Ac 441299(i) BEXLEY LIBRARY BEX 17 borough of bexley Annual Report of the Medical Officer of Health and Report on the School Health Service For the Year 1952 JOHN LANDON, M. R C.S. L.R.C.P., D.P.H. Medical Officer of Health BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health For the Year 1952 JOHN LANDON, M.R.C.S., L.. R.C. P. , D.P.H., Medical Officer of Health Borough of Bexley. Mayor: Alderman P. R. Relph, J.P. Deputy Mayor: Councillor J. Mason,. HEALTH COMMITTEE. Chairman: Councillor Mrs. H. F. Piggott. Vice-Chairman: Councillor J. M. Pawson. Alderman J. C. McLean, J.P. Alderman M. J. Corr. Alderman H. P. Tanner. Alderman P. R Relph, J.P. Councillor F. W. Archer. Councillor H. C. Crawford. Councillor Mrs. A. Welch. Councillor Mrs. E. M. Sheppard. 2 PUBLIC HEALTH STAFF, 1952. 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 Cleansing Officer and Shops Acts Inspector. *† G. Hind, M.S.I.A. Deputy Chief Sanitary Inspector *† J. T. Boocock. District Sanitary Inspectors *† F. W. Willington. *† G. F. Lovegrove. *† W. E. Moses. Chief Clerk G. A. Pearson. Senior Clerk R. V. Hoad. Clerks E. M. Pearmine (Miss). M. E. Smith (Miss) (Shorthand Typist). Public Analyst H. E. Monk, B.Sc., F.R.I.C. Refuse Foreman G. E. Packman. * 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 1952. The vital statistics of the Borough for the year 1952 have again been satisfactory indicating that the health of the population, as measured by the instruments at our disposal, has been maintained. It is necessary to add the caution that there are no morbidity statistics relating specifically to the Borough so that we do not know how many people had, during the year, to attend hospital, to visit their private doctors, to resort to self-medication or who failed to achieve that degree of functional efficiency which is the essence of health; but there is reason to believe that the number was considerable. The birth rate for 1952 was 12 per 1,000 of the population compared with 12.79 in 1951. The birth rate for 1952 after correction by the comparability factor supplied by the Registrar General was 11.28. The uncorrected birth rate for England and Wales was 15.3 so that the Bexley rate for the year was appreciably lower than the national rate and was, in fact, the lowest rate ever recorded in the Borough. This rate was linked with a new low record in the infant mortality rate, namely, 11.34 per 1,000 live births and justified the optimism expressed in the 1950 annual report 4 that a rate of 10 per 1,000 could be achieved. (It is interesting to recall that, in 1902, the birth rate of the Bexley Urban District was 28.4 per 1,000 and the infant mortality rate was 99.1 per 1,000 live births). The death rate for the Borough for 1952 was 9.14 per 1,000 of the whole population compared with 9.6 per 1,000 in 1951. After correction by the comparability factor for deaths, the rate was 10.78 compared with the uncorrected death rate for England and Wales for 1952, namely 11.3 per 1,000. Cancer is second after diseases of the heart and blood vessels among the chief causes of death. One death occurred in the Borough in 1952 as the result of childbirth giving a maternal mortality rate of 0.93 per 1,000 live and still-births compared with a rate of nought in 1951. The incidence of infectious disease was again low with the exception of measles which reached epidemic proportions in November, 1952. The disease was, on the whole, mild and there were no deaths. As there had been a measles epidemic in 1951, the biennial periodicity normally expected in urban communities was not experienced. The disease did not occur uniformly over the whole Borough but was patchy in its incidence and it was possible, in some cases, to trace its progression from one Ward to another and then to the areas of contiguous authorities. During the week ending 15th November, 1952, there were 153 cases notified in Bexley while there were no cases notified at all in the adjacent Borough of Erith. This latter district had had a small outbreak of measles in July, 1952, and measles did not recur until March, 1953. It is curious that measles, sometimes, appears to stop along a local government boundary this, no doubt, being bound up with the location of the schools attended by the children. Practically all Bexley children attend schools in the Borough and, although there is a small interchange of school children at the boundary with Erith and Sidcup the numbers are, probably, too small to influence the epidemiological position. The schools, therefore, appear to be the primary focus of measles infection in the Borough and the preschool children probably are infected by their brothers and sisters of school age. This is supported by the fact that the general standard of housing in the Borough, with its almost total lack of tenement dwellings, does not favour the wide dissemination of measles by spread among the under fives. On the 7th October, 1952, a public enquiry was held in the Borough in connection with the application of the 5 Council for the confirmation of the Compulsory Purchase Orders relating to the East Wickham hutments. This necessitated a comprehensive survey of the 259 hutments still existing on these sites. The orders have now been confirmed by the Ministry of Housing and Local Government. These hutments represent the last of the clearance schemes of any size at present envisaged and, although the obsolescence factor is not a serious one in the Borough, there still exist, in the older parts of the town, nests of older property which will need to be reviewed for possible demolition in the near future. In spite of the real progress which is being made in the provision of new houses, much remains still to be done to rehouse those families who are living in inadequate and unsuitable accommodation. The disposal of household refuse came under review in 1952 because of the limited life of the East Wickham controlled tipping site. There appear to be no alternative sites in the Borough which could be used when the life of the present tip is finished and consideration is being given to the use of sites in neighbouring districts. This may be inevitable although it is realised that costs would, probably, rise as a result of increased haulage and the possible need to re-organise existing transport arrangements. The Clean Food Campaign made further progress during the year although there is nothing spectacular to report. The general public do not, perhaps, sufficiently recognise that effective official action is only possible with their co-operation and, although lip-service is often paid to the need for cleaner food production and handling, there is considerable public apathy in regard to film shows, lectures and exhibitions. This is, however, a long term project in health education and the up-hill nature of the task does not make it in any way less worthwhile. The prevention of accidents in the home is likely to receive considerable attention in the coming year and will come to be regarded more and more as an integral part of preventive medicine. It is just as worthy to prevent the death of a child from burns as from diphtheria and there is, here, a fruitful field for the endeavours of the Health Department in collaboration with the voluntary organisations in the Borough. It is too little realised that, in the country as a whole, there are 5,000 to 6,000 fatalities every year from home accidents and that 20 per cent of the deaths occur in children under the age of five years and about 60 6 per cent in old people and, further, that more children under 15 years die from accidental causes in their homes than are killed in road accidents. 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 sustained and valuable work during the year. I am, Your obedient servant, JOHN LANDON, Medical Officer of Health. 7 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. New Dwellings Erected. Registrar General's Estimate midyear, 1952 88,160 Houses 355 Relative figures for previous years. Population—Mid-Y ear. 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. 1950 89,410 102 + 15 rebuilt. 1951 88,420 319 Number of inhabited houses at end of 1952 (according to Rate Books) approximately 26,429 Rateable Value £664,732 Sum represented by a penny rate £2,709 Unemployment. Men Women Boys Girls Total December 31st, 1951 191 100 22 18 331 December 31st, 1952 308 103 18 21 450 Social Conditions and Amenities. The Borough of Bexley continues to be a healthy residential district and is specially favoured in that it has ample open spaces and recreational facilities for its inhabitants. Like other districts, however, that suffered severe bombing during the war, and whose population is tending all the time to increase, housing shortages, at present, constitute the main barrier to health for a relatively large number of its citizens. The housing programme is being accelerated as much as possible and it can only be hoped that, as the momentum increases, the housing position of the Borough will gradually reach the optimum standards for which the Council are striving. 8 The Corporation supplied the district with electricity until the date of transfer of this service to the London Electricity Board, and the South Eastern Gas Board supplies gas. The following public open spaces have been provided by the Corporation:— Bexley Woods 26.00 acres Brampton Park Recreation Ground 4.21 Bursted Wood 30.47 „ Danson Park 210.00 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 Gardens .70 „ Playground off Broadway (Proposed) 1.16 Riverside Walk 10.50 Russell Park 13.25 Rutland Shaw, Bexley 2.90 „ Sheldon Sports Ground 7.66 „ Shoulder of Mutton Green (L.C.C.) 3.86 „ Sports Stadium (Proposed) 7.03 Steeple Avenue and Danson Mead 1.50 * Stevens Park 9.55 St. Mary's Recreation Ground 12.86 The Green, Bexleyheath 1.10 „ The Green, Welling 1.80 Total 536.70 „ * Reserved under agreement with J. Stevens—freehold, still to be acquired. Facilities for outdoor games are provided in many of these open spaces, including the large Swimming Pool in Danson Park, opened in July, 1936. 9 GRAPH SHOWING RISE IN POPULATION SINCE 1911 SUMMARY OF VITAL STATISTICS England and Wales. 160 County Boro's and Great Towns including London. 160 Smaller Towns Resident Populations 25,000 to 50,000 at 1951 Census. London Administrative County. Borough of Bexley. Births- Rates per 1,000 Home Population. Live 15.3 16.9 15.5 17.6 12.0 Still 0.35 0.43 0.36 0.34 0.18 22.6(a) 24.6(a) 23.0(a) 19.2(a) 12.18(a) Deaths- All Causes. 11.3 12.1 11.2 12.6 9.14 Typhoid and Paratyphoid 0.00 0.00 0.00 _ _ Whooping Cough 0.00 0.00 0.00 0.00 — Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.24 0.28 0.22 0.31 0.19 Influenza 0.04 0.04 0.04 0.05 0.02 Smallpox 0.00 — — — — Acute Poliomyelitis (including Polioencephalitis 0.01 0.01 0.00 0.01 Pneumonia 0.47 0.52 0.43 0.58 0.48 Notifications (corrected) Typhoid Fever 0.00 0.00 0.00 0.00 — Paratyphoid Fever 0.02 0.02 0.03 0.01 — Meningococcal Infection 0.03 0.03 0.03 0.02 0.03 Scarlet Fever 1.53 1.75 1.58 1.56 1.07 Whooping Cough 2.61 2.74 2.57 1.66 2.13 Diphtheria 0.01 0.01 0.03 0.01 — Erysipelas 0.14 0.15 0.12 0.14 0.23 Smallpox 0.00 0.00 0.00 — — Measles 8.86 10.11 8.49 9.23 17.97 Pneumonia 0.72 0.80 0.62 0.57 0.48 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.06 0.06 0.06 0.06 0.08 Non-Paralytic 0.03 0.03 0.02 0.03 0.01 Food Poisoning 0.13 0.16 0.11 0.18 0.11 Puerperal Pyrexia 17.87(a) 23.94(a) 10.22(a) 30.77(a) 16.76(a) Rates per 1,000 Live Births. Deaths All causes under one year of age 27.6(b) 31.2 25.8 23.8 11.34 Enteritis and Diarrhoea under two years of age 1.1 1.3 0.5 0.7 0.95 (a) Per 1,000 Total (Live and Still) Births. (b) Per 1,000 related live births. A dash (—) signifies that there were no deaths. 11 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 61 0.09 A116 Abortion with toxaemia 13 0.02 1 Other toxaemias of pregnancy and the puerperium 147 0.21 A117 Haemorrhageof pregnancy and childbirth 59 0.09 A118 Abortion without mention of sepsis or toxaemia 31 0.04 3 A119 Abortion with Sepsis 47 0.07 5 A120 Other complications of pregnancy, childbirth and the puerperium 138 0.20 EXTRACTS FROM VITAL STATISTICS FOR THE Year 1952. The Registrar General's Estimate of home population for the mid-year is 88,160 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 558 500 1,058 Legitimate 543 486 1,029 Illegitimate 15 14 29 Birth Rate. Rate per 1,000 estimated home population 12.0 The following relates to the Birth Rate during the past ten years: — 1942 Birth Rate 19.07 per thousand 1943 „ 18.03 „ 1944 „ „ 21.06 .. 1945 „ „ 18.81 „ 1946 19.75 „ 1947 „ „ 18.72 „ 1948 „ .. 15.36 .. 1949 „ 14.02 „ 1950 „ 13.13 „ 1951 „ „ 12.79 „ 12 Rate per 1,000 for England and Wales, 1952 15.3 „ „ „ „ County Boroughs and Great Towns, including London 16.9 „ „ Smaller Towns (estimated population 25,000 to 50,000 at Census. 1951) 15.5 „ „ London Administrative County 17.6 29 illegitimate live births were registered against 50 in 1951. The Registrar-General has supplied a comparability factor for 1952. The standardised birth rate which allows for comparison with other parts of the country is 11.28. Stillbirths. Males Females Total Total 6 10 16 Rate per 1,000 total (live and still) births 12.18 The following relates to the Stillbirth Rate during the past ten years: — Rate per Thousand Year Total Live and Still Births Population 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 1951 18.23 0.24 16 Stillbirths were registered during the year. This represents a rate of 0.18 per 1,000 population against 0.24 per 1,000 population in 1951. 13 Rate per 1,000 for England and Wales, 1952 0.35 ,, ,, ,, ,, County Boroughs and Great Towns, including London 0.43 ,, ,, ,, ,, Smaller Towns (estimated population 25,000 to 50,000 at Census. 1951) 0.36 ,, ,, ,, ,, London Administrative County 0.34 There were no stillbirths registered as illegitimate. Deaths. Males Females Total All causes 441 365 806 Death rate per 1,000 of estimated home population 9.14 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 0.93 Deaths of Infants under one year of age 6 6 12 Legitimate 6 6 12 Illegitimate — — — Death rate of Infants under one year of age: Total per 1,000 live births 11.34 Legitimate per 1,000 legitimate live births 11.34 Illegitimate per 1,000 illegitimate live births — Deaths from Measles (all ages) — — — ,, ,, Whooping Cough (all ages) — — — „ „ Diarrhoea (under 2 years of age) 1 — 1 ,, ,, Cancer (all ages) 77 66 143 14 Death Rate of Country:— Rate per 1,000 for England and Wales, 1952 11.3 ,, ,, ,, ,, County Boroughs and Great Towns, including London 12.1 ,, ,, ,, ,,Smaller Towns (estimated population 25,000 to 50,000 at Census. 1951) 11.2 ,, ,, ,, ,, London Administrative County 12.6 Death Rate of Area during last ten years:— 1942 8.73 per thousand. 1943 9.21 „ 1944 10.20 „ 1945 9.28 „ 1946 8.55 „ 1947 9.17 „ 1948 7.53 „ 1949 8.15 „ 1950 8.56 „ 1951 9.6 „ The rate for Bexley compares favourably with that for other parts of the country. The Registrar-General has supplied a comparability factor for 1952. The standardised death rate which allows for camparison with other parts of the country is 10.78. 15 CAUSES OF DEATH IN THE BOROUGH. REGISTERED DURING THE YEAR 1952. Causes of Death. M. F. Total All Causes 441 365 806 1 Tuberculosis, respiratory 10 4 14 2 Tuberculosis, other 1 2 3 3 Syphilitic disease 2 — 2 4 Diptheria — — — 5 Whooping Cough — — — 6 Meningococcal infections — 2 2 7 Acute poliomyelitis — — — 8 Measles — — — 9 Other infective and parasitic diseases 1 1 2 10 Malignant neoplasm, stomach 17 14 31 11 Malignant neoplasm, lung, bronchus 27 3 30 12 Malignant neoplasm, breast — 11 11 13 Malignant neoplasm, uterus — 10 10 14 Other malignant and lymphatic neoplasms 33 28 61 15 Leukaemia, aleukaemia — 3 3 16 Diabetes 2 3 5 17 Vascular lesions of nervous system 44 69 113 18 Coronary disease, angina 86 31 117 19 Hypertension with heart disease 7 9 16 20 Other heart disease 52 65 117 21 Other circulatory disease 33 29 62 22 Influenza 2 — 2 23 Pneumonia 21 21 42 24 Bronchitis 35 19 54 25 Other diseases of the respiratory system 6 1 7 26 Ulcer of stomach and duodenum 9 4 13 27 Gastritis enteritis and diarrhoea 2 2 4 28 Nephritis and nephrosis 4 4 8 29 Hyperplasia of prostate 5 — 5 30 Pregnancy, childbirth, abortion — 1 1 31 Congenital malformations 4 2 6 32 Other defined and ill-defined diseases 23 24 47 33 Motor vehicle accidents 8 2 10 34 All other accidents 4 — 4 35 Suicide 2 1 3 36 Homicide and operations of war 1 — 1 16 17 INFANT MORTALITY, 1952 DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 19'32 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0— 1— 2— 3— 4— 0— 6— 7— .4— 21— 28- 2— 3— 4— 5— 6— 7— 8— 9— lO- ll— 12 Congenital Malformation, Premature Birth 1 1 1 1 1 Anencephaly 1 Atelectasis 1 1 Cerebral Spinal Meningitis 1 Gastro Enteritis 1 Cerebral Haemorrhage 1 Pneumonia (Virus Infection) Cardiac Failure 1 Totals 3 2 1 – 1 – — – — – – 3 2 – – – – – – – – – The number of infants under one year of age who died during the year 1952 as shown by the table is 12. 7 of these deaths, that is 58.33 per cent., occurred in the neonatal period (within one month of birth). In 1951 the corresponding figure was 71.43 per cent. 12 were registered during the year giving an infantile mortality rate per 1,000 live births of 11.34. Rates over previous years have been:— 1942 32.7 per 1,000 live births 1943 26.01 „ „ „ „ 1944 31.37 „ „ „ „ 1945 33.9 „ „ „ „ 1946 29.5 „ „ „ „ 1947 28.6 „ „ „ „ 1948 19.03 „ „ „ „ 1949 24.0 „ „ „ „ 1950 14.48 „ „ „ „ 1951 24.76 „ „ „ „ Maternal Deaths. There was one maternal death during the year giving a maternal mortality rate of 0.93 per 1,000 live and stillbirths. Rates over previous years have been:— 1942 1.32 per 1,000 live and stillbirths 1943 1.44 ,, ,, ,, ,, ,, 1944 1.30 ,, ,, ,, ,, ,, 1945 Nil ,, ,, ,, ,, ,, 1946 1.73 ,, ,, ,, ,, ,, 1947 1.19 ,, ,, ,, ,, ,, 1948 Nil ,, ,, ,, ,, ,, 1949 0.78 ,, ,, ,, ,, ,, 1950 0.84 ,, ,, ,, ,, ,, 1951 Nil ,, ,, ,, ,, ,, 18 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Isolation Hospital Accommodation. This had been available in the past at the Bow Arrow Hospital of the Dartford Joint Hospital Committee of which the Council was the largest contributing member. With the transfer of the Hospital to the Regional Hospital Board on 5th July, 1948, the Joint Hospital Committee became redundant and there is now no control of this Hospital by the Local Authority. Patients suffering from infectious disease are now admitted to hospitals controlled by the Woolwich and Dartford Hospital Management Committees. General Hospitals. Provisions made by S.E. Metropolitan Regional Hospital Board. AMBULANCE FACILITIES. The provision of these facilities now rest with the Kent County Council as Local Health Authority. NATIONAL ASSISTANCE ACT, 1948. Action taken under Section 47. It was not necessary during the year under review to take statutory action under this Section owing to the removal of patients by voluntary co-operation. Action taken under Section 50. One Burial took place under this Section during the year. PUBLIC MORTUARY. During 1951 the public mortuary was enlarged and equipped with refrigeration for six bodies. The total work was completed in February, 1952. The mortuary is also used by Erith and Crayford Authorities by arrangement with the Bexley Borough Council. During the year it was used on 126 occasions and 123 post-mortem examinations were made. 16 inquests were held. 19 LABORATORY FACILITIES. Pathological and bacteriological work for the area is carried out at the County Hall, Maidstone, through the Public Health Laboratory Service. NURSING HOMES. 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 66 Total 71 20 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. List of Adoptive Acts, etc., in force. Acts. Date Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 Public Libraries Act, 1892-1919 Oct. 1893 Private Street Works Act, 1892 Jan. 1899 Public Health Acts Amendment Act, 1907, Parts 8 and 9 Apr. 1909 Part 2—the whole May 1909 „ 4—Sees. 53 and 54 „ 6—the whole „ 10—Sec. 95 Public Health Act, 1925, Part 2 Jan. 1926 Slaughter of Animals Act, 1933 Jan. 1934 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 21 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 at least five times per week of all supplies and, in the case of the wells, 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 0-5 0-98 0-13 in 100 c.c. (ii) Drainage and Sewerage. The following foul and surface water sewers were laid during the year:— East Rochester Way— 78 Lin. yards Foul Sewer. Brook Lane— 196 Lin. yards S.W. Sewer. 2. Rivers and Streams. Complaints were received during the year regarding the unsatisfactory condition of the lake on the Blendon Estate. Samples of water taken revealed no sewage pollution, but there was evidence of decomposition of organic material, probably from the surface water drainage discharging into the lake, and from decaying vegetation in the lake. 22 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 1952. 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) 315 465 Houses inspected (defects only recorded) 271 950 Houses inspected (Housing Act, 1936, Overcrowding) 43 12 Houses inspected re Infectious Disease (including Scabies) 201 48 Factories with mechanical power 251 17 Factories without mechanical power 33 – Schools 1 – Refuse Tips 464 – Bakehouses 109 26 Outworkers 94 – Food shops and premises where food is prepared 1906 52 Visits re Unsound Food 576 40 Dairies and Milkshops 97 1 Ice Cream Premises 137 1 Fried Fish Premises 207 4 Offensive Accumulations 72 33 Keeping of Animals 157 30 Rats 155 167 Verminous Premises 83 99 Insufficient Ashplace Accommodation 28 25 Drains Inspected 1150 864 Drains Tested (water, smoke or colour) 70 10 Visits re Refuse Removal and Salvage 716 – Public Conveniences 285 13 Food and Drugs Act re Samples 243 3 Water Samples 22 – Shops Act, 1950 1493 – Council House Applicants 502 76 Cleansing Station 26 – Mortuary 19 – Merchandise Marks Act, 1926 109 12 Pet Animals Act, 1951 14 3 Miscellaneous Inspections 1430 144 24 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 16 Provided with sufficient ashplace accommodation 15 Provided with sufficient water supply 15 Houses Improved Internally— Dirty rooms cleansed 47 Walls and ceilings repaired 132 Dampness in rooms remedied 128 Defective floors repaired 31 Ventilation of rooms improved 22 Windows repaired 43 Coppers repaired – Stoves, fireplaces, etc. provided 01 repaired 18 Houses Improved Externally— Roofs repaired 19 Eaves, gutters and down spouts fixed or repaired 43 Yards paved or repaired 2 Chimney stacks repaired 3 Walls repointed or repaired 9 Miscellaneous repairs 46 Drainage— Drains cleansed or repaired 617 New drains constructed 9 New Gullies provided – Ventilation of drainage system improved 4 Inspection chambers built or improved 11 Waste pipes provided or improved 7 New sinks provided – Offensive accumulation removed 16 Nuisances from animals abated 1 Other nuisances abated 10 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 63 Houses visited including revisits 249 Rooms disinfected 18 Notices delivered to Education Authorities, etc. 328 25 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered. Beef lbs. 1.256¾ Ox Tails 299½ Ox Livers 30 Mutton and Lamb 406¾ Pork 140 Rabbits 8 Poultry 134½ Jellied Veal 33 Tinned Ham 1,296¾ Sausages 169 Cheese 175½ Bacon 21¾ Dried Pineapple 12 Prunes 749¾ Walnuts 221 Tea 20 Flour 42 Coffee 23 Cereals 58 Split Peas 13 Coconut 63 Fish 834 Fish Tins 104 Milk 83 Vegetables 1,136 Meat 1,047 Fruit and Fruit Juices 1,451 Soups 541 Puddings 56 Baby Food 29 Preserves Tins and Jars 229 Fish and Meat Pastes 65 26 Cereals Packets 42 Biscuits 23 Pom 31 Blancmange Powder 16 Cake and Pudding Mixtures 35 Figs 15 Ground Almonds 9 Dates 4 Desiccated Coconut 6 Cheese Boxes and Packets 145 Sauces and Pickles, etc Bottles and Jars 156 Eggs 11 Confectionery 89 Miscellaneous Items 70 27 TABLE No. 5. Factories Act, 1937. 1. Inspections for Purposes of Provisions as to Health. Including Inspections made by Sanitary Inspectors. Premises. 1 Number of:— Inspections. 2 Written Notices. 3 Prosecutions. 4 Factories with mechanical power 403 2 – Factories without mechanical power 127 – – *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 530 2 – 2. Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.l) 3 3 – – Overcrowding (S.2) – – – – Unreasonable temperature (S.3) – – – – Inadequate ventilation (S.4) – – – – Ineffective drainage of floors (S.6) – – – – Sanitary Conveniences (S.7)— Insufficient – – – – Unsuitable or defective – – – – 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.) 1 1 – – Total 4 4 – – 28 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 cleansing and maintenance of public conveniences. Refuse Collection. A weekly collection of refuse was given throughout the year except at Bank Holiday periods, when some delay occurred. It is becoming increasingly difficult to find temporary labour to carry out this work, and this means that time lost by holidays has to be made up by the normal staff. The following table gives details of the transport used for this service:— S. & D. Dust Carts (Side loading) 12 Karrier Lorries 2 Bedford Lorry 1 Karrier Bantam 1 Commer Utility Van 1 Three of the S. & D. Dust Carts purchased in 1947 were thoroughly re-conditioned and painted by the makers during the year. Refuse Disposal. All refuse is disposed of by controlled tipping at East Wickham. A muledozer is used for levelling and consolidating the iefuse, and has continued to give satisfactory service. Covering material is obtained mainly by excavating soil from the site by means of a Chaseside Shovel, which is hired from the Highways Department as and when required. Preliminary steps were taken during the year with a view to finding a site for the disposal of refuse when the present tip is filled. There is no suitable land available within the area for this purpose, but efforts are being made to find a tip within a reasonable distance, in order that transport costs may be kept as low as possible. 29 Salvage. Details of salvage sales for the financial year ended 31st March, 1953, are set out below:— Tons cwts. qrs. £ s. d. Waste Paper 434 4 2 3,694 4 7 Textiles 27 8 3 552 5 3 Kitchen Waste 579 18 1 1,932 8 4 Ferrous Metals 46 15 1 203 18 9 Non-Ferrous Metals 1 19 1 180 16 8 Miscellaneous Items 4 8 1 12 6 10 1,094 14 1 6,576 0 5 The income received from the sale of waste paper was greatly below what was anticipated, due to the fact that several reductions in price took place during the year. By the end of March, 1953, the price being paid for baled mixed papers was £6 10s. Od. per ton as compared with £13 per ton in April, 1952. In addition to the reduction in price, the merchants found it necessary to limit the quantity taken, with the result that a considerable stock had accumulated at the Salvage Depot by the end of the year. Kitchen Waste is collected twice weekly from some 400 communal bins placed in the streets and sent to the Woolwich Borough Council's Concentrator Plant at White Hart Lane, Plumstead. Public Conveniences. Public Conveniences for men and women are situated at the following sites:— Market Place, Bexleyheath. Townley Road, Bexleyheath. Brampton Road, Bexleyheath. Danson Park, Welling. Library Building, Bellegrove Road, Welling. High Street, Bexley. St. Mary's Recreation Ground, Bexley. The new conveniences in Brampton Road were completed in April, 1952, and have met a long felt need in that part of the Borough. These conveniences are the first to be 30 provided by the Council in accordance with their policy of erecting one set of conveniences each year in parts of the area where this service is badly needed. At the end of the year new conveniences at Westwood Lane, Blackfen, were being built. The cost of the erection and maintenance of these conveniences is to be shared in agreed proportion by the Council and the Chislehurst and Sidcup Urban District Council. 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 animals. Details of infestations dealt with during the year are set out below. Number of Properties Inspected 1,407 Number of Inspections 3,152 Number of Infestations Found—Major Minor 237 Mice 34 Number of Treatments carried out Rats Mice Local Authority's premises 7 1 Dwelling Houses 209 20 Business Premises 21 13 PET ANIMALS ACT, 1951. Licences to keep pet shops were issued to 4 persons under the above Act. One contravention of the conditions of the licence was found, and the Council issued a warning to the person concerned. 31 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 730 shops on the Council's Register at the end of the year. During the year 1,493 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. 32 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 by means of the latest method of break-point chlorination. Samples of water have been taken by this department from time to time and the results of bacterioligical 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 0-8 0-9 Absent Shallow end 0-16 0-19 Absent Verminous Premises. During the year a total of 28 houses found to be infested with bed bugs were treated with satisfactory results; 18 of these were Council Houses, and, 10 private dwellings. Fifteen infestations were found by the District Sanitary Inspectors as a result of visits to applicants who had been allocated Council Houses or were being transferred from one house to another. Whilst these visits take up a considerable amount of time, there is no doubt that they serve a useful purpose in preventing the spread of infestations. In 7 cases the furniture and effects were treated with hydrogen cyanide prior to removal to Council Houses. Schools. There are 26 County Modern and County Primary Schools, 6 non-provided schools and a Day Technical School for Girls in the Borough. 33 SECTION D —HOUSING. The following particulars relate to the houses built by the Council on the various Estates and still occupiable:— Houses  Welling— Welling Estate 428 – Westwood Lane Estate 126 – Carlton Road 16 – Dovedale Close 14 – John Newton Court – 102 Marwood Estate – 8 East Wickham— Glenmore Road No. 1 116 – Glenmore Road No. 2 88 – Bexleyheath— Highland Road Estate and Pickford Road Estate (including bungalows) 304 Cannon Road – 28 Alers Road 84 Halcot Estate No. 1 200 Halcot Estate No. 2 112 Faygate Estate 58 Bexley— Hartford Road Estate and Victoria Road Estate 54 Royal Park Estate No. 1 58 Royal Park Estate No. 2 74 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 Hurst Farm Estate 97 1,955 138 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 586 34 (b) Number of inspections made for the purpose (including re-inspection) 2,001 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 315 (b) Number of inspections made for the purpose (including re-inspections) 780 (3) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 311 (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 249 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 177 3. Action under Statutory Powers during the year. A. Proceedings under Section 9, 10 and 16 of the Housing Act, 1936— (1) Number of dwelling houses in respect of which notices were served requiring repairs – (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners – (b) By local authority in default of owners – B. Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 21 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 21 (b) By local authority in default of owners – 35 C. Proceedings under Sections 11 and 13 of Housing Act, 1936— (1) Number of dwelling houses in respect of which Demolition Orders were made 1 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 1 D. Proceedings under Section 12 of the Housing Act, 1936— Number of Closing Orders made– Houses closed as a result of informal procedure 2 Public Health Act, 1936. Section 75. Provision of Dustbins. Notices served requiring provision of bins 1 Number complied with— (a) by Owners – (b) by Local Authority in default of Owners 1 Bins provided in consequence of informal action 15 36 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The milk retailed for consumption in the area is ail pasteurised and bottled. 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 16 Tuberculin Tested Milk 16 Sterilised Milk 23 Supplementary Licences:— Pasteurised Milk 5 Tuberculin Tested Milk 5 Sterilised Milk 5 (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 223 samples taken during the year. Formal Informal Milk 17 – Soup, Meat Extracts – 4 Pastes, Potted Meat 1 2 Pudding or Cake Mixture, Flour, etc. 5 – Jellies, Custard'Powders, etc 8 1 Patent Medicines – 2 Sausages, Sausage Meat, etc 18 – Fruit, Fruit Juices and Fruit Puree 8 6 Condiments, Sauces, Pickles, Spices, etc. 11 12 Pure Coffee, Coffee Extract, Coffee and Chicory 2 2 Meat Pies and Puddings 5 – Fish and Fish Cakes 3 2 Cereals 2 3 Glace Cherries 2 1 Sweets and Confectionery 10 8 37  Formal Informal Essences – 8 Fats 3 – Ice Cream 16 – Synthetic Cream and Synthetic Cream Powder 1 2 Olive Oil 1 2 Skimmed Milk Powder – 1 Luncheon Meats 4 2 Pepper and Pepper Flavoured Compound 2 6 Split Peas 1 – Desiccated Coconut 1 – Processed Cheese 4 1 Mixed Peel 3 – Baking Powder – 2 Ground Ginger – 1 Tomatoes – 3 Beans in Tomato Sauce 1 – Cake 3 – Minerals – 1 Powder Glucose – 1 Beverages 1 1 Preserves 3 1 Beef Suet 2 – Chicken 1 – Chocolate Filled Wafers – 1 Wines and Spirits 6 – Ground Almonds 1 – Bread – 1 No legal proceedings were taken during the year. (d) Food Preparation Premises. During the year 1,958 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 3 Floors, walls, ceilings, etc., repaired 1 Cockroach Infestation dealt with 1 Selling of Horseflesh without Notice displayed 1 38 Rooms cleansed 28 Water closets cleansed or repaired 3 Drains cleansed or repaired 8 Yards cleansed or repaired 2 Accumulation of refuse removed 6 Accommodation for storage of refuse improved 2 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 1 Sale of Ice Cream 119 Preparation of Sausages, etc 46 24 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. 39 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 94 cases were notified as compared with 101 the previous year. Of these 9 were isolated in hospital and 85 were isolated at home. No of deaths Nil Return cases from Hospital cases Nil Return cases from home nursed cases 1 During the past 15 years the character of this disease has changed from one of considerable severity to one characterised by its extreme mildness. The acute stage is, nowadays, in most cases, short and unaccompanied by high pyrexia and complications are in most cases mild or completely absent. Scarlet fever can now be disregarded as an important cause of acute endocarditis and acute nephritis which, in the past, were frequently encountered. Diphtheria. No cases were notified during the year. T^ie following figures on Immunisation and Vaccination have been supplied by the County Medical Officer:— 40 41 Immunisation against Diphtheria and Vaccination against Smallpox, 1952. 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, 1952:— (A) Diphtheria Immunisation. Year of Birth 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 Total Primary Inoculations 131 773 68 26 12 59 57 40 16 9 1 2 1 2 – 1197 Reinforcing Inoculations – – – 2 75 722 221 94 72 39 7 40 5 13 7 1297 (B) Vaccination. Year of Birth 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 Before 1938 Total Primary Vaccination 480 255 6 9 11 10 – 2 7 – 1 1 2 2 2 55 843 Revaccination – 1 – 2 5 6 4 3 5 2 5 6 3 1 4 179 226 Immunisation against Diphtheria, 1952. 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, 1952, who had completed a course of immunisation at any lime before that date (i.e., at any time since 1st January, 1938). Year of Birth 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 Total 1200 1139 1029 1012 1111 1223 1449 1536 1205 1390 1266 1151 1039 921 131 16,802 Enteric Fever. There were no cases notified during the year. Puerperal Pyrexia. 18 cases were notified during the year, of which 13 were from Bexleyheath Maternity Hospital, where they were isolated and treated. 4 cases were removed to other hospitals and one case was isolated at home. Ophthalmia Neonatorum. 1 case was notified during the year. Measles. 1,584 cases were notified during the year. 6 cases were treated in hospital. Whooping Cough. 188 cases were notified, 2 of which were treated in hospital. Acute Anterior Poliomyelitis. 7 Paralytic cases and 1 Non-Paralytic case were notified and were treated in hospital. There were no deaths. Scabies. 2 cases were notified during the year. Food Poisoning. 10 sporadic cases were notified during the year. 42 43 The following table gives the particulars concerning the cases of Infectious Disease (other than Tuberculosis) notified in the area duriug the year. NOTIFIABLE DISEASES (Other than Tuberculosis) DURING THE YEAR 1952. 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 94 – – 7 82 4 1 – – 9 – Diphtheria – – – – – – – – – – – Puerperal Pyrexia 18 – – – – – 5 13 – 17 – Ophthalmia Neonatorum 1 1 – – – – – – – – – Pneumonia 42 1 3 2 7 – – 29 – 15 – Acute Paralytic Poliomyelitis 7 – – – 1 1 3 2 – 7 – Acute Non-Paralytic Poliomyelitis 1 – – – – – 1 – – 1 – Erysipelas 20 – – – 1 – – 19 – 1 – Food Poisoning 10 – – 1 3 1 – 5 – 2 – Dysentery 1 – – – – – – 1 – – – Typhoid Fever – – – – – – – – – – – Para-Typhoid Fever – – – – – – – – – – – Meningococcal Infection 3 1 2 – – – – – – 3 2 Measles 1584 25 231 364 923 20 10 11 – 6 – Whooping Cough 188 10 53 55 64 1 1 4 – 2 – Scabies 2 – – – 1 – 1 – – – – Totals 1971 38 289 429 1082 27 22 84 – 63 2 TUBERCULOSIS. During the year 116 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1952 are contained in the following table:— Age Period New Cases Deaths Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. 0–1 – 1 – – – – – – 1–5 3 2 2 1 – – – 1 5–10 3 4 1 – – – – – 10–15 – 2 – – – – – – 15–20 5 5 1 2 – – – – 20–25 4 8 – 2 – 1 – – 25–35 14 14 – – 2 1 – – 35–45 12 3 1 – 1 1 – 1 45–55 9 4 – 2 4 – – – 55–65 7 2 – – 4 – 1 – 65 and upwards 1 1 – – 3 1 – – Totals 58 46 5 7 14 4 1 2 Of the 21 deaths shown in the table the number of non-notified Tuberculosis deaths was 4. Pulmonary. Non-Pulmonary. Total. M F M F No. on Register at commencement of year 560 401 73 76 1,110 No. on Register at end of year 469 325 36 43 873 The decrease in the number of cases on the Register was mainly due to a revision of the tuberculosis register which entailed the removal of the names of cases long quiescent or lost sight of by the Chest Clinic. Rehousing. 4 cases were referred to me by the Chest Physician for rehousing and during the year one case was rehoused by the Housing Committee. 44 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1952 JOHN LANDON, M.R.C.S.. I..R.c.P D.P.H Medical Officer of Health EXCEPTED DISTRICT OF BEXLEY WELFARE AND SCHOOL ATTENDANCE SUB-COMMITTEE Chairman' Councillor T. M. Gauge. Vice-Chairman: Miss M. Woodward. Alderman A. S. Masey Councillor J. Cronin Councillor Mrs. A. Welch Councillor Mrs. E. M. Sheppard Alderman M. J. Corr Councillor F. W. Archer Councillor Mrs. H. F. Piggott Co-opted Members: Miss D. C. Collins Revd. E. Maynard Wilson Borough Education Officer W. E. D. Stephens, M.A. Deputy Borough Education Officer R. R. Sutton SCHOOL HEALTH SERVICE Medical Officer of Health John Landon, 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). Lucy M. Boyd, M.B., Ch.B. (Part-time) (Resigned 31.1.52). Helen D. Fox, M.B., B.S. (Wholetime) (Transferred to another area 18.8.52). Stella M. Ring, M.B., B.S., M.R.C.S., L.R.C.P. D.C.H. (Part-time) (Appointed 18.2.52). Sybil R. Yeates, M.B., B.S., M.R.C.S., L.R.C.P. (Whole-time) (Appointed 18.8.52). Ophthalmic Surgeon Roland M. Chambers, M.B., B.S.. D.O.M.S. Orthopaedic Surgeons K. F. Hulbert, F.R.C.S. B. Lawson, F.R.C.S. Dental Officers H. Wade, L.DS. Elizabeth Francis, B.D.S., L.D.S. (Part-time). Francis Quail, L.D.S., R.C.S. (Appointed 21.7.52). 46 Orthodontist Gordon Charles Dickson, L.D.S., B.Ch.D., F.D.S., R.C.S., England. (Resigned Feb. 1952). Gerald Holgate Roberts, L.D.S., B.Ch.D., D.D.S. (Transferred to this area Feb. 1952). 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 L. G. Exley, S.R.N., and Health Visitor's Certificate. (Part-time). Mrs. C. A. Tucker, S.R.N., and Health Visitor's Certificate. (Part-time). Mrs. M. T. Layton, S.R.N., and Health Visitor's Certificate. (Part-time). Miss Golding, S.R.N., and Health Visitor's Certificate. (Part-time). 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 (Whole-time). Miss K. M. Dunkley (Whole-time). Mrs. Sproule (Transfered to this area 22.9.52). Miss Ellis—Hygienist (Transfered to another area June, 1952). Miss Soley (Transfered to this area 4.9.52). School Health Service Clerk Miss M. C. A. Smith. General Clerks Miss C. E. Anderson. Miss O. G. Turnbull. Mrs. C. Judd (Resigned 21.6.52). Miss A. Jopling (Appointed 28.7.52). 47 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1952. To the Chairman and Members of the Welfare and School Attendance Sub-Committee. Ladies and Gentlemen, 1 have the honour to present my Annual Report for the year 1952. Although the amount of dental inspection in schools increased during the year under review, and the amount of treatment given was considerable, it is still not possible to say that there has been a return to the systematic supervision of the dental health of the children which existed prior to the last war. Staff shortages continue but there is a tendency, at the present time, for dental surgeons to return from private practice to the local authority services and it is hoped that this will make possible, in the not too distant future, a return to pre-war conditions. In any case, a further whole-time dental surgeon is needed in the School Health Service. If, as also seems possible, the scheme to provide an additional dental unit at the Murchison Avenue Clinic comes to fruition, the ground would be prepared for such an appointment. The time is certainly ripe for the School Dental Service in the Borough to be overhauled and expanded to provide a service which is more truly conservatory than is possible at present. The ear, nose and throat treatment which is now provided for school children at the West Hill Hospital, Dartford, has proved to be adequate to the needs of the children, both in regard to new appointments and for the purposes of " follow up " treatment. Plans are being made at present for the carrying out of an audiometric survey of the 10-year old age group of school children in the near future, as there are, no doubt, many children who cannot benefit to the full extent from tuition because of minor degrees of hearing defect which could be remedied by simple treatment. A present-day feature of the School Health Service is the increasing number of children who are referred to the Child Guidance Clinic for behaviour disorders. Durins the year, 47 children were so referred and there were, in addition, many children who were examined by the Assistant Medical Officers for lesser degrees of personality defects. There is a shortage of places in schools for maladjusted children and, although the number of cases requiring admission in the Borough is small, the problems which they raise are of an extremely urgent nature. Only too often, the causes of the defect are to be found in the home invironment of the child. 48 although the latter, does not, because of this, escape the unfortunate label which is applied to him. As in previous years, considerable care was given to the ascertainment and treatment of the various categories of handicapped children who are to be found in any large school community. The special needs of these children call for the closest link between the School Health Service, the family doctor and the consultant hospital services and the Education Service, and it is a pleasure to record the excellent teamwork which obtains between these agencies. The care of spastic children has been facilitated by the opening of the Valence School for Physically Handicapped Children and the provision of home tuition does much for the spastic child who, either through lack of mobility, or intelligence, cannot be admitted to a special school. During the year, the mothers of some of these children and the Health Visitors co-operated in taking a number of these children to the Bertram Mills Circus at Olympia, which entailed a high degree or organisation and demonstrates the extraordinary zest for life possessed by so many of these children. There were no serious outbreaks of infectious disease during the year but the incidence of measles and chickenpox was responsible for a considerable loss of school time among the schoolchildren. The place of schools in the spread of measles is referred to in the foreword to the annual report on page 5. It is a matter for regret that lack of time makes it impossible to pursue a more active policy of health education in the schools, although as much as possible is done by visiting doctors and school nurses and in fact, by the teachers themselves. During the year, systematic lectures on child care and mothercraft were given to the older girls, who were due to leave school, and there is, no doubt, an even wider scope for increase in this kind of activity. 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 School Health Department whose help and industry 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 49 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Bexley County Technical School for Girls. Average number on Roll at 31st December, 1952, Bexley 806 Wilmington Annex 227 Six County Secondary Schools. Average number on Roll 2,807 Twenty-one County Primary Schools. Average number on Roll 6,484 Voluntary Schools. Two Primary Schools. Average number on Roll 297 Voluntary Aided Schools. One Secondary School. Average number on Roll 322 Two Primary Schools. Average number on Roll 754 Total 11,697 Clinics. Minor Ailments. Welling—Little Danson, Dansington Road. Tuesday and Wednesday, 2-4 p.m. Saturday, 9.30-11 a.m. Doctor in attendance — Wednesday and Saturday. Welling—Wrotham Road. Tuesday and Thursday, 9.30-11 a.m. 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. Bexley—Murchison Avenue. Tuesday and Friday, 9.30-11 a.m. Doctor in attendance—Friday. 50 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. Monday, Wednesday, Thursday, Friday and Saturday mornings, 9.30-11 a.m. Monday, Tuesday, Thursday, Friday afternoons, 2-4 p.m. Extraction sessions, Monday afternoon and 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. Orthopædic. 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. (Discontinued 1.11.52 — Transferred to Murchison Avenue). Bexley—Murchison Avenue. Monday, 2-5 p.m. Specialist in attendance 1st Monday in month, 10-12.30 a.m. Appointments made through County Medical Officer by the Borough Medical Officer of Health. 51 Speech. Welling—Wrotham Road. Friday, 9.30-12 noon, 2-4 p.m. Appointments made through County Medical Officer by the Borough Medical Officer of Health. Child Guidance. Crayford—Woodside Road. Clinics held daily. Appointments made through County Medical Officer by the Borough Medical Officer of Health. 52 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 co-operation of Head Teachers and their staffs and it is true to say that this is now regarded as an integral part of the school curriculum. It is at these inspections that the greatest number of defects are discovered and where a great deal of information is obtained in regard to the school children by discussions with the parents. Generally speaking, it was found that entrants, 8-yearolds 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 inspection 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 60 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 preventive aspect of School Health Work. School Meals—1952. Average number of pupils in attendance:— Primary Schools 7,168 Secondary Schools 3,956 11.124 Average number of pupils taking meals daily:— Primary Secondary Free 68 117 Payment 3,531 2,740 Total 3,599 2,857 53 Milk. Average number of pupils taking milk daily:— Primary 6,887 Secondary 2,640 Total 9,527 Orthopaedic Clinic. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on the Orthopaedic Clinic:— The clinics have continued on the 1st and 3rd Wednesday mornings of the month throughout the past year. We are still severely handicapped by the conditions under which we have to work, the building being totally inadequate for the purpose and it is the worst clinic as far as building is concerned that I attend. The inadequacies of this building have been reported on previous occasions. The type of case coming up has not altered and there is nothing out of the ordinary to report here. Postural deformities of the back and feet still comprise the vast majority of cases, and I can't help feeling that efficient physical training at school would eliminate a large proportion of such cases and save a lot of time away from school. The treatment of spastics still looms very large, and there is still room for much improvement here, there being inadequate provision for the education and reablement of these cases in this area. Miss Cheeseman continues to carry on the Physiotherapy very well indeed, and our thanks are all due to her. Dental Treatment. I am indebted to Mr. Wade, L.D.S., Dental Surgeon, for the following report:— Maternity and Child Welfare. The treatments in this clinic have followed their usual course and attendances have been up to usual standard with rather a larger number of toddlers being attended. Orthodontic. During the period under review orthodontic treatment was carried out under the direction of the County Orthodontist and there was an increase of patients needing treatment and the necessary appliances were put in hand. Cases of interest. A patient at the dental clinic presented a swelling of the mandible which was referred for X-rays and a radiologist's report after which the case was sent to the 54 Eastman Dental Hospital where Sir William Kelsey-Fry took it over for surgical treatment. Again the Eastman Dental Hospital has treated those patients referred for jacket crowns and has been most co-operative. General. On account of an increase of staff, by the employment of a part-time dental surgeon in the Borough, greater time has been given to school inspections, thus the clinic was faced with a mass of dental neglect and had, perforce, to adopt short cuts to eradicate septic and painful conditions in order to cope with the amount of disease which presented itself, thus entailing many more cases for a general anaesthetic than in the past. The usual help in running the clinic has been maintained throughout the year and I thank you for your interest and help whenever sought. I am indebted to Mrs. Elizabeth Francis, B.D.S., L.D.S., for the following report:— It has not yet been possible at this clinic to return to the ideal sequence of school inspections and subsequent treatment, indeed, I do not believe this to be feasible until there are more dental officers in this area. However, we have achieved some advances this year. Two sessions each week are now devoted to dealing with children who need emergency treatment. The schools are co-operating well in this scheme so that the other sessions are undisturbed by casual patients. Naturally accident cases resulting in fractures and so on, are seen immediately. The dental hygienist who visits the clinic one day a week is considerably improving the state of dental health of the children. This is especially apparent in those who have only come to the clinic because of toothache. When their neglected mouths have been cleaned and they have been instructed in oral hygiene, the majority show great keenness in maintaining a clean and healthy mouth. Speech Therapy. I am indebted to Miss Joan Pollitt, Chief Speech Therapist to the Kent Education Committee for the following report:— The Bexleyheath Speech Therapy Clinic is a part of the Speech Therapy Department within the County as a whole. Statements in regard to the Bexleyheath Clinic which have been made in the comprehensive report have not been duplicated here. 55 It has been possible to close 26 cases at Bexleyheath during 1952. Very satisfactory results have been obtained in 16 cases; either no abnormality now exists in 15 cases or these cases have improved to such an extent that only a slight residual defect remains; the improvement in the sixteenth case was as great as could be expected in view of the nature of the disability. Treatment was incomplete in 4 cases; three of these were in contact with hospitals in relation to their problems, and, for various reasons, cessation of attendance at the Speech Therapy was necessary; in the fourth case attendance ceased without any reason being given and the parents did not respond to letters sent to them. One case was closed as little, if any, progress was being made after a considerable period of attendance at the clinic. A further case was closed as Speech Training in School was proving to be beneficial. One case was found to have improved when the child was first seen at the clinic. Training was arranged elsewhere in two cases prior to appointments at the clinic and one child had left the district prior to appointments being offered. Twenty cases remained in contact with this clinic at the end of 1952 and will continue attendance at the clinic in 1953. The waiting list at the end of 1952 was 94. Close contact has been maintained with teachers in schools and with other staff of the Education Committee and School Health Service. The link between the County Speech Therapy Service and the Regional Hospital Board has developed into a mutual one whereby consultants working in hospitals under the latter have referred child, adolescent and adult patients to the Speech Therapy Departments and whereby the Speech Therapists have been able to consult specialists in the hospitals in regard to specific cases not previously seen by hospital consultants. Audiometric tests, neurological examinations, consultation with ear, nose and throal consultants, plastic surgeons, paediatricians and orthodontists have been arranged where necessary. A further valuable service has been that of confirmation in regard to therapist's mental assessment findings by Assistant County Medical Officers and Psychologists. Consultation with members of Child Guidance Clinic Staffs has also taken place. 56 Cleanliness Inspections. (See Table III). During the year the School Nurses carried out 14,220 examinations of children in Schools and 67 were found to have some infestation with vermin. In nearly all cases, the condition was cleared up by parents who were assisted, where necessary, by the School Nurses. The infestation rate is commendably low and speaks well for the standard of child care in the Borough. Physical Education. The quality of work in the Borough has been maintained at a good level, some schools showing work of an exceptionally high standard. Small and large apparatus has been used to advantage in the Primary Schools, where the movement of the children appears to be bolder, and the children more inventive, and self-disciplined, occupying their time intelligently, without the continual assistance and cajoling of the teacher. In boys' secondary schools the stress (as last year) has been laid on Games training and sports, whilst in the girls' schools the work has been based on the movement principles of Mr. Rudolph Laban. The girls are trained to appreciate qualities of movement, rather than to perform specific exercises and vaults. The movements are of the girls' own creation employing the use of varying speeds, and strengths, and training sensitivity to space and shape. Swimming. Coaching was continued at:— (i) Danson Pool (ii) Plumstead Baths (iii) Eltham Baths (indoor) (iv) Eltham Open Air Baths. Average number of pupils attending each week:— Primary 583 Secondary 838 424 swimming certificates were awarded during the year. In many schools foot inspection is routine, during the first few days of term. In this way early detection of Verrucae and Athletes Foot is possible, treatment advised, and the number of cases in schools reduced. 57 SCHOOL HEALTH SERVICES. Statistical Tables. Table I — Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. B. Other Inspections. C. Pupils found to require Treatment. Table II — A. Return of Defects found by Medical Inspection. B. Classification of the General Condition of Pupils Inspected during the year in the Age Groups. Table III — Infestation with Vermin. Table IV — Treatment Tables. Group I Diseases of the Skin. Group II Eye Diseases, Defective Vision and Squint. Group III Diseases and Defects of Ear, Nose and Throat. Group IV Orthopaedic and Postural Defects. Group V Other Treatment given. Table V — Dental Inspection and Treatment including Orthodontics. Table VI — Handicapped Children. 58 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. — Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 1,619 Second Age Group 737 Third Age Group 754 Total 3,110 Number of other Periodic Inspections 729 Grand Total 3,839 B. — Other Inspections. Number of Special Inspections 3,980 Number of Re-Inspections 4,115 Total 8,095 C. — Pupils Found to Require Treatment. Number of Individual Pupils found at Periodic Medical Inspection to require Treatment: Group For defective vision (excluding squint) For any of the other conditions recorded in Table HA Total Individual pupils (1) (2) (3) (4) Entrants 16 309 318 Second Age Group 76 125 185 Third Age Group 73 111 173 Total (prescribed groups) 165 545 676 Other Periodic Inspections 92 272 256 Grand Total 257 817 932 59 TABLE II. A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1952. 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 198 110 221 5 5. Eyes— a. Vision 257 159 195 3 b. Squint 35 52 34 3 c. Other 53 49 80 3 6. Ears— a. Hearing 11 74 11 5 b. Otitis media 10 50 16 3 c. Other 19 34 16 2 7. Nose or Throat 129 466 209 28 8. Speech 12 32 9 - 9. Cervical Glands 9 168 46 5 10. Heart and Circulation 22 108 9 3 11. Lungs 17 269 129 23 12. Developmental— a. Hernia 7 26 5 1 b. Other 10 126 2 - 13. Orthopaedic— a. Posture 137 80 20 1 b. Flat Foot 243 129 40 3 c. Other 122 221 88 8 14. Nervous System— a. Epilepsy 2 11 2 2 b. Other 6 36 17 4 15. Psychological— a. Development 6 48 11 5 b. Stability 4 185 47 16 16. Other 19 83 198 134 60 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 1619 594 36.68 898 55.46 127 7.84 Second Age Group 737 378 51.28 294 39.89 65 8.95 Third Age Group 754 338 44.82 372 49.33 44 5.83 Other Periodic Inspections 729 322 44.17 367 50.34 40 5.48 Total 3839 1632 42.51 1931 50.29 276 7.18 TABLE III. Infestation with Vermin. Primary and Secondary Schools. (i) Total number of examinations in the schools by the school nurses or other authorised persons 14,220 (ii) Total number of pupils on roll of schools visited 9,921 (iii) Total number of individual pupils found to be infested 67 (iv) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act. 1944) 2 (v) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) - Grammar and Technical Schools. (i) Total number of examinations in the schools by the school nurses or other authorised persons 230 (ii) Total number of pupils on roll of schools visited 980 61 (iii) Total number of individual pupils found to be infested - (iv) number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) - (v) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) - TABLE IV.—Treatment Tables. Group I.—Diseases of the Skin (excluding uncleanliness, for which see Table III). Number of cases treated or under treatment during the year by the Authority otherwise Ringworm—(i) Scalp — — (ii) Body 211 — Scabies 2 — Impetigo 12 — Other skin diseases 433 — Total 658 — Group II.—Eye Diseases, Defective Vision and Squint. No. of Cases dealt with by the Authority otherwise External and other, excluding errors or refraction and squint 61 — Errors of refraction (including squint) 2,016 — Total 2,077 — Number of pupils for whom spectacles were (a) Prescribed 466 — (b) Obtained 353 — 62 Group III.—Diseases and Defects of Ear, Nose and Throat. Number of cases treated by the Authority otherwise Received operative treatment (a) for diseases of the ear — 2 (b) for adenoids and chronic tonsillitis — 103 (c) for other nose and throat conditions — 3 Received other forms of treatment — 69 Total — 177 Group IV.—Orthopaedic and Postural Defects. (a) Number treated as in-patients in hospitals 13 by the Authority otherwise (b) Number treated otherwise, e.g., in clinics or outpatients departments 309 20 Group V.—Other Treatment Given. Number of cases treated by the Authority otherwise (a) Miscellaneous minor ailments 1,337 — (b) Other 1. Minor Eye Defects 143 — 2. Minor Ear Defects 93 — 3. Minor Injuries 72 — Total 1,645 — 63 TABLE V. Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 2,832 (b) Specials 1,530 Total (1) 4,362 (2) Number found to require treatment 3,376 (3) Number referred for treatment 3,376 (4) Number actually treated 2,181* (5) Attendances made by pupils for treatment 7,021* (6) Half-days devoted to: Inspection 17 Treatment 741 Total (6) 758 (7) Fillings: Permanent Teeth 923 Temporary Teeth 291 Total (7) 1,214 (8) Number of teeth filled: Permanent Teeth 906 Temporary Teeth 288 Total (8) 1,194 (9) Extractions: Permanent Teeth 705 Temporary Teeth 3,516 Total (9) 4,221 (10) Administration of general anaesthetics for extraction 1,140 (11) Other operations: Permanent Teeth 8,156* Temporary Teeth 546 Total (11) 8,702 *These figures include orthodontic work. 64 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, 1952:- (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Special Schools or homes — — — 1 5 3 — — 9 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes — 1 — 1 53 7 11 1 — 74 On or about December 1st, 1952:- C. Number of capped Pupils from the area:- (i) attending Special Schools as (a) Day Pupils — 5 7 3 — 18 22 — — 55 (b) Boarding Pupils — — — — — — — — — — (ii) Boarded in Homes — — — — — — — — — — (iii) Attending pendent schools under ments made by the Authority — — — — — — — — — — Total (C) — 5 7 3 — 18 22 — — 55 (D) Number of capped Pupils being educated under ments made under Section 56 of the Education Act, 1944:- (i) In hospitals — — — — — 1 — — — 1 (ii) Elsewhere — — — — 1 5 — — — 6 E. Number of capped Pupils from the area requiring places in Special Schools ing any such unplaced children who are porarily receiving home tuition) — — — — 5 4 5 1 — 15 Number of children reported during the year:— (a) Under Section 57(3) (excluding any returned under (b) ) 3 (c) „ „ „ relying on Section 57(4) — „ „ „ 54 (5) 1 of the Education Act, 1944. 65 INDEX. ITEM PAGE Health Committee 2 Public Health Staff 3 STATISTICS AND SOCIAL CONDITIONS. Acreage 8 Population 8 Unemployment 8 Social Conditions and Amenities 8—9 Population Graph 10 Summary of Vital Statistics 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—18 Maternal Deaths 18 GENERAL PROVISION OF HEALTH SERVICES. Isolation Hospital Accommodation 19 General Hospitals 19 Ambulance Facilities 19 National Assistance Act, 1948 19 Public Mortuary 19 Laboratory Facilities 20 Registration of Nursing Homes 20 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 21 Water Supply 22 Drainage and Sewerage 22 Rivers and Streams 22 Chief Sanitary Inspector's Report— Tables of Inspections and Improvements, etc. 24—25 Food Inspection 26—27 Tables—Factories Act, 1937 Closet Accommodation Public Cleansing 29 Refuse Collection and Disposal 29 Salvage 30 Public Conveniences 30—31 Prevention of Damage by Pests Act, 1949 31 Pet Animals Act, 1951 31 Shops Act, 1950 32 Swimming Pool 32 Verminous Premises 32—33 Schools 33 66 ITEM PAGE HOUSING. Council Estates 34 Inspection of Dwelling Houses 34—35 Remedy of Defects without formal notice 35 Action under Statutory Powers 35—36 Public Health Act, 1936—Provision of Dust Bins 36 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 37 Meat Inspection 37 Adulteration of Food—Food & Drugs Act 37—38 Food Preparation Premises 38—39 Registration of Premises 39 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 40 Diphtheria 40 Diphtheria Immunisation and Vaccination 41 Enteric Fever 42 Puerperal Pyrexia 42 Ophthalmia Neonatorum 42 Measles 42 Whooping Cough 42 Acute Anterior Poliomyelitis 42 Scabies 42 Food Poisoning 42 Tables of Infectious Diseases Notified 43 Tuberculosis 44 SCHOOL HEALTH SERVICES REPORT, 1950. Welfare and School Attendance Sub-Committee 46 Staff 46—47 Schools 50 Clinics 50—52 Co-ordination— Periodic Medical Inspections 53 School Meals and Milk 54 Orthopaedic Clinic 55 Dental Treatment 54—55 Speech Therapy 5—56 Cleanliness Inspections 57 Physical Education 7 Swimming 7 Statistical Tables 58—65 67