BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Services For the Year 1953 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 1953 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health Borough of Bexley. Mayor: Alderman M. J. Corr, J.P. Deputy Mayor: Alderman A. S. Masey. HEALTH COMMITTEE. Chairman: Councillor Mrs. H. F. Piggott. Vice-Chairman: Councillor J. W. Bateman. 4 Alderman' M. J. Corr, J.P. Councillor E. W. Dines. Alderman J. C. McLean, J.P. Councillor E. S. Newton. Alderman P. R. Relph. Councillor Mrs. E. M. Sheppard. Alderman H. P. Tanner. Councillor Mrs. A. Welch. 2 PUBLIC HEALTH STAFF, 1953. Medical Officer of Health John Landon, M.R.C.S., L.R.C.P., D.P.H. (Joint appointment with Borough of Erith and U.D. Crayford). Chief Sanitary Inspector, Public *† G. Hind, M.S.I.A. Cleansing Officer and Shops Acts Inspector. Deputy Chief Sanitary Inspector *† J. T. Boocock. District Sanitary Inspectors *† F. W. Willington. *† G. F. Lovegrove. *† W. E. Moses. Chief Clerk G. A. Pearson. Senior Clerk R. V. Hoad. Clerks E. M. Pearmine (Miss). M. E. Smith (Miss) (Shorthand Typist). E. S. Merry (Mrs.) (Temporary Shorthand Typist, 19.5.536.6.53). F. L. Gurr (Mrs.) (Temporary Shorthand Typist, 16.6.537.11.53). 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 1953. The vital statistics of the Borough indicate once again that, according to this limited yardstick, the health of the Borough can be considered satisfactory. The customary warning must however be given that these figures should be accepted with guarded optimism as they give only a part, albeit an important one, of the total health situation of a population numbering nearly 88,000. The birth rate for 1953 was 12.7 per 1,000 of the population compared with 12.0 in 1952 which was the lowest ever recorded in the Borough. It would be premature to suppose that this represents a reversal of the downward trend which has been noticeable for over 40 years and it is impossible to forecast what the future rates may be. The birth rate for 1953, after correction by the comparability factor supplied by the Registrar General (1.03), was 13.08. The uncorrected birth rate for England and Wales was 15.5 so it will be seen that, once again, the birth rate for the Borough was well below that of the country as a whole. The death rate for 1953, at 8.8 per 1,000 of the whole population, was appreciably lower than the rate for 1952 which was 9.14 per 1,000. After correction by the comparability factor for deaths (1.14), the rate was 10.03 and the uncorrected death rate for England and Wales for 1953 was 11.4. Cancer was again second, after diseases of the heart and blood vessels, among the chief causes of death. The infant mortality rate for 1953 at 14.36 per 1,000 live births showed an increase on the record low rate for 1952 namely, 11.34 per 1,000 live births. The rate for the country as a whole was 26.8 per 1,000 related births so that the favourable position of the Borough, in this respect, may be appreciated. Of the 16 infantile deaths in the Borough, six were due to causes which were, probably, preventable, including bronchitis and pneumonia, but it does not pay to be too dogmatic in this matter when there are so many unknown factors. Infectious diseases when judged by the standards of 25 years ago, were very low. Measles headed the list with 459 4 cases, whooping cough with 345 and scarlet fever with 245, the latter disease being, generally speaking, of low virulence. There is more and more evidence that the great problem of the future will be the control of the virus infections, tight cases of paralytic poliomyelitis which is now, unfortunately, an annual visitant and may, in fact, be regarded as endemic in this country, were notified. There is, however, at the present time, a somewhat greater hope of controlling this disease by immunisation although vaccination against poliomyelitis is still very much in the experimental stage. It may be some years yet before a vaccine can be produced in such a reliable form that it can be depended upon to produce resistance to the virus of this disease. The welfare of old people continues to take up a considerable amount of the time of the department. The notification of an old person living alone, often in very bad conditions, may present itself as an emergency requiring immediate attention. It is often a serious problem to decide as to the best action to be taken. Admission to hospital sometimes provides a temporary respite to the difficulties of the old person but still leaves the problem of what is going to happen when he or she is ready for discharge. A tribute is due to those volunteers, from many sources, who are prepared to clean up the home and receive the old person on return from hospital. Recognition must, also, be given to the Woolwich Group Hospital Management Committee who are very co-operative in this matter. It may be that in spite of all the contra-indications it is in the interests of the old person to be kept at home, however deplorable this may be and to apply, to the fullest extent, the social remedies which are available. In this connection the Home Help Service is invaluable. Many old people ask for no more than to be allowed to keep their independence and their old homes and, wherever possible, this must be respected. The work of the Old People's Welfare Committee and the "good neighbours" of whom there are so many, often makes it possible for this solution to be applied. I have many times reported to the Health Committee that, although the death rate from tuberculosis has been falling rapidly during recent years due to great improvements in medical treatment, the notification rate has not shown a similar reduction. This may be due, in part, to better means of ascertainment, notably by means of Miniature Mass Radiography, but I have, from time to time, suggested that an attack on the problem of tuberculosis from all possible angles, preventative and curative, is necessary if the disease is to be finally conquered. The Minister of Health has now prepared a memorandum which accompanied Circular No. 8/54 in which he indicates a need for 5 fying various preventative measures and reviews the value of existing measures to bring the disease under control. Among the suggested remedies are greater efforts to discover the source of a new case, the supervision of contacts, the extension of the use of B.C.G. Vaccine, and the more selective use of Miniature Mass radiography. It will be seen, therefore, that the implementation of this scheme requires the closest co-operation between Chest Clinics, the Local Health Authority the general practitioners and the Local Authorities; the latter being concerned, mainly, as housing authorities and as the authorities responsible, in an important measure, for the local control of infectious disease. The task is one of the most arduous thrown on the health services for many years but it is the only sure way of getting rid of tuberculosis in the foreseeable future. The need for the collaboration of a large number of medical and social workers is called for and the effect on the health department would be considerable. It is to be hoped that, in the coming years, this joint action will be taken. Another impending development is the new housing legislation which is at present embodied in the Housing Repairs and Rents Bill now before Parliament. While the provision of new housing has proceeded apace, the older houses have tended to deteriorate during the war and since and the new Bill is, in part, concerned with slum clearance, the patching up of sub-standard houses and the improvement and conversion of older properties with a view to extending their life while further new houses are provided. There are no slums in the Borough in the accepted sense of the word but there is a manageable number of obsolescent houses which are ripe for demolition and could be tackled within the next few years. These could be demolished as individual unfit houses or as small clearance schemes and, particularly in the former case, the problem of rehousing the occupants is one of great difficulty. Often they are occupied by old persons living on their old age pension and the transfer to a more hygienic new house or flat is overshadowed by the fear of higher rents and the possible reduction of expenditure on food and other essentials. It is, however, true that the National Assistance Board, is often able to offset rent increases in such cases where supplementary allowances are in force. The Food and Drugs (Amendment) Bill at present before Parliament may also place further responsibilities on the Health Department in that it foreshadows the extension of registration to classes of premises not covered at present by Section 14 of the Food and Drugs Act, 1938. The Bexley, Erith and Crayford Clean Food Guild has continued its work during the year and at present 112 6 plaques have been awarded. The co-operation of many of the multiple firms has been obtained and this long term essay in health education, stimulated perhaps by the Food and Drugs (Amendment) Act, when it reaches the Statute Book, will help to provide that higher standard of food hygiene which we all desire. During the year a Clean Food Week was held which culminated in an address and demonstration by the Deputy Medical Director of the Central Council for Health Education and was followed by a film show and discussion. The newly formed Bexley, Erith and Crayford Home Safety Committee promises to become an active instrument for the reduction of accidents in the home and is, in fact, complementary in its function to the Bexley, Erith and Crayford Road Safety Committee. The Minister of Housing and Local Government has given his approval to the making of a grant by each of the constituent authorities so that the Committee has, financially speaking, got off to a flying start. The collection of reliable statistics of home accidents is proceeding well and, in the near future, activities will be undertaken to draw the attention of the public, by propaganda methods, to the preventable nature of home accidents which, as is now well known, greatly exceed the number of accidents on the roads. The question of delegation of functions under Part III of the National Health Service Act, 1946 and other enactments to the Borough of Bexley is still being considered and there can be no doubt that a satisfactory solution of this problem would bring a degree of integration to the Health Services of the Borough which would redound to the benefit of the users of these services. The investigation into the Incidence and Causation of Health among Bexley children has now been completed for some time and problems of commercial publication have been encountered. I am glad to report that a grant of £250 has been made by the Eugenics Society to the Kent Paediatric Society and it is hoped that the Report will be published towards the end of 1954. In conclusion, I wish to thank the Chairman and 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. 7 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. New Dwellings Erected. Registrar General's Estimate midyear, 1953 87,990 Houses 265 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 has increased considerably, housing shortages, at present, constitute the main barrier to the health of relatively large number of its citizens. The housing programme has been accelerated as much as possible and it can only be hoped that the housing position of the Borough will gradually reach the optimum standards for which the Council are striving. 8 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1943 5 1935 59,970 1944 Nil 1940 77,670 1945 2 1945 75,040 1946 82+ 64 rebuilt 1950 89,410 1947 199+ 216 rebuilt 1951 (Census) 88,420 1948 334+ 286 rebuilt 1952 88,160 1949 138+ 73 rebuilt 1950 102+ 15 rebuilt 1951 319 1952 355 Number of inhabited houses at end of 1953 (according to Rate Books) approximately 26,686 Rateable Value £674,043 Sum represented by a penny rate £2,750 Unemployment. Men Women Boys Girls Total December 31st, 1952 308 103 18 21 450 December 31st, 1953 248 115 35 12 410 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 Memorial Garden 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 „ 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 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 15.5 17.0 15.7 17.5 12.7 Still 0.35 0.43 0.34 0.38 0.28 22.4(a) 24.8(a) 21.4(a) 21.0(a) 12.94(a) Deaths— All Causes 11.4 12.2 11.3 12.5 8.8 Typhoid and Paratyphoid 0.00 0.00 — Whooping Cough 0.01 0.01 0.00 0.00 0.01 Diphtheria 0.00 0.00 0.00 — — Tuberculosis 0.20 0.24 0.19 0.24 0.10 Influenza 0.16 0.15 0.17 0.15 0.08 Smallpox 0.00 0.00 0.00 — — Acute Poliomyelitis (including Polioencephalitis 0.01 0.01 0.01 0.01 __ Pneumonia 0.55 0.59 0.52 0.64 0.30 Notifications(corrected) Typhoid Fever 0.00 0.00 0.00 0.01 — Paratyphoid Fever 0.01 0.01 0.01 0.01 0.01 Meningococcal Infection 0.03 0.04 0.03 0.03 0.02 Scarlet Fever 1.39 1.50 1.44 1.02 2.78 Whooping Cough 3.58 3.72 3.38 3.30 3.93 Diphtheria 0.01 0.01 0.01 0.00 — Erysipelas 0.14 0.14 0.13 0.12 0.17 Smallpox 0.00 0.00 0.00 — — Measles 12.36 11.27 12.32 8.09 5.22 Pneumonia 0.84 0.92 0.76 0.73 0.48 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.07 0.06 0.06 0.07 0.09 Non-Paralytic 0.04 0.03 0.04 0.03 — Food Poisoning 0.24 0.25 0.24 0.38 0.11 Puerperal Pyrexia 18.23(a) 24.33(a) 12.46(a) 28.61(a) 5.27(a) Rates per 1,000 Live Births. Deaths All causes under one year of age 26.8(b) 30.8 24.3 24.8 14.36 Enteritis and Diarrhoea under two years of age 1.1 1.3 0.9 1.1 — (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 68 0.10 — A116 Abortion with toxaemia 7 0.01 1 Other toxaemias of pregnancy and the puerperium 166 0.24 — A117 Haemorrhage of pregnancy and childbirth 90 0.13 — A118 Abortion without mention of sepsis or toxaemia 30 0.04 3 A119 Abortion with Sepsis 39 0.06 4 A120 Other complications of pregnancy, childbirth and the puerperium 125 0.18 — EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1953. The Registrar General's Estimate of home population for the mid-year is 87,990 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 551 563 1,114 Legimate 529 551 1,080 Illegimate 22 12 34 Birth Rate. Rate per 1,000 estimated home population 12.7 The following relates to the Birth Rate during the past ten years: — 1943 Birth Rate 18.03 per thousand 1944 „ 21.06 „ 1945 „ 18.81 „ 1946 „ 19.75 „ 1947 „ 18.72 „ 1948 „ 15.36 „ 1949 „ 14.02 „ 1950 „ 13.13 „ 1951 „ 12.79 „ 1952 „ 12 00 „ 12 Rate per 1,000 for England and Wales, 1953 „ „ „ „ County Boroughs and Great 15.5 Towns, including London 17.0 „ „ „ „ Smaller Towns (estimated population 25,000 to 50,000 at Census, 1951) 15.7 „ „ „ „ London Administrative County 17.5 34 illegitimate live births were registered against 29 in 1952. The Registrar-General has Supplied a comparability factor for 1953. The standardised birth rate which allows for comparison with other parts of the country is 13.08. Stillbirths. Males Females Total Total 15 10 25 Rate per 1,000 total (live and still) births 12.94 25 Stillbirths were registered during the year. This represents a rate of 0.28 per 1,000 population against 0.18 per 1,000 population in 1952. The following relates to the Stillbirth Rate during the past ten years: — Year Rate per Thousand Total Live and Still Births Population 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 1952 12.18 0.18 13 Rate per 1,000 for England and Wales, 1953 0.35 „ „ „ „ County Boroughs and Great Towns, including London 0.43 „ „ „ „ Smaller Towns (estimated population 25,000 to 50,000 at Census, 1951) 0.34 „ „ „ „ London Administrative County 0.38 There was one stillbirth registered as illegitimate. Deaths. Males Females Total All causes 413 365 778 Death rate per 1,000 of estimated home population 8.8 Number of women dying in, or in consequence of, childbirth: From Puerperal and Post Abortive Sepsis — — From other Puerperal Causes 3 3 Death rate per 1,000 total Give and still) births 2.63 Deaths of Infants under one year of age 12 4 16 Legitimate 11 4 15 Illegitimate 1 — 1 Death rate of Infants under one year of age: Total per 1,000 live births 14.36 Legitimate per 1,000 legitimate live births 13.89 Illegitimate per 1,000 illegitimate live births 29.41 Deaths from Measles (all ages) — — — „ „ Whooping Cough (all ages) 1 — 1 „ „ Diarrhœa (under 2 years of age) — — — „ „ Cancer (all ages) 100 85 185 14 Death Rate of Country: — Rate per 1,000 for England and Wales, 1953 11.4 „ „ „ „ County Boroughs and Great Towns, including London 12.2 „ „ „ „ Smaller Towns (estimated population 25,000 to 50,000 at Census, 1951) 11.3 „ „ „ „ London Administrative County 12.5 Death Rate of Area during last ten years: — 1943 9.21 per thousand. 1944 10.20 „ „ 1945 9.28 „ „ 1946 8.55 „ „ 1947 9.17 „ „ 1948 7.53 „ „ 1949 8.15 „ „ 1950 8.56 „ „ 1951 9.6 „ „ 1952 9.14 „ „ The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1953. The standardised death rate which allows for comparison with other parts of the county is 10.03. 15 CAUSES OF DEATH IN THE BOROUGH. REGISTERED DURING THE YEAR 1953. Causes of Death. M. F. Total All Causes 413 365 778 1 Tuberculosis, respiratory 4 3 7 2 Tuberculosis, other 2 — 2 3 Syphilitic disease 3 1 4 4 Diphtheria — — — 5 Whooping Cough 1 — 1 6 Meningococcal infections — — — 7 Acute poliomyelitis — — — 8 Measles — — — 9 Other infective and parasitic diseases — 2 2 10 Malignant neoplasm, stomach 13 13 26 11 Malignant neoplasm, lung, bronchus 31 6 37 12 Malignant neoplasm, breast — 23 23 13 Malignant neoplasm, uterus — 6 6 14 Other malignant and lymphatic neoplasms 56 37 93 15 Leukaemia, aleukaemia 2 1 3 16 Diabetes 1 7 8 17 Vascular lesions of nervous system 32 47 79 18 Coronary disease, angina 86 30 116 19 Hypertension with heart disease 8 9 17 20 Other heart disease 28 53 81 21 Other circulatory disease 26 27 53 22 Influenza 3 4 7 23 Pneumonia 18 14 32 24 Bronchitis 38 27 65 25 Other diseases of the respiratory system 2 4 26 Ulcer of stomach and duodenum 10 — 10 27 Gastritis enteritis and diarrhoea — 3 3 28 Nephritis and nephrosis 4 6 10 29 Hyperplasia of prostate 5 — 5 30 Pregnancy, childbirth, abortion — 3 3 31 Congenital malformations 5 3 8 32 Other defined and ill-defined diseases 20 30 50 33 Motor vehicle accidents 6 1 7 34 All other accidents 5 4 9 35 Suicide 4 3 7 36 Homicide and operations of war — — — 16 17 INFANT MORTALITY, 1953 DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1953 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0— 1— 2— 3— 4— 6— 6— 7— 14— 21— 28— 2— 3— 4— 5— 6— 7— 8— 9— 10— 11— 12— Congenital Malformation, Premature Birth 3 1 1 1 1 1 1 Whooping Cough 1 Multiple Renal Venous Infarction 1 Acute Bronchitis 1 Broncho Pneumonia 1 1 1 1 Totals 3 — 1 — — — — 1 1 — — 5 1 — 1 1 2 — — — — — The number of infants under one year of age who died during the year 1953 as shown by the table is 16 6 of these deaths, that is 37.5 per cent., occurred in the neonatal period (within one month of birth). In 1952 the corresponding figure was 58.33 per cent. 16 were registered during the year giving an infantile mortality rate per 1,000 live births of 14.36. Rates over previous years have been:— 1943 26.01 per 1,000 live births 1944 31.37 „ „ „ „ 1945 33.9 „ „ „ „ 1946 29.5 „ „ „ „ 1947 28.6 „ „ „ „ 1948 19.03 „ „ „ „ 1949 24.0 „ „ „ „ 1950 14.48 „ „ „ „ 1951 24.76 „ „ „ „ 1952 11.34 „ „ „ „ Maternal Deaths. There were three maternal deaths during the year giving a maternal mortality rate of 2.63 per 1,000 live and stillbirths. Rates over previous years have been:— 1943 1.44 per 1,000 live and stillbirths 1944 1.30 ,, „ ,, ,, ,, 1945 Nil ,, „ ,, ,, ,, 1946 1.73 „ „ „ „ „ 1947 1.19 ,, „ ,, ,, ,, 1948 Nil ,, „ ,, ,, ,, 1949 0.78 ,, „ ,, ,, ,, 1950 0.84 ,, „ ,, ,, ,, 1951 Nil ,, „ ,, ,, ,, 1952 0.93 ,, „ ,, ,, ,, 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 (S.E. Metropolitan Regional Hospital Board). General Hospitals. Provision 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. No burials were arranged 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 158 occasions and 156 post-mortem examinations were made. 31 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 66 Total 71 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 Total No. of visits made during 1953 13 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 Payments 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 water to the district is supplied by the Metropolitan Water Board and is derived from several sources, namely, Wilmington, Darenth, Wansunt, Crayford, Bexley and Deptford wells, the latter mixed with Thames-derived water, filtered at Walton. 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, Deptford and Walton. 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. 0-13694 0-11412 0-1 in 100 c.c. (ii) Drainage and Sewerage. The following foul and surface water sewers were laid during the year:— Lodge Hill Estate— S.W. Sewers 1,451 lin. yds. Foul Sewers 288 lin. yds. Wickham Street and Chaucer Road Scheme— S.W. Sewers 50 lin. yds. Foul Sewers 100 lin. yds. Willow Close— S.W. Sewers 127 lin. yds. Brookdale Road— Foul Sewers 80 lin. yds. S.W. Sewers 73 lin. yds. Hurst Springs— S.W. Sewers 40 lin. yds. Thirteen cesspools were emptied a total of 37 times. 2. Rivers and Streams. No serious case of pollution of rivers or streams was found during the year. 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 1953. 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) 26 69 Houses inspected (defects only recorded) 223 780 Houses inspected (Housing Act, 1936, Overcrowding) 31 16 Houses inspected re Infectious Disease (including Scabies) 341 74 Factories with mechanical power 220 18 Factories without mechanical power 14 — Schools 6 — Refuse Tips 519 — Bakehouses 130 5 Outworkers 59 — Food shops and premises where food is prepared 2,135 116 Visits re Unsound Food 479 72 Dairies and Milkshops 122 — Ice Cream Premises 172 7 Fried Fish Premises 188 8 Offensive Accumulations 54 23 Keeping of Animals 137 17 Rats 172 142 Verminous Premises 44 83 Insufficient Ashplace Accommodation 55 4 Drains Inspected 1,013 766 Drains Tested (water, smoke or colour) 96 2 Visits re Refuse Removal and Salvage 851 — Public Conveniences 312 1 Food and Drugs Act re Samples 292 — Water Samples 22 — Shops Act, 1950 1,284 7 Council House Applicants 448 113 Cleansing Station 15 — Mortuary 12 — Tents, Vans and Sheds 25 33 Pet Animals Act, 1951 29 2 Miscellaneous Inspections 1,327 130 24 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 18 Provided with sufficient ashplace accommodation 9 Provided with sufficient water supply 13 Houses Improved Internally— Dirty rooms cleansed 11 Walls and ceilings repaired 69 Dampness in rooms remedied 108 Defective floors repaired 31 Ventilation of Rooms improved 10 Windows repaired 36 Stoves, fireplaces, etc. provided or repaired 14 Houses Improved Externally— Roofs repaired 18 Eaves, gutters and down spouts fixed or repaired 44 Yards paved or repaired 1 Chimney stacks repaired 7 Walls repointed or repaired 17 Miscellaneous repairs 30 Drainage— Drains cleansed or repaired 469 New drains constructed 1 New Gullies provided 1 Ventilation of drainage system improved 1 Inspection chambers built or improved 14 Waste pipes provided or improved 7 New sinks provided — Offensive accumulation removed 14 Nuisances from animals abated — Other nuisances abated 6 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 49 Houses visited including revisits 25 Rooms disinfected 37 Notices delivered to Education Authorities, etc. 702 25 Food Inspection. TABLE No. 4. The following is a summary of unsound food surrendered. Beef lbs. 1,456+ Ox Liver 99 13 Ox Tongues 99 56 Mutton and Lamb 99 13 Pork 99 108 Rabbit 99 50 Sausages 99 290½ Pork Hearts 99 51 Sweetbread 99 96 Corned Beef 99 125 Tinned Ham 99 167 Ham and Cooked Meats 99 375¾ Bacon 99 4½ Prunes 99 117½ Sultanas 99 30 Cheese 99 85 Chestnuts 99 70 Flour 99 4 Barley 99 28 Rice 99 108 Butter 99 11 Biscuits 99 66 Confectionery 99 56 Fish 99 616 Fish Tins 99 Milk 99 264 Vegetables 99 823 Meat 99 531 Fruit and Fruit Juices 99 2,711 Soups 99 56 Preserves 99 312 Fish pastes 99 59 Barley 99 42 Pork Sausages 99 230 Cereals Pkts 6 Figs 99 10 Biscuits 99 26 Pickles and Sauces Jars 49 Sandwich Spread 99 55 Cheese Boxes 49 Cheese Portions 12 Miscellaneous 68 All condemned food is disposed of by burying at the Council's refuse tip. 26 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 without mechanical power 73 1 — Factories with mechanical power 373 5 — *Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 4 — — •Electrical Stations should be reckoned as factories. Total 450 6 — 2. Defects Found. Particulars. 1 Number of Delects. Number of Prosecutions. 5 Found. 2 Remedied. 3 Referred to H.M. Inspector. 4 Want of cleanliness (S.1) 5 5 — — 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 8 8 — — Not separate for sexes — — — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 2 2 — — Total 15 15 — — 27 Closet Accommodation. With the exception of a few houses, all the closet accommodation in the Borough is on the water carriage system. PUBLIC CLEANSING 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. The following table gives details of the transport used for this service:— S. & D. Dust Carts (Side loading) 12 Karrier Lorries 2 Karrier Bantams 2 Commer Utility Van 1 Two of the S. & D. Dust Carts purchased in 1947 were thoroughly re-conditioned and painted by the makers during the year. Refuse Disposal. Refuse is disposed of by controlled tipping at East Wickham. A muledozer is used for levelling and consolidating the refuse, 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. Salvage. Details of salvage sales for the financial year ended 31st March, 1954, are set out below: Tons cwts. qrs. £ s. d. Waste Paper 454 8 1 2,919 6 0 Textiles 20 2 2 398 15 4 Kitchen Waste 493 5 3 1,834 11 6 Ferrous Metal 149 14 0 416 11 0 Non-Ferrous Metals 2 0 0 159 13 0 Miscellaneous Items 5 11 2 18 12 9 1,125 2 0 5,747 9 7 28 The income from salvage sales was below that of the previous years, mainly due to the decrease in the average price received for waste paper and the fact that the merchants continued to limit the quantity taken. During the year the Council took over a building at East Wickham Farm, Welling, for use as a salvage Depot and the old depot at the tip site was discontinued. The collection of kitchen waste from some 400 communal street bins is carried out twice weekly. During part of the year the waste food was sent to the Woolwich Borough Council's Concentrator Plant at White Hart Lane, Plumstead, but this had to be discontinued owing to the fact that the Woolwich Council were unable to find a market for the concentrated food. As a result of this, a considerable quantity of kitchen waste had to be disposed of at the refuse tip until another market was found. 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. Hudson Road Children's Playground. Westwood Lane, Blackfen. (Maintained jointly by the Chislehurst and Sidcup Urban District Council and Bexley Corporation). Provision was made in the estimates for the erection of new conveniences at Riverside Walk, Bexley, but owing to objections from residents in the area with regard to the proposed site, it was not possible for the conveniences to be built. During the year the Department took over the cleansing and maintenance of the conveniences at Hudson Road Children's Playground. 29 ATMOSPHERIC POLLUTION. During the year the Council agreed to be represented on the Thameside Advisory Committee for the Abatement of Atmospheric Pollution. By arrangement with this Committee a deposit gauge was placed on the roof of the Education Office in Brampton Road, Bexleyheath, on the 1st August, 1953, and the following table gives the results obtained. t MONTH TONS PER SQUARE MILE. Rainfall inches Total water insoluble matter Soluble in C.S.2. Ash Other combustible matter Total water soluble matter Calcium Chlorine Sulphates Total solids August 1.46 6.62 0.13 4.74 1.75 5.00 1.33 0.33 1.71 11.62 September 2.00 7.45 0.13 5.29 2.03 7.97 1.28 0.72 2.63 15.42 October 3.99 10.50 0.22 7.87 2.42 11.07 1.48 0.94 4.56 21.58 November 0.30 2.68 0.09 1.86 0.73 3.05 0.37 0.40 1.23 5.74 December 0.75 13.36 0.03 10.31 3.02 13.36 2.35 0.59 7.44 26.71 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. 30 Details of surface infestations dealt with during the period are set out below. Number of Properties Inspected 1,708 Number of Inspections 4,008 Number of Infestations found: Rats — Major 1 Minor 355 Mice 61 Number of Treatments carried out Rats Mice Local Authority's premises ' 8 — Dwelling Houses 327 48 Business Premises 21 13 PET ANIMALS ACT, 1951. Licences to keep pet shops were issued to 6 persons under the above Act. 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 746 shops on the Council's Register at the end of the year. During the year 1,291 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. 31 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 growth on Agar at: B. coli presumptive 37° C. 22° C. Deep end 0- 9 0- 4 Absent Shallow end 0- 7 0- 9 Absent Verminous Premises. During the year a total of 29 premises found to be infested with bed bugs were treated with satisfactory results; 14 of these were Council Houses, and, 15 other premises. Two houses were treated for flea infestations. Five 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 considerable time, there is no doubt that they serve a useful purpose in preventing the spread of infestations. One house was treated with hydrogen cyanide. Wasps. The destruction of wasps nests is undertaken by the Department and during the year 6 nests were destroyed. 32 Schools. There are 26 County Modern and County Primary Schools, 6 non-provided schools and a Day Technical School for Girls in the Borough. Tents, Vans and Sheds. A small number of caravans found temporary accommodation in the area from adjoining districts after being forced from their permanent winter quarters by the East Coast floods early in the year, and these were given supervision until they were able to return. 33 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 — 132 Marwood Estate — 22 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 (including Bungalows) 126 Faygate Estate 58 Bristow Road — 52 Upton Close 15 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 Place Estate 144 2,031 234 34 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) 249 (b) Number of inspections made for the purpose (including re-inspection) 1,098 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 28 (b) Number of inspections made for the purpose (including re-inspections) 95 (3) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 28 (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 191 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 189 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 — 35 B. Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 10 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 17 (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 respect of which Demolition Orders were made 5 (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 1 E. Proceedings under Section 10 (1) of the Local Government Act (Miscellaneous Provisions) Act, 1953— Number of Closing Orders made 1 Clearance Schemes. Lodge Lane Hutments (Compulsory Purchase) Order, 1938. During the year 23 hutments on the Lodge Lane Estate were demolished and the re-development of the estate commenced. East Wickham Hutment Clearance Areas Nos. 1, 2 and 3 (Compulsory Purchase) Orders, 1939. East Wickham Nos. 1 and 2 (Compulsory Purchase) Orders 1953. The above Orders, covering a total of 260 hutments, 47 hutment sites and adjoining parcels of land were confirmed by the Minister of Housing and Local Government during the year, and are now in operation. 36 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The milk retailed for consumption in the area is all 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 255 samples taken during the year. Formal Informal Milk 11 1 Soup, Meat Extracts 7 4 Pastes, Potted Meat — 10 Pudding or Cake Mixture, Flour Etc. 4 — Jellies, Custard Powders, etc 4 8 Patent Medicines — 5 Sausages, Sausage Meat, etc. 5 1 Fruit, Fruit Juices and Fruit Puree 1 8 Condiments, Sauces, Pickles, Spices, etc. 2 15 Pure Coffee, Coffee Extract, Coffee and Chicory 1 2 37  Formal Informal Meat Pies and Puddings 1 3 Fish and Fish Cakes 1 — Cereals 5 4 Sweets and Confectionery 30 13 Essences — 2 Butter and Fats 5 1 Ice Cream Mix 1 — Ice Cream 8 — Tinned Cream — 9 Olive Oil — 1 Tinned Milk — 1 Luncheon Meats 1 — Desiccated Coconut — 2 Cheese and Processed Cheese 2 — Mixed Peel 1 1 Baking Powder — 1 Preserved Ginger 1 1 Cake 6 — Minerals — 1 Beverages 2 — Beef Suet 3 1 Wines and Spirits 9 — Ground Almonds 2 1 Bread, Bread Crumbs or Rolls 2 — Tomato and Cheese Sandwich Spread — 1 Lemonade Crystals, etc 2 1 Alcholic Drinks 3 2 Preserves 14 1 Welsh Rarebit — 2 Water Ices — 1 Salted Nuts — 2 Dried Fruits 3 — Peanut Butter 2 — Curry Powder 1 2 Tea 2 — Potato Crisps — 1 Demerera Sugar 1 — Sage and Onion Stuffing 1 — Wafer Biscuits 1 1 145 110 Legal proceedings were taken during the year in respect of a loaf of bread containing foreign matter, and the defendants were fined £10 and £5 5s. 0d. cost. 38 (d) Food Shops and Food Manufacturing Premises. The classification of the various food shops and food manufacturing premises in the Borough is as follows:— Butchers 44 Cafes and Restaurants 28 Greengrocers 45 Sweet Shops 70 General Provisions 101 Bakers and Confectioners 29 Wet and Fried Fish Shops 26 Public Houses 41 384 During the year 2,251 visits were made and the following is a summary of various improvements carried out. Hot water supply provided or improved 3 Floors, walls, ceilings, etc., repaired 9 Cockroach Infestation dealt with 1 Roofs repaired 2 Rooms cleansed 26 Water closet accommodation improved 2 Drains cleansed or repaired 1 Yards cleansed or repaired 2 Accumulation of refuse removed 2 Accommodation for storage of refuse improved 3 Fish preparing room improved 1 Washing accommodation provided 2 Registration of Premises under Food and Drugs Act, 1938. No. of premises registered for:— Manufacture and Sale of Ice Cream 1 Sale of Ice Cream 122 Preparation of Sausages, etc 46 35 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 245 cases were notified as compared with 94 the previous year. Of these 14 were isolated in hospital and 231 were isolated at home. No. of deaths Nil Return cases from Hospital cases Nil Return cases from home nursed cases 2 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:— 40 41 Immunisation against Diphtheria and Vaccination against Smallpox, 1953. 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, 1953: — (A) Diphtheria Immunisation. Year of Birth 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 Total Primary Inoculations 140 757 54 22 12 22 57 16 10 8 1 4 1 — — 1104 Re-inforcing Inoculations — — — — 66 599 330 99 73 48 41 45 1 25 4 1331 (B) Vaccination. Year of Birth 1953 1952 1951 1950 1949 1948 1947 IR46 1945 1944 1943 1942 1941 1940 1939 Before 1939 Total Primary Vaccination 543 259 3 4 4 8 5 4 4 5 1 1 1 — 1 33 876 Re-vaccination — — — 4 4 3 1 5 2 3 4 2 3 — 2 127 160 Immunisation against Diphtheria, 1953. 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, 1953, who had completed a course of immunisation at any lime before that date (i.e., at any time since 1st January, 1939). Year of Birth 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 Total Last complete course of injections (whether primarv or booster) 1949—1953 51f 354 188 328 806 977 872 1073 1383 130? 1249 1061 975 888 140 12111 1948 or earlier 624 675 825 682 184 80 374 148 64 — — — — — — 3656 Population 1951 Census 1257 1230 1272 1188 1053 1088 1325 1360 1457 1377 1071 1553 1314 1211 1113 19469 Para Typhoid Fever. 1 case was notified during the year. Puerperal Pyrexia. 6 cases were notified during the year, of which 3 were from Bexleyheath Maternity Hospital, where they were isolated and treated. 2 cases were removed to other hospitals and one case was isolated at home. Ophthalmia Neonatorum. There were no cases notified during the year. Measles. 459 cases were notified during the year. 4 cases were treated in hospital Whooping Cough. 345 cases were notified, 2 of which were treated in hospital. There was one death of an unnotified case. Acute Anterior Poliomyelitis. 8 Paralytic cases were notified and 6 were treated in hospital. There were no deaths. Scabies. 4 cases were notified during the year. Food Poisoning. 10 cases were notified during the year. Of these 5 were sporadic cases. 2 Outbreaks occurred. One of three cases and one of two cases. • In one outbreak the agent identified was the staphylococcus (Coagulase positive). 42 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 1953. 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 245 — 10 40 101 22 4 2 — 14 — Diphtheria — — — — — — — — — — — Puerperal Pyrexia 6 — — — — — 1 5 — 5 — Ophthalmia Neonatorum — — — — — — — — — — — Acute Paralytic Poliomyelitis 8 — 1 1 — 1 1 4 — 6 — Acute Non-Paralytic Poliomyelitis — — — — — — — — — — — Pneumonia 42 3 4 — 3 ] 3 28 — 13 1 Erysipelas 15 — — — — — — 15 — 1 — Pood Poisoning 10 — — — 2 — 2 6 — 1 — Dysentery 1 — — — — — — — — — — Typhoid Fever — — — — — — — — — — — Para-Typhoid Fever 1 — 1 — — — — — — — — Meningococcal Infection 2 — — 1 1 — — — — 2 — Measles 459 9 89 121 215 13 7 5 — 4 — Whooping Cough 345 15 (58 91 162 3 — 6 — 2 — Scabies 4 — — — 2 — 1 1 — — — Malaria 2 — — — — — 2 — — 1 — Totals 1140 27 173 260 540 40 21 73 — 49 1 TUBERCULOSIS. During the year 91 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1953 are contained in the following table:— Age Period New Cases Deaths Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. 0—1 — — — — — — — — 1— 5 2 — 1 — — — — — 5—10 1 3 — — — — — — 10—15 2 1 — 1 — — — — 15—20 8 3 1 1 — — — — 20—25 7 3 — — — — — — 25—35 11 7 1 — — 1 1 — 35—45 9 2 — 1 — — 1 — 45—55 12 5 1 — 2 — — — 55—65 4 — — — 1 1 — — 65 and upwards 2 2 — — 1 1 — — Totals 58 26 4 3 4 3 2 — Of the 9 deaths shown in the table the number of non-notified Tuberculosis deaths was 3. Pulmonary. Non-Pulmonary. Total. M F M F No. on Register at commencement of year 469 325 36 43 873 No. on Register at end of year 499 333 40 43 915 Rehousing. 10 cases were referred to me by the Chest Physician for rehousing and during the year three cases were rehoused by the Housing Committee. 44 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1953 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health EXCEPTED DISTRICT OF BEXLEY WELFARE AND SCHOOL ATTENDANCE SUB-COMMITTEE Chairman- Councillor T. M. Gauge. Vice-Chairman: Miss M. Woodward, L.L.A. Alderman A. S. Masey Alderman H. P. Tanner. Councillor J. Cronin Councillor F. W. Archer Councillor Mrs. A. Welch Councillor Mrs. H. F. Piggott Councillor Mrs. E. M. Sheppard 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). Stella M. Ring, M.B., B.S., M.R.C.S., L.R.C.P. D.C.H. (Part-time) Sybil R. Yeates, M.B., B.S., M.R.C.S., L.R.C.P 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.D.S. Elizabeth Francis, B.D.S., L.D.S. (Part-time). Mrs. A. M. Readett, L.D.S. (Part-time) from 1.12.53. Orthodontist Gerald Holgate Roberts, L.D.S., B.Ch.D., D.D.S. (Resigned 31.10.53). Neil K. Thorn, L.D.S., R.C.S., London. (Appointed Nov. 1953). 46 Health Visitors Miss K. P. Hart, S.R.N., S.C.M., and Health Visitor's Certificate. Mrs. A. E. Matthews, S.R.N. (Temporary). 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. Miss K. M. Dunkley. Mrs. Sproule. Miss Soley — Hygienist. School Health Service Clerk Miss M. C. A. Smith. General Clerks Miss C. E. Anderson. Miss O. G. Turnbull. Miss A. C. Jopling. 47 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1953. 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 1953. The amount of dental inspection in schools during the year showed an increase over that of 1952 but it is not yet possible to say that the dental services are as systematic as we would all like them to be. The fluctuation of the staffing position and the task of treating dental caries referred by schools, medical officers and parents, together with emergency cases, has caused difficulty in the past but routine dental inspections are increasing and there are signs that we may look forward to a return to the pre-war system of routine inspection followed by treatment. The Murchison Avenue clinic is, at present, being enlarged to provide an additional dental unit and a speech therapy unit and in both these fields it is hoped that a full time officer will be appointed in addition to the staff already provided. It is, also, a fact that many parents are taking their children to private dentists for treatment under the National Health Service Act, 1946, as they are of course entitled to do, but the figures quoted at the end of this report do not include such cases. It has, unfortunately, been found necessary, by the Local Health Authority, to close the Sunlight Clinic at 315, Broadway, Bexleyheath. This was done only after every aspect of the efficacy of this form of treatment had been considered. The beneficial action of sunlight, whether natural or artificial, is to produce vitamin D in the skin and, with the high level of child health and nutrition in the Borough at the present time, and the almost total absence of rickets, it is difficult to jusify the continuation of a clinic the purpose of which might well be to produce a psychological effect rather than a truly clinical benefit; that is, to deal with a deficiency disease resulting from the absence of an essential vitamin. At the time of writing, an audiometric survey of all school children in the 10 year old group has been completed. Although a general analysis of our results has yet 48 to be made, it is already evident that this survey has been well worth while and it is our intention to deal with other age groups as soon as possible. An interesting development in the orthopaedic clinic has recently taken place in the Borough. In the past, the orthopaedic clinic has not had an adequate liaison with the physical training activities in the schools, although the recommendations of the Orthopaedic Surgeon have been, in all cases, sent on to the schools for implementation, as far as possible. It has now been arranged for the Physiotherapist at the orthopaedic clinic to visit the schools and to discuss with the Headteachers and Physical Training Instructors the type of remedial work required in the case of particular children who had been seen at the orthopaedic clinic. This is vitally important but, as in so many fields of work, the number of specialist staff is inadequate for the fullest co-operation between school and clinic. This matter is being pursued so that children found to suffer from postural defects of various kinds may have the fullest benefit not only of treatment at the clinics but, also, of follow-up treatment at the schools. It has long been felt that there should be in the Borough of Bexley a day school for Physically Handicapped Pupils and, as is well known, such children are at present being sent to day schools operated by the London County Council. Several premises have recently been inspected for possible adaptation to such a purpose but, so far, no suitable place has been found. The adaptation of such buildings is difficult and their maintenance extremely costly. It is to be hoped that, in the not too distant future, the building of such a special school may be undertaken in the locality by the Kent Education Committee. One must refer, also, in this connection, to the activities of the National Spastics Society to provide clinics for Spastic children and there has been much local activity in this respect among townspeople who are interested in this project. It is essential that any scheme for the provision, by the Kent Education Committee, of a Physically Handicapped School should take into account the special needs of this relatively small, but hitherto neglected, class of handicapped child. Some of these children are admitted to the Valence Residential Special School and home tuition continues to provide further help for them. Certainly, their needs are being more and more recognised by the authorities. Child Guidance work in the Bexley area suffered a severe set-back by the untimely death, early in 1954, of 49 Dr. Eric Wellisch, the Director of the Crayford Child Guidance Clinic. Dr. Wellisch had a profound interest in the emotional needs of the schoolchild and many parents have reason to be grateful to him for his help in the past. Dr. D. M. Zausmer has been appointed to fill the vacancy. It will be seen that the work of the School Health Service, although based generally on well tried principles, is in no way static and it is always the intention of those engaged in the provision and operation of this service, and in particular the Welfare and School Attendance Sub-Committee, to extend and improve the facilities which are provided. It must be remembered that the true basis of the School Health Service is the periodic medical inspection, the consultative clinic (linked up as it is with the general practitioner service) and the close link that exists between headteachers, parents, school medical officers and the health visitors. Recognition should also be made of the work of the School Enquiry Officers whose reports on families and individual children are often the basis for medical action of benefit to the child. 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 which I have received during the year from the Chairman and Members of the Committee, from Miss Smith, the Senior Clerk, from the County Medical Officer and his staff and the Borough Education Officer. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, John Landon, Medical Officer of Health. 50 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Bexley County Technical School for Girls. Average number on Roll at 31st December, 1953. Bexley 755 Wilmington Annex 211 Six County Secondary Schools. Average number on Roll 2,616 Twenty-one County Primary Schools. Average number on Roll 6,684 Voluntary Schools. Two Primary Schools. Average number on Roll 324 Voluntary Aided Schools. One Secondary School. Average number on Roll 340 Two Primary Schools. Average number on Roll 815 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. 51 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. Each morning 9.30-11 a.m. Each afternoon, except Saturday, 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. 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, 2-4 p.m. Saturday, 9.30-11 a.m. Specialist in attendance 1st and 3rd Wednesday at 10 a.m. Bexley—Murchison Avenue. Monday, 2-5 p.m. Thursday, 9.30-11 a.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. 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 School Meals—1953. Average number of pupils in attendance:— Primary Schools 7,323 Secondary Schools 3,675 10,998 Average number of pupils taking meals daily:— Primary Secondary Free 87 109 Payment 3,356 2,309 Total 3,443 2.418 53 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 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 preventive aspect of School Health Work. Milk. Average number of pupils taking milk daily:— Primary 6,947 Secondary 2,399 Total 9,346 Orthopaedic Clinic. I am indebted to Mr. K. F. Hulbert, F.R.C.S., lor the following report on the Orthopaedic Clinic:— Treatment and classes for exercises have been carried on as far as the very limited accommodation will allow. During the past year an attempt has been made to keep contact with the Orthopaedic Department and the Physical Training Instructors in the schools, and the physiotherapist in charge, Miss Cheeseman, is now visiting certain of these schools in order to see what kind of exercises are being done and to give the necessary advice. It is hoped that this scheme will continue and be developed so that a more pragmatic approach to physical education in the schools may be adopted. Dental Treatment. I am indebted to Mrs. Readett, L.D.S., Dental Surgeon, for the following report: — I find that the dental work for Bexley is well in hand. Since starting here I have examined the children at St. Mary's School, Bridgen School, and the Bexley Technical School. The majority of the children at the Technical School receive private treatment but on the whole the response from the schools has been good. The orthodontic list was quite large when I started, but it is gradually being reduced. I should like to comment on the co-operation I have received from the X-ray Department of the West Hill Hospital, Dartford. The patients referred there are seen quickly and the X-rays reach the clinic within a day or two. . Several children have been referred to the Eastman Dental Clinic, Grays Inn Road, for special treatment. These children have been seen straight away and their treatment started promptly. I find there is good co-operation in this area between the parents, schools and the clinic and the parents are particularly appreciative of the dental service. 54 Orthodontic Treatment as at 31st December, 1953. No. under treatment 239 No. waiting for treatment 80 No. who have completed treatment 28 Ophthalmic Clinic. I am indebted to Mr. R. M. Chambers, M.B., B.S., D.O.M.S., for the following report: — The work of the clinic continued at a satisfactory level during 1953, at the rate of five sessions per week. The total number of attendances has not altered significantly. I feel it is a pity that under school age children should be debarred from the clinic for the investigation of squint. Often they are part of a large family, older members of which are already coming here. The harassed mother has to make separate journeys for broadly speaking the same complaint and would welcome treatment for all the family under the same roof at the same time. I make a point of enquiring about younger members of the family, and where possible " family parties " are invited. This makes for a better assessment of prognosis, a less reserved response from the youngest and a somewhat noisy session. The number of infective conditions remains low, but of course this is no index of the total number since the majority are treated by their own doctors. The provision of a Livingstone Binocular Gauge has enabled convergence and accommodational anomalies to be followed more closely. There are a number of cases needing orthoptic treatment which as yet is only available at some distance from this area. As I stressed in an earlier report I feel that this is a very real need. I intend to investigate the problem of word-blindness which may be responsible for much backwardness among school children and hope to make a report next year. An analysis of non-refractive cases is as follows: — Infective. Conjunctivitis, acute 8 Conjunctivitis. Chronic 10 Blepharitis 9 Styes 11 Dacryocystitis, acute 2 Meibomian cyst 8 Meibomian abscess 2 Keratitis, punctate 3 55 Congenital. Ptosis 6 Nystagmus 7 Ocular Palsy 3 Optic Nerve Coloboma 1 Colour defect 36 Red Blind 7 Green blind 11 Partial Red-Green 17 Complete 1 Acquired. Migraine 19 Ocular Torticollis 4 Corneal scarring 5 Retinal oedema 1 Cataract 1 I would like to record my appreciation of the help which Miss Golding gave so freely during her two years attendance at this clinic. Speech Therapy. I am indebted to Miss Joan Pollitt, Chief Speech Therapist to the Kent Education Committee for the following report: — It is hoped that it will not be too long before is is possible to open a full-time clinic in the Bexleyheath district, in addition to the part-time sessions already being given at Wrotham Road. It has been possible during the year to help the waiting list in Bexleyheath a little, by transferring some cases, living adjacent to the Crayford and Sidcup Clinics to those clinics. The Sidcup clinic opened during the Autumn of 1953. Closed Cases. Thirty-five Bexleyheath cases have been closed during the year. The following is an analysis of the reason for closing these cases: — Very satisfactory result. Wrotham Road Clinic 13 Crayford Clinic 2 Some considerable improvement but no further progress made for so long a period that, with consent of all concerned, case was closed. Wrotham Road Clinic 1 Improved to the extent to which nature of condition was likely to allow; patient then left district. Wrotham Road Clinic 1 56 Appointments discontinued prior to completion of treatment. In one case he mother was satisfied with progress and saw no reason to continue further. Wrotham Road Clinic 2 Found to have improved when seen at clinic. Wrotham Road Clinic 1 Sidcup Clinic 5 Reported to have improved prior to, or when appointment was offered. Wrotham Road Clinic 2 Sidcup Cninic 4 Following investigatory interviews, further appointments not kept. Wroham Road Clinic 1 Sidcup Clinic 1 Appointments offered but no appointments kept. Sidcup Clinic 1 Left school prior to appointments being offered. Sidcup Clinic 1 35 Open Cases. Twenty-seven cases who were attending at the clinics during 1953, will continue attendance into 1954. Of these, seventeen are attending at Wrotham Road, six at Sidcup and four at Crayford. Waiting Lists. Bexleyheath cases on the waiting lists at the three clinics on 1st January, 1954, were as follows: — Wrotham Road Clinic 96 Crayford Clinic 2 Sidcup 3 111 Mrs. Rant has continued to train a student in clinical practice at the Wrotham Road Clinic. This student is working for her Speech Therapy Licentiate-ship at the Kingdon Ward Speech Therapy Training School. 57 Cleanliness Inspections. (See Table III). During the year the School Nurses carried out 9,466 examinations of children in School and 45 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 review of Physical Education for the years 1951 and 1952 made special mention of the general acceptance of child-centred work, individual rates of progress and informal methods of teaching. These features, which are found to promote most effectively the physical development, self assurance and self discipline of the child, have been emphasised in the recent editions of Physical Education in the Primary School, Parts 1 and 11, published by the Ministry of Education. The practical guidance offered to teachers in Part 11 " Planning the Programmehas provided a welcome stimulus to physical activities in the Primary Schools and has continued the opportunity and increased the scope of the work in the daily lesson. The strong work now so evident at the Primary level is desirable and should be continued in the Secondary Schools. It is hoped to establish during the coming year a closer link between the work of the upper Primary and the lower Secondary School classes. The development of Modem Dance in the Girls' Secondary Schools has continued as it is felt that this type of work can provide an effective groundwork for movement in most branches of physical education for girls. In the Boys' Secondary Schools, the demand for more objective training techniques has again involved a prominence to games practices and sports and the developmental value of indoor gymnastic work has received due recognition. The support of parents in the provisions of Physical Education clothing and footwear has, on the whole, been praiseworthy. Some need remains, however, to reiterate that the vigorous nature of indoor and outdoor physical activities demands special clothing for the sake of the child's hygiene, freedom of movement and safety. It is hoped that during the coming year more adequate provision will be possible to alleviate this difficulty. 58 THE SCHOOL HEALTH SERVICE AND HANDICAPPED PUPILS REGULATIONS, 1953. CIRCULAR 269, MINISTRY OF EDUCATION DATED 25.8.53. The Minister has made new Regulations, called the School Health Service and Handicapped Pupils Regulations, 1953 (S.I. 1953 No. 1,156) to take the place of the Handicapped Pupils and School Health Service Regulations 1945. They took effect from the 4th August, 1953. The Regulations incorporate changes which have been found to be desirable as a result of eight years experience of the working of the previous Regulations and of the Education Act, 1944 Title of School Medical and Dental Officers. Under Regulation 5, the medical officer in charge of the School Health Service will be known in future as the Principal School Medical Officer. It is suggested that medical officers on his staff should now be called School Medical Officers instead of Assistant School Medical Officers. A change has also been made, in Regulation 6, in the title of the dental officer responsible to the Principal School Medical Officer for the conduct of the Authority's School Dental Service. This officer will in future be called the Principal School Dental Officer instead of the Senior Dental Officer as previously. 59 Swimming. During 1953 schools again took advantage of the facilities available for school swimming. Attendances at the baths at Plumstead, Eltham and Danson Park were: — Schools. Attendances. No. of Children. Secondary 30 classes of 25-30 children each week approx. 900 per week. Primary 31 classes of 30-35 children each week approx. 1,000 per week. Total 1,900 per week. Medical and Dental Inspection. Regulation 10 introduces certain changes in the requirements regarding medical and dental inspections. Under the 1945 Regulations three general medical inspections were prescribed during a pupil's attendance at school, at specified periods in his school career. Under the new Regulations a minimum of three is prescribed during the perioa of school life, but it is left to the Authority's discretion when to arrange these and also whether to arrange for additional general inspections. Many Authorities limiting the number of general inspections to three will no doubt decide to conduct two of them during the first and last years of compulsory school attendance, and to carry out the intermediate inspection either during the last year in the primary school or during the first year in the secondary school. An arrangement of this kind has much to recommend it; in particular it is useful for record purposes for the three main inspections to cover complete age groups. Where this is done, however, it will also be desirable to inspect young children under five as soon as possible after they begin school, in addition to inspecting them with the five year age group, and to inspect during their last year at school pupils who stay at school beyond fifteen. Authorities will notice that in Regulation 10(l)(a) the Minister may approve arrangements which do not provide for as many as three general inspections during the period of compulsory school age. This provision has been included to enable Authorities who wish to do so to experiment with other arrangements not based on periodical medical inspections. Where it is possible, for instance, for the school doctor to visit the schools regularly (e.g., at least two or three times a term), it may be found preferable for him to see on each occasion such children as are brought to his attention bv parents, teachers, or the school nurse instead of seeing all the children of a particular age group at infrequent intervals, The Minister will be prepared to consider sympathetically any proposals which Authorities may wish to put forward. In deciding whether or not to approve them she will be guided by the extent to which they appear likely to make a positive contribution to the efficiency of the preventative work of the School Health Service. Regulation 10(l)(b) requires an Authority to conduct a dental inspection of every pupil as soon as possible after his admission to a maintained school and on " such later occasions as may be practicable and necessary The 60 ing of this Regulation has been purposely left somewhat indefinite owing to tne difficulty in recruiting sufficient school dentists. The Minister wishes to emphasise, however, that in her view, the objective should be to inspect the teeth of every pupil at least once a year—preferably more frequently—and to offer prompt treatment to such children as are found to need it. Under the 1945 Regulation the Minister issued a direction requiring Authorities to provide for the annual medical and dental inspection of all pupils at mantained special schools. This provision is changed in the new Regulations. The requirements regarding dental inspection of special school pupils are now the same as for pupils in ordinary schools; medical inspection of special school pupils is dealt with by requirements (in Regulation 10(l)(a) and (c)) that, in addition to the three inspections prescribed for all children, an Authority shall arrange for other inspections of any pupils on such occasions as may be necessary or desirable and that the attention paid to general health and welfare of any pupil who is suffering from a disability of mind or body shall include particular attention to his disability. In practice Authorities will find it necessary to examine many handicapped children more often than once a year, particularly those whose disability is subject to change either for the better or for the worse, or about the correctness of whose placement in their present school there is some doubt. The efficient conduct of the School Health Service depends above all on the close contact of doctors and nurses with the teachers and the children in the schools. They should be regular visitors and the teachers should be encouraged to bring forward to their notice both those children who show particular defects and those whose general condition seems to indicate the need for an expert medical examination. Approval of Medical Officers. Regulation 11 continues the existing requirement that Medical Officers shall be approved by the Minister if they are being employed for the ascertainment of pupils needing education in a special school as educationally sub-normal. The requirement has been slightly modified so as to make it unnecessary for an Authority to seek the Minister's approval in the case of a Medical Officer who has already been approved for similar employment by another Authority. 61 Special Educational Treatment. The following changes have been made in the definitions of the different categories of handicapped pupils. The definition of partially deaf pupils has been slightly amended with a view to clarification. There is no longer a separate category of diabetic pupils who are now included in the general category of delicate pupils. In the 1945 Regulations, epileptic and physically handicapped pupils were so defined as to imply that they could not be educated in an ordinary school. Many children who are in fact epileptic or physically handicapped can be educated in ordinary schools if special arrangements are made or facilities provided to enable them to overcome their particular difficulties. Such arrangements or facilities constitute a departure from the normal regime of ordinary schools, and the effect of the amended definitions is to bring within their scope all physically handicapped and epileptic children who are able, with some degree of special help, to attend ordinary school. The definition of pupils suffering from speech defects has been slightly simplified The definition of delicate pupils has been changed so as to make this the residual category, covering all handicapped pupils who do not specifically come under the heading of one of the other handicaps. As indicated in (b) above, diabetic pupils now come within this category. The definition has also been slightly widened to take account of the fact that some delicate pupils can be educated under the normal regime of an ordinary school but may need a change of environment to make this possible (e.g., some asthmatics and diabetics). It is now no longer necessary to get a determination from the Minister before a physically handicapped, epileptic or aphasic pupil can be educated otherwise than in a special school, or before a blind or epileptic pupil can be educated otherwise than in a boarding school. 62 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. 63 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. — Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 1,231 Second Age Group 1,108 Third Age Group 893 Total 3,232 Number of other Periodic Inspections 2,017 Grand Total 5,249 B. — Other Inspections. Number of Special Inspections 1,953 Number of Re-Inspections 3,370 Total 5,323 C. — Pupils Found to Reauire 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 IIA Total Individual pupils (1) (2) (3) (4) Entrants 22 374 337 Second Age Group 116 475 468 Third Age Group 94 456 396 Total (prescribed groups) 232 1305 1201 Other Periodic Inspections 245 619 699 Grand Total 477 1924 1900 64 65 TABLE II. A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1953. Defect Code Defect or Disease No. PERIODIC INSPECTIONS SPECIAL INSPECTIONS No. of defects No. of defects Reqairing 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 272 153 138 16 5. Eyes— a. Vision 477 399 70 3 b. Squint 57 70 10 3 c. Other 94 63 51 5 6. Ears— a. Hearing 32 161 20 11 b. Otitis media 14 99 10 9 c. Other 121 63 15 7 7. Nose or Throat 203 675 133 67 8. Speech 19 43 18 6 9. Cervical Glands 17 286 5 15 10. Heart and Circulation 14 140 18 35 1. Lungs 23 421 84 110 2. Developmental— a. Hernia 10 24 2 – b. Other 55 198 4 2 .3. Orthopaedic— a. Posture 386 117 6 1 b. Flat Foot 471 172 13 1 c. Other 265 311 50 28 14. Nervous Systema. Epilepsy 7 17 4 6 b. Other 8 67 2 15 5. Psychological— a. Development 4 46 – 7 b. Stability 17 237 103 33 6. Other 2 4 245 350 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 9,260 (ii) Total number of pupils on roll of schools visited 4,998 (iii) Total number of individual pupils found to be infested 44 (iv) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 5 (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 206 (ii) Total number of pupils on roll of schools visited 227 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. % ol col. 2 No. % of col. 2 No. % of col. 2 (I) (2) (3) (4) (5) (6) (7) (8) Entrants 1231 481 39.0 689 55.9 61 4.9 Second Age Group 1108 458 41.3 615 55.5 35 3.1 Third Age Group 893 463 51.7 416 46.5 14 1.5 Other Periodic Inspections 2017 877 43.4 1049 52.0 91 4.5 Total 5249 2279 43.4 2769 52.7 201 3.8 66 (iii) Total number of individual pupils found to be infested 1 (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 84 — Scabies 5 — Impetigo 11 — Other skin diseases ... 213 — Total 313 Group II.—Eye Diseases, Defective Vision and Squint. No. of Cases dealt with by the External and other, excluding errors of refraction and squint Authority otherwise 172 — Errors of refraction (including squint 1,938 — Total 2,100 Number of pupils for whom spectacles were (a) Prescribed 527 (b) Obtained 448 67 Group V.—Other Treatment Given. Number of cases treated by the Authority otherwise (a) Miscellaneous minor ailments 1,025 — (b) Other 1. Minor Eye Defects 96 — 2. Minor Ear Defects 99 — 3. Minor Injuries 39 — Total 1,259 — 68 Group IV.—Orthopædic and Postural Defects. (a) Number treated as in-patients in hospitals 12 by the Authority otherwise (b) Number treated otherwise, e.g., in clinics or outpatients departments 288 19 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 — 87 (c) for other nose and throat conditions — 7 Received other forms of treatment — 37 Total — 133 69 TABLE V. Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 3,112 (b) Specials 1,642 Total (1) 4,754 (2) Number found to require treatment 3,100 (3) Number referred for treatment 3,100 (4) Number actually treated 1,916* (5) Attendances made by pupils for treatment 5,896* (6) Half-days devoted to: Inspection 19 Treatment 779 Total (6) 798 (7) Fillings: Permanent Teeth 1,116 Temporary Teeth 283 Total (7) 1,399 (8) Number of teeth filled: Permanent Teeth 1,071 Temporary Teeth 272 Total (8) 1,343 (9) Extractions: Permanent Teeth 598 Temporary Teeth 3,004 Total (9) 3,602 (10) Administration of general anaesthetics for extraction 1,422 (ID Other operations: Permanent Teeth 715* Temporary Teeth 644 Total (11) 1,359 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 (8) Maladjusted (9) Epileptic Total (1) to (9) In the calendar year ended 31st December, 1953 ;•— A. Handicapped Pupils newly placed in Day Special Schools or Boarding Homes (1) (2) (3) (4) (5) (#) (7) (8) (9) iid) – – – – – 4 8 3 – 15 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes – 1 – – 27 5 5 1 2 41 On or about December 1st, 1953 :— C. Number of Handicapped Pupils from the area:— (i) attending Special Schools as (a) Day Pupils – 6 5 3 – 18 26 – – 58 (b) Boarding Pupils 2 — 4 — 28 7 5 2 2 40 (ii) Attending independent schools under arrangement made by the Authority – – 1 – – 1 – 3 – 5 (iii) Boarded in Homes and not already included under (i) or (ii) – — 26 — — — – Total (C) 2 6 10 3 28 31 5 2 103 D. Number of Handicapped Pupils being educated under arrangements made under Section 56 of the Education Act, 1944:— (i) In hospitals – – – – – 1 – – – 1 (ii) Elsewhere (Home tuition) — — — — 3 3 — – — 6 E. Number of Handicapped Pupils from the area requiring places in Day Special Schools (Including any such children:— – – – – 4 2 2 2 1 11 (i) who are temporarily receiving home tuition — — — (ii) whose parents have not yet consented to their attending a Special School) — — — — 1 — — — — 1 Number of children reported during the year :— (a) tinder Section 57(3) (excluding any returned under (b) ) 3 (b) „ „ ,, relying on Section 57(4) — (c) ,. „ 57(5) of the Education Act, 1944. 3 70 INDEX. ITEM PAGE Health Committee 2 Public Health Staff 3 Foreword 4— 7 STATISTICS AND SOCIAL CONDITIONS. Acreage 8 Population 8 New Houses Erected 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 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 PROVISIONS 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 Tables—Factories Act, 1937 27 Closet Accommodation 28 Public Cleansing Service 28 Refuse Collection and Disposal 28 Salvage 28—29 Public Conveniences 29 Atmospheric Pollution 30 Prevention of Damage by Pests Act, 1949 30—31 Pet Animals Act, 1951 31 Shops Act, 1950 31 Swimming Pool 32 Verminous Premises 32 Wasp Destruction 32 Schools 33 Tents, Vans and Sheds 33 71 ITEM PAGE HOUSING. Council Estates 34 Inspection of Dwelling Houses 35 Remedy of Defects without formal notice 35 Action under Statutory Powers 35—36 Clearance Schemes 36 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 37 Meat Inspection 37 Adulteration of Food -Food & Drugs Act, 1938 37—38 Food Shops and Food Manufacturing Premises 39 Registration of Premises 39 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 40 Diphtheria 40 Diphtheria Immunisation and Smallpox Vaccination 41 Para Typhoid 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, 1953. Welfare and School Attendance Sub-Committee 46 Staff 46—47 Foreword 48—50 Schools 51 Clinics 51—52 Co-ordination Periodic Medical Inspections 53 School Meals and Milk 53—54 Orthopaedic Clinic 54 Dental Treatment 54—55 Ophthalmic Clinic 55—56 Speech Therapy 56—57 Cleanliness Inspections 58 Physical Education 58 Swimming 59 The School Health Service and Handicapped Pupils Regulations, 1953 59—62 Statistical Tables 63—70 72