PRO Region 12 BEX 19 AC4412(1) BEXLEY BOROUGH OF BELEY Annual Report of the Medical Officer of Health and Report on the School Health Services For the Year 1954 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 1954 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health Borough of Bexley. Mayor: Councillor John Mason, B.A. (Cantab.), J P. Deputy Mayor: Councillor J. W. Bateman. HEALTH COMMITTEE. Chairman: Alderman Mrs. H. F. Piggott. Vice-Chairman: Councillor J. W. Bateman. Alderman M. J. Corr. Alderman J. C. McLean, J.P. Alderman P. R. Relph. Councillor F. W. Archer Councillor A. S. Mildwater. Councillor E. S. Newton. Councillor W. P. Webster. 2 PUBLIC HEALTH STAFF, 1954. Medical Officer of Health John Landon, M.R.C.S., L.R.C.P.. D.P.H. (Joint appointment with Borough of Erith and U.D. Crayford). Chief Sanitary Inspector, Public Cleansing Officer and Shops Acts Inspector. Deputy Chief Sanitary Inspector District Sanitary Inspectors Chief Clerk Senior Clerk Clerks Public Analyst Refuse Foreman *† G. Hind, M.S.I.A. *†J. T. Boocock. *† F. W. Willington. *† G. F. Lovegrove. *†W. E. Moses. G. A. Pearson. R. V. Hoad. E. M. Pearmine (Miss). M. E. Smith (Miss) (Shorthand Typist). J. M. Moon (Mrs.) (Temporary Shorthand Typist, 12.4.5426.6.54). H. E. Monk, B.Sc., F.R.I.C. 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 1954. The assessment of the health of the Borough is based on a judicious mixture of knowledge and opinion. The former is represented by the vital statistics relating to births, deaths and infectious disease which are compiled in the Health Department and are collated by the General Register Office to allow for comparison with the country as a whole; the latter is based on personal observation and on information reaching the Department from doctors, sanitary inspectors, health visitors, voluntary organisations and the Press. In a highly developed modern community enjoying the benefits of over a 100 years of Public Health one can no longer be content to regard health as the mere absence of infectious or other recognisable disease although this was the case during the many decades when the amelioration of the external environment was the main preoccupation of the Health Services. This is not to suggest that all the environmental hazards have been removed and, indeed, this is far from being the case. It is true that we now have a pure water supply which has almost totally eliminated the diarrhoeal diseases but we are still confronted with the perils of atmospheric pollution, of the chemical sophistication of much of our food and of a host of less obvious but equally insidious causes of loss of health, happiness and efficiency including those resulting from industrial mechanisation and sociological changes affecting work, recreation and personal objectives. In other words, the state of a modern civilised community must be judged far more from the viewpoint of its mental health than was considered necessary, or even possible, in earlier days. We have no statistics to measure the mental health of the people nor the amount of sub-normal health in general resulting in a departure from that functional " wholeness " which is the essence of health and, while it is true that such philosophical speculations may lead one into fields far removed from the conventional activities of the older public health, they are, nevertheless, an important part of the newer social 4 medicine. It is necessary to point this out before proceeding to examine some of the statistical pointers to the health of the Borough. The birth rate for 1954 was 11.8 per thousand of the population compared with 12.7 per 1,000 in 1953 and represents the lowest birth rate ever recorded in the Borough. Thus the downward trend of the past four years has continued The standardised birth rate, which allows for comparison with other parts of the country, is 12.2, but the rate is well below that for England and Wales which was 15.2. It looks as if we may have to regard a low birth rate as a permanent feature of our modern society. When this is coupled with a low death rate and a greater expectation of life, the result can only be an ageing population with the many social and industrial problems which that must bring. The death rate for the Borough fell still further to 8.1 per thousand of the estimated home population compared with 8.8 in 1953 and a rate of 11.3 per 1,000 for England and Wales. The two main causes of death, as in recent years, were diseases of the heart and blood vessels and cancer, the latter including 32 deaths from cancer of the lung. The prevention of cancer is one of the great public health tasks of the future and may well be, in part, wrapped up with a Clean Air policy as fore-shadowed by the Beaver Report. Since we are mortal and must die of something the best we can hope for is that life should come quietly and peacefully to an end without the intervention of any preventable catastrophe in which category at least some forms of cancer probably fall. The infant mortality rate for 1954, that is the number of children dying in the first year of life for every 1,000 live births, was 22.1 per 1,000 against 14.36 per 1,000 in 1953. This is the highest rate since 1951 when the rate was 24.76. Of the 23 deaths which were responsible for this rate, no less than 13 were due to congenital malformation and premature birth, conditions of which too little is still known for any form of prevention to be applied. The rate for England and Wales for 1954 was 25.5 In 1952 the low figure of 11.34 was recorded in the Borough, but there is no need for undue concern in that the overall trend of infant mortality is favourable and there are bound to be annual variations which are to a large extent fortuitous. Although there were 1,056 total births during the year there were no maternal deaths. This is a fine record and 5 speaks well for the obstetrical services in the area and for the standard of ante-natal care available for the expectant mother. The incidence of infectious disease was again low. Once again no case of diphtheria occurred but it is still very necessary that mothers should not fail to have their children immunised as only thus can a continued freedom from this disease be ensured. Only two paralytic cases of poliomyelitis occured in the Borough compared with eight in the previous year. The number of cases of tuberculosis during 1954 was 89 compared with 91 during 1953. The number of deaths, however, was only 5 as against 9 in 1953. A comparison of notifications and deaths over the past 10 years is in keeping with the national tendency for deaths from this disease to decrease at a greater rate than notifications. In other words, the curative services are tending to outstrip the preventive services and very much more needs to be done to track down the infectious cases within the community and to lessen the chances of infection of susceptible persons. During the year a survey was commenced in accordance with Section 1 of the Housing Repairs and Rents Act, 1954, to ascertain how many houses would require to be demolished within the next five years, and it was found that the number of obviously unfit houses was relatively small as was to be expected in an area in which so much housing development took place between the two wars. The demolition of these houses will not, necessarily, be followed by 100% replacement on the site as some of these may be considered unsuitable for new development. The rehousing of these tenants may, therefore, be a matter of some difficulty but it is hoped that the rate of demolition will be such as to allow for the assimilation of such families into the Council's rehousing programme in general. The Clean Food Campaign continued to make real, if not spectacular progress, and at the time of writing 156 plaques have been awarded by the Bexley, Erith and Crayford Clean Food Traders' Guild. Far more could, no doubt, be achieved if the necessary staff were available, and indeed this applies to Health Education in general. A good case could be made for the appointment of a Health Education Officer to serve the Borough or such wider area as appeared to be indicated. 6 The work of the Bexley, Erith and Crayford Home Safety Committee is gaining momentum and will undoubtedly increase the scope if its activities in the near future. Our thanks are due to the Woolwich and Dartford Hospital Management Committees for providing statistics of home accidents treated at hosptial over the past year. These undoubtedly emphasise the need for the instruction of the public in the causes of these accidents and the methods by which they may be prevented. The Old Peoples' Welfare Committee, now on a voluntary basis but sponsored originally by the Bexley Borough Council, has done excellent work in alleviating the lot of many old people by friendly help, by assistance in kind when necessary, by making arrangements for inexpensive holidays and in other ways. Their work to some extent co-ordinates and is complementary to that of the many old peoples' organisations in the Borough providing clubs and other recreational facilities. The work of these voluntary organisations is invaluable to the old people in the Borough. In October, 1954, the Report of the Kent Paediatric Society " A Study in the Epidemiology of Health " was published from the Health department, with the aid of a grant from the Eugenics Society, after five years work. The report was based on an investigation into the incidence and causation of health among 10—11 year old children in the Borough of Bexley and has been widely reviewed by the medical press in this and other countries. In conclusion, I wish to thank the Chairman and Members of the Health Committee for their support and encouragement and the Chief Sanitary Inspector, Chief Clerk and all members of the Health Department for their devoted service 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, 88,180. Houses 503 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1944 Nil 1935 59,970 1945 2 1940 77,670 1946 82+ 64 rebuilt 1945 75,040 1947 199 +216 rebuilt 1950 89,410 1948 334+ 286 rebuilt 1951 (Census) 88,420 1949 138+ 73 rebuilt 1952 88,160 1950 102+ 15 rebuilt 1953 87,990 1951 319 1952 355 1953 265 Number of inhabited houses at end of 1954 (according to Rate Books) approximately 27,096 Rateable Value £685,457 Sum represented by a penny rate £2,800 Unemployment. Men Women Boys Girls Total December 31st, 1953 248 115 35 12 410 December 31st, 1954 167 118 19 13 317 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 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 187.84„ 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 514.54 „ 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 10 SUMMARY OF VITAL STATISTICS England and Wales. Borough of Bexley. Rates per 1,000 Home Population. Births- Live 15.2 11.8 Still 0.36 0.16 23.4(a) 13.26(a) Deaths— All Causes 11.3 8.1 Typhoid and Paratyphoid 0.00 — Whooping Cough 0.00 0.01 Diphtheria 0.00 — Tuberculosis 0.18 0.06 Influenza 0.05 0.02 Smallpox — — Acute Poliomyelitis (including Polioencephalitis 0.00 Pneumonia 0.48 0.32 Notifications (corrected) Typhoid Fever 0.00 — Para Typhoid Fever 0.01 — Meningococcal Infection 0.03 — Scarlet Fever 0.97 1.39 Whooping Cough 2.39 2.61 Diphtheria 0.00 — Erysipelas 0.12 0.25 Smallpox — — Measles 3.32 0.51 Pneumonia 0.60 0.36 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.03 0.02 Non-Paralytic 0.01 0.01 Food Poisoning 0.20 0.09 Puerperal Pyrexia 17.74(a) 8.52(a) Rates per 1,000 Live Births. Deaths All causes under one year of age 25.5(b) 22.1 Enteritis and Diarrhœa under two years of age 0.8 0.96 (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 England and Wales Borough of Bexley Bates per 1,000 total live and still births Maternal causes, excluding abortion 0.58 Nil Due to abortion 0.11 Nil Total maternal mortality 0.69 Nil EXTRACTS FROM VITAL STATISTICS FOR THE Year 1954. The Registrar General's Estimate of home population for the mid-year is 88,180 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births- —Total 555 487 1,042 Legimate 453 464 1,007 lllegimate 12 23 35 Birth Rate. Rate per 1,000 estimated home population 11.8 The following relates to the Birth Rate during the past ten years: — 1944 Birth Rate 21.06 per thousand 1945 „ „ 18.81 „ „ 1946 „ „ 19.75 „ „ 1947 „ „ 18.72 „ „ 1948 „ „ 15.36 „ „ 1949 „ „ 14.02 „ „ 1950 „ „ 13.13 „ „ 1951 „ „ 12.79 „ „ 1952 „ „ 12.00 „ „ 1953 „ „ 12.70 „ „ 12 Rate per 1.000 for England and Wales 1954 15.2 35 illegimate live births were registered against 34 in 1953. The Registrar-General has supplied a comparability factor for 1954. The standardised birth rate which allows for comparison with other parts of the country is 12.2. Stillbirths. Males Females Total Total 7 7 14 Rate per 1,000 total (live and still) births 13.26 The following relates to the Stillbirth Rate during the past ten years: — Year Rate per Thousand Total Live and Still Births Population 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 1953 12.94 0.28 Rate per 1,000 for England and Wales, 1954 0.36 14 Stillbirths were registered during the year. This represents a rate of 0.16 per 1,000 population against 0 28 per 1,000 population in 1953. There were no stillbirths registered as illegitimate. 13 Deaths. Males Females Total All causes 392 324 716 Death rate per 1,000 of estimated home population 8.1 Number of women dying in, or in consequence of, childbirth: From Puerperal and Post Abortive Sepsis — — From other Puerperal Causes — — Death rate per 1,000 total (live and still) births — Deaths of Infants under one year of age 16 7 23 Legitimate 16 7 23 Illegitimate — — — Death rate of Infants under one year of age: Total per 1,000 live births 22.1 Legitimate per 1000 legitimate live births 22.8 Illegitimate per 1,000 illegitimate live births Nil. Deaths from Measles (all ages) — — — Whooping Cough (all ages) 1 — 1 „ Diarrhoea (under 2 years of age) 1 — 1 Cancer (all ages) 89 69 158 Rate per 1,000 for England and Wales, , 1954 11.3 14 Death Rate of Area during last ten years: — 1944 10.20 per thousand. 1945 9.28 „ „ 1946 8.55 „ „ 1947 9.17 „ „ 1948 7.53 „ „ 1949 8.15 „ „ 1950 8.56 „ „ 1951 9.6 „ „ 1952 9.14 „ „ 1953 8.8 „ „ The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1954. The standardised death rate which allows for comparison with other parts of the country is 9.2. 15 CAUSES OF DEATH IN THE BOROUGH. REGISTERED DURING THE YEAR 1954. es of Death. M. F. Total All Causes 392 324 716 1 Tuberculosis, respiratory 2 2 4 2 Tuberculosis, other 1 — 1 3 Syphilitic disease 2 — 2 4 Diphtheria — — — 5 Whooping Cough 1 — 1 6 Meningococcal infections — — — 7 Acute poliomyelitis — — — 8 Measles — — — 9 Other infective and parasitic diseases 1 1 2 10 Malignant neoplasm, stomach 17 10 27 11 Malignant neoplasm, lung, bronchus 25 7 32 12 Malignant neoplasm, breast — 13 13 13 Malignant neoplasm, uterus — 6 6 * 14 Other malignant and lymphatic neoplasms 47 33 80 15 Leukaemia, aleukaemia 2 8 10 16 Diabetes 1 4 5 17 Vascular lesions of nervous system 36 56 92 18 Coronary disease, angina 83 30 113 19 Hypertension with heart disease 10 16 26 20 Other heart disease 31 48 79 21 Other circulatory disease 21 22 43 22 Influenza — 2 2 23 Pneumonia 16 12 28 24 Bronchitis 22 8 30 25 Other diseases of the respiratory system 4 4 8 26 Ulcer of stomach and duodenum 8 1 9 27 Gastritis enteritis and diarrhœa 6 5 11 28 Nephritis and nephrosis 6 3 9 29 Hyperplasia of prostate 5 — 5 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 3 2 5 32 Other defined and ill-defined diseases 26 25 51 33 Motor vehicle accidents 5 1 6 34 All other accidents 1 3 4 35 Suicide 9 1 10 36 Homicide and operations of war 1 1 2 16 17 INFANT MORTALITY, 1954 DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1954 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0— 1— 2— 3— 4— 5— 6— 7— 14— 21— 28- 2 3— 4— 5— 6— 7— 8— 9— 10— 11— 12 Congenital Malformation, Premature Birth 7 1 1 1 1 1 1 Convulsions, Gastroenteritis 1 Atelectasis 1 2 1 Broncho Pneumonia 2 1 1 B. Coli Meningitis, Lumbar Meningo Myocele 1 Totals 8 3 2 — 1 1 — 1 3 — — 2 1 — — — — 1 — — — — The number of infants under one year of age who died during the year 1954 as shown by the table is 23. 19 of these deaths, that is 82.6 per cent., occurred in the neonatal period (within one month of birth). In 1953 the corresponding figure was 37.5 per cent. 23 were registered during the year giving an infantile mortality rate per 1,000 live births of 22.1. Rates over previous years have been:— 1944 31.37 per 1,000 live births 1945 33.9 „ „ „ „ 1946 29.5 „ „ „ „ 1947 28.6 „ „ „ „ 1948 19.03 „ „ „ „ 1949 24.0 „ „ „ „ 1950 14.48 „ „ „ „ 1951 24.76 „ „ „ „ 1952 11.34 „ „ „ „ 1953 14.36 „ „ „ „ Maternal Deaths. There were no maternal deaths during the year. Rates over previous years have been:— 1944 1.30 per 1,000 live and stillbirths 1945 Nil „ „ „ „ „ 1946 1.73 „ „ „ „ „ 1947 1.19 „ „ „ „ „ 1948 Nil „ „ „ „ „ 1949 0.78 „ „ „ „ „ 1950 0.84 „ „ „ „ „ 1951 Nil „ „ „ „ „ 1952 0.93 „ „ „ „ „ 1953 2.63 „ „ „ „ „ 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. Two 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 122 occasions and 114 post-mortem examinations were made. 22 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 1 No. of patients provided for:— Maternity — Others 20 Total 20 No. of Homes on the Register at end of year 5 No. of patients provided for:— Maternity 5 Others . 78 Total 83 20 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. List of Adoptive Acts, etc., in force. Date Acts. Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 Public Libraries Act, 1892-1919 Oct. 1893 Private Street Works Act, 1892 Jan. 1899 Public Health Acts Amendment Act, 1907, Parts 8 and 9 Apr. 1909 Part 2—the whole „ 6—the whole May 1909 „ 10—Sec. 95 Public Health Act, 1925, Part 2 Jan. 1926 Slaughter of Animals Act, 1933 Jan. 1934 Byelaws. Wireless Loudspeakers, Gramophones, etc. Mar. 1939 Fouling by Dogs of Footways July 1938 Baths, Wash-houses, Swimming Baths and Bathing Places Aug. 1938 Parks and Pleasure Grounds May 1939 Building June 1939 Defacing of Pavements Nov. 1939 Deposit of Litter to the Detriment of Public amenities „ Deposit of Dangerous Substances „ Organs „ Loitering at Church Doors „ Indecent Language, etc „ Noisy Hawking „ Touting „ Noisy Animals „ Violent Behaviour, etc., on School Premises „ Nursing Homes June 1940 Sale of Contraceptives in Slot Machines Dec. 1949 Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air May 1950 21 1. (i) Water Supply. The 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 all the well stations and Walton works. 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. 0-39 0-15 0-1 in 100 c.c. (ii) Drainage and Sewerage. Private sewers have been constructed on the following estates: — Ravenswood, Lynsted Close, Stratton Close, Southview Close, Margaret Road, and Hurst Springs. These sewers are of the back drainage system and have not as yet been taken over as Public Sewers. Thirteen cesspools were emptied a total of 32 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 1954. 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) 19 62 Houses inspected (defects only recorded) 187 843 Houses inspected (certificates of disrepair) 9 10 Houses inspected (Housing Act, 1936, Overcrowding) 42 10 Houses inspected re Infectious Disease (including scabies) 220 51 Factories with mechanical power 253 15 Factories without mechanical power 31 1 Outworkers' premises 32 — Other premises under the Act 5 — Bakehouses 101 13 Water Samples 20 2 Food and Drugs Act re Samples 321 5 Dairies and distributors 92 1 Ice Cream premises 148 4 Restaurants, etc. 266 5 Fish premises 187 9 Meat Shops 836 12 Public Houses 30 — Shops re unsound food 373 38 Other premises where food is prepared 916 64 Offensive accumulations 46 16 Stables 62 5 Keeping of Animals 17 4 Rats 213 290 Drains inspected 979 864 Drains tested (water, smoke or colour) 83 2 Dustbins 53 16 Verminous premises 42 107 Smoke observations 18 27 Tents, Vans and Sheds 7 6 Refuse Tips 507 — Refuse Removal and Salvage 587 15 Conveniences 303 2 Pet Animals Act, 1951 40 7 Cleansing Station and Mortuary 47 — Council House applicants 329 180 Shops Act, 1950 850 3 Miscellaneous inspections 1,265 131 24 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 24 Provided with sufficient ashplace accommodation 8 Provided with sufficient water supply 5 Houses Improved Internally— Dirty rooms cleansed 9 Walls and ceilings repaired 67 Dampness in rooms remedied 107 Defective floors repaired 17 Ventilation of Rooms improved 25 Windows repaired 33 Stoves, fireplaces, etc. provided or repaired 8 Houses Improved Externally— Roofs repaired 16 Eaves gutters and down spouts fixed or repaired 36 Yards paved or repaired — Chimney stacks repaired 10 Walls repointed or repaired 17 Miscellaneous repairs 19 Drainage— Drains cleansed or repaired 690 New drains constructed 6 New Gullies provided 2 Ventilation of drainage system improved 3 Inspection chambers built or improved 16 Waste pipes provided or improved 11 New sinks provided — Offensive accumulation removed 7 Nuisances from animals abated — Other nuisances abated 2 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 36 Houses visited including revisits 271 Rooms disinfected 19 Notices delivered to Education Authorities, etc. 381 25 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered. Beef lbs. 2,087 Ox Liver 83 Ox Cheeks 529 Pork 79 Rabbit 168 Sausages 91½ Corned Beef 296¾ Tinned Ham 233½ Ham and Cooked Meats 115 Kidneys 140 Figs 10 Cheese 707½ Flour 36 Suet 8 Raisins 30 Biscuits 60¼ Tea -½ Fish 555 Fish Tins 217 Meat 529 Milk 383 Vegetables 963 Fruit and Fruit Juices 1,448 Preserves 83 Soups 85 Meat Puddings 14 Baby Foods 48 Fish Paste 1 Synthetic Cream Powder Pkts 110 Cheese 73 Almond Mixture 42 Coconut 15 Cereals 17 Figs 56 Pickles and Sauces Jars 27 Bread Loaves 4 Miscellaneous Items 45 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 W ritten Notices. 3 Prosecutions. 4 Factories without mechanical power 66 — — Factories with mechanical power 382 3 — other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) Electrical Stations should be reckoned as factories. 5 — — Total 453 3 2. Defects Found. Particulars. 1 Number of Defects. Number of Prosecutions. 6 Found. 2 Remedied. 3 Referred to H.M. Inspector. 4 Want of cleanliness (S.l) 6 6 — — 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 3 3 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.) Total 9 9 — — 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 and Disposal. The following table gives details of the transport used for the collection of refuse and salvage: — S. & D. Dust Carts (Side loading) 12 Karrier Lorries 3 Commer Utility Van 1 Trailers 12 Some difficulty was experienced in maintaining a weekly collection at certain periods of the year, largely due to shortage of staff. The manpower position is becoming acute, and it is extremely difficult to replace men leaving the service or on holiday. All refuse is disposed of by controlled tipping at East Wickham. A muledozer is used for levelling and consolidating the refuse, and a large proportion of the covering material obtained by excavating soil from the site by means of a Chaseside shovel. The site at East Wickham will be filled in some three years time, and there is no other suitable tipping land in the area. This being so, the Council have found it necessary to look for another site outside the area, and after visiting a number of sites, disused gravel pits at Stone, near Dartford, appeared to offer the best facilities for the purpose. An agreement has been reached to use certain portions of these pits, subject to planning consent being obtained. A public enquiry has recently been held with regard to the use of these pits, together with other chalk pits in the North-West Kent area, and the decision of the Minister of Housing and Local Government is awaited. The proposal to use these pits, if approved, will increase the average haul to the disposal point from 2½ miles to 7 28 miles, and the Council are considering the question of a larger type of vehicle for collection purposes in order to cope with the additional distance. Salvage. Details of salvage sales for the financial year ended 31st March, 1955, are set out below: Tons cwts. qrs. £ s. d. Waste Paper 556 15 2 4,071 17 2 Textiles 21 13 3 462 0 1 Ferrous Metal 76 9 3 208 6 5 Non-Ferrous Metals 1 8 1 130 16 2 Miscellaneous Items 4 18 1 18 19 3 661 5 2 4,891 19 1 The collection of kitchen waste from the 350 communal street bins in the area was carried out by a contractor under an agreement with the Council, and this arrangement has worked satisfactorilv. 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. Riverside Walk, Bexley Hudson Road Children's Playground. Westwood Lane, Blackfen. (Maintained jointly by the Chislehurst and Sidcup Urban District Council and Bexley Corporation). New conveniences at Riverside Walk, Bexley, were completed and opened during the year. 29 ATMOSPHERIC POLLUTION. The Council is 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 during 1954. 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 January 0.97 13.47 0.15 10.60 2.72 8.32 1.06 1.64 3.14 21.79 February 1.70 7.44 0.25 5.60 1.60 7.48 1.11 0.92 3.41 14.93 March 1.40 9.95 0.08 7.83 2.04 6.63 1.34 0.82 3.39 16.58 April 0.20 7.57 0.11 5.71 1.75 4.87 1.07 0.54 2.06 12.44 May 1.49 11.34 0.13 8.49 2.72 7.00 1.04 0.81 2.35 18.34 June 3.17 6.82 0.12 5.16 1.54 6.24 0.97 0.67 3.44 13.06 July 2.52 4.53 0.09 3.24 1,20 4.03 0.27 0.44 1.55 8.56 August 2.96 4.38 0.11 3.05 1.22 3.93 0.54 0.50 1.38 8.32 September 1.51 3.93 0.10 2.68 1.14 4.01 0.47 0.59 1.45 7.94 October 1.44 2.69 0.10 2.24 0.35 3.15 0.30 0.45 1.32 5.84 November 3.86 4.68 0.15 3.36 1.16 8.79 0.60 2.05 1.94 13.47 December 1.31 3.91 0.15 2.70 1.05 5.71 0.57 1.43 1.87 9.61 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 1,078 Number of Inspections 3,179 Number of Infestations found: Rats — Major 2 Minor 299 Mice 44 Number of Properties Treated Rats Mice Local Authority's premises 6 1 Dwelling Houses 266 29 Business Premises 29 14 PET ANIMALS ACT, 1951. Licences to keep pet shops were issued to 4 persons under the above Act. One contravention of the conditions of the Licence was found and a warning issued to the person concerned. 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 wen approximately 750 shops on the Council's Register at the end of the year. During the year 853 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 B. coli growth on Agar at: presumptive 37° C. 22° C. Deep end 0-12 0-14 Absent Shallow end 0 0 Absent Verminous Premises. During the year a total of 26 premises found to be infested with bed bugs were treated with satisfactory results; 6 of these were Council Houses, and 20 other premises. 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. Infestations by cockroaches at 2 Public Houses, 1 Bakehouse, 1 Sweetshop and 1 Private School were also dealt with. Wasps. The destruction of wasps nests is undertaken by the Department and during the year 35 nests were destroyed. Schools. There are 26 County Modern and County Primary Schools, 6 non-provided schools and a Day Technical School for Girls in the Borough. 32 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 Lodge Hill 154 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 — 60 Upton Close 15 Bexley— Hartford Road Estate and Victoria Road Estate 54 Royal Park Estate No. 1 57 Royal Park Estate No. 2 74 Midhurst Hill 20 Newick Close 14 Henfield Close 8 Rye Close and Extension 38 Glenhurst Avenue 34 Merlin Road 1 S.D.A. Houses 9 Hurst Place Estate 144 2,182 252 33 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses spected for housing defects (under Public Health or Housing Acts) 206 (b) Number of inspections made for the purpose (including re-inspection) 1,111 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 19 (b) Number of inspections made for the purpose (including re-inspection) 81 (3) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 19 (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 ... 180 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 147 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 1 (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 — 34 B. Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 22 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 18 (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 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 6 D. Proceedings under Section 12 of the Housing Act, 1936— (a) Number of Closing Orders made (b) Parts of Buildings closed 1 Clearance Schemes. Lodge Lane Hutments (Compulsory Purchase) Order, 1938. During the year 93 hutments on the Lodge Lane Estate were demolished and the re-development of the estate continued. Housing Repairs and Rents Act, 1954. This Act came into operation on the 30th August, 1954, and to the end of the year eight applications for certificates of disrepair were received, one of which was withdrawn. Seven certificates were issued. 35 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The milk retailed for consumption in the area is all pasteurised and bottled. No. of Distributors with Dairy Premises 5 No. of Distributors with Shop Premises 30 No. of Distributors from outside area 6 Licences granted by the Council under the Milk (Special Designation) (Raw Milk) Regulations, 1949, and the Milk (Special Designation) (Pasteurised and Sterilised Milkj Regulations, 1949:— Dealers' Licences:— Pasteurised Milk ... 27 Tuberculin Tested Milk 27 Sterilised Milk 35 Supplementary Licences:— Pasteurised Milk 5 Tuberculin Tested Milk 5 Sterilised Milk 6 (b) Slaughterhouses. There is no public slaughterhouse in the area, and no licences have been granted for private slaughterhouses. The majority of the butchers in the area obtain their supplies through Smithfield Market, and only three indicated any interest in slaughtering facilities. These butchers were able to make satisfactory arrangements at slaughterhouses in adjoining areas. It has been necessary to inspect the following carcases at shops in the area following slaughter: — Cattle 4 Calves 19 Sheep and Lambs 22 Pigs 72 4 Pigs Heads (weight 42 lbs.) and 1 mesenteric fat (weight 2 lbs.) were condemned with Tuberulosis, and one set of lungs (weight 3} lbs.) with pneumonia. 36 (c) Adulteration of Food. Food and Drugs Act, 1938. The following table summarises the 255 samples taken during the year. Formal Informal Milk 14 — Soup, Meat Extracts 1 6 Pastes, Potted Meat — 11 Pudding or Cake Mixture, Flour etc. 2 6 Jellies, Custard Powders, etc. 5 2 Patent Medicines — 3 Sausages, Sausage Meat, etc 17 — Fruit, Fruit Juices and Fruit Puree 4 5 Condiments, Sauces, Pickles, Spices, etc. 1 15 Pure Coffee, Coffee Extract, Coffee and Chicory 2 1 Meat Pies and Puddings 4 3 Cereals 7 1 Sweets and Confectionery 27 15 Essences — 3 Butter and Fats 19 2 Water Ices — 1 Ice Cream 8 — Minerals 2 2 Beverages 8 5 Wines and Spirits 5 — Peanut Butter — 1 Preserves 10 2 Fruit Pie and Pie Filling 1 3 Ground Almonds 3 — Cream 1 4 Synthetic Cream Powder 1 — Baking Powder 1 — Cakes 7 2 Mincemeat 1 — Fish and Fish Cakes 1 3 Glace Cherries 2 — Sugar 1 1 Olive Oil — 1 Desiccated Coconut 1 — Lamb Chop — 1 156 99 37 Legal Proceedings. The following legal proceedings were instituted during the year. (1) Butterscotch—Contained no significant amount of butter. Vendor fined £15. Wholesaler fined £10, and Manufacturer fined £20. (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 44 Sweet Shops 72 General Provisions 101 Bakers and Confectioners 28 Wet and Fried Fish Shops 25 Public Houses 41 384 During the year 3,095 visits were made and the following is a summary of various improvements carried out. Hot Water supply provided or improved 2 Floors, walls, ceilings, etc. repaired 8 Cockroach infestation dealt with 4 Rooms Cleansed 22 Water closet accommodation improved 8 Additional protection provided for foodstuffs ... 3 Lighting improved 1 New cutting block provided 1 Accumulation of refuse removed 4 Accommodation for storage of refuse improved 3 Food preparing room improved 2 Washing accommodation improved 1 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 128 Preparation of Sausages, etc. 47 25 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. 38 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 123 cases were notified as compared with 245 the previous year. Of these 7 were isolated in hospital and 116 were isolated at home. No. of deaths Nil Return cases from Hospital cases Nil Return cases from home nursed cases 1 During the past 15 years the character of this disease has changed from one of considerable severity to one of 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:— 39 40 Immunisation against Diphtheria and Vaccination against Smallpox, 1954. 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, 1954: — (A) Diphtheria Immunisation. Year of Birth 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 Total Primary Inoculations 141 763 63 21 8 20 28 5 8 7 2 3 1 2 1072 Re-inforcing Inoculations — — — — 63 733 250 73 40 23 17 23 3 2 1 1228 (B) Vaccination. Year of Birth 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 Before 1940 Total Primary Vaccination 498 259 11 3 4 6 5 3 3 6 1 3 — 3 2 31 838 Re-vaccination. 1 9 2 3 2 1 3 2 2 2 2 — 104 126 Immunisation against Diphtheria, 1954. 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, 1954, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1940;. Year of Birth 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 Total Last complete course of injections (whether primary or booster) 1950—1954 235 84 170 302 389 811 1075 1355 1074 1402 1088 996 951 903 141 10976 1949 or earlier 620 608 562 528 707 91 43 70 239 88 — — — — — 3556 Typhoid Fever and Para Typhoid Fever. There were no cases notified during the year. Puerperal Pyrexia. 9 cases were notified during the year, of which 3 were from Bexleyheath Maternity Hospital, where they were isolated and treated. 5 cases were removed to other hospitals and one case was isolated at home. Ophthalmia Neonatorum. There were no cases notified during the year. Measles. 45 cases were notified during the year. 1 case was treated in hopital. Whooping Cough. 230 cases were notified, 3 of which were treated in hospital. There was one death of an unnotified case. Acute Poliomyelitis. 2 Paralytic cases and 1 Non Paralytic case were notified and all were treated in hospital. There were no deaths. Scabies. 1 case was notified during the year. Food Poisoning. 8 cases were notified during the year. Of these 3 were treated in hospital. 41 42 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 1954. DISEASE. Total cases notified Under 1 1 to 2 3 to 4 5 to 9 10 to 1 4 15 to 24 25 & over Age unknown Cases admitted to Hospital Total Deaths Smallpox — — — — — — — — — — — Scarlet Fever 123 — 7 15 8S 10 2 1 — 7 — Diphtheria — — — — — — — — — — — Puerperal Pyrexia 9 — — — — — 3 6 — 8 — Ophthalmia Neonatorum — — — — — — — — — — — Acute Paralytic Poliomyelitis 2 — — — 1 — — 1 — 2 — Acute Non-Paralytic Poliomyelitis 1 — — — 1 — — — — 1 — Pneumonia 32 1 3 2 4 — — 22 — 10 2 Erysipelas 22 — 1 — — 1 1 19 — — — Pood Poisoning 8 2 1 — — — — 5 — 3 — Dysentery 3 — — — 1 — 1 1 — 1 — Typhoid Fever — — — — — — — — — — — Para-Typhoid Fever — — — — — — — — — — — Meningococcal Infection — — — — — — — — — — — Measles 45 1 5 9 28 1 1 — — 1 — Whooping Cough 230 11 40 64 103 7 1 4 — 3 1 Scabies 1 — — — — — 1 — — — — Malaria 1 — — — — — — — — — — Totals 477 15 57 90 226 19 11 59 — 36 3 TUBERCULOSIS. During the year 89 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1954 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 Under 5 — 2 — — — — — — 6—14 2 1 1 1 — — — — 15—24 12 10 3 — — — — — 25—44 18 16 — 3 — — — 45—64 14 6 — — 2 1 — — 65 — — — — 1 1 — — Age Unknown — — — — — — — — Totals 46 35 4 4 3 2 — — Of the 5 deaths shown in the table the number in nonnotified cases was 1. Pulmonary. Non-Pulmonary. Total. M F M F No. on Register at commencement of year 499 333 40 43 915 No. on Register at end of year 512 347 43 44 946 Rehousing. 8 cases were referred to me by the Chest Physician for rehousing and during the year four cases were rehoused by the Housing Committee. 43 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1954 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: Miss M. Woodward, L.L.A. Vice-Chairman: Alderman Mrs. H. F. Piggott. Alderman M. J. Corr Councillor F. W. Archer Councillor L. D. Riches Councillor W. P. Webster Alderman A. S. Masey Councillor John Cronin Councillor S. W. Tinham Co-opted Members: Miss D. C. Collins, O.B.E. 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. (Resigned 5.8.54). Elizabeth Francis, B.D.S., L.D.S. (Resigned 26.4.54). P. G. Arnold, L.D.S., R.C.S. (Eng.). (Part-time). Mrs. A. M. Readett, L.D.S. (Resigned 31.12.54). G. Wilson Lawrence, L.D.S., R.C.S. (Appointed 19.7.54) (Parttime). 46 Orthodontist Neil K. Thorn, L.D.S., R.C.S., (London). (Part-time). 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. (Transferred to another area 1.4.54). Mrs. M. Ayers, S.R.N, (from 24.5.54) (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. Sproul. Miss Soley — Hygienist. School Health Service Clerk Miss M. C. A. Smith. General Clerks Miss C. E. Anderson (Resigned 6.10.54). Miss O. G. Turnbull. Miss A. C. Jopling (Resigned 14.8.54). Miss R. Thomas (Appointed 17.8.54). Miss E. Turner (Appointed 4.10.54). 47 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1954. 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 1954. It may fairly be said that the general health of the schoolchildren in the Borough during the year under review has been satisfactory. Standards of nutrition and general care and cleanliness are of a high order. Apart from a small number of schoolchildren with recurrent minor infestations, cleanliness surveys are serving only to point out these exceptions to the general rule. The staffing position in the School Dental Service has shown little change during the past four years during which we have averaged the equivalent of one and eight elevenths of dental surgeons' time. The amount of dental inspections has shown a progressive increase, however, and the number of dental inspections in 1954 was 6,783 as compared with 4,754 in 1953. There has, also, been a marked increase in the amount of treatment provided and some progress has been made towards a return to the pre-war system of systematic routine inspection and treatment. The appointment of another whole time dental surgeon would probably complete this process and it is hoped that this may be possible in the not too distant future. A modern dental unit is now in readiness at the Murchison Avenue Clinic and could come into operation as soon as the necessary staff can be recruited. The objective is, of course, to inspect the teeth of every pupil at least once a year and to offer prompt treatment to such children as are found to need it. The extension of the Murchison Avenue Clinic includes, also, a Speech Therapy Unit which is now staffed by the equivalent of a whole time Speech Therapist and the waiting list for treatment has been reduced very considerably. During the year an audiometric survey of 10 year old schoolchildren in the Borough was completed and an analy- 48 sis of the results has re-affirmed how worthwhile such surveys can be. A further survey of other age groups is in progress at the present time. It is felt that in a Borough with a school population of 11,662, audiometry should be a regular part of the School Health Service, and it is hoped that this will be possible in the future either by the provision of an audiometer for exclusive use in the Borough or by making adequate provision for the Borough within the ambit of a wider scheme for the County as a whole. The Medical Research Council's Committee on the Educational Treatment of Deafness has considered the relative merits of group audiometer and sweep-frequency testing of children with defective hearing by means of the pure-tone audiometer and has decided in favour of the latter. This method is also replacing the gramophone audiometer in routine screening tests of hearing and has much to recommend it. Not the smallest advantage is that the sweep-frequency test can be made in a small room which is usually more easily available and a greater degree of quiet can also be ensured. The method is also reasonably economical of time as compared with the gramophone audiometer. As from January, 1956, the intermediate periodic medical examination, at present being carried out during the last year of primary school, will be transferred to the first year in the secondary school. This will allow for two assessments in the primary school at 5 and 8 years respectively and two in the secondary school at 11 years and school leaving age respectively. The opening of the new Grammar School and the Gravel Hill School in 1955 will increase the responsibilities of the School Health Service and may require some addition to the medical and health visiting staff and any further extension of the Bexley Technical School for Girls may have a similar effect. Once again it is my pleasure to acknowledge the excellent co-operation that exists between headteachers, parents, school medical officers and health visitors and to refer to the work of the school enquiry officers whose reports on families and individual children are instrumental in bringing to our notice any departures from health as early as possible. I have also to record the excellent team work of all members of the staff on which the success of the School 49 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, 1954. Bexley 796 Wilmington Annex 213 Seven County Secondary Schools. Average number on Roll 2,982 Twenty-five County Primary Schools. Average number on Roll 7,671 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. Tuesday and Thursday, 9.30-11 a.m., 2-4 p.m. Bexleyheath—315, Broadway. Thursday, Friday, Saturday morning 9.30-11 a.m. Thursday, Friday afternoon, 2-4 p.m. 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 and Friday, 9.30-11 a.m., 2-4 p.m. Thursday, 2-4 p.m. Orthopedic. 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. Bexley—Murchison Avenue. Each morning, except Saturday 9.30-12.30 noon. Each afternoon, except Saturday 2-4.30 p.m. Child Guidance. Crayford—Woodside Road. Clinics held daily. Appointments made through County Medical Officer by the Borough Medical Officer of Health. 52 CO-ORDINATION. In spite of the transfer of the Maternity and Child Welfare Services from the local Council to the Kent County Council, a satisfactory degree of co-ordination of effort between the School Health Service and the Infant Welfare Services has been maintained as a result of the co-operative attitude of all members of the Staff concerned. Periodic Medical Inspections. See Table 1. The successful carrying out of routine medical inspections was made possible by the excellent co-operation of Head Teachers and their staffs and it is true to say that this is now regarded as an integral part of the school curriculum. It is at these inspections that the greatest number of defects are discovered and where a great deal of information is obtained in regard to the school children by discussions with the parents. Generally speaking, it was found that entrants, 8-yearolds and 11-year-olds showed a uniformly high standard of personal hygiene. Clothing was good and clean and the incidence of skin diseases very low. In only a few cases was it necessary to record a defect in clothing or of footwear. The attendance of parents at routine medical inspection was good, being practically 100 per cent. in the case of entrants, but as might be expected there was a falling off in the case of senior children. Reference to the Statistical Table on Page 62 emphasizes the number of defects discovered. Bearing in mind that these defects are nearly always diagnosed in the early stages and observation or treatment instituted at once, periodic inspections will be seen to represent the truly preventive aspect of School Health Work. School Meals—1954. Average number of pupils in attendance:— Primary Schools 7,234 Secondary Schools 3,677 10,911 Average number of dinners served to children daily: — Paid Free Total Primary 3,265 76 3,341 Secondary 2,934 90 3,024 53 Milk. Average number of pupils taking milk daily:— Primary 7,008 Secondary 2,399 Total 9,407 Orthopaedic Clinic. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on the Orthopaedic Clinic:— The Orthopaedic Clinics have continued throughout the past year on the 1st and 3rd Wednesday of every month. There has been a falling off of the total numbers of attendances but there is still no marked change in the type of case. The problem of the treatment and handling of spastics still occupies a great deal of our time and the facilities for looking after these unfortunate children are still very inadequate. The remarks of previous years with regard to the accommodation at this clinic still apply. And to Mr. B. Lawson, F.R.C.S.E. for the following:— 1 do not think there has been any alteration in the trend of the Clinics since I first undertook this work. The majority of the patients were referred for flat feet, knock knees and postural scoliosis. The greatest difficulty at present appears to be the lack of schools for physically handicapped patients. Dental Treatment. I am indebted to Mr. N. K. Thorn, L.D.S., R.C S. for the following report: — Thank you for your letter concerning the orthodontic treatment we are undertaking at Little Danson Clinic. Personally I have under treatment 200 patients; the number of visits for treatment during the period were 666; 27 were successfully terminated. I am averaging an attendance here of two sessions weekly during the school year. Mr. Hall also had a considerable number of orthodontic cases under treatment; his statistics are not, of course, included here. 54 Ophthalmic Clinic. I am indebted to Mr. R. M. Chambers, M.B., B.S., D.O.M.S., for the following report: — The attendance at Little Danson Ophthalmic Clinic has been well maintained during the year and the waiting list has rarely exceeded four weeks. The number of squint cases shows little change and those needing orthoptic treatment are still faced with the journey to London which may have to be made each week for some months. In a few particularly difficult cases it has been possible to arrange treatment at an L.C.C. centre nearer Welling but this can be done only on rare occasions. I have often been impressed by the connection between squints and family tensions is so far as they can be divined at one or two visits. Frequently a temporary breakdown of binocular vision coincides with a crisis at home and the awareness of this has often avoided a change of glasses which might otherwise have been thought necessary. In connection with this it is of great help to receive some hints of the family habits, if they appear to have a bearing on the case. I would like to record my appreciation of the ready help I have received from The Head Teachers of the various schools whose pupils come to me. Speech Therapy. I am indebted to Miss Joan Pollitt, Chief Speech Therapist to the Kent Education Committee for the following report. Plans have proceeded during the year for the opening of a new clinic at Murchison Avenue. The opening of this clinic will enable sessions to be given throughout the week, instead of on Fridays only as at present. The additional sessions will considerably decrease the waiting list of 81, which was being carried at the end of 1954 by the Wrolham Road Clinic. It has been possible even this year to relieve the waiting list to some extent by arranging for certain cases to attend the Sidcup and Crayford Clinics. Forty-seven cases have been closed during the year; twenty-two having been dealt with at the Wrotham Road Clinic, two at Crayford twenty at Sidcup, and three cases having been closed without being seen. 55 The following table shows the reason for closing these cases:— Very satisfactory result— Wrotham Road 13 Crayford 1 Sidcup 3 17 Treatment incomplete as families left district—in one case considerable progress had been made— Wrotham Road 2 Crayford 1 Sidcup 0 3 Little if any change of condition— (Sidcup) 2 Consultation only, followed by the necessary recommendation— (Sidcup) 1 Found to have improved when first seen by the therapist— (Sidcup) 3 Reported to have improved prior to appointments being offered 3 Appointments offered but not kept— many of these cases had been on the waiting list for some considerable time and it is possible that appointments were no longer necessary 18 47 Thirty-three cases who were attending at the clinics during 1954 will continue to attend into 1955. Of these, eighteen are being seen at Wrotham Road, four at Crayford and eleven at Sidcup. Cleanliness Inspections. (See Table III). During the year the School Nurses carried out 16,266 examinations of children in School and 62 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. 56 Physical Education. Physical Education during the year 1954 has shown steady progress and marked consolidation of many useful schemes of work. The modern approach demands greater effort in every way from the teaching in the skilful planning and presentation of the lesson and encourages purposeful work of good standard, self-discipline, courage and selfreliance from the child. Suitable facilities in most schools and an adequate supply of equipment provided by the Education Committee have done much to encourage effort generally and to assist, in particular, with the possible attainment of objectives, unfortunately, during 1954 adverse weather conditions have seriously interfered with many outdoor activities and the temporary use of hall space as classrooms, due to the increased school population, has deprived some schools of essential alternative indoor accommodation. Every effort has been made to carry out the normal games programme but this year the exceptionally sodden state of the ground, together with the unsuitable footwear often worn by many children, has limited the scope of the training. For several years the provision of special clothing and footwear foi Physical Education has been a serious problem but it is pleasing to note again that the praiseworthy support of parents has, in general, been further maintained. It is hoped that more adequate provision will be possible in the near future so that opportunities for field activities will thus be more regular and allow of active participation by greater numbers of children. In this connection the hygiene of the lesson should become a more positive part of the programme. It is pleasing to note that, where available, the regular use of showerbaths has been conducive to much higher standards of cleanliness and self-respect. The general training at the Primary level with an emphasis on freedom of effort and activity provides an ideal groundwork for the development of specific techniques in all branches of Physical Education in the Secondary Schools. The broader outlook encouraged in the subject should allow every boy and girl to develop some aspect of physical activity in which he or she has special interest or aptitude; it is hoped that the excellent groundwork provided in the schools will be utilised in Youth and Adult life so that school leavers can pursue some healthy indoor or outdoor recreation in their leisure hours. 57 Swimming. The continued co-operation of the Baths Department is greatly appreciated. Facilities at the baths at Plumstead, Eltham and Danson Park are now used to their fullest extent and requests for accommodation have always been granted whenever possible Provision was made for a session of ten weeks duration during the Summer Term, but inclement weather reduced rather seriously the teaching value of some of these swimming periods in the open air. Schools. Attendances. No. of Children. 5 Secondary 14 classes of 25-30 children each week approx. 350 per week. 11 Primary 27 classes of 30-35 children each week approx. 900 per week. Total 1,250 per week. The number of Swimming Certificates issued to the pupils in Primary and Secondary Schools in the Borough during 1954 for distances between 25 yards and one mile was 398. Arrangements were made for classes from one secondary school and one primary school to attend the Baths at the beginning of 1954 and classes were sent from two Primary schools during the Autumn Term. This extension of the Swimming Season enabled indoor facilities to be enjoyed by schools whose normal programme has previously been chequered by the problems connected with an open air swimming bath; any future expansion in this sphere must depend upon a relaxation in the present financial restrictions. Further Training of Teachers. The further training of teachers has continued steadily throughout the year, providing a wide choice of subjects to cover the many aspects of modern Physical Education. Opportunities to attend the following Courses have been available to teachers: — (1) Basket Ball Course for men teachers. Held on seven evenings during the Autumn Term. (2) Athletics Course for teachers in Secondary Schools. Held on five evenings during the Autumn Term. 58 (3) Physical Education in the Primary School for men and women teachers. Demonstration lessons and a lecture held during one evening during the Summer Term. (4) Physical Education in the Infant School for men and women teachers. Held on live evenings during the Autumn Term. (5) Remedial Course for men and women at Kingsgate, Broadstairs, for one week-end during the Summer Term. (6) Athletics Course for women teachers held at stone for one Saturday during the Summer Term. 59 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. 60 TABLE L Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. — Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 1,278 Second Age Group 1,123 Third Age Group 841 Total 3,242 Number of other Periodic Inspections 1,251 Grand Total 4,493 B. — Other Inspections. Number of Special Inspections 1,627 Number of Re-Inspections 2,716 Total 4,343 C. — Pupils Found to Require Treatment. Number of Individual Pupils found at Periodic Medical Inspection to require Treatment: Group (1) For defective vision (excluding squint) (2) For any of the other conditions recorded in Table IIA (3) Total individual pupils (4) Entrants 30 245 234 Second Age Group 107 272 318 Third Age Group 66 260 280 Total (prescribed groups) 203 777 832 Other Periodic Inspections 149 248 334 Grand Total 352 1025 1166 61 TABLE II. A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1954. PERIODIC INSPECTIONS SPECIAL INSPECTIONS No. of defects No. of defects Defect Code Defect or Disease No. (1) Requiring Treatment (2) Requiring to be kept under observation but not requiring treatment (3) Requiring Treatment (4) Requiring to be kept under observation but not requiring treatment (5) 4. Skin 182 137 91 11 5. Eyes— a. Vision 352 397 70 10 b. Squint 85 72 15 2 c. Other 80 48 43 2 6. Ears— a. Hearing 27 200 47 34 b. Otitis medic 10 100 10 6 c. Other 48 99 17 4 7. Nose or Throat 149 624 131 58 8. Speech 12 46 19 2 9. Cervical Glands 20 264 7 8 10. Heart and Circulation. 9 119 11 20 11. Lungs 20 367 58 69 12. Developmental— a. Hernia 9 22 2 2 b. Other 19 154 2 — 13. Orthopaedic— a. Posture 156 145 6 2 b. Flat Foot 148 156 15 2 c. Other 124 398 48 15 14. Nervous System a. Epilepsy 2 18 — 4 b. Other — 36 7 11 15. Psychological— a. ment — 41 4 73 b. Stability 9 210 38 54 16. Other 44 192 225 104 62 B. — Classification of the General Condition of Pupils Inspected during the Year in the Age Groups. Age Groups (1) No. of Pupils Inspected (2) A. (Good) B. (Fair) O. (Poor) No. (3) % of col. 2 (4) No. (5) % of col. 2 (6) No. (7) % of col. 2 (8) Entrants 1278 461 36.1 761 59.5 56 4.4 Second Age Group 1123 535 47.6 551 49.1 37 3.3 Third Age Group 841 470 55.9 356 42.3 15 1.8 Other Periodic Inspections 1251 574 45.9 632 50.5 45 3.6 Total 4493 2040 45.40 2300 51.19 153 3.41 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 16,266 (ii) Total number of pupils on roll of schools visited 10,779 (iii) Total number of individual pupils found to be infested 62 (iv) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 12 (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 (ii) Total number of pupils on roll of schools visited 63 (iii) Total number of individual pupils found to be infested — (iv) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) — (v) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) — TABLE IV.—Treatment Tables. Group I.—Diseases of the Skin (excluding uncleanliness, for which see Table III). Number of cases treated or under treatment during the year by the Authority otherwise Ringworm—(i) Scalp — — (ii) Body 6 — Scabies 2 — Impetigo 5 — Other skin diseases 131 — Total 144 — Group II.—Eye Diseases, Defective Vision and Squint. No. of Cases by the Authority dealt with otherwise External and other, excluding errors of refraction and squint 198 31 Errors of refraction (including squint 1,998 25 Total 2,196 56 Number of pupils for whom spectacles were (a) Prescribed 531 — (b) Obtained 491 — 64 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 — 1 (b) for adenoids and chronic tonsilitis — 83 (c) for other nose and throa conditions — 1 Received other forms of treatment — 28 Total — 113 Group IV.—Orthopaedic and Postural Defects. (a) Number treated as in-patients in hospitals 10 • by the Authority otherwise (b) Number treated otherwise, e.g., in clinics or outpatients departments 172 25 Group V.—Other Treatment Given. Number of cases treated by the Authority otherwise (a) Miscellaneous minor ailments 686 — (b) Other 1. Minor Eye Defects 95 — 2. Minor Ear Defects 109 — 3. Minor Injuries 34 — Total 924 — 65 TABLE V. Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 5,205 (b) Specials 1,578 Total 6,783 (2) Number found to require treatment 4,601 (3) Number referred for treatment 4.601 (4) Number actually treated 2,339* (5) Attendances made by pupils for treatment 8,094* (6) Half-days devoted to: Inspection 30 Treatment 941 Total (6) 971 (7) Fillings: Permanent Teeth 2,636 Temporary Teeth 1,171 Total (7) 3,807 (8) Number of teeth filled: Permanent Teeth 2,301 Temporary Teeth 1,149 Total (8) 3,450 (9) Extractions: Permanent Teeth 1,040 Temporary Teeth 3,281 Total (9) 4,321 (10) Administration of general anæsthetics for extraction 1,428 (11) Other operations: Permanent Teeth 1,514* Temporary Teeth 291 Total (11) 1,805 * These figures include orthodontic work. 66 TABLE VI. Handicapped Pupils requiring Education at special Schools or boarding in Boarding Homes. (1) Blind (2) Partially sighted (3) Deaf (4) Partially Deaf (5) Delicate (6) Physically Handicapped (7) Educationally sub-normal (8) Maladjusted (9) Epileptic Total (1) to (9) In the calendar year ended 31st December, 1954:— (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Day Special Schools or Boarding Homes - 2 - 1 32 4 3 4 1 47 B. Handicapped Pupils newly ascertlined as requiring education at Special Schools or boarding in Homes - 1 - - 34 4 10 - - 49 On or about December 1st, 1954:— C. Number of Handicapped Pupils from the area:— (i) attending Special Schools as (a) Day Pupils - 7 5 4 - 16 19 - - 51 (b) Boarding Pupils 2 - 3 - 26 7 5 7 1 51 (ii) Attending independent schools under arrangement made by the Authority - - - 1 - - - - - 1 (iii) Boarded in Homes and not already included under (i) or (ii) - - - - - - - - - - Total (C) 2 7 8 5 26 23 24 7 1 103 D. Number ot Handicapped Pupils being educatedunder arrangements made under Section 56 of the Education Act, 1944:— (i) In hospitals - - - - - 1 - - - - (ii) In other groups (e.g. units for spastics) - - - - - 1 - - - 1 (iii) At home - - - - - 5 1 - - 6 E. Number of Handicapped Pupils from the area requiring places in Day Special Schools (Including any such children who are temporarily receiving home tuition or whose parents have not yet consented to their attending a Special School) :— (i) Day — — — — — — 8 — — 8 (ii) Boarding — — — — 10 3 2 1 — 16 Number of children reported during the year:— (a) Under Section 57(3) (excluding any returned under (b) 2 (b) „ „ „ relying on Section 57(4) (c) „ 57(5) 4 of the Education Act, 1944. 67 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 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—29 Salvage 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 32 68 ITEM PAGE HOUSING. Council Estates 33 Inspection of Dwelling Houses 34 Remedy of Defects without formal notice 34 Action under Statutory Powers 34—35 Clearance Schemes 35 Housing Repairs and Rents Act, 1954 35 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 36 Slaughterhouses 36 Adulteration of Food—Food & Drugs Act, 1938 37—38 Food Shops and Food Manufacturing Premises 38 Registration of Premises 38 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 39 Diphtheria 39 Diphtheria Immunisation and Smallpox Vaccination 40 Typhoid Fever and Para Typhoid Fever 41 Puerperal Pyrexia 41 Ophthalmia Neonatorum 41 Measles 41 Whooping Cough 41 Acute Anterior Poliomyelitis 41 Scabies 41 Food Poisoning 41 Tables of Infectious Diseases Notified 42 Tuberculosis 43 SCHOOL HEALTH SERVICES REPORT, 1954. 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 Ophthalmic Clinic 55 Speech Therapy 55—56 Cleanliness Inspections 56 Physical Education 57 Swimming 58 Further Training of Teachers 58—59 Statistical Tables 60—67 69 cX