AC 4412 (1) BEXLEY LIBRARY BEXIS BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Service For the Year 1950 JOHN LANDON, m.r.C.S., I.R.C.P., D.P.H. Medical Officer of Health BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health For the Year 1950 JOHN LANDON, m.r.C.S., I.R.C.P., D.P.H. Medical Officer of Health Borough of Bexley. Mayor: Councillor J. D. Vergette, J.P. Deputy Mayor: Alderman Mrs. A. Welch, J.P. HEALTH COMMITTEE. Chairman: Councillor J. M. Pawson. Vice-Chairman: Councillor M. J. Corr. Alderman R. G. Broomfield. Councillor J. Duffus. Alderman J. C. McLean, J.P. Councillor J. W. Bateman. Alderman H. P. Tanner, C.C. Councillor H. C. Crawford. Alderman Mrs. A. Welch, J.P. Councillor J. D. Vergette, J.P. PUBLIC HEALTH STAFF, 1950. 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). Chief Sanitary Inspector, Public *† G. Hind, M.S.I.A. Cleansing Officer and Shops Acts Inspector. Deputy Chief Sanitary Inspector *† J. T Boocock. District Sanitary Inspectors *† F. W. Willington. *† G. F. Lovegrove. *† W. E. Moses Chief Clerk G. A. Pearson. Senior Clerk R. V. Hoad (from 31.1.60). Clerks R. V. Hoad (to 30.1.50). E. M. Pearmine (Miss) (appointed 1.5.50). M. E. Smith (Miss) (Shorthand Typist). E. M. Lawrence (Mrs.) (temporary until 23.9.50). Public Analyst M. E. Monk, B.Sc., F.R.I.C. * Certificate for Inspection of Meat and other Foods, t 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 1950. The vital statistics of the Borough have again been satisfactory indicating that the health of the population has been well maintained. The birth rate during 1950 was 13.13 per 1,000 of the population compared with 14.02 in 1949 and 15.36 in 1948. The birth rate for 1947 was 18.72 per thousand and it would appear that the increase in the birth rate at. the end of the War has not been maintained and that there has been a reversal to the tendency of the birth rate to fall which has been noticed during the past 40 years. The birth rate for the Borough of Bexley corrected by the use of a comparability factor (0.94), supplied by the RegistrarGeneral, was 12.3. The uncorrected birth rate for the country as a whole during 1950 was 15.8, so that the Bexley rate for the year is appreciably lower than the national rate. The death rate for the Borough during 1950 was 8.56 per thousand of the home population, or, after correction by means of the comparability factor for deaths (1.18), 10.10 compared with an uncorrected death rate for the country as a whole of 11.6 per thousand. A new low record in the infant mortality rate was achieved during 1950, namely 14.48 infantile deaths during the first year of life for every thousand live births, compared with 24 per thousand in 1949, and a national rate for 1950 of 29.8 per 1,000. The infant mortality rate is perhaps the most sensitive index we possess of social conditions and the care afforded to young children by their parents and by the personal health services. The Medical Officer of Health recording, in 1945, a rate of 33.9 per thousand, commented that "a goal of 25 can be reached in this area". It would have been difficult to believe at that time that, in the course of 5 years, the infant mortality rate for the Borough would be halved, and there is no reason to believe that this improvement will not be maintained, given favourable and settled conditions. The best infant mortality 4 rate achieved prior to the 1950 rate was 19.03 per thousand live births during 1948 so that there has been a progressive fall which may be thought to be an encouraging feature of the statistics. Of the 17 infantile deaths which occurred there were 3 deaths from pneumonia and 1 from tuberculous meningitis, all of which are "prima facie" preventable, and the other deaths were due to prematurity and congenital malformation over which there is not, at the present time, any important degree of control. Prophecy in this matter is perhaps unwise, but who would be rash enough to say that we have now reached the irreducible minimum in regard to infant mortality? It would now seem that a rate of 10 per thousand may not be a Utopian idea but a practical possibility. The reduction in infant mortality, it must be remembered, is due "inter alia", to the fall in the birth rate as well as to improved conditions of life and health services but, even so, we are reaping the benefit of 40 years of welfare services and of continuous health education in infant welfare clinics and in the homes of the children. In this way the preventive services, when their results are reviewed over a period, afford some compensation to workers in the health field who may feel that their day to day work is unspectacular when compared with the curative services. There was one death resulting from childbirth, giving a maternal mortality rate of 0.84 per thousand live and stillbirths compared with 0.78 in 1949 and nil in 1948. The incidence of infectious disease was once again extremely low during 1950. No case of diphtheria was notified as compared with 1 during 1949. It would be safe to say that the three most important infectious diseases, apart from tuberculosis, which have now to be taken into account are measles (304 cases), whooping cough (281 cases) and acute anterior poliomyelitis, or infantile paralysis (19 cases), which gives a good indication of the changes which have been brought about by improvements in environmental health during the past 75 years. Apart from sporadic cases and the small and controlled epidemic, gone, for all practical purposes, are such diseases as smallpox, typhoid fever, malignant scarlet fever, haemorrhagic diphtheria and cerebro-spinal fever, to name only the most important. With regard to poliomyelitis, it was found, during the year, as the result of an investigation carried out at 5 the London School of Hygiene and Tropical Medicine, that there was some slight association between this disease and inoculation procedures carried out within one month of the onset of illness. The majority of the Borough cases occurred in the Welling area and, as one case had occurred where this association had been noted, immunisation was suspended at the Welling clinics for a period and resumed as soon as any possible danger had passed. Concurrently, arrangements were made through the Hospital Management Committees to suspend tonsils operations during the period of maximum incidence of this disease. In regard to inoculation in relation to poliomyelitis, methods have now been found to diminish any risk to negligible proportions, and it is self-evident that nothing should be allowed to interfere with the successful prosecution of the diphtheria immunisation campaign which has been largely responsible for the freedom from this disease which we now enjoy. On the 1st May, 1950, a Food Traders' Guild was set up, comprising representatives of the local authorities and food traders, with a view to the carrying out of a Clean Food Campaign for the area of Bexley, Erith and Crayford. The 'Guild has had several meetings and has now approved Codes of Practice for most of the food trades. Approval of the remaining Codes should be obtained in the near future when this work will enter a new and more strenuous phase of inviting applications from the food traders for membership of the Guild and the inspection of their premises to ensure that they comply, in all respects, with the requirements of the appropriate Codes. A programme of health education is also being arranged with the object of bringing home to food handlers, in the three districts, their responsibilties to the public in regard to the clean preparation and handling of food. A Clean Food Exhibition was planned during the latter part of the year and was successfully held in May, 1951. This wort tends to be rather slowmoving but this is not necessarily a disadvantage. It enables due consideration to be given to important detail and allows for a closer co-operation with the food traders themselves who are invited to the meetings at which the Codes are considered. Looked at as a long term essay in health education the Clean Food Campaign, it is hoped, will, in time, result in the raising of standards of food hygiene in the districts concerned. 6 During the year, the welfare of old people came into prominence. Ministry of Health Circular 11/50 recognised the plight of old people living alone in circumstances, often, of extreme loneliness and isolation from their fellows. His Worship the Mayor accordingly called a townspeoples' meeting and, as a result, an Old People's Welfare Committee was formed which has since done much good work in providing good-neighbourly services for many old people. I feel that a tribute should be paid to those good neighbours, both inside and outside the Old Peoples' Welfare Committee, who, voluntarily, undertake the care of old people living near them who are alone and uncared for. The number of such old people seems to be increasing and were it not (for the good offices of well-disposed persons the plight of the old people concerned would be grim indeed. A case has occurred where the intelligent action of a milk roundsman who noticed that the milk on the doorstep of an old person living alone had not been taken in, led to the discovery, by the Health Department, to whom he reported the matter, that the old person was in a state of extreme collapse and it is certain that her life was saved by the action that was taken when her plight was discovered. The investigation into the Incidence and Causation of Health among Bexley schoolchildren which is being undertaken by the Kent Paediatric Society is still proceeding and is now entering its final stages, although there is a lot of work still to be done before a Report can be made. During the year, the Council approved a scheme for the rebuilding of the Borough Mortuary to provide improved facilities including refrigeration for six bodies. The Borough of Eritli and the Urban District of Cravford have agreed to use the facilities provided on a basis to be agreed. In conclusion, I wish to thank the members of the Health Committee for their support and encouragement and the Chief Sanitary Inspector, the Chief Clerk and all members of the Health Department for their devotion to duty at all times during the year. I am, Your obedient servant, JOHN LANDOJST, Medical Officer of Health. 7 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. New Dwellings Erected. Registrar General's Houses 102 Estimate mid- Demolished Houses year, 1950 89,410 Rebuilt 15 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1,165 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. 1949 89,270 138 + 73 rebuilt. Number of inhabited houses at end of 1950 (according' to Rate Books) approximately 25,772 Rateable Value £638,064 Sum represented by a penny rate £2,626 Unemployment. Men Women Boys Girls Total December 31st, 1949 210 55 15 17 297 December 31st, 1950 275 76 6 18 375 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 hoxising 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 210.00 ,, 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 ,, Parlchurst 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. Eacilities 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 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. Births— Kates per 1,000 Home Population. Live 15.8 17.6 16.7 17.8 13.13 Still 0.37 0.45 0.33 0.36 0.16 Deaths- All Causes 11.6 12.3 11.6 11.8 8.56 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 Whooping Cough 0.01 0.01 0.01 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.36 0.42 0.33 0.39 0.18 Influenza 0.10 0.09 0.10 0.07 0.01 Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 0.02 0.02 0.02 0.01 Pneumonia 0.46 0.49 0.45 0.48 0.32 Notifications(corrected) Typhoid Fever 0.00 0.00 0.00 0.01 0.01 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.03 Meningococcal Infection 0.03 0.03 0.02 0.03 0.01 Scarlet Fever 1.50 1.56 1.61 1.23 1.08 Whooping Cough 3.60 3.97 3.15 3.21 3.14 Diphtheria 0.02 0.03 0.02 0.03 — Erysipelas 0.17 0.19 0.16 0.17 0.25 Smallpox 0.00 0.00 — — — Measles 8.39 8.76 8.36 6.57 3.40 Pneumonia 0.70 0.77 0.61 0.50 0.36 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.13 0.12 0.11 0.08 0.16 Non-Paralytic 0.05 0.05 0.06 0.05 0.06 Food Poisoning 0.17 0.16 0.14 0.25 0.06 Kates per 1,000 Live Births. Deaths All causes under one year of age 29.8(a) 33.8 29.4 26.3 14.48 Enteritis and Diarrhoea under two years of age 1.9 2.2 1.6 1.0 Kates per 1,000 Total (Live and Mill) Births. Notifications(corrected) Puerperal fever and Pvrexia 5.81 7.43 4.33 6.03 1.68 (a) Per 1,000 related live births. A dash (—) signifies that there were no deaths. 11 International List No. and Cause Rates per 1,000 Total (Live and Still) Births Rates per million Women aged 15 to 44 651 Abortion with Sepsis 0.09 7 650-652 Other Abortion 0.05 4 640-649, 670-678 Complication of Pregnacy and Delivery 0.54 681 Sepsis of Childbirth and the Puerperium 0.03 680, 682-689 Other Complications of Puerperium 0.15 EXTRACTS FROM VITAL STATISTICS FOR THE Year 1950. The Registrar General's Estimate of home population for the mid-year is 89,410 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 585 589 1,174 Legitimate 561 559 1,120 Illegitimate 24 30 54 The following relates to the Birth Rate during the past ten years:— 1940 Birth Rate 16.46 per thousand 1941 ,, ,, 15.88 ,, ,, 1942 „ 19.07 „ 1943 ,, ,, 18.03 ,, ,, 1944 21.06 „ 1945 „ 18.81 „ 1946 ,, 19.75 ,, 1947 18 79 1948 ,, „ 15.36 ,, ,, 1949 „ „ 14.02 „ Birth Rate. Rate per 1,000 estimated home population 13.13 12 Rate per 1,000 for England and Wales, 1950 15.8 ,, ,, ,, ,, County Boroughs and Great Towns, including London 17.6 ,, ,, ,, ,, Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) ,, ,, ,, ,, London Administrative 16.7 County 17.8 54 illegitimate live births were registered against 30 in 1949. The Kegistrar-General has supplied a comparability factor for 1950. The standardised birth rate which allows for comparison with other parts of the country is 12.3. Stillbirths. Males Females Total Total 9 5 14 Bate per 1,000 total (live and still) births 11.78 The following relates to the Stillbirth Rate during the past ten years:— Rate per Thousand Total Live and Year Still Births Population 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 1949 31.01 0.45 14 Stillbirths were registered during the year. This represents a rate of 0.16 per 1,000 population against 0.45 per 1,000 population in 1949. 13 Rate per 1,000 for England and Wales, 1950 0.37 ,, ,, ,, ,, County Boroughs and Great Towns, including London 0.45 ,, ,, ,, ,, Smaller Towns (estimated population 25,000 to 50^00 at Census, 1931) 0.38 ,, ,, ,, ,, London Administrative County 0.36 There were no Stillbirths registered as illegitimate. Deaths. Males Females Total All causes 410 355 765 Death rate per 1,000 of estimated home population 8.56 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 0.84 Deaths of Infants under one year of age 7 10 17 Legitimate 6 8 14 Illegitimate 1 2 3 Death rate of Infants under one year of age: Total per 1,000 live births 14.48 Legitimate per 1,000 legitimate live births 12.5 Illegitimate per 1,000 illegitimate live births 55.5 Deaths from Measles (all ages) — — — ,, ,, Whooping Cough (all ages) — 1 1 ,, ,, Diarrhoea (under 2 years of age) — — — ,, ,, Cancer (all ages) 75 70 145 14 Death Rate of Country: — Rate per 1,000 for England and Wales, 1950 11.6 ,, ,, „ „ County Boroughs and Great Towns, including London 12.3 ,, ,, ,, ,, Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 11.6 ,, ,, ,, ,, London Adminstrative County 11.8 h Rate of Area during Inst ten years: — 1940 10.40 per thousand. 1941 9.68 „ 1942 8.73 ,, ,, 1943 9.21 „ 1944 10.20 „ 1945 9.28 „ 1946 8.55 „ ,, 1947 9.17 ,, 1948 7.53 „ 1949 8.15 ,, ,, The rate for Bexley compares favourably with that for other parts of the country. The Registrar-General has supplied a comparability factor for 1950. The standardised death rate which allows for comparison with other parts of the country is 10.10. 15 CAUSES OF DEATH IN THE BOROUGH. REGISTERED DURING THE YEAR 1950. Causes of Death. M. F. Total All Causes 410 355 765 1 Tuberculosis, respiratory 9 6 15 2 Tuberculosis, other — 1 1 3 Syphilitic disease 3 — 3 4 Diphtheria — — — 5 Whooping' Cough — 1 1 6 Meningococcal infections — — — 7 Acute poliomyelitis — — — 8 Measles — — — 9 Other infective and parasitic diseases 9 2 4 10 Malignant neoplasm, stomach 12 10 22 11 Malignant neoplasm, lung, bronchus 24 2 26 12 Malignant neoplasm, breast — 15 15 13 Malignant neoplasm, uterus — 3 3 14 Other malignant and lymphatic neoplasms 39 40 79 15 Leukaemia, aleukaemia 1 — 1 16 Diabetes 6 — 6 17 Yascular lesions of nervous system 55 55 110 18 Coronary disease, angina 67 35 102 19 Hypertension with heart disease 21 16 37 20 Other heart disease 54 58 112 21 Other circulatory disease 14 10 24 22 Influenza — 1 1 23 Pneumonia 15 14 29 24 Bronchitis 23 17 40 25 Other diseases of the respiratory system 2 o 26 Ulcer of stomach and duodenum 6 3 9 27 Gastritis enteritis and diarrhoea — — — 28 Nephritis and nephrosis 7 5 12 29 Hyperplasia of nrostate 6 — 6 30 Pregnancy, childbirth, abortion — 1 1 31 Congenital malformations 1 4 5 32 Other defined and ill-defined diseases 27 43 70 33 Motor vehicle accidents 5 1 6 34 All other accidents 9 5 14 35 Suicide 2 7 9 36 Homicide and operations of war — — — 16 17 INFANT MORTALITY, 1950. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1950 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0— 1 — 2— 3— 4— 5— 6— 7— 14— 21— 28— 2— 3— 4— 5— 6— 7— 8— 9— .0— 11— 12— Congenital Malformation, Premature Birth, Birth Injury, etc. 3 1 1 2 1 1 Pneumonia 2 1 lost Natal Asphyxia and Atelectasis 1 1 T.B. Meningitis 1 Kernicterus E- nthroblastosis 1 Cerebral Softening secondary to Pinks Disease 1 Totals 3 2 1 3 — — — 1 3 — — — 1 1 — — — — 1 — 1 — The number of infants under one year of age who died during the year 1950 as shown by the table is 17. 13 of these deaths, that is 7G.47 per cent., occurred in the neonatal period (within one month of birth). In 1949 the cot-responding figure was 80 per cent. 17 were registered during the year giving an infantile mortality rate per 1,000 live births of 14.48. Rates over previous years have been:— 1940 45.4 per 1,000 live births 1941 1942 32.7 ,, ,, ,, 1943 26.01 „ ,, „ „ 1944 31.37 ,, ,, ,, 1945 33.9 ,, ,, „ ,, 1946 29.5 ,, ,, ,, ,, 1947 28.6 „ „ ,, „ 1948 19.03 „ „ „ „ 1949 24.0 ,, ,, ,, ,, Maternal Deaths. There was 1 maternal death during the year giving a maternal mortality rate of 0.84 per 1,000 live and stillbirths. Rates over previous years have been: — 1940 0.79 per 1,000 live and stillbirths 1941 2.77 ,, ,, ,, ,, „ 1942 1.32 ,, ,, ,, „ ,, 1943 1.44 ,, ,, ,, ,, „ 1944 1.30 ,, ,, ,, ,, „ 1945 nil ,, ,, ,, ,, „ 1946 1.7 3 ,, ,, ,, ,, 1947 1.19 ,, ,, ,, ,, „ 1948 Nil ,, ,, ,, ,, „ 1949 0.78 ,, ,, ,, ,, 18 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Isolation Hospital Accommodation. Tliis 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 oth 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, 1848. Action taken under Section 47. It was not neccssary during the year under review to take statutory action under this Section owing to the removal of patients by voluntary co-operation. 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 122 occasions and 122 post-mortem examinations were made. 29 inquests were held. The foreword to this Report contains a reference to the rebuilding of the Mortuary. LABORATORY FACILITIES. Pathological and bacteriological work for the area is carried out at the County Hall, Maidstone, through the Public Health Laboratory Service. 19 Registration of Nursing Homes, Public Health Act, 1936. (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 5 No. of patients provided for:— Maternity 5 Others 63 Total 68 No. of inspections made during year 12 No. cancelled on request of applicant 1 20 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, 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 Part 2—the whole ,, 4—Sees. 53 and 54 ,, 6—the whole ,, 10—Sec. 95 Apr. 1909 May 1909 Public Health Act, 1925, Part 2 Slaughter of Animals Act, 1933 Jan. 1926 Jan. 1934 Byelaws. Wireless Loudspeakers, Gramophones, etc. Fouling by Dogs of Footways Baths, Wash-houses, Swimming Baths and Bathing Places Parks and Pleasure Grounds Building Defacing of Pavements 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 Sale of Contraceptives in Slot Machines Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air Mar. 1939 July 1938 Aug. 1938 May 1939 June 1939 Nov. 1939 „ „ „ „ „ „ „ June 1940 Dec. 1949 May 1950 21 The Byelaws relating to: Cieansing of Earth Closets and Cesspools; Common Lodging Houses; Hop Pickers' and Fruit Pickers' Lodgings; Cleansing of Privies; Removal of Offensive and Noxious Matters; Nuisances; Offensive 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 tlie Minister refused to sanction the proposed Byelaws put forward. No recent application has been made for renewal, but it may be necessary in the near future to endeavour to obtain the Ministry's approval to Byelaws with regard to nuisances. 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 1949 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. (Minimum and maximum numbers of organisms.) No. of organisms per c.c. capable of B. coli growth on Agar at: presumptive 37° C. 22° C. Absent in 100 c.c 0-506 0-1,701 in all samples 22 (ii) Drainage and Sewerage. The following foul and surface water sewers were laid during the year:— Fay gate Estate— 230 lin yards Foul Sewer. 250 lin yards S.W. Sewer. Danson Park— 96 lin yards 18" and 120 yards 21" S.W. Sewer. East Wickham Valley— 400 lin yards S.W. Sewer. Glenmore Estate— 300 yards Foul Sewer. 321 yard S.W. Sewer. Royal Park Estate— 81 yards Foul Sewer. 155 yards 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 1950. The report consists mainly of a tabulated record of work carried out by the Sanitary Inspectors. 23 TABLE No. 1. Details of Inspection Work Carried Out. Inspections Re-inspections Houses inspected (all particulars recorded) 7 14 Houses inspected (defects only recorded) 339 1,267 Houses inspected (Housing Act, 1936, Overcrowding) 90 21 Houses inspected re Infectious Disease (including Scabies) 353 30 Factories with mechanical power 206 75 Factories without mechanical power 42 4 Schools 12 — Refuse Tips 356 — Bakehouses 101 34 Outworkers 85 — Food shops and premises where food is prepared 1,618 33 Visits re Unsound Food 436 25 Dairies and Milkshops 89 — Ice Cream Premises 215 4 Fried Fish Premises 197 17 Offensive Accumulations 60 25 Keeping of Animals 115 6 Rats 221 106 Verminous Premises 78 74 Insufficient Ashplace Accommodation 84 96 Drains Inspected 1,448 1,218 Drains Tested (water, smoke or colour) 150 9 Visits re Refuse Removal and Salvage 475 — Public Conveniences 154 --- Food and Drugs Act re Samples 284 — Water Samples 17 — Shops Act, 1950 1,031 — Miscellaneous Inspections 1,191 150 24 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 52 Provided with sufficient ashplace accommodation 32 Provided with sufficient water supply 28 Houses Improved Internally— Dirtv rooms cleansed 107 Walls and ceilings repaired 558 Dampness in rooms remedied 180 Defective floors repaired 51 Ventilation of rooms improved 34 Windows repaired 155 Coppers repaired 1 Stoves, fireplaces, etc., provided or repaired 30 Houses Improved Externally— Roofs repaired 77 Eaves, gutters and down spouts fixed or repaired 5G 6 Yards paved or repaired Chimney stacks repaired 9 Walls repointed or repaired 50 Miscellaneous repairs 84 Drainage— Drains cleansed or repaired 1,084 New drains constructed 4 New Gullies provided 3 Ventilation of drainage system improved I Inspection chambers built or improved 11 Waste pipes provided or improved 15 Offensive accumulation removed 8 Nuisances from animals abated 3 Other nuisances abated 10 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 67 Houses visited including revisits 383 Rooms disinfected 30 Notices delivered to Education Authorities, etc. 535 Houses at which defective sanitary conditions were found ] 25 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered. Beef lbs. 1,318 Mutton and Lamb 45½ Pork 17 Rabbits 45 Liver 422 Corned Beef 342£ Corned Mutton 30 Tinned Ham 52 Sausages 90 Bacon 112½ Fats 233 Cake, Biscuits and Flour 30 Dried Peas 412 Sova Flour 112 Fish ,330 Fish Tins 192 Meat 221 Milk 426 Vegetables 567 Soups 174 Fruit and Fruit Juices 312 Puddings 11 Preserves Tins and Jars 414 Pastes 638 Gravy Powder Tins and Packets 218 Cheese lbs. 84 Cheese Boxes 25 Pickles and Sauces Jars and Bottles 161 Cereals Packets 339 Cereals lbs. 50 Dried Fruit „ 156 Dried Fruit Packets 56 Cake Mixtures and Puddings „ 19 Dates Boxes 64 Fish Cakes 156 Miscellaneous items 91 26 TABLE No. 5. Factories Act, 1937. 1. Inspections for Purposes of Provisions as to Health. Including Inspections made by Sanitary Inspectors. Number of :— Premises. 1 Inspections. 2 Written Notices. 3 Prosecutions. 4 Factories with mechanical power 416 4 — Factories without mechanical power 131 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. 8 — — Total 555 6 2. Defects Found. Number of Defects. Number of Prose- Particulars. Found. Remedied. Referred to H.M. 1 2 3 4 5 Want of cleanliness (S.l) 5 5 — — Overcrowding (8.2) Unreasonable temperature (8.3) Inadequate ventilation (8.4) Ineffective drainage of floors (S.6) Sanitary Conveniences (8.7)— Unsuitable or defective 18 18 — — Not separate for sexes 1 1 — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1037.) 1 1 — — Total 25 25 — — 27 During the year 5 Certificates were issued to factories under Section 34 of the Factories Act, 1937, with regard to adequate means of escape in case of fire. Closet Accommodation. With the exception of a few houses, all the closet accommodation in the Borough is on the water carriage system. FUBLIC CLEANSING SERVICE. The Health Committee is responsible for the collection and disposal of house and trade refuse, the collection and sale of salvageable materials, and the maintenance of Public Conveniences. Refuse Collection and Disposal. A weekly collection of refuse was well maintained during the year with the exception of the Bank Holiday periods, when some delay occurred. The chief difficulty in this respect arises after the Christmas holiday, when refuse is at its heaviest. Temporary labour to clear arrears is almost impossible to obtain, and in addition, the sickness rate among the staff engaged on this work is higher after Christmas than at any other time during the year. For this reason it is generally several weeks before collections are back to their normal day. During the year two old freighters were replaced with new S. & D. Dust Carts, and two further vehicles were ordered for delivery in 1951. All refuse is disposed of by controlled tipping at East Wickham. Further land adjoining the Ivy Cottage Site was acquired for refuse tipping after a Public Enquiry conducted by J. Sumner, Esq., A.M.I.Mech.E., of the Ministry of Health. Consent was also given for the stream running through this land to be culverted at a cost of some £12,000, and this work was commenced in November, 1950. The muledozer has continued to prove its worth in dealing with house refuse, and the abolition of sleeper roads has resulted in a far better consolidation of the refuse. 28 The tip is kept under constant supervision, and it is worth recording that not a single complaint was received during the year, although at times refuse was being tipped very near to occupied houses. Salvage. In spite of the difficulty which was experienced early in 1950 of disposing of waste paper, the Council decided to continue collection, and this policy has since proved to be justified. Kitchen waste is collected twice weekly from some 450 communal bins placed in the streets and sent to the Woolwich Borough Council's Concentrator Plant at White Hart Lane, Plumstead. The revenue from salvage sales during the year was £5,900 18s. Od. made up as follows: — Tons cwts. qrs. £ s. d. Waste paper 426 14 0 3,382 10 5 Textiles 26 3 3 555 5 6 Bones 14 0 4 3 5 Kitchen Waste 660 1 0 1,810 5 10 Ferrous Metals 22 9 1 54 8 2 Non-Ferrous Metals 1 4 1 80 13 8 Bottles and Jars 8 3 14 8 Miscellaneous 1 18 3 12 16 4 1,139 13 3 5,900 18 0 Public Conveniences. The public conveniences in the Borough are situated at the following sites : — Market Place, Bexleyheath. Townley Road, Bexleyheath. Danson Park, Welling. Library Building, Bellegrove Road, Welling. High Street, Bexley. St. Mary's Recreation Ground, Bexley. Various other sites have been earmarked for additional small conveniences, which are badly needed in outlying parts of the area. 29 RATS AND MICE (DESTRUCTION) ACT, 1919. INFESTATION ORDER, 1943. The Council employ one full-time Eodent Operative for the treatment of surface infestations, and the test baiting 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 in a large number of cases were caused by the keeping of animals. The following table gives details of infestations found and dealt with by the Department for the period 1st April, to 31st December, 1950. as supplied to the 1950, as supplied to the Ministry of Agriculture and Fisheries: — Number of Properties Inspected 260 Number of Inspections 1,558 Number of Infestations Found—Major 2 Minor 176 Mice 32 Number of Treatments carried out Rats Mice Local Authority's premises 2 — Dwelling Houses 166 29 Business Premises 10 3 SHOPS ACT, 1950. 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 740 shops on the Council's Register at the end of the year. 30 During the year 1,031 inspections were made under the Shops Act, 1950, 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. (Minimum and maximum numbers of organisms.) No. of organisms per c.c. capable of B. coli growth on Agar at: presumptive 37° C. 22° C. Deep end 0-2 0-16 Absent Shallow end 0-24 0-30 Absent Eradication of Bed Bugs. Number of houses found to be infested: — (a) Corporation houses 15 (b) Other houses 15 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 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. Improvements were carried out to the sanitary conveniences at one school during the year. 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 126 — Carlton Road 16 — Dovedale Close 14 — East Wickham— Glenmore Road No. 1 116 Glenmore Road No. 2 6 — Bexleyheath— Highland Road Estate and Pickford Road Estate (including bungalows) 306 Cannon Road — 28 Alers Road 84 — Halcot Estate No. 1 200 — Halcot Estate No. 2 8 — Bex Jev— 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 34 — Merlin Road 1 —- S.D.A. Houses 9 — 1,542 28 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling bouses inspected for housing defects (under Public Health or Housing Acts) 34G (b) Number of inspections made for the purpose (including re-inspection) 1,(527 32 (2) (a) Number of dwelling bouses cluded under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 1925 to 1932 7 (b) Number of inspections made for the purpose (including re-inspections) 21 (3) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (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 319 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 258 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 (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 38 38 (2) Number of dwelling houses in which delects were remedied after service of formal notices— (a) By owners 48 (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 — (2) Number of dwelling houses demolished in pursuance of Demolition Orders 7 (3) Houses demolished as a result of informal procedure 5 D. Proceedings under Section 12 of the Housing Act, 1936— Number of Closing Orders made — Public Health Act, 1936. Section 75. Provision of Dustbins. Notices served requiring provision of bins 6 Number complied with— (a) by Owners 5 (b) by Local Authority in default of Owners 3 Bins provided in consequence of informal action 24 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 the Milk (Special Designations) (Raw Milk) Regulations, 1949, and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949: — Dealers' Licences: — Pasteurised Milk 1G Tuberculin Tested Milk 15 Sterilised Milk 20 Supplementary Licences: — Pasteurised Milk 5 Tuberculin Tested Milk 4 Sterilised Milk 3 (b) Meat Inspection. The slaughterhouses in the area remained closed during the year. (c) Adulteration of Food. Food and Drugs Act, 1938. The following table summerises the 250 samples taken during the year. Formal Informal Milk 18 1 Soups, Meat Extracts, etc. 1 6 Fish Pastes — 3 Pudding or Cake Mixture, Flour, etc. 8 8 Jellies, Custard Powders, etc. 4 11 Patent Medicines, etc. G 11 Beverages 11 1 Sausages, Sausage Meat, etc. 14 — Fruit, Fruit Juice and Fruit Puree 3 3 Malt and Chocolate Spread 3 3 Cereals 5 2 Sweets 6 4 Cake 7 2 35  Formal Informal Pepper Flavoured Compound 1 4 Cocktail and Glace Cherries 2 1 Meat Pies 1 — Minerals, etc. 5 Gelatine and Jelly Crystals 2 1 Condensed Milk — 1 Beer, Wines and Spirits 7 — Potato Crisps 2 1 Baking Powder 2 2 Cochineal Colouring — 1 Condiments, Sauces, Pickles, Spices, etc. 12 14 Cheese 1 — Peanut Butter 1 1 Haricot Beans 1 — Pure Coffee, Coffee Extract and Coffee & Chicory 5 2 Flavouring Essence — 2 Pate-de-foie — 1 Preserves ... 3 4 Meat 4 2 Mussels 1 Arrowroot 1 — Desiccated Coconut 2 1 Ovaltine Tablets 1 — Margarine 1 — Butter 1 — Parsley — 1 Frying Oil 1 1 Malt Milk 1 — Fruit Pie — I Suet with Flour and Shredded Suet 4 — Fish and Vegetable Puree — 1 Legal proceedings were instituted in respect of a bottle of milk containing foreign matter, and the defendants were fined £10 0s. Od. and £3 3s. Od. costs. 36 (d) Food Preparation Premises. During the year 1,651 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 7 Sinks provided 2 Floors, walls, ceilings, etc., repaired 6 Rooms cleansed 8 Water closets cleansed or repaired 7 Drains cleansed or repaired 3 Dirty Yards cleansed or repaired 2 Accumulation of refuse removed 2 Accommodation for storage of refuse improved ... 5 Registration of Premises under Food and Drugs Act, 1938. No. of premises registered for: — Sale or Manufacture of Ice Cream 1 Sale of Ice Cream 136 Preparation of Sausages, etc. 42 24 samples of Ice Cream were submitted for examination under !the Ice Cream (Heat Treatment) Regulations, 1947. 37 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 150 cases were notified as compared with 135 the previous year. Of these 27 were isolated in hospitals and 123 were isolated at home. No. of deaths Nil Return cases from Hospital cases Nil Return cases from home nursed cases 6 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. No cases were notified as compared with one in the previous year. The following figures on Immunisation and Vaccination have been supplied by the County Medical Officer: — 38 39 Immunisation against Dipntneria and Vaccination against Smallpox, 1950. 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, 1950:— (A) Diphtheria Immunisation. Year of Birth 1950 1949 1948 1947 1946 1945 1944 1913 1912 1911 1940 1939 1938 1937 1936 Total Primary Inoculations 92 809 73 20 21 32 34 8 6 3 1 2 — — — 1101 Immunised in 1949 and received in 1950 — 3 15 2 — 1 — — 1 — — — — — — 22 Reinforcing Inoculations — — 2 1 26 322 146 37 19 11 6 11 10 7 12 610 Immunised in 1949 and received in 1950 — — — — — 2 2 4 — 1 — — — — — 9 (B) Vaccination. Age at 31st December, 1950 Under 1 1 to 4 5 to 14 15 or over Total Number Vaccinated 485 359 68 67 979 Number Re-Vaccinated — 12 41 219 272 Immunisation against Diphtheria, 1950. The following is a return of the number of ch ildren resident in the Borough of Bexley under the age of 15 years on 31st December, 1950, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1936). Year of Birth 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 Total 1080 1091 1189 1130 1025 1007 1107 1212 1431 1481 1120 1317 1231 957 92 16,470 Enteric Fever. There were no cases notified during the year. Puerperal Pyrexia. Two cases were notified during the year, from the Bexleyheath Maternity Hospital, where they were isolated and treated. Ophthalmia Neonatorum. One case was notified. Measles. 304 cases were notified. Three cases were treated in hospital. There were no deaths. Whooping Cough (Pertussis). 281 cases were notified, none of which was treated in hospital. There was 1 death but the case was not notified. Acute Anterior Poliomyelitis. 19 Cases were notified and were treated in hospital, 14 Paralytic and 5 Non-Paralytic. There were no deaths. Scabies. Seven cases were notified. Food Poisoning. Five cases were notified. 40 41 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 1950. DISEASE. Total cases 1 notified Under 1 1 to 2 3 to 4 1 5 to 9 10 to 14 15 to 24 25 & over Age unknown Cases admitted to Hospital Total Deaths Smallpox — — — — — — Scarlet Fever 150 — 7 23 93 19 5 — 27 Diphtheria — — — — — —. — Puerperal Pyrexia 9 — — — — — 2 __ 2 Ophthalmia Neonatorum 1 1 — — — — — Pneumonia 32 1 — 2 2 1 4 22 8 Acute Paralytic Poliomyelitis 14 — — 3 7 2 2 — 14 Acute Non-Paralytic Poliomyelitis 5 — — 1 1 1 1 1 5 Erysipelas 22 — — — — — 4 18 1 Food Poisoning 5 — — — — 1 — 4 1 Dysentery 1 — — — — 1 — — 1 Typhoid Fever 1 — — — — _ 1 —- — 1 Para-Typhoid Fever 3 1 — — — 1 1 — Meningoccal Infection 1 — — — — 1 — — 1 Measles 304 4 43 84 167 4 2 — — 3 Whooping Cough 281 8 60 90 110 1 2 4 — Scabies 7 — — — 1 1 2 3 — — — Totals 829 15 110 203 390 31 25 55 — 67 — TUBERCULOSIS. During the year 128 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1950 are contained in the following table:— New Cases Deaths Age Period Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. 0—1 — 1 — — — — — 1 1— 5 1 1 1 — — — — — 5—10 5 1 — — — — — 10—15 4 1 1 — — — — — 15—20 10 7 — 1 — 1 — — 20—25 9 15 1 1 — — 25—35 12 12 4 3 — — — 35—45 4 6 — 2 1 2 — — 45—55 17 2 — 1 — — — — 55—65 6 — — 1 3 1 — — 65 and upwards 1 1 3 — — Totals 69 47 3 9 11 G — 1 The number of non-notified Tuberculosis deaths was 2 Pulmonary. Non-Pulmonary. Total M F M F No. on Register at commencement of year 454 329 68 69 920 No. on Register at end of year 511 362 70 73 1,016 Rehousing. , 10 cases were referred to me by the Chest Physician for rehousing and in two cases the families were rehoused by the Housing Committee. 42 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1950 JOHN LANDON, M.R.C.S., L.R.C.P., U.IMI. Medical Officer of Health EXCEPTED DISTRICT OF BEXLEY WELFARE AND SCHOOL ATTENDANCE SUB-COMMITTEE Chairman: Alderman R. G. Broomfield. Vice-Chairman: Miss M. Woodward. Alderman J. Cronin Alderman Mrs. A. Welch Councillor A. S. Masey Councillor W. G. Searle Councillor Mrs. E. Boswell Councillor M. J. Corr Councillor J. M. Pawson Miss D. C. Collins Co-opted Members: Revd. H. Charleston STAFF 1950 Borough Education Officer Deputy Borough Education Officer Education Welfare Officers W. E. D. Stephens, M.A. R. R. Sutton. M. D. H. Garrett, R. W. Forbes, R. N. Harrison. SCHOOL HEALTH SERVICE Medical Officer of Health Assistant Medical Officers Ophthalmic Surgeon Aural Surgeon ... Orthopaedic Surgeon John Landon, M.R.C.S., L.R.C.P., D.P.H. Robert Bruce Killoh, M.B., Ch.B., D.P.H. (Part time). Nora Walter (nee Kelly) M.B., B.Cli., B.A.O., D.C.H. (Part time). Irene D. M. Hastilow, M.B., Ch.B., M.R.C.S., L.R.C.P., D.P.H., D.R.C.O.G., D.C.H. (Whole time) Lucy M. C. Boyd, M.B., Ch.B., Appointed locum tenens 21.8.50 to 22.12.50 (Appointed permanently 8.1.51). 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. B. Lawson, F.R.C.S., (from 9.10.50). 44 Dental Officers H. Wade, L.D.S. T. A. Hall, L.D.S. (Part time). Elizabeth Francis. B.D.S., L.D.S. (Appointed 2.10.50). Orthodontist Gordon Charles Dickson, L.D.S., B.Ch.D., F.D.S., R.C.S. England. Health Visitors Mrs. E. A. Bowman, S.R.N., and Health Visitor's Certificate. (Retired 31.3.50). Miss K. P. Hart, S.R.N., S.C.M.. and Health Visitor's Certificate. Mrs. V. Waters, S.R.N., S.C.M. (Temporary) (Resignedl5.4.50). Mrs. A. E. Matthews, S.R.N. (Temporay). Miss P. D. Martin, S.R.N., and Health Visitor's Certificate. (Part time from 1.5.50). Miss C. T. Heymann, S.R.N., and Health Visitor's Certificate. (Part time from 1.5.50). Miss L. G. Exley, S.R.N., and Health Visitor's Certificate. (Part time from 1.5.50). Miss D. Stanley, S.R.N., and Health Visitor's Certificate. (Part time from 1.5.50). Mrs. C. A. Tucker, S.R.N., and Health Visitor's Certificate. (Part time from 1.5.50). Mrs. M. T. Leyton, S.R.N., and Health Visitor's Certificate. (Part time from 1.5.50). Miss M. Beer, S.R.N., and Health Visitor's Certificate. (Part time from 1.5.50). Physiotherapist Miss R. Cheeseman, M.C.S.P., M.S.R. Speech Therapist Mrs. D. Rant, L.C.S.T. Dental Attendants Mrs. Ivy Birtchnell. Miss K. M. Dunkley. School Health Service Clerk ... Miss M. C. A. Smith. General Clerks Miss C. E. Anderson. Miss E. M. Pearmine (Resigned 1.5.50). Mrs. A. L. A. Baldly (Appointed 1.5.50). 45 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1950. To the Chairman and Members of the Welf are and School Attendance Sub-Committee. Ladies and Gentlemen, I have the honour to present my annual report for the year 1950. The shortage of dental surgeons in the School Health Service was relieved, to some extent, during the year by the appointment of Mrs. E. Francis, L.D.S., t6 the Little Danson Dental Clinic for seven sessions per week. While it is fully appreciated that the shortage of dental officers is a difficulty experienced over the whole country it is, nevertheless, necessary to say that the dental services for schoolchildren in the Borough remain inadequate and that it has not been possible to maintain the high standards of dental care which have been provided, in the past. The effect of this, if continued indefintely, can only be a serious deterioration in the dental health of the schoolchildren, and itis sincerely hoped that recruitment into this branch of the service will improve in the near future. It is encouraging to note that plans are being made for the provision of an additional dental clinic at Murchison Avenue and it is hoped that, in due course, the staff for this clinic will also be forthcoming. To relieve the pressure on the Orthopaedic Centre at the Station Approach Clinic an additional Orthopaedic Clinic was provided at 315, The Broadway, Bexleyheath, and this has facilitated the treatment of many children suffering from orthopaedic defects. During the year 19 cases of acute anterior poliomyelitis occurred in the Borough, mostly in the Welling area and immunisation was discontinued at the Clinics in this part of the Borough during the period of maximum incidence. Reference to this matter and also to the suspension of tonsillectomy are referred to in the foreword to the first part of the Annual Report. The School Health Service has continued to operate with great activity during the year. Staff changes have necessitated a re-arrangement of clinic duties and steps were taken during the year to use the services, in the School Health work, of Health Visitors previously 46 engaged entirely on Maternity and Child Welfare duties. This is a desirable development and makes possible for the children a continuity of care from birth to school leaving age by the same health visitor; it is also desirable from the Health Visitor's point of view. There were no serious epidemics during the year and the health of the schoolchildren has, on the whole, been satisfactory. The special needs of the many categories of handicapped children continues to be a major preoccupation of the staff and reference to the statistical report will give some indication of the extent and scope of this work. 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 have received from the Education Department. The investigation into the health of schoolchildren which is proceeding in the Borough of Bexley under the aegis of the Kent Paediatric Society continues to make progress and a stage has now been reached when interviews are being arranged with approximately 200 families of Bexley schoolchildren. The first part of the investigation relating to the Incidence of Health has been completed and our enquiry into the Causation of Health is proving to be a very fascinating part of our work. A report will in due course be published which should be of great interest to all who are concerned with the health of schoolchildren and indeed with health in general. Once again, I have to record the excellent team work of all members of the staff on which the success of the School Health Service so largely depends and finally, I wish to express my appreciation of the help and encouragement which I have received during the year from the Chairman and Members of the Committee, from Miss Smith, the Senior Clerk, and from the County Medical Officer and his staff, whose help and co-operation during the year have been a very valuable asset. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, John Landon, Medical Officer of Health. 47 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Six County Secondary Schools with seven departments. Average number on Roll at 31st December, 1950 3,106 Twenty-three County Primary Departments. Average number on Roll at 31st December, 1950 7,341 One Nursery Class attached to Uplands Primary School. Average number on Roll 53 Bexley County Technical School for Girls. Average number on Roll: Bexley 817 Wilmington Annexe 191 Total ...11,508 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, Wednesdav, 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. 48 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. Bexleyheath—315, Broadway. Monday, 2-5 p.m. Specialist in attendance 1st and 3rd Monday, 10 a.m.-12.30 p.m. (This clinic commenced on the 9th October, 1950.) Aural. Welling—Little Danson, Dansington Road. Tuesday morning, 9.30-11 a.m. Appointments made from Office. (Discontinued 1G.4.51.) 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. 49 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—1950. Average number of pupils in attendance:— Primary Schools 7,341 Secondary Schools 3,106 10,447 50 Average number of pupils taking meals daily:— Primary Secondary (1) Free 120 162 (2) Payment 3,024 2,412 Total 3,144 2,574 Milk. Average number of pupils taking milk daily:— Primary 6,703 Secondary 2,834 Total 9,537 Work of the Ophthalmic Clinic. I am indebted to Mr. R. M. Chambers, M.B., B.S., D.O.M.S., for the following report:— During the year 2,697 examinations were made on 1,799 children from 0 to 16 years of age, an increase of ten per cent, on the previous year's figures. A total of 588 new cases were seen and 549 prescriptions were dispensed (including old and new cases). An analysis of the refractive errors in this community which required correction showed:— Hypermetropia 12.5% (237 cases). Myopia 14.3% (256 cases). Mixed Astigmatism 2.2% ( 39 cases). Astigmatism 38.0% (213 cases) in all corrected cases. A survey of higher degrees of ametropia showed:— Hypermetropia (Over 6 Dioptres) 13 cases. Myopia (Over 5 Dioptres) ... ... 19 cases. Astigmatism (4 Dioptres and over) 14 cases. High astigmatic and myopic errors were twice as common in girls as in boys, but this sex ratio was reversed in high hypermetropia. These figures correspond closely with those obtained by other authorities working with larger numbers in different urban areas. A number of circulars were printed dealing with the broad principles of treatment of myopes and appear to have been of some help to parents concerned. 51 The incidence of amblyopia and squint has not altered significantly (Squint 12%). There is still a number of cases of squint, etc., that could be cured were it not for the difficulty of obtaining orthoptic treatment. I stressed the need in my report two years ago and again wish to draw attention to the desirability of an orthoptic clinic in this area. A number of interesting cases presented themselves: 1. Three (unrelated) cases of arachnodactyly, oxycephaly, etc. Parents were warned of the ophthalmic complications that may develop. 2. Tay's Choroiditis. 3. Traumatic Horner's syndrome with contralateral anhydrosis. 4. Migraine associated with paroxysmal altitudinal hemianopia. 5. Binocular vision in presence of 5 dioptres of anisometropia. 6. Macular pigmentation with high hypermetropia. 7. Nystagmus and word blindness of cerebellar origin. 8. Early arcuate opacities in a Mongol. Orthopaedic Clinic, I am indebted to Mr. K. F. Hulbert, E.R.C.S., for the following report on the Orthopiedic Clinic:— The Orthopaedic Clinic at Welling has been continued throughout the year on the first and second Wednesday mornings of the month and the waiting list has been considerably reduced by the running of a second Clinic in Bexleyheath under the direction of Mr. B. Lawson, F.R.C.S. Our work is still severely cramped and hindered by the shortage of accommodation, which is totally inadequate for the number of cases with which we now have to deal, and it is impossible to undertake any more treatments than we now do, because the treatment rooms will not hold any more children. There has been no marked change in the type of case coming for treatment, but the rising cost of shoes is 52 now becoming a serious problem for children who, because of some defect or other, wear their shoes out very rapidly. Miss Cheeseman has carried out the Physiotherapy with keenness and efficiency throughout the year, lor which we all should be very grateful. Dental Treatment. I am indebted to Mr. Dickson, L.D.S., Orthodontist, for the following report:— An orthodontic clinic has been held for approximately one half day per week at Little Danson Clinic. 200 patients are now under treatment, the maximum number which can be dealt with in this time. The waiting list is increasing as new cases cannot be commenced until current ones are completed. A greater number are now being treated by fixed appliances, thus extending the scope of the work, but for reasons of economy of surgery time the bulk of cases are treated by removable appliances, made in the Maidstone workshop. Excellent lateral skull radiographs taken by the radiologist of the West Hill Hospital, Dartford, have greatly assisted in the diagnosis of difficult cases — a co-operation which is much appreciated. In my opinion at least one and a half days a week would be necessary to satisfactorily keep up with the demand for orthodontic treatment at this clinic alone. I am indebted to Mr. Wade, L.D.S., Dental Surgeon, for the following report:— I have to submit my fourth annual short report upon the work of the Dental Clinics allotted to me. The year under review has been a very full one and the shortage of Dental Surgeons in the Borough is being felt more acutely year by year and there appears to be no prospect of this position improving. Maternity and Child Welfare. The attendances by these classes of patient continues to grow and their treatment reflects adversely upon the school population. 53 Education. Once again I stress that, in my opinion, a few lectures arranged by the Senior County Dental Officer to parents and the older school age groups would do much towards the dental hygiene of your Borough. Orthodontic Treatment. The treatments in this branch are behind hand, brought about chiefly by the County Dental Laboratory being unable, until recently, to cope with making the necessary appliances. Headway is again being made. Cases of Interest. A child aged about five years presented a very thickened upper lip. On examination the upper aspect of the orbicularis oris was found to be adhering to the pre-maxilla area and the lower incisors biting into it. This appears to be a rare congenital condition and it was referred to hospital for surgical interference. Many parents are bringing their children showing green pigmentation of the deciduous teeth and brown pigmentation of the dentine in permanent teeth. Recent investigation has been carried out upon the green pigmentation and it appears to have been established that the Rhesus factor is responsible. Of the brown staining, research appears to have established that fluorine in the water supply is responsible. No doubt the fluorine in the water supply of your Borough has already received your attention. I have received every assistance in the running of the clinics and to you, personally, I express my thanks for the help you have given. Cleanliness Inspections. (See Table V.) During the year the School Nurses carried out 15,921 examinations of children in Schools and 323 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. 54 Physical Education. I am indebted to the Borough Education Officer for the following report. In all the maintained schools in the Borough, the standards of physical education continue to rise, although the economy measures imposed by the County Council have made it difficult to ensure that all children change into rubber shoes and where appropriate, into shorts and singlets. At a number of primary schools out-door climbing and agility apparatus has been installed and good use is being made of this. A number of schools have held displays of physical education and many parents and citizens of the Borough have had an opportunity of seeing the pleasing results of modern methods of physical education. Particular thanks are due to the efforts of the two physical training Advisers, Miss H. Foster and Mr. J. Loughran. They have held a number of courses for teachers in this and neighbouring areas, the results of which are becoming increasingly apparent. Swimming. During the year 1950, schools in the Borough again took advantage of the facilities available for swimming. Ten Primary Departments and six Secondary Departments used the Charlton Park, Eltham Park, Plumstead and Danson Baths. A total of 537 swimming certificates were issued during the year, compared with 300 in 1948 and 416 in 1949. 55 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. Table IV — Dental Inspection and Treatment including Orthodontics. Table V — Infestation with Vermin. Table VI — Handicapped Children. A. Children 5-16 years. B. Children 2 years-4 years 11 months. 56 TABLE 1. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. — Periodic Medical Inspections. Number of Inspections in the prescribed Groups : Entrants 1,193 Second Age Group 1,120 Third Age Group 832 Total 3,145 Number of other Periodic Inspections 2,158 Grand Total 5,303 B. — Other Inspections. Number of Special Inspections 5,157 Number of Re-inspections 5,011 Total 10,168 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 (l) (2) (3) (4) Entrants 34 694 453 Second Age Group 62 557 430 Third Age Group 82 660 415 Total (prescribed groups) 178 1,911 1,298 Other Periodic Inspections 229 1,562 1,016 Grand Total 407 3,473 2 314 57 TABLE II. A. — Return of Defects Found by Medical Inspection in the Year ended the 31st December, 1950. 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 314 212 220 24 5. Eyes— a. Vision 407 389 253 3 b. Squint 38 65 14 — c. Other 136 42 118 12 6. Ears— a. Hearing 73 62 29 9 b. Otitis Media 22 26 49 7 c. Other 37 94 26 4 7. Nose or Throat 414 723 363 88 8. Speech 20 49 9 3 9. Cervical Glands 26 457 12 5 10. Heart and Circulation 97 115 55 36 11. Lungs 101 265 123 74 12. Developmental — a. Hernia 21 55 1 7 b. Other 94 286 5 6 13. Orthopaedic— a. Posture 761 192 22 9 b. Flat-foot 558 148 27 4 c. Other 559 203 80 17 14. Nervous system— a. Epilepsy 3 12 1 b. Other 24 75 26 12 15. Psychological— a. Development 6 28 9 4 b. Stability 33 109 56 39 16. Other 302 345 340 202 58 B. — Classification of the General Condition of Pupils Inspected during the Year in the Age Groups. Ago 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 1193 404 33.86 673 56.41 116 9.73 Second Age Group 1120 350 31.25 669 59.73 101 9.02 Third Age Group 832 352 42.30 441 53.00 39 4.70 Other Periodic Inspections 2158 724 33.54 1238 57.37 196 9.09 Total 5303 1830 34.50 3021 56.96 452 8.52 TABLE III.—Treatment Tables. Group 1—Minor Ailments (excluding Uncleanliness, for which see Table Y). SKIN Number of Defects treated, or under treatment during the year. Ringworm—Scalp— (i) X-Ray treatment — (ii) Other treatment — Ringworm—Body 21 Scabies 3 Impetigo 18 Other skin diseases 351 TOTAL 393 59 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) 1,797 (2) Other defect or disease of the eyes (excluding those recorded in Group 1) 12 Total 1,809 (3) No. of Pupils for whom spectacles were (a) Prescribed 455 (b) Obtained 383 Croup III—Treatment of Defects of Nose and Throat. Total number treated Received operative treatment— (a) for adenoids and chronic tonsillitis 96 (b) for other nose and throat conditions — Received other forms of treatment ... 444 Total ... 540 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 2,165 (b) Specials 677 Total ... 2,842 60 Croup IV—Orthopaedic and Postural Defects. (a) No. treated as in-patients in hospital 12 (b) No. treated otherwise e.g. in clinics or out-patient departments ... ... 029 (2) Number found to require treatment 1,675 (3) Number referred for treatment 1,675 (4) Number actually treated 2,060 (5) Attendances made by pupils for treatment 6,656 (6) Half-days devoted to (a) Inspection 11 (b) Treatment 670 Total 681 (7) Fillings: Permanent Teeth 1,404 Temporary Teeth 275 Total 1,679 (8) Number of teeth filled : Permanent Teeth 1,368 Temporary Teeth 270 Total 1,638 (9) Extractions: Permanent Teeth 616 Temporary Teeth 3,501 Total 4,117 (10) Administration of general anaesthetics for extraction 1,472 (11) Other operations: Permanent Teeth 561 Temporary Teeth 406 Total 967 Scalings 24 967 Cleaning 9 Polishing 29 Root Dressing's 34 Teeth Crowned 1 Dressings: Permanent Teeth 464 Temporary Teeth 406 61 Orthodontic. Attendances for mechanical appliances 1,144 Completely Treated 5 Impressions Upper 126 Lower 106 Bites 5 Try-ins 9 Dentures Fitted—Upper 20 Dentures Repaired 1 Examination and Advice 305 Appliances Fitted—Upper 94 Lower 4 Remakes—Upper 5 Lower 2 Repairs 20 Adjustments 473 TABLE V. Infestation with Vermin. (i) Total number of examinations in the schools by the school nurses or other authorised persons 15,921 (ii) Total number of individual pupils found to be infested 323 (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) - 62 TABLE VI. Physically Handicapped Children. Population: 5 yrs. to 16 yrs. Table A1 No. of children ages 5 yrs. to 16 yrs. Defects (l) (2) (3) (4) (5) At Ordinary schools At Day special schools At Residential special schools including hospital schools At Home Totals (a) Having home teaching (b) Not having home teaching B. G. B. G. B. G. B. G. B. G. B. G. Total Congenital Heart 1 1 1 1 2 2 4 Rheumatic Heart 2 2 2 Haemophilia 1 1 1 Cerebral Palsy (including athetosis) 1 1 3 2 3 3 4 13 Poliomyelitis 3 1 1 1 1 2 7 Muscular Dystrophy 1 1 — 1 Muscular Atrophy — Spinabifida — Osteomyelitis 1 1 — 1 Hydrocephalus 1 1 1 Fragilitas Ossium 1 1 1 Achondroplasia 1 1 1 A rthrogryphosis Perthe's Disease 1 1 1 Tb. joints 1 1 2 1 Talipes 1 1 1 Cong. Dislocation hips X 1 1 Cong, deformities: (a) arms and hands 1 1 1 1 (b) legs and feet 1 1 1 Amputations: (a) legs 1 1 1 (b) arms 1 1 1 Rheumatoid arthritis including Still's disease _ _ _ Septic arthritis _ _ _ Fractured Skull _ _ _ Brain Tumour 1 1 _ 1 Friedrich's Ataxia _ _ _ Others (specify) 1 1 2 1 3 4 TOTAL 8 8 6 3 5 3 3 4 7 1 30 19 49 63 Table AIII No. of P.H. children at home, or at Ordinary schools, who are waiting admission to:— (1) (2) Residential P.H. schools Totals * Day P H. schools (a) For seriously crippled children, e.g Hinwick Hall (b) For less seriously crippled children e.g. Victoria Home, Bournemouth Boys Girls Boys Girls Boys Girls Boys Girls Total 1 1 1 *P.H. children who are sent to day open air schools because there are no accessible day P.H. schools should be included under this heading. Table AIII Totals No. of seriously P.H. children for whom home teaching is the best provision (excluding those who are waiting admission to special schools) Boys Girls Total — 1 1 Table AIV Totals Boys Girls Total No. of P.H. children in bed at home Table AV Already in Residential P.H. schools Waiting admission to Residential schools *For whom Home teaching is best provision Totals B. G. B. G. B. G. B. G. Tota How many have incontinence of:— (1) Bladder — — — (2) Bowel — — — (3) Both — — — How many are chair cases: (1) Sell-propelled — — — (2) Push chairs 1 1 1 1 2 2 4 6 How many with crutches or two sticks 3 3 — 3 How many are: P.H. + E.S.N 1 1 1 1 2 3 P.H. + Epileptic — — — P.H. + Maladjusted — — — P.H. + Blind — — — P.H. + Pt. Sighted — — — P.H. + Deaf — — — P.H. + Pt. Deaf — — — P.H. + More than one other defect 2 2 — 2 * Excluding those who are waiting admission to special schools. 64 TABLE VI, Physically Handicapped Children. Population: 2 yrs. to 4 yrs. 11 mths. Table Bl No. of children ages 2 yrs. to 4 yrs. 11 mths. Defects (l) (2) (3) (4) (5) At Ordinary schools At Day special schools At Residential special schools including hospital schools At Home Totals (a) Having home teaching (b) Not having home teaching B. G. B. G. B. G. B. G. B. G. B. G. Total Congenital Heart 6 — 6 6 Rheumatic Heart — — — Haemophilia — — — Cerebral Palsy (including athetosis) 2 — 2 2 1 Poliomyelitis 1 1 — [Muscular Dystrophy 1 — 1 1 Muscular Atrophy — — Spinabifida — — Osteomyelitis 1 1 — 1 3 Hydrocephalus 1 2 1 2 Fragilitas Ossium — — Achondroplasia — — — Arthrogryphosis Perthe's Disease 1 — — — 1 1 1 2 Tb. joints — — — Talipes 1 1 — 1 Cong. Dislocation hips 3 — 3 3 Cong, deformities: (a) arms and hands 1 1 1 1 2 (b) legs and feet — — — Amputations: (a) legs — — — (b) arms — — — Rheumatoid arthritis including Still's disease Septic arthritis — — — Fractured Skull — — — Brain Tumour — — — Friedrich's Ataxia — — — Others (specify) 1 — 1 1 TOTAL 6 17 6 17 23 65 Table BII No. of P.H. children at home, or at Ordinary schools, who are waiting admission to:— Totals (1) (2) Residential P.H. schools *Day P.H. schools (a) For seriously crippled children, e.g. Hinwick Hall (b) For less seriously crippled children e.g. Victoria Home, Bournemouth Boys Girls Boys Girls Boys Girls Boys Girls Total 2 - - - - - 2 - 2 *P.H. children who are sent to day open air schools because there are no accessible day P.H. schools should be included under this heading. Table BIII Totals No. of seriously P.H. children for whom home teaching is the best provision (excluding those who are waiting admission to special schools) Boys Girls Total - - - Table BIV No. of P.H. children in bed at home Totals Boys Girls Total — 1 1 Table BV Already in Residential P.H. schools Waiting admission to Residential schools *For whom Home teaching is best provision Totals How many have incontinencc of:— B. G. B. G. B. G. B. G. Total (1) Bladder — — — (2) Bowel — — — (3) Both — — — How many are chair cases; (1) Self-propelled — — — (2) Push chairs — — — How many with crutches or two sticks How many are: P.H. + E.S.N. — — — P.H. + Epileptic — — — P.H. + Maladjusted — — — P.H. + Blind — — — P.H. + Pt. Sighted — — — ; P.H. + Deaf — — — P.H. + Pt. Deaf — — — P.H. + More than one other defect — * Excluding those who are waiting admission to special schools. 66 INDEX. Item page Health Committee 2 Public Health Staff 3 STATISTICS AND SOCIAL CONDITIONS. Acreage 8 Population 8 Unemployment 3 Social Conditions and Amenities 8—9 Population Graph 10 Summary of Vital Statistics, 1950 11—12 Extracts from Vital Statistics— Births and Birth Rates, etc. 12—13 Stillbirths and Stillbirth Rates 13—14 Deaths and Death Rates 14—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 20 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 21 Water Supply 22 Bacteriological 22 Drainage and Sewerage 23 Rivers and Streams 23 Chief Sanitary Inspector's Report— Tables of Inspections and Improvements, etc. 24—25 Food Inspection 26 Tables—Factories Act, 1937 27 Closet Accommodation 28 Public Cleansing 28 Refuse Collection and Disposal 28 Salvage 29 Public Conveniences 29 Rats and Mice (Destruction) Act, 1919 30 Shops Act, 1950 30 Swimming Pool 31 Eradication of Bed Bugs 31 Camping Sites 31 Schools 31 67 ITEM PAGE 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 37 Registration of Premises 37 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 38 Diphtheria 38 Diphtheria Immunisation and Vaccination 39 Enteric Fever Puerperal Pyrexia 40 Ophthalmia Neanatorum 40 Measles 40 Whooping Cough 40 Acute Anterior Poliomyelitis 40 Scabies 40 Food Poisoning 40 Tables of Infectious Diseases Notified 41 Tuberculosis 41 SCHOOL HEALTH SERVICES REPORT, 1949. Welfare and School Services Sub-Committee 44 Staff 44—45 Schools 48 Clinics 48—49 Co-ordination— Periodic Medical Inspections 50 School Meals 50 Ophthalmic Clinic 51—52 Orthopsedic Clinic 52 Dental Treatment 53 Cleanliness Inspections 54 Physical Education 55 Swimming 55 Statistical Tables 56—66 68