AC 4412(1) BEXLEY BEX 16 BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Service For the Year 1951 JOHN LANDON, m.r.c.p.. l.rc.p., d.p.h. Medical Officer of Health BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health For the Year 1951 JOHN LANDON, m.r.c.p.. l.r.c.p., d.p.h. Medical Officer of Health Borough of Bexley. Mayor: Councillor J. D. Vergette, J.P. Deputy Mayor: Councillor P. R. Relph. HEALTH COMMITTEE. Chairman: Alderman R. G. Broomfield. Vice-Chairman: Alderman H. P. Tanner, C.C. Alderman J. C. McLean, J.P. Alderman Mrs. A. Welch. Councillor M. J. Corr. Councillor E. S. Newton. Councillor H. C. Crawford. Councillor J. D. Vergette, J.P. Councillor Mrs. H. F. Piggott. Councillor Miss R. A. F. Taylor. PUBLIC HEALTH STAFF, 1951. 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 *† P. W. Willington. *† G. F. Lovegrove. *† W. E. Moses Chief Clerk G. A. Pearson. Senior Clerk R. V. Hoad. Clerks E. M. Pearmine (Miss). M. E. Smith (Miss) (Shorthand Typist). E. Patten (Miss) (temporary Shorthand Typist, Jan-Sept. 1951). 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 1951. The vital statistics of the Borough are, broadly, satisfactory and present a number of interesting features. The birth rate during 1951 was 12.79 per thousand of the home population compared with 13.13 per thousand in 1950, 14.02 in 1949, 15.36 in 1948, 18.72 in 1947, 19.75 in 1946, 18.81 in 1945 and 21.06 in 1944. Between 1931 and 1944 the lowest birth rate recorded was 15.88 (1941) and so it will be seen that the increase in the birth rate towards the end of the war has not been maintained and the birth rate in fact shows an accelerated rate of decline which, in general, follows the trend in the birth rate for the country as a whole, although the birth rate for Bexley is appreciably lower than the national rate (15.5). There is a number of possible explanations. Firstly, the housing position is a major deterrent to young married people to start a family. Added to this there is the high cost of living, including the high cost of setting up a home. The birth rate for the Borough corrected by the use of the Registrar General's comparability factor (0.94) was 12.02. Between the two wars the birth rate of Bexley was higher than that for the country as a whole, the reason no doubt being that the rapid development of the town attracted a young type of resident. The Borough has now practically reached saturation point in regard to the building of houses and it would appear that young people are tending to seek accommodation in other districts or deferring the date of starting a family. Bearing in mind the low death rate which we enjoy, nowadays, and the fact that the level of the population is being maintained only by the fertility of the past, two things are obvious; firstly that the number of old people must increase and secondly (seeing that we are all mortal) the death rate must be expected to rise and the population stablised at a lower level based on present day fertility factors. 4 The death rate for the Borough, during 1951, was 9.6 compared with 8.56 for 1950, or, after correction by means of the comparability factor for deaths (1.18), 11.33 compared with an uncorrect death rate for the country as a whole of 12.5. The infant mortality rate for 1951, at 24.76 per thousand live births, was considerably higher than the record low rate for 1950, namely, 14.48. The number of babies who died in the first year of life per thousand live births, during 1951, was 28 compared with 17 in 1950. The percentage of children dying during the first month of life (neo-natal deaths) was, roughly, the same as in 1950 but there was a marked increase, in 1951, in the number of deaths from bronchitis and pneumonia, namely, 10 compared with 3 in 1950. These diseases are, prima facie, preventable and demonstrate, notwithstanding the record low rate for 1950, the need for further improvement in environmental conditions and standards of maternal care. Nevertheless the rate for 1951 compares favourably with a rate of 29.6 for the country as a whole. It is necessary to point out that the trend of infant mortality in a district such as this, based as it is on a relatively small number of deaths, must not be judged by small annual fluctuations which may be due to fortuitous circumstances, but over a period of years and by this criterion our figures are very satisfactory. There were no maternal deaths during the year which reflects credit on the local midwifery services, bearing in mind the fact that there were 1,131 live births during the year, in addition to 21 still births. The incidence of infectious disease within the Borough continued to be very low. No case of diphtheria was notified for the second year in succession. Although this is eminently satisfactory, there is an implied danger in the freedom from this disease in that the young mothers of to-day have never seen a child with diphtheria or heard of a child recently dving from this cause. There is a noticeable tendency for diphtheria immunisation to be neglected in many cases. It cannot be too strongly stressed, however, that our present freedom from this disease is dependent on a continued high level of immunisation of young children as a group and parents should realise that thev have both a public and a private duty to perform in this matter. Although there were 2,209 cases of measles there was only one death from this cause. 440 cases of whooping cough were notified without a single death. These two 5 diseases, with the exception of tuberculosis, are the two most important infectious diseases experienced at the present time, leaving out for the moment the unpredictable incidence of poliomyelitis. Constant vigilance has to be exercised in regard to the prevention of smallpox. As a result of the Brighton epidemic in 1950/51, 22 contacts were traced to this area and vaccination was carried out by the Health Department in most cases and intensive supervision exercised during the danger period. On two other occasions ships arrived in nearby ports carrying a case of smallpox and contacts were traced to this area. Vaccination was carried out wherever necessary and the appropriate surveillance exercised. During 1951, 37 cases of paratyphoid fever occurred in an area covering adjacent London boroughs and districts in Kent and Sussex. The cause of the outbreak was judged to be synthetic cream supplied from a food establishment in a neighbouring district. Some of the cases occurred in the Borough of Bexley, an extensive investigation developed and it is likely that the control measures which were instituted prevented a more widespread epidemic. In addition to these cases, 7 cases of food poisoning were notified during the year. Generally speaking the infectious diseases which took such a heavy toll of life and health in the past have diminished in importance but continued vigilance is needed as some change in the natural history of the organisms or some lowering of individual resistance in peace or in war may precipitate a return to former conditions. Tuberculosis remains the most important of the infectious diseases which are encountered. It is a tragedy that this disease which is preventable is not being prevented. It presents a medico-social problem of great complexity, a description of which is outside the scope of this foreword. I would emphasise one aspect, however, which demands immediate attention, namely, the discharge from sanatorium to their own homes of open, i.e. infectious, cases when their continued stay in hospital can no longer be of benefit to them. These frequently chronic cases are responsible for a good deal of mischief and our powers under the Public Health Act to control this source of infection are inadequate in that such patients may only be compulsorily removed to hospital provided suitable accommodation is available for them. 6 The report of the Central Health Services Council for the year ended December 31st, 1950, recognises that "this is a potent source of infection" and recommends "that for chronic infectious patients who are ambulant it is desirable to provide hostels affording domiciliary care and medical supervision." In my view an anomalous position has arisen in regard to the domiciliary tuberculous patient. The presence of a tuberculous person in a household is often regarded by the Housing Committee, and rightly so, as grounds for the rehousing of the patient or of a second family, especially if it includes young children, who are occupying the same premises. It would, perhaps, be more efficacious and less costly to remove the source of infection to suitable hospital or other accommodation. The care of old people living alone is becoming more and more the responsibility of the Health Department. Under Section 47 of the National Assistance Act, 1948, as amended by the National Assistance (Amendment) Act, 1951, it is the responsibility of the local authority to take appropriate action in the cases of persons "who are suffering from grave chronic disease or being aged and infirm or physically handicapped are living in ???nsanitary conditions and are unable to devote to themselves, and are not receiving from other persons, proper care and attention." The effects of the ageing of the population are now being felt in the increase of such cases. Old people are often discovered to be living in conditions grotesque from the point of view of loneliness and the absence of even the lowest standards of comfort, care and cleanliness. These old people are nearly always infirm to a greater or lesser extent and I would like to express my appreciation of the help which is so readily forthcoming from the officers of the Woolwich Group Hospital Management Committee who do their best under difficult circumstances to find accommodation for these urgent cases. The affiliation of the local Elderly People's Walfare Committee to the North West Kent Old People's Welfare Committee, operating under the North West Kent Council of Social Service, has now taken place and the experiment is being tried of appointing district liaison officers somewhat on the lines of the Tuberculosis After-Care Committee. The work of the new Committee will be, firstly, to ascertain on a Ward basis the old people needing additional care, to co-ordinate the work of all agencies providing for the care of old people and to 7 afford to the latter a wide range of good neighbourly services. One of the added functions will be the raising of funds from various charitable sources and the assistance of old people, in suitable cases, by small monetary grants or their equivalent in food and other requirements needed for their comfort. Although the state is now responsible for a wide range of statutory services for old people, it is considered essential that each local community should interest itself in the deprived old people who are living in their midst. The joint Clean Food Campaign with Erith and Crayford goes forward slowly but steadily and good progress has been made in what is essentially a long term health education project. In May, 1951 a clean food exhibition was held and was reasonably well supported by the general public. Organised parties of school children from the three areas visited the exhibition and lectures and film shows were given. Codes of Practice have now been formulated for all the main food trades and applications for membership have been received from 98 food traders, of which 19 have been approved to date. There is still a great deal of work to be done in this sphere during the next few years to bring into membership the majority of the food traders in the area. An attractive plaque has now been prepared which, we hope, will become more and more familiar to the public as it appears in increasing numbers in the windows and on the premises of food establishments of the Borough. The prevention of accidents in the home is being recognised more and more as coming within the realm of preventive medicine and therefore a legitimate field of endeavour for the public health authorities. This matter can best be dealt with by a partnership of local health authority, local authority and the local Road Safety Committees, whose functions could be enlarged to cover by means of a sub-committee this important part of the work of accident prevention in general. Preliminarv steps to achieve this end have been taken locally and it is hoped that further developments will take place during 1952. The research into the epidemiology of health which has been carried out by the Kent Paediatric Society, through the Bexley Health Department, in connection with Bexlev school children, during the past three years, is progressing well and is now entering its final stages. It is hoped that a report will be published about the end of *1952. 8 During 1951 the public mortuary was enlarged and equipped with refrigeration for six bodies. It will also be used by Erith and Crayford Authorities by arrangement with the Bexley Borough Council. 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 LANDON, Medical Officer of Health. 9 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. Registrar General's Estimate midyear, 1951 88,420 New Dwellings Erected. Houses 319 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. 4950 89,410 102+15 rebuilt. Number of inhabited houses at end of 1951 (according to Rate Books) approximately 26,038 Rateable Value £652,783 Sum represented by a penny rate £2,611 Unemployment. Men Women l Boys Girls Total December 31«t, 1950 275 76 6 18 375 December 31st, 1951 191 100 22 18 331 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. 10 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 „ Parkhurst Gardeus .70 „ Playground off Broadway 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. 11 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— Hates per 1,000 Home Population. Live 15.5 17.3 16.7 17.8 12.79 Still 0.36 0.45 0.38 0.37 0.24 Deaths— All Causes 12.5 13.4 12.5 13.1 9.6 Typhoid and Paratyphoid 0.00 0.00 0.00 — Whooping Cough 0.01 0.01 0.01 0.01 — Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.31 0.37 0.31 0.38 0.28 Influenza 0.38 0.36 0.38 0.23 0.09 Smallpox 0.00 0.00 0.00 — — Acute Poliomyelitis (including Polioencephalitis 0.00 0.01 0.01 0.00 — Pneumonia 0.61 0.65 0.63 0.61 0.42 Notifications(corrected) Typhoid Fever 0.00 0.00 0.00 0.01 — Paratyphoid Fever Meningococcal 0.02 0.03 0.02 0.01 0.02 Infection 0.03 0.04 0.03 0.03 — Scarlet Fever 1.11 1.20 1.20 1.10 1.14 Whooping Cough 3.87 3.62 4.00 3.11 4.98 Diphtheria 0.02 0.02 0.03 0.01 — Erysipelas 0.14 0.15 0.12 0.15 0.19 Smallpox 0.00 0.00 0.00 — — Measles 14.07 13.93 14.82 14.64 24.98 Pneumonia 0.99 1.04 0.96 0.72 0.41 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.03 0.03 0.03 0.02 0.02 Non-Paralytic 0.02 0.02 0.03 0.02 — Food Poisoning 0.13 0.15 0.08 0.23 0.08 Rates per 1,000 Live Births. Deaths All causes under one year of age 29.6(a) 33.9 27.6 26.4 24.76 Enteritis and Diarrhoea under two years of age 1.4 1.6 1.0 0.7 — Rates per 1,000 Total (Live and Still) Births. Notifications(corrected) Puerperal fever and Pyrexia 10.66 13.77 8.08 14.90 6.08 (a) Per 1,000 related live births. A dash (—) signifies that there were no deaths. 13 Maternal Mortality in England and Wales. Intermediate List No. and cause Number of Deaths Rates per 1,000 Total (Live and Still) Births Rates per million women aged 15-44 A115 Sepsis of pregnancy, childbirth and the puerperium 70 0.10 — A116 Abortion with toxaemia 3 0.00 0 Other toxaemias of pregnancy and the puerperium 167 0.24 — A117 Haemorrhage of pregnancy and child birth 91 0.13 — A118 Abortion without mention of sepsis or toxaemia 37 0.05 4 A119 Abortion with Sepsis 66 0.09 7 A120 Other complications of pregnancy, childbirth and the puerperium 125 0.18 — EXTRACTS FROM VITAL STATISTICS FOR THE Year 1951. The Registrar General's Estimate of home population for the mid-year is 88,420 and this figure is assigned tor the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 573 558 1,131 Legitimate 549 532 1,081 Illegitimate 24 26 50 Birth Rate. Rate per 1,000 estimated home population 12.79 The following relates to the Birth Rate during the past ten years:— 1941 Birth Rate 15.88 per thousand 1942 „ „ 19.07 „ 1943 „ „ 18.03 „ 1944 „ „ 21.06 „ 1945 „ „ 18.81 „ 1946 „ „ 19.75 „ 1947 „ „ 18.72 „ 1948 „ „ 15.36 „ 1949 „ „ 14.02 „ 1950 „ „ 13.13 „ 14 Rate per 1,000 for England and Wales, 1951 15.5 ,, ,, ,, ,, County Boroughs and Great Towns, including London 17.3 ,, ,, ,, ,, Smaller Towns (estimated population 25,000 to 50,00 at Census, 1931) 16.7 ,, ,, ,, ,, London Administrative County 17.8 50 illegitimate live births were registered against 54 in 1950. The Registrar-General has supplied a comparability factor for 1951. The standardised birth rate which allows for comparison with other parts of the country is 12.02. Stillbirths. Males Females Total Total 8 13 21 Rate per 1,000 total (live and still) births 18.23 The following relates to the Stillbirth Rate during the past ten years:— Year Rate per Thousand Total Live and Still Births Population 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 1950 11.78 0.16 21 Stillbirths were registered during the year. This represents a rate of 0.24 per 1,000 population against 0.16 per 1,000 population in 1950. 15 Rate per 1,000 for England and Wales, 1951 0.36 ,, ,, ,, ,, County Boroughs and Great Towns, including London 0.45 ,, ,, ,, ,, Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 0.38 ,, ,, ,, ,, London Administrative County 0.37 There was 2 stillbirths registered as illegitimate. Deaths. Males Females Total All causes 457 392 849 Death rate per 1,000 of estimated home population 9.6 Number of women dying in, or in consequence of, childbirth: From Puerperal and Post Abortive Sepsis — From other Puerperal Causes — Death rate per 1,000 total (live and still) births — Deaths of Infants under one year of age 10 18 28 Legitimate 9 17 26 Illegitimate 1 1 2 Death rate of Infants under one year of age: Total per 1,000 live births 24.76 Legitimate per 1,000 legitimate live births 24.05 Illegitimate per 1,000 illegitimate live births 40.0 Deaths from Measles (all ages) 1 — 1 ,, ,, Whooping Cough (all ages) — — — ,, ,, Diarrhoea (under 2 years of age) — — — ,, ,, Cancer (all ages) 89 70 159 16 Death Rate of Country:— Rate per 1,000 for England and Wales, 1951 12.5 ,, ,, ,, ,, County Boroughs and Great Towns, including London 13.4 ,, ,, ,, ,, Smaller Towns (estimated population 25,000 to 50,000 at Census, 1931) 12.5 „ ,, ,, „ London Adminstrative County 13.1 Death Rate of Area during last ten years:— 1941 9.68 per thousand 1942 8.73 „ „ 1943 9.21 „ 1944 10.20 „ 1945 9.28 „ 1946 8.55 „ „ 1947 9.17 „ 1948 7.53 „ „ 1949 8.15 „ 1950 8.56 „ The rate for Bexley compares favourably with that for other parts of the country. The Registrar-General has supplied a comparability factor for 1951. The standardised death rate which allows for comparison with other parts of the country is 11.33. 17 CAUSES OF DEATH IN THE BOROUGH. REGISTERED DURING THE YEAR 1951. Causes of Death. M. F. Total All Causes 457 392 849 1 Tuberculosis, respiratory 16 5 21 2 Tuberculosis, other 3 1 4 3 Syphilitic disease 1 — 1 4 Diphtheria — — — 5 Whooping Cough — — — 6 Meningococcal infections — — — 7 Acute poliomyelitis — — — 8 Measles 1 — 1 9 Other infective and parasitic diseases — 1 1 10 Malignant neoplasm, stomach 16 8 24 11 Malignant neoplasm, lung, bronchus 32 8 40 12 Malignant neoplasm, breast — 20 20 13 Malignant neoplasm, uterus — 5 5 14 Other malignant and lymphatic neoplasm 41 29 70 15 Leukaemia, aleukaemia — 3 3 16 Diabetes 1 4 5 17 Vascular lesions of nervous system 49 61 110 18 Coronary disease, angina 69 33 102 19 Hypertension with heart disease 12 19 31 20 Other heart disease 58 73 131 21 Other circulatory disease 15 17 32 22 Influenza 3 5 8 23 Pneumonia 23 14 37 24 Bronchitis 46 22 68 25 Other diseases of the respiratory system 8 2 10 26 Ulcer of stomach and duodenum 8 3 11 27 Gastritis enteritis and diarrhoea — — — 28 Nephritis and nephrosis 6 3 9 29 Hyperplasia of prostate 6 — 6 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 1 6 7 32 Other defined and ill-defined diseases 29 44 73 33 Motor vehicle accidents 5 — 5 34 All other accidents 6 6 12 35 Suicide ... ... 2 — 2 36 Homicide and operations of war — — — 18 19 INFANT MORTALITY, 1951 DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1951 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— 10— 11— 12 Congenital Malformation, Premature Birth, Birth Injury, etc. 2 3 1 1 2 2 Anencephaly 1 Asphyxia from inhalation of internal fluid 1 Asphyxia 1 Pneumonia 1 2 2 1 1 Eyathroblastosis Foetalis 2 1 Anoxia 1 Heart Failure and Bronchitis 1 T.B. Meningitis 1 Acute Laryngo Trachoo Bronchitis 1 Totals 7 4 2 — — — 1 3 3 — — 3 2 1 — — — 2 — — — — The number of infants under one year of age who died during the year 1951 as shown by the table is 28. 20 of these deaths, that is 71.43 per cent., occurred in the neonatal period (within one month of birth). In 1950 the corresponding figure was 76.47 per cent. 28 were registered during the year giving an infantile mortality rate per 1,000 live births of 24.76. Rates over previous years have been:— 1941 35.4 per 1,000 live births 1942 32.7 „ „ „ „ 1943 26.01 „ „ „ „ 1944 31.37 „ „ „ „ 1945 33.9 „ „ „ „ 1946 29.5 „ „ „ „ 1947 28.6 „ „ „ „ 1948 19.03 „ „ „ „ 1949 24.0 „ „ „ „ 1950 14.48 „ „ „ „ Maternal Deaths. There were no maternal deaths during the year. Rates over previous years have been:— 1941 2.77 per 1,000 live and stillbirths 1942 1.32 „ „ „ „ „ 1943 1.44 „ „ „ „ „ 1944 1.30 „ „ „ „ „ 1945 nil „ „ „ „ „ 1946 1.73 „ „ „ „ „ 1947 1.10 „ „ „ „ „ 1948 Nil „ „ „ „ „ 1949 0.78 „ „ „ „ „ 1950 0.84 „ „ „ „ „ 20 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Isolation Hospital Accommodation. This had been available in the past at the BowArrow 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. Ceneral 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 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 137 occasions and 132 post-mortem examinations were made. 16 inquests were held. LABORATORY FACILITIES. Pathological and bacteriological work for the area is carried out at the County Hall. Maidstone, through the Public Health Laboratory Service. 21 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 5 No. of patients provided for:— Maternity 5 Others 63 Total 68 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 22 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. List of Adoptive Acts. etc., in force. Acts. Date Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 Public Libraries Act, 1892-1919 Oct 1893 Private Street Works Act, 1892 Jan. 1899 Public Health Acts Amendment Act, 1907, Parts 8 and 9 Apr. 1909 Part 2—the whole 1 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 „ Nursing Homes June 1940 Sale of Contraceptives in Slot Machines Dec. 1949 Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air May 1950 23 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; 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. 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 1950 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 0-3 0-25 in all samples 24 (ii) Drainage and Sewerage. The following foul and surface water sewers were laid during the year:— Hurst Place Estate— 1046 lin yards Foul Sewer. 1112 lin yards S.W. Sewer. 2. Rivers and Streams. No serious case of pollution of rivers or streams was found during the year. Two samples of water were taken from the stream at East Wickham Tip. The Analyst's report stated that the water was of fair quality and that there was no evidence of any serious pollution of excreta 1 origin. 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 1951. The report consists mainly of a tabulated record of work carried out by the Sanitary Inspectors. 25 TABLE No. 1. Details of Inspection Work Carried Out. Inspections Re-in- spections Houses inspected (all particulars recorded) 2 2 Houses inspected (defects only recorded) 281 959 Houses inspected (Housing Act, 1936, Overcrowding) 73 6 Houses inspected re Infectious Disease (including Scabies) 318 50 Factories with mechanical power 256 22 Factories without mechanical power 37 3 Schools 3 — Refuse Tips 358 — Bakehouses 130 38 Outworkers 56 — Food shops and premises where food is prepared 1819 47 Visits re Unsound Food 553 29 Dairies and Milkshops 89 3 Ice Cream Premises 206 — Fried Fish Premises 221 5 Offensive Accumulations 71 16 Keeping of Animals 116 18 Rats 224 176 Verminous Premises 107 93 Insufficient Ashplace Accommodation 39 29 Drains Inspected 1185 995 Drains Tested (water, smoke or colour) 82 6 Visits re Refuse Removal and Salvage 564 — Public Conveniences 251 — Food and Drugs Act re Samples 231 — Water Samples 21 — Shops Act, 1950 1166 — Miscellaneous Inspections 1149 109 26 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— ##] Provided with sufficient w.c. accommodation 27 Provided with sufficient ashplace accommodation 68 Provided with sufficient water supply 13 Houses Improved Internally— Dirty rooms cleansed 147 Walls and ceilings repaired 393 Dampness in rooms remedied 193 Defective floors repaired 37 Ventilation of rooms improved 28 Windows repaired 99 Coppers repaired — Stoves, fireplaces, etc., provided or repaired 18 Houses Improved Externally— Roofs repaired 89 Eaves, gutters and down spouts fixed or repaired 85 Yards paved or repaired — Chimney stacks repaired 43 Walls repointed or repaired 72 Miscellaneous repairs 67 Drainage— Drains cleansed or repaired 834 New drains constructed 1 New Gullies provided 1 Ventilation of drainage system improved 5 Inspection chambers built or improved 13 Waste pipes provided or improved 4 New sinks provided 3 Offensive accumulation removed 15 Nuisances from animals abated 5 Other nuisances abated 11 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 69 Houses visited including revisits 368 Rooms disinfected 33 Notices delivered to Education Authorities, etc. 337 Houses at which defective sanitary conditions were found 27 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered. Beef lbs. 1,333 Ox Heads ,, 1,227 Sweetbreads ,, 19 Mutton and Lamb ,, 14½ Pork ,, 38 Rabbits ,, 220 Poultry ,, 43½ Corned Beef ,, 246¼ Corned Mutton ,, 14¼ Tinned Ham ,, 4,973 Brawn ,, 10 Suet ,, 2 Bacon ,, 2½ Fats ,, 19½ Vegetable Sausage ,, 43½ Puddings ,, 16 Prunes ,, 30 Confectionery ,, 72 Tea ,, 2½ Flour and Biscuits ,, 109 Dessicated Coconut ,, 7 Cereals ,, 48 Fish Roes ,, 56 Fish ,, 868 Fish Tins 279 Milk ,, 393 Vegetables ,, 806 Meat ,, 567 Fruit and Fruit Juices ,, 1,021 Soups ,, 141 Puddings ,, 2 Preserves ,, 243 28 Preserves Jars 8 Fish and Meat Pastes ,, 5 Cereals Packets 13 Pastry Mixtures ,, 18 Beef Cubes ,, 40 Soup Powders ,, 6 Cakes and Pudding Mixtures ,, 636 Figs ,, 128 Figs lbs. 37 Cheese ,, 1934 Cheese Packets 384 Vinegar Bottles 19 Sauces and Pickles etc Bottles and Jars 121 Miscellaneous Items 84 29 TABLE No. 5. Factories Act, 1937. 1. Inspections for Purposes of Provisions as to Health. Including Inspections made by Sanitary Inspectors. Premises. Number of:— Inspections. Written Notices. Prosecutions. 1 2 3 4 Factories with mechanical power 446 4 — Factories without mechanical power 96 1 — *Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) *Electrical Stations should be reckoned as factories. — — — Total 542 5 — 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 3 4 — — Not separate for sexes — — — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 3 3 Total 11 12 — — 30 During the year 1 Certificate was 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. PUBLIC 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. During the year a weekly collection of refuse was maintained except at Bank Holiday periods, when some delay occurred, but at all holidays the arrears were quickly cleared, and there was no unduly long period between collections. Two new S. & D. Dust Carts were delivered in April, and the whole of the fleet of vehicles used for refuse collection has now been renewed since 1947. All refuse is disposed of by controlled tipping at East Wickham, and once again I have to record that no complaints were received about the tip during the year. In order to conserve the available tipping space as much as possible, the practice of accepting covering material from outside sources has been discontinued, and practically all covering is now excavated from the site. Salvage. The income received from the sale of salvage materials was a record, and this was due to the great increase of the price paid for waste paper. The increased price resulted in a number of private collectors setting up in business, and a large amount of waste paper was cleared by them, particularly from the shopping areas. In spite of this, the tonnage collected by the Council was approximately the same as the previous year. Details of salvage sales for the year ended 31st March, 1952, are set out below. 31  Tons cwts. qrs. £ s. d. Waste paper 420 13 3 7,441 3 11 Textiles 28 18 3 749 18 8 Bones 16 3 6 0 7 Kitchen Waste 036 16 2 1,880 1 1 Ferrous Metals 64 14 2 214 8 1 Non-Ferrous Metals 2 2 1 181 15 3 Bottles and Jars 7 0 1 33 4 10 Miscellaneous 3 14 1 37 16 4 1,164 17 0 10,544 8 9 Kitchen waste is collected twice weekly from some 425 communal bins placed in the streets and sent to the Woolwich Borough Council's Concentrator Plant at AVhite Hart Lane, Plumstead. 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. Provision was made in the estimates for the erection of additional conveniences in the Brampton Ward, and these were completed in April, 1952. PREVENTION OF DAMAGE BY PESTS ACT, 1949. One full time Rodent Operative is employed by the Department 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. No charge is made for treatment carried out at private dwelling houses, but the occupiers of business premises are charged for disinfestation work. Most of the infestations found are of minor character, and a large proportion of the cases dealt with at private dwelling houses are connected with the keeping of fowls and other animals. 32 Details of infestations dealt with during the year are set out below. Number of Properties Inspected 1,473 Number of Inspections 3,546 Number of Infestations Found— Major 1 Minor 245 Mice 59 Number of Treatments carried out Rats Mice Local Authority's premises 8 1 Dwelling Houses 208 40 Business Premises 30 18 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, 194G. There were approximately 740 shops on the Council's Register at the end of the year. During the year 1,166 inspections were made under the Shops Act, 1950, and no legal proceedings were instituted. 1 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. 33 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 0-15 Absent Shallow end 0-1 0-2 Absent Verminous Premises. 18 houses found to be infested with bugs were treated by spraying with satisfactory results. 4 other houses were treated for flea infestation. The furniture and effects from one house infested with bugs was treated with hydrogen cyanide prior to removal to a Council House. Infestation by cockroaches at a bakehouse, a fried fish shop and a hotel were successfully treated by the Department. 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 26 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 34 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 - John Newton Court — 48 East Wickham— Glenmore Road No. 1 116 - Glenmore Road No. 2 88 — 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. 2 112 — Bexley— Hartford Road Estate and Victoria Road Estate 54 - Royal Park Estate No. 1 58 — Royal Park Estate No. 2 40 — 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 — 1,768 76 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses iusoected for housing defects (under Public Health or Housing Acts) 283 35 (b) Number of inspections made for the purpose (including re-inspection) 1,244 (2) (a) Number of dwelling houses cluded under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 1925 to 1932 2 (b) Number of inspections made for the purpose (including re-inspections) 4 (3) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 225 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 231 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 25 36 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 19 (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 1 (2) Number of dwelling houses demolished in pursuance of Demolition Orders (3) Houses demolished as a result of informal procedure 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 2 Number complied with— (a) by Owners 1 (b) by Local Authority in default of Owners 1 Bins provided in consequence of informal action 66 37 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 Designation) (Raw Milk) Regulations, 1949, and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949:— Dealers' Licences:— Pasteurised Milk 17 Tuberculin Tested Milk 16 Sterilised Milk 21 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 summarises the 202 samples taken during the year. Formal Informal Milk 13 — Soups, Meat Extracts, etc. 4 12 Pastes — 9 Pudding or Cake mixture, Flour, etc 6 4 Jellies, Custard Powders, etc. 2 6 Patent Medicines, etc. 1 4 Sausages, Sausage Meat, etc. 15 3 Fruit, Fruit Juice and Fruit Puree 2 2 Lemon Sweet Spread — 1 Cereals 4 1 Sweets 2 6 Cake 3 1 Ice Cream 25 — Pepper and Pepper Flavoured Compound 3 Soft Icing - 1 38  Formal Informal Meat Pies 1 Minerals, etc. 3 1 Gelatine and Jelly Crystals 1 1 Condensed Milk — 1 Beer, Wines and Spirits 3 — Baking Powder 1 Condiments, Sauces, Pickles, Spices, etc. 7 12 Processed Cheese - 1 Peas 1 2 Ground Ginger 1 1 Pure Coffee, Coffee Extract and Coffee and Chicory 2 3 Flavouring Essence — 4 Vegetable Salad 2 — Preserves 1 1 Luncheon Meat 1 1 Mussels 1 Salted Nuts — 1 Sweetened Ground Almonds 1 2 Synthetic Cream 2 3 Margarine — 1 Oysters — 1 New Potatoes — 1 Bread 2 Mixed Fruit 2 - Tea — 1 Legal Proceedings. The following legal proceedings were instituted during the year:— (1) Beef Adulterated 24% deficient Fined £2 plus Sausages in meat £1 1s. Od. costs (2) Ice Adulterated 1.4% deficient Fined £5 plus Cream in fat content £1 1s.Od.costs (d) Food Preparation Premises. During the year 1,866 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 6 Sinks provided 1 Floors, walls, ceilings, etc., repaired 10 39 Rooms cleansed 13 Water closets cleansed or repaired 2 Drains cleansed or repaired 3 Dirty Yards cleansed or repaired 2 Accumulation of refuse removed 8 Accommodation for storage of refuse improved 4 New fish frying range provided 1 Registration of Premises under Food and Drugs Act, 1938. No. of premises registered for:— Sale or Manufacture of Ice Cream l Sale of Ice Cream 144 Preparation of Sausages, etc. 42 24 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. 40 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 101 cases were notified as compared with 150 the previous year. Of these 21 were isolated in hospital and 80 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 during the year. The following figures on Immunisation and Vaccination have been supplied by the County Medical Officer:— 41 Immunisation against Diphtheria and Vaccination against Smallpox, 1951. 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, 1951:— (A) Diphtheria Immunisation. Year of Birth 1951 1950 1949 1948 1947 1946 1945 1944 1943 1912 1941 1940 1939 1938 1937 Total Primary Inoculations 148 879 168 23 14 28 15 2 2 3 3 3 7 11 11 1317 Reinforcing Inoculations — — — — 78 562 192 42 136 80 17 193 347 392 394 2433 (B) Vaccination. Age at 31st December, 1951 Under 1 1 to 4 5 to 14 15 or over Total Number Vaccinated 505 322 43 93 963 Number Re-Vaccinated — 18 58 250 326 42 Immunisation against Diphtheria, 1951. 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, 1951, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1937). Year of Birth 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 Total 1102 1200 1137 1028 1010 1110 1214 1433 1496 1148 1331 1254 1125 971 148 16,707 Enteric Fever. There were no cases notified during the year. Puerperal Pyrexia. 7 cases were notified during the year, of which 3 were from Bexleyheath Maternity Hospital, where they were isolated and treated. 3 cases were removed to other hospitals and one case was isolated at home. Ophthalmia Neonatorum. There were no cases notified during the year. Measles. 2,209 cases were notified. 13 cases were treated in hospital. There was 1 death. Whooping Cough (Pertussis). 440 cases were notified, 7 of which were treated in hospital. Acute Anterior Poliomyelitis. 2 Paralytic cases were notified and were treated in hospital. There were no deaths. Scabies. There were no cases notified during the year. Food Poisoning. 7 cases were notified. 43 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 1951. DISEASE. Total cases notified Under 1 1 to 2 3 to 4 5 to 9 10 to 14 15 to 24 25 & over Age unknown Cases admitted to Hospital Total Deaths Smallpox - - - - - - - - - - Scarlet Fever 101 — 4 21 66 6 4 — — 21 - Diphtheria — . — — — — — — — — — - Puerperal Pyrexia 7 - - - - - 1 6 — 6 - Ophthalmia Neonatorum — — — — — — — — — — — Pneumonia 36 — 1 2 2 — 1 30 — 11 2 Acute Paralytic Poliomyelitis 2 — — — 1 — — 1 — 2 — Acute Non-Paralytic Poliomyelitis — — — — — — — — — — — Erysipelas 17 — — — — — — 17 — 2 - Food Poisoning 7 — 1 — 1 — — 5 — 1 - Dysentery 5 1 1 1 1 — — 1 — 4 — Typhoid Fever - - - - - - - - - - - Para-Typhoid Fever 2 — — — 1 — — 1 - 2 - Meningoccal Infection — — — — — — — - - - - Measles 2209 52 402 625 1089 22 14 5 — 13 1 Whooping Cough 440 28 110 139 145 5 2 11 — 7 — Scabies — — — — — — — — — - - Totals 2826 81 519 788 1306 33 22 77 — 69 3 44 TUBERCULOSIS. During the year 123 new cases were notified. Particulars relating to the same, and also to the deaths which ocurred during 1951 are contained in the following table:— Age Period New Cases Deaths Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. 0— 1 - 2 - - - 1 - - 1— 5 1 1 - - - 5—10 1 I - - - - - 10—15 — 3 1 - - - 15—20 14 11 1 1 - . - - 20—25 6 8 1 1 1 2 - - 25—35 12 10 - 1 1 - - - 35—45 15 3 1 1 1 - - 45—55 9 2 1 1 6 - - - 55—65 8 3 4 1 1 - 65 and upwards 3 1 — — 4 - - — Totals 69 45 5 4 17 5 1 — The number of non-notified Tuberculosis deaths was 6. Pulmonary. Non-Pulmonary. Total M F M F No. on Register at commencement of year 511 362 70 73 1,016 No. on Register at end of year 560 401 73 76 1,110 Rehousing. 5 cases were referred to me by the Chest Physician for rehousing and during the year five cases were rehoused by the Housing Committee from these and pievious cases. 45 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1951 JOHN LANDON, m.R.c.s.. l.r.c.p., d.p.h. Medical Officer of Health EXCEPTED DISTRICT OF BEXLEY WELFARE AND SCHOOL ATTENDANCE SUB-COMMITTEE Chairman: Alderman R. G. Broomfield. Vice-Chairman: Miss M. Woodward. Alderman J. Cronin Councillor M. J. Corr Alderman Mrs. A. Welch Councillor T. M. Gauge Councillor A. S. Masey Councillor Mrs. H. F. Piggott Councillor Mrs. E. Boswell Co-opted Members: Miss D. C. Collins Revd. H. Charleston Borough Education Officer W. E. D. Stephens, M.A. Deputy Borough Education Officer R. R. Sutton. SCHOOL HEALTH SERVICE Medical Officer of Health John London, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officers Nora Walter, M.B., B.Ch., B.A.O., D.C.H. (Part-time). Robert Bruce Killoh, M.B., Ch.B., D.P.H., (Part-time) Resigned Ml.12.50. Irene D. M. Hastilow, M.B., Ch.B., M.R.C.S., L.R.C.P., D.P.H., DO., R.C.O.G., D.C.H. (Whole-time) Resigned 10.3.51. Lucy M. Boyd, M.B., Ch.B. (Part-time). Helen D. Fox, M.B., B.S., (Whole-time) Appointed 12.3.51 Ophthalmic Surgeon Roland M. Chambers, M.B.B.S., D.O.M.S. Aural Surgeon W. MacGregor, O.B.E., V.D., M. K. Orthopaedic Surgeons K. F. Hulbert, F.R.C.S. B.. Lawson, F.R.C.S. 48 49 Dental Officers H. Wade, L.D.S. Elizabeth Francis, B.D.S., L.D.S. (Part-time). Orthodontist Gordon Charles Dickson, L.D.S., B.Ch.D., F.D.S., R.C.S. England. Health Visitors Miss K. P. Hart. S.R.N., S.C.M.. and Health Visitor's Certificate. (Whole time), Mrs. A. E. Matthews, S.R.N. (Temporary) Whole-time Miss P. D. Martin, S.R.N., and Health Visitor's Certificate. (Part-time). Miss C. T. Heymann, S.R.N., and Health Visitor's Certificate. (Part-time) Resigned 31.7.51. Miss L. G. Exley, S.R.N., and Health Visitor's Certificate. (Part-time). Miss D. Stanley, S.R.N., and Health Visitor's Certificate. (Part-time) transferred full time M. & C.W. 1.11.51. Mrs. C. A. Tucker, S.R.N., and Health Visitor's Certificate. (Part-time). Mrs. M. T. Leyton, S.R.N., and Health Visitor's Certificate. (Part-time). Miss M. Beer, S.R.N., and Health Visitor's Certificate. (Pa rt-time). Miss Golding, S.R.N., and Health Visitor's Certificate (Part-time) as from August, 1951. Physiotherapist Miss R. Cheeseman, M.C.S.P., M.S.R. Speech Therapist Mrs. D. Bant, L.C.S.T. Dental Attendants Mrs. Ivy Birtehnell (Whole-time). Miss K. M. Dunkley (Wholetime). School Health Service Clerk Miss M. C. A. Smith. General Clerks Miss C. E. Anderson. Mrs. A. L. A. Baldry (Resigned 3.11.51). Miss (). G. Turnbull (Appointed 5.11.51). Mrs. Catherine Judd (Appointed 15.1.51). 50 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1951. To the Chairman and Members of the Welfare and School Attendance Sub-Committee. Ladies and Gentlemen, I have the honour to present my annual report for the year 1951. The continued shortage of dental staff has continued to militate against the maintenance of the high standard of dental care of our school children to which we had become accustomed in past years. The old method of routine dental inspection followed by treatment has been disturbed and the dental surgeons are more and more concerned in trying to catch up with arrears of work and in treating cases of acute toothache. There is at present, therefore, no real systematic supervision of the dental health of the school children as a priority class. At the time of writing there does seem to be a slight tendency foxdentists to return to the local authority dental service as a result of the diminishing demand from the adult population and the new charges for dental treatment imposed under recent health legislation. The plans for an additional dental clinic at Murchison Avenue have not been included in the County estimates for 1952/53 on the grounds of economy but the matter is still being pursued and it is hoped that this addition to the school dentai service in the Borough may come to fruition in the following year or that, alternatively, a suitable clinic will be provided in adapted premises, as an interim measure. During the year, the Ear, Nose and Throat Clinic at Little Danson Clinic was closed down and provision for treatment was made at the West Hill Hospital by arrangement with the Dartford Group Hospital Management Committee. This resulted, in the first place, in considerable delay in the treatment of school children as well as some difficulty in their follow-up treatment. The position has now been improved by the provision of additional out-patient facilities for school children at this hospital and it may be taken that, generally speaking, the facilities for ear nose and throat treatment are reasonably satisfactory. Owing to the opening of Hillsgrove School in 1950 an additional minor ailment clinic was established at the Wrotham Road Clinic to cater for the children attending this school and for those children attending the East 51 Wickham Junior and Welling County Secondary Schools who had some difficulty of access to Little Danson Clinic including the crossing of a busy main road. Another result of the general economy campaign of the Kent Education Committee has been a review, during the year, of the extent to which vitamins and various medicaments should be supplied to school children by medical officers at minor ailment clinics. The view-point has been taken that, as the medical functions of the school health service are mainly inspectorial and advisory, children requiring drugs and other medicaments should be referred to their own doctors for treatment under the National Health Services Acts. Care must be taken that this tendency, which is justifiable up to a point and in accord with the general trend that the general practitioner should be brought more and more into collaboration with the School Health Service, or vice versa, should not deprive the assistant medical officers working in the clinics of certain basic treatments for common disorders. On the whole a "modus viveudi" has been reached and it is hoped that a state of equilibrium will result in the light of further experience. The most important factor is, of course, that the school child shall not be deprived of essential treatment and it is possible to give an assurance that this is the case in practice. There were no serious epidemics during the year and the health of the school children has, on the whole, been satisfactory. Only two cases of poliomyelitis occurred during the year as against 19 during 1950. The special needs of the many categories of handicapped children continues to be a major preoccupation of the staff and reference to the statistical reports will give some indication of the extent and scope of this work. 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 the County Medical Officer and his staff and from Miss Smith, the Senior Clerk, and all members of the staff, whose help and co-operation during the year have been a very valuable asset. I am, Mr. Chairman, Ladies and Gentlemen, Tour obedient servant, John Landon. Medical Officer of Health. 52 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Bexley County Technical School for Girls'. Average number on Roll at 31st December, 1951, Bexley 750 Wilmington Annex 230 Six County Secondary Schools. Average number on Roll 2,944 Twenty County Primary Schools. Average number on Roll 6,140 One Nursery Class attached to Uplands Primary School. Average number on Roll 52 Voluntary Schools. Two Primary Schools. Average number on Roll 258 Voluntary Aided Schools. One Secondary School. Average number on Roll 311 Two Primary Schools. Average number on Roll 728 Total 11,413 Clinics. Minor Ailments. Welling—Little Danson, Dansington Road. Tuesday and Wednesday, 2-4 p.m. Monday and Saturday, 9.30-11 a.m. (Monday discontinued as from 1.11.51). Doctor in attendance— Wednesday and Saturday. Welling—Wrotham Road. Tuesday and Thursday, 9.30-11 a.m. (Commencing 1.11.51). Doctor in attendance—Thursday. Bexleyheath—315, Broadway. Tuesday, 2-4 p.m. Monday, Wednesday, Friday and Saturday, 9.30-11 a.m. Doctor in attendance—Tuesday and Saturday. 53 Bexley—Murchson Avenue. Tuesday, Thursday and Friday, 9.30-11 a.m. (Thurday discontinued as from 24.10.51). Doctor in attendance—Friday. Dental. Welling—Little Danson, Dansington Road. Each morning, except Saturday, 9.30-11 a.m. Tuesday and Thursday, 2-4 p.m. Bexleyheath—315, Broadway. Thursday and Friday, 9.30-11 a.m., 2-4 p.m. Saturday, 9.30-11 a.m. Extraction Session—Friday morning. Crayford—Woodside Road. Monday,Tuesday and Wednesday,9.30-11 a.m., 2-4 p.m. 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. Bexleyheath—315, Broadway. Monday, 2-5 p.m. Specialist in attendance 1st and 3rd Monday, 10 a.m.-12.30 p.m. Appointments made through County Medical Officer. I Aural. Welling—Little Danson, Dansington Road. Tuesday morning, 9.30-11 a.m. Appointments made from Office. (Discontinued 16.4.51.) 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. .">5 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 tnat 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. Reference to the Statistical Table on Page 65 emphasizes the number of defects discovered. Bearing in mind that these defects are nearly always diagnosed in the early stages and observation or treatment instituted at once, periodic inspections will be seen to represent the truly preventative aspect of School Health Work. School Meals—1951. Average number of pupils on Roll:— Primary Schools 6,913 Secondary Schools 3,877 10,790 5fi Average number of pupils taking meals daily:— Primary Secondary Free 103 146 Payment 3,377 2,580 Total 3,480 2,726 This shows an increase of almost 500 meals daily since 1950. Milk. Average number of pupils taking milk daily:— Primary 6,553 Secondary 2,465 Total 9,018 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:— The attendances during 1951 have been well maintained. A total of 2,163 children were seen (previous year 1,799) and in all 2,596 attendances were made. 460 new patients were seen. The number of cases requiring correction of a refractive error amounted to 50% of those attending, of these 8% needed orthoptic and or surgical treatment. A small number (15) suffering from Amblyopia failed to respond to any treatment and were hereditarily determined. The incidence of symptons caused by convergence deficiency rose significantly during the pre-examinational periods. Treatment of these cases, usually girls, rather conscientious and over anxious, sitting for scholarships or other competitive examinations, is somewhat ineffective since the condition is brought about by the unavoidable stresses of school life, and when these are overcome or the examination is passed (or failed) the symptons abate, though the exophoria may persist. A few however (6) required further orthoptic treatment. It was noteworthy that only one case was a boy out of total of 21. 57 The provision of a Giles Archer Colour Testing Unit has enabled a number of children to be examined for colour defect and so has prevented in a number of cases, preparations being made for entry into obviously unsuitable occupations. The incidence of colour defect corresponded closely with that of the average population. An attempt has been made to avoid delays in seeing patients by a more even spacing of appointments and the postponements of all possible clerical work to the end of the session. This has proved satisfactory in that the average waiting period before being seen is 15 minutes. The prompt provision of glasses has materially helped this clinic to provide an effective service for those in need of it. The analysis ot cases other than retractive errors is attached:— Infective. Squamous Blepharitis 15 Blepharo-Conjunctivitis 5 Conjunctivitis 6 Conjunctivitis Phlyctenula 3 Styes 16 Meibomian Cyst 7 Non-Infective. Cornea—Abrasion 2 Opacity 3 Iris—Heterochromia 7 Iridodialysis (Traumatic) 1 Lens—Fine Opacaties 4 Cataract (Aphakic) 3 Retina—Mild maculer pigmentation (other than myopia) 5 Toxoplasmosis (not confirmed serologically) 2 Old Detachment (in situ) 1 Neurological. Nerve Palsy 9 Nystagmus 3 Ptosis 4 Migraine 18 Consilutional. Albinism 1 Colour Blindness 55 Incomplete 43 Complete 12 ,, Red Blind 8 ,, Green Blind 4 Orthopaedic Clinic. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on the orthopaedic Clinic:— The Orthopaedic Clinic has continued for the past year at the Welling Clinic on the first and third Wednesdays of every month. There has been a dropping off in the number of attendances to a certain extent, but the type of case remains the same. We are still very handicapped for treatment on account of the poor accommodation in the present building, but Miss Cheeseman, the Physiotherapist has carried on very well in spite of all difficulties. Dental Treatment. I am indebted to Mr. Wade, L.D.S., Dental Surgeon, for the following report:— Maternity and Child Welfare. As you are aware we are still treating these patients for the County and this still means that treatment for the school population is behindhand. Education. It is with regret that I note that lectures on Dental Hygiene have not yet been arranged as suggested in my previous reports. The appalling ignorance on this subject in the district is most marked. Orthodontic Trenment. Much headway has been made in this branch and many treatments have been completed entirely satisfactorily. Parents and patients have cooperated well. Cases of interest. Several cases of apisectomy have been treated at the Eastman Dental Hospital followed by the fitting of jacket crowns. Our thanks is due to the hospital for its readiness to help in these complicated and difficult cases. Hurst Road. There are indications that the Mobile Unit should visit this school again as it appears the new Dental Clinic there will not be built for an indefinite time. ft 9 General. Private Practitioners are not now so busy on account of payments having to be made over 21 years of age and also tor prosthetic work, and it may be expected, therefore, that more school age patients will be accepted for treatment by Private Practitioners than in recent times. This, to some extent, is an advantage to the patient as they will be treated out of school hours. Already signs of this have been noticed; and Private Practitioners are sending their orthodontic patients for treatment to school clinics after completing conservative operations and extractions. This procedure is being experienced thoughout the country. I have received co-operation by all members of the medical staff, and to you, personally, I again express my thanks for the help and interest you have given to the clinics. I am indebted to Mrs. Elizabeth Francis for the following report:— Before Autumn 1950, there had been no Dental Surgeon for nearly three years at this clinic; therefore, there is now a very long waiting list of those who, during that time, filled in forms requesting treatment. At the same time, the condition of the teeth generally is so poor that we are dealing with a continual stream of children with toothache. To do inspections at the 21 schools in this area is obviously a waste of time at the moment, as I shall not be able to start systematic treatment for some time. The dental hygienist, who has been working here one day a week, has been most helpful both in teaching the children the rudiments of oral hygiene and in scaling and cleaning their teeth. She left the County last month and one hopes that she will be replaced soon as her work is most necessary. Speech Therapy. I am indebted to Miss Joan Pollitt, Chief Speech Therapist to the Kent Education Committee for the Statistics relating to the work carried out during the year:— Analysis of the work carried out:— A. Total number of patients 46 Cases closed during 1951 23 Patients attending clinics at the end of 1951 and, therefore, carried forward into 1952 23 46 60 11. Number of patients awaiting appointments at the end or 1951 and therefore, carried forward into 1952 86 132 Discharges during the year:— (a) Improved so that no abnormality existed or condition became such that little residual defect remained 8 (Including one of poor mental calibre) (b) Treatment incomplete owing to parent and patient being satisfied with the condition, or owing to parent and patient being unwilling to continue further, or owing to patient leaving district, etc. 4 (c) Little if any change following Treatment 1 (d) Transferred to School for the Deaf 1 (e) Treatment arranged elsewhere 1 (f) Reported by the Medical Officer, parent and/or school to have improved and, therefore, investigatory appointments at Speech Therapy clinic cancelled 4 (g) Started work or left district prior to appointment being made 4 22 Patients, whose cases were closed during the year, suffered from stammer, dysarthria, hyper-rhinophonia (not due to Cleft palate) defect associated with severe hearing loss, dysphonia + dyslalia, retarded speech development associated with mental retardation. Cleanliness Inspections. (See Table V.) During the year the School Nurses carried out 11,094 examinations of children in Schools and 130 were found to have some infestation with vermin. In nearly all cases, the condition was cleared up by parents who 61 were assisted, where necessary, by the School Nurses. The infestation rate is commendabry low and speaks well for the standard of child care in the Borough. Physical Education. Schemes of work have proceeded steadily and teachers are reducing the spate of post-war ideas to workable limits in their varying circumstances. This is particularly true in the Infant and Junior Schoo.ls, where most experiment has been made in recent years. It was noticable that in the Infant and Junior Schools, children showed greater self-assurance in their work. It is thought that this is largely due to three factors:— (1) a greater use of small apparatus, which allows the individual child to advance in skill at a rate commensurate with his ability; (2) the introduction of agility apparatus upon which the child can satisfy his need for climbing, hanging and swinging; (3) the use of teaching methods which demand more thought on the part of the individual child, rather than the drill system which tended to produce automatic, unthinking response. The work in Secondary Schools proceeded on traditional lines and existing standards were maintained. Recent research into the curriculum for the Secondary School has resulted in a shift of emphasis, rather than the introduction of new activities, and more attention has been paid to the English games and sports, at the expense, necessarily (in view of restrictions of time) of Swedish gymnastics. Distinct progress has been made in Modern and National Dancing in the Girls' Secondary Schools, and further development is expected in view ot' the great interest shown in these activities in the Primary Schools. Swimming. Swimming, mainly in the Summer Season, was enjoyed by 584 Secondary pupils and 614 Junior pupils at the following swimming baths;— (i) Danson Pool (ii) Plumstead (iii) Eltham indoor (iv) Eltham open air (v) Charlton Park 62 Each child attended, on the average, 10 times, and as a result of the training the following certificates were awarded:— (a) Learners' 380 (b) More advanced 60 (including 14 Bronze Medals of the Royal Life Saving Society) Refresher courses for teachers in National Dancing, Basketball and Secondary Boys' Physical Education were held locally, and a week-end course in Remedials was held at Broadstairs. 63 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. Orthopaidic and Postural Defects. Group V. Other treatment given. Table IV— Dental Inspection and Treatment including Orthodontics. Table V — Infestation with Vermin. Table VI — Handicapped Children. 64 TABLE i. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. — Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 1,533 Second Age Group 930 Third Age Group 951 Total 3,414 Number of other Periodic Inspections 1,595 Grand Total 5,009 B. — Other Inspections. Number of Special Inspections 5,412 Number of Re-Inspections 3,670 Total 9,082 C. — Pupils Found to Require Treatment at Periodic Medical Inspections. Group Fur defective vision (excluding squint) For any of the other conditions recorded in Table IIA Total individual pupils (1) (2) (3) (4) Entrants 469 441 Second Age Group 74 193 218 Third Age Group 08 375 350 Total (prescribed groups) 178 1,037 1,009 Other Periodic Inspections 138 402 426 Grand Total 316 1,439 1.435 65 TABLE II. A. — Return of Defects Found by Medical Inspection in the Year ended the 31st December, 1951. 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 356 108 221 17 5. Eyes— a. Vision 316 260 36 7 b. Squint c. Other 32 84 14 4 93 44 87 4 6. Ears— a. Hearing 50 77 21 5 b. Otitis Media 21 57 34 4 c. Other 38 18 58 5 7. Nose or Throat 290 477 286 48 8. Speech 9 47 15 6 9. Cervical Glands 11 106 8 7 10. Heart and Circulation 108 90 80 9 11. Lungs 50 268 131 34 12. Developmental — a. Hernia 3 19 4 — b. Other 24 146 13 6 13. Orthopaedic— a. Posture 118 151 21 7 b. Flat-foot 188 160 15 5 c. Other 121 262 66 11 14. Nervous system— a. Epilepsy 2 14 1 3 b. Other 19 100 38 15 15. Psychological— a. Development - 29 5 5 b. Stability 19 177 45 18 16. Other 143 157 231 32 66 B. — Classification of the General Condition of Pupils Inspected during the Year in the Age Groups. Age Groups No. of Pupils Inspected A. (Good) B. (Fair) C. (Poor) No. % of col. 2 No. % of col. 2 No. % of col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 1533 470 30.65 937 61.12 126 8.21 Second Age Group 930 334 35.91 563 65.37 33 35.48 Third Age Group 951 460 48.37 452 47.62 39 28.90 Other Periodic Inspections 1595 571 35.79 931 58.36 93 5.83 Total 5009 1835 36.63 2883 57.55 291 5.80 TABLE III.—Treatment Tables. Croup 1—Diseases of the Skin (excluding' uncleanliness, for which see Table V). Number of cases treated or under treatment during the year by the authority otherwise Ringworm—(i) Scalp — 1 X-Ray (ii) Body 109 — Scabies — — Impetigo 7 — Other skin diseases 479 1 Total 595 2 Croup 2—Eye Diseases, Defective Vision and squint No. of cases dealt with by the authority otherwise External and other, -excluding errors of refraction and squint Errors of refraction (including 237 — squint) 1,926 - Total 2,163 - 67 Number of pupils for whom spectacles were (a) Prescribed 431 (b) Obtained 394 — 825 — Croup 3—Diseases and Defects of Ear, Nose and Throat. Received operative treatment No. of cases by the authority treated otherwise (a) for diseases of the ear — 2 (b) for adenoids and chronic tonsillitis 98 (c) for other nose and throat conditions _ _ Received other forms of treatment 155 19 155 119 Group 4—Othopaedic and Postural Defects. (a) Number treated as inpatients in hospitals 9 by the authority otherwise (b) Number treated otherwise, e.t)., in clinics or outpatient departments 433 16 Croup 5—Other Treatment Given. No. of cases by the treated authority otherwise (a) Miscellaneous minor ailments 1,628 (b) Other (specify) 1 Minor Injuries 42 - 2 Minor Ear Defects 115 - 3 Minor Eye Defects 140 - Total 1,925 - 68 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 2,442 (b) Specials 1,524 Total 3,966 (2) Number found to require treatment 2,761 (3) Number referred for treatment 2,761 (4) Number actually treated 2,138 (5) Attendances made by pupils for treatment 5,315 (6) Half-days devoted to: Inspection 13 Treatment 660 Total 673 (7) Fillings: Permanent Teeth 1,061 Temporary Teeth 326 Total 1,371 (8) Number of teeth filled: Permanent Teeth 1,048 Temporary Teeth 312 Total 1,345 (9) Extractions: Permanent Teeth 687 Temporary Teeth 3,132 Total 3,742 (10) Administration of general anaesthetics for extraction 1,455 (11) Other operations: Permanent Teeth 676 Temporary Teeth 387 Total 1,059 69 Orthodontic. Attendances 1,107 Referred for mechanical appliances 80 Impressions Upper 126 Lower 114 Try-ins 13 Dentures Fitted Upper 16 Lower 1 Dentures Repaired 1 Easing of dentures 10 Appliances Fitted Upper 108 Lower 2 Re-made Upper 1 Repair 1 Adjustments 215 Examinations and Advice 592 TABLE V. Infestation with Vermin. (i) Total number of examinations in the schools by the school nurses or other authorised persons 11,094 (ii) Total number of individual pupils found to be infested 130 (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) - 70 TABLE VI. Handicapped Pupils requiring Education at special Schools or boarding in Boarding Homes. (1) Blind (2) Partially sighted (3) Deaf (4) Partially Deaf (5) Delicate (6) Physically Handicapped (7) Educationally sub-normal (8) Maladjusted (9) Epileptic Total. (1) to (9) In the calendar year ended 31st December, 1951;— (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Special Schools or homes - 1 1 1 - 1 6 - - 10 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes - - - - 67 7 9 - 1 84 On or about December 1st, 1951 :— C. Number of Handicapped Pupils from the area:— (i) attending Special Schools as (a) Day Pupils - 6 4 - - 11 12 - - 33 (b) Boarding Pupils - - - - - - - - - - (ii) Boarded in Homes - - - - - - - - - - (iii) Attending independent schools under arrangements made by the Authority - - - - - - - - - - Total (C) — 6 4 — - 11 12 — — 33 D. Number of Handicapped Pupils being educated under arrangements made under Section 56 of the Education Act, 1944:— (i) In hospitals - - - - - - - - - - (ii) Elsewhere 1 — — — 2 8 — — — 11 E. Number of Handicapped Pupils from the area requiring places in Special Schools (including any such unplaced children who are temporarily receiving home tuition) — 1 — — — 5 2 — — 8 Number of children reported during the year:— (a) Under Section 57(3) (excluding any returned under (b) ) 2 (b) ,, „ „ relying on Section 57(4) — (c) „ 57(5) of the Education Act, 1944, 1 71 INDEX. ITEM PAGE Health Committee 2 Public Health Staff 3 STATISTICS AND SOCIAL CONDITIONS. Acreage 10 Population 10 Unemployment 10 Social Conditions and Amenities 10—11 Population Graph 12 Summary of Vital Statistics 13—14 Extracts from Vital Statistics—- Births and Birth Bates, etc 14—15 Stillbirths and Stillbirth Rates16—16 Deaths and Death Rates16—17 Causes of Death 18 Infantile Mortality 19—20 Maternal Deaths 20 GENERAL PROVISION OF HEALTH SERVICES. Isolation Hospital Accommodation 21 General Hospitals 21 Ambulance Facilities 21 National Assistance Act, 1948 21 Public Mortuary 21 Laboratory Facilities 21 Registration of Nursing Homes 22 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 23 Water Supply 24 Bacteriological 24 Drainage and Sewerage 25 Rivers and Streams 25 Chief Sanitary Inspector's Report— Tables of Inspections and Improvements, etc. 26—27 Food Inspection 28—29 Tables—Factories Act, 1937 30—31 Closet Accommodation 31 Public Cleansing 31 Refuse Collection and Disposal 31 Salvage 31—32 Public Conveniences 32 Prevention of Damage by Pests Act, 1949 32—33 Shops Act, 1950 33 Swimming Pool 33—34 Verminous Premises 34 Camping Sites 34 Schools 34 72 ITEM PAGE HOUSING. Council Estates 35 Inspection of Dwelling Houses 35—36 Remedy of Defects without formal notice 36 Action under Statutory Powers 36—37 Public Health Act, 1936—Provision of Dust Bins 37 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 38 Meat Inspection 38 Adulteration of Food—Food & Drugs Act 38—39 Food Preparation Premises 39—40 Registration of Premises 40 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 41 Diphtheria 41 Diphtheria Immunisation and Vaccination 42 Enteric Fever 43 Puerperal Pyrexia 43 Ophthalmia Neonatorum 43 Measles 43 Whooping Cough 43 Acute Anterior Poliomyelitis 43 Scabies 43 Food Poisoning 43 Tables of Infectious Diseases Notified 44 Tuberculosis 45 SCHOOL HEALTH SERVICES REPORT, 1950. Welfare and School Services Sub-Committee 48 Staff 48—49 Schools 52 Clinics 52—54 Co-ordination— Periodic Medical Inspections 55 School Meals 55—56 Ophthalmic Clinic 56—58 Orthopædic Clinic 58 Dental Treatment 58—59 Speech Therapy 59—60 Cleanliness Inspections 60—61 Physical Education 61 Swimming 61—62 Statistical Tables 63—70