 1050 279 26.6 718 68.4 53 5.0 Third Age Group 1235 396 32.1 762 61.7 77 6.2 Other Periodic Inspections 1532 357 23.3 1073 70.0 102 6.7 Total 5530 1505 27.22 3729 67.43 296 5.35 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 1 Ringworm—Body 65 Scabies 2 Impetigo 23 Other skin diseases 875 Eye Disease (External and other, but excluding errors of refraction, squint and cases admitted to hospital.) 395 Ear Defects 310 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.). 4,939 Total 6,610 (b) Total number of attendances at Authority's minor ailments clinics 16,793 61 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) 1,618 (2) Other defect or disease of the eyes (excluding those recorded in Group 1) 12 Total 1,630 (3) No. of Pupils for whom spectacles were (a) Prescribed 383 (b) Obtained 259 Croup III—Treatment of Defects of Nose and Throat. Total number treated Received operative treatment— (a) for adenoids and chronic tonsillitis 117 (b) for other nose and throat conditions 4 Received other forms of treatment 106 Total 227 Croup IV—Orthopaedic and Postural Defects. (a) No. treated as in-patients in hospital or hospital schools 9 (b) No. treated otherwise e.g. in clinics or out-patient departments 384 Croup V—Child Guidance Treatment and Speech Therapy. No. of pupils treated (a) under Child Guidance arrangements 62 (b) Under Speech Therapy arrangements 30 62 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 2,126 (b) Specials 377 Total (Periodic and Specials) 2,503 (2) Number found to require treatment 1,642 (3) Number actually treated 1,896 (4) Attendances made by pupils for treatment 5,514 (5) Half-days devoted to (a) Inspection 15 (b) Treatment 541 Total (a) and (b) 556 (6) Fillings: Permanent Teeth 1,307 Temporary Teeth 221 Total 1,528 (7) Extractions: Permanent Teeth 600 Temporary Teeth 2,983 Total 3,583 (8) Administration of general anaesthetics for extraction 1,437 (9) Other Operations (a) Permanent Teeth 664 (b) Temporary Teeth 415 Total (a) and (b) 1,079 Scalings 23 1,079 Cleaning 12 Polishing 92 Dressings Permanent Teeth 512 Temporary Teeth 415 Root Dressings 25 63 Attendances for mechanical appliances 949 Impressions Upper 102 Lower 91 Bites 12 Try-ins 1 Dentures Fitted—Upper 71 Appliances Fitted—Upper 34 Lower — Remakes—Upper 2 Lower 1 Repairs — Adjustments ... 373 TABLE V. Infestation with Vermin. (i) Total number of examinations in the schools by the school nurses or other authorised persons 22,146 (ii) Total number of individual pupils found to be infested 477 (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) 64 65 TABLE VI. Handicapped Pupils Requiring Education at Special Schools or Boarding in Boarding Homes. 1949 (1) Blind (2) Partially Sighted (3) Deaf (4) Partially Deaf (5) Delicate (6) Physically handicapped (7) Educationally Sub-normal (8) Maladjusted (0) Epileptic (1) (2) (3) (4) (5) (6) (7) (8) (9) In the calendar year A. Handicapped Pupils newly placed in Special Schools or Homes - - 3 - 13 4 2 - - B. Handicapped Pupils newly ascertained as requiring education at Special Schls. or boarding in Homes 1 - 5 - 41 8 7 - - On December 31st C. No. of Handicapped pupils from the area (i) attending special schools Day - 4 5 1 - 8 30 - - Boarding 1 — 3 — 13 8 5 1 1 (ii) boarded in homes — — — — — — — — - (iii) attending assisted schools (under approved arrangements) - - - - - - - - - D. No. of Handicapped pupils from the area requiring places in Special Schools but remaining unplaced 1 - 2 - 7 4 7 - - E. No. of Handicapped pupils receiving home tuition (including those also returned in D.) - - - 1 - 6 - - - F. No. of Handicapped pupils from the area on 31st December attending Special Schools or boarded Homes on account of:—(i) Defect of Speech Nil. (ii) Diabetes Nil. INDEX. ITEM PAGE Health Committee 2 Public Health Staff 3 STATISTICS AND SOCIAL CONDITIONS. Acreage 8 Population 8 Unemployment 8 Social Conditions and Amenities 8—9 Population Graph 10 Summary of Vital Statistics, 1949 11—12 Extracts from Vital Statistics— Births and Birth Rates, etc. 12 Stillbirths and Stillbirth Rates 13 Deaths and Death Rates 14—15 Deaths and Death Rates in Wards 15 Causes of Death 16 Infantile Mortality 17 Maternal Deaths 18 GENERAL PROVISION OF HEALTH SERVICES. Isolation Hospital 19 General Hospitals 19 Ambulance Facilities 19 National Assistance Act, 1948 19 Public Mortuary 19 Laboratory Facilities 19 Registration of Nursing Homes 19 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 21—22 Water Supply 22 Drainage and Sewerage 23 Rivers and Streams 23 Chief Sanitary Inspector's Report— Tables of Inspections and Improvements, etc. 23—25 Food Inspection 26 Tables—Factories Act, 1937 27 Closet Accommodation 28 Public Cleansing 28 Refuse Collection and Disposal 28 Salvage 28—29 Rats and Mice (Destruction) Act, 1919 29 Shops Acts, 1912—1936 30 66 ITEM PAGE Swimming Pool 30 Eradication of Bed Bugs 30 Camping Sites 30 Schools 30 HOUSING. Council Estates 32 Inspection of Dwelling Houses 32—33 Remedy of Defects without formal notice 33 Action under Statutory Powers 33—34 Public Health Act, 1936—Provision of Dust Bins 34 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 35 Meat Inspection 35 Adulteration of Food—Food & Drugs Act 35—36 Food Preparation Premises 36 Registration of Premises 36 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 37 Diphtheria 37 Diphtheria Immunisation and Vaccination 37—38 Enteric Fever 39 Puerperal Pyrexia 39 Ophthalmia Neanatorum 39 Measles 39 Whooping Cough 39 Acute Anterio Poliomyelitis 39 Scabies 39 Food Poisoning 39 Tables of Infectious Diseases Notified 40 Tuberculosis 41 SCHOOL HEALTH SERVICES REPORT, 1949. Welfare and School Services Sub-Committee 44 Staff 44—45 Schools 49 Clinics 49—50 67 item page Co-ordination— Periodic Medical Inspections 51 School Meals 51 Ophthalmic Clinic 52-53 Orthopaedic Clinic 53 Aural Clinic 53—54 Dental Treatment 54- 56 Cleanliness Inspections 56 Physical Education 56-57 Swimming 57 Statistical Tables 58-65