AC 4412(1) BEXCEY BEX 20 BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Services For the Year 1955 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health 68004 BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health For the Year 1955 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health Borough of Bexley. Mayor: Councillor J. W. Bateman, J.P. Deputy Mayor: Councillor D. C. Clarke. HEALTH COMMITTEE. Chairman: Alderman Mrs. H. F. Piggott. Vice-Chairman: Alderman M. J. Corr. Alderman J. M. Pawson. Councillor Mrs. E. M. Sheppard. Councillor S. H. Philpot. Councillor Mrs. J. Tatham. Councillor Mrs. D. A. Shearn. Councillor W. P. Webster. Councillor N. S. Harrild. 2 PUBLIC HEALTH STAFF, 1955. 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 (Retired 30.9.55). *† G F. Lovegrove (Resigned 4.5.55). *† W. E. Moses. *† D. W. Townsend (Appointed 17.6.55). *† J. R. Greig (Appointed 24.10.55). Chief Clerk G. A. Pearson. Senior Clerk R. V. Hoad. Clerks E. M. Pearmine (Miss). M. E. Smith (Miss) (Shorthand Typist). I. D. Dashfield (Mrs.) (Temporary Shorthand Typist, Appointed 16.11.55). Public Analyst H. E. Monk, B.Sc., F.R.I.C. Refuse Foreman G. E. Packman. Public Health General Assistant A. C. Ward (Appointed 2.11.55). * 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 submit my Annual Report for the year, 1955, the tenth which it has been my privilege to present. The widening of our conception of health in recent years to include mental as well as physical aspects imposes special difficulties on anyone who attempts an objective assessment of the health of a community. The Medical Officer of Health of the Urban District Council of Bexley in the year 1901, on the other hand, could have suffered from no such inhibitions faced, as he was, with a heavy load of infectious disease, an infant mortality rate of 136.6 per thousand live births and a wide variety of environmental problems which survive only as a faint echo in the present day health administration of the Borough. It should be borne in mind that the population of the district at the turn of the century was barely 13,000 but, even so, there were 9 cases of smallpox with 1 death, 35 cases of diphtheria with 8 deaths, and 5 deaths from measles and whooping cough, respectively. School closure was a frequent occurrence on account of infectious disease, and mass exclusion of children took place during that year on no less that 6 occasions. Sewerage schemes were in their infancy and, even in 1909, house refuse was removed by the Council once a fortnight, placed on agricultural land and ploughed in. The first Midwives Act had yet to be passed (1902) and maternal mortality was high (about 5 deaths per thousand total births) due, largely, to the ministrations of midwives of the Sairey Gamp type who were entirely untrained and were, in addition, dirty, dishonest and intemperate. Nutritional standards were much lower than they are today and the health of schoolchildren, in particular, was a source of great concern. The School Health Service did not come into operation until 1907. The general level of health of the population was well exemplified by the fact that, of all recruits examined in 1901, 40% were found to be unfit for army service on account of lack of physical development, defective vision, bad teeth and heart disease. 4 A comparison with the vital statistics for 1955 will, therefore, show the extent of the progress which has taken place in the intervening 50 years as a result of improvements in environmental hygiene, in standards of living generally, in the techniques of health education and through the introduction of a wide range of personal health services. Yet in spite of all this, it would be to take a superficial view to say that the present day health of the community can be regarded as entirely satisfactory. Considerable emphasis is, nowadays, being placed on mental health and there is a widespread feeling that neurosis and anxiety states are on the increase. It is, certainly, true that a very high proportion of hospital beds in the country as a whole is devoted to the treatment of mental disease. There are no statistics on which to base realistic assessment of the mental health of our community and general impressions, even when they are the result of careful enquiry, may not be altogether reliable. The mental health of schoolchildren is nowadays receiving greater attention than it did a decade ago but this may be the result, not of an actual increase in maladjustment and behaviour problems, but of a reorientation of medical outlook and an increase in the ascertainment of such children. In other words, higher levels of health are now being sought than in days gone by. One significant development is the widespread anD growing use of the class of drugs known as the "chemical tranquillizers" of which phenobarbitone is, perhaps, the best known and which are used to reduce anxiety and tension with a view to making life more tolerable in an age in which it is not, always, easy to achieve that inward peace of mind which is, undoubtedly, a pre-requisite of the health of the individual. On a more optimistic note, an important criterion of the health of a community, as of an individual, is the degree of activity which it undertakes. Judged by this standard, the Borough acquits itself well. The official list of organisations operating in the Borough runs into seven pages of typescript and covers a very wide range of activities with the cultural, social and charitable organisations much in evidence. The cumulative work of these organisations represents a very considerable force working for the good of the community. Many instances could, also, be quoted in which neighbourly help and solicitude by individuals have made it possible for the old and infirm to remain in their own homes in conditions of relative peace and contentment. It would not be an exaggeration to say that never in the 5 history of the Borough has greater voluntary effort been expended in the care of the elderly and the handicapped than is the case today. Turning to those aspects of health in which definite information is available, the vital statistics for the Borough were, once again, satisfactory. The birth rate at 12.6 per thousand showed an increase over the rate of 11.8 in 1954, which was the lowest birth rate ever recorded in the Borough but there has been no discernible upward or downward trend over the past five years. The standardised birth rate, which allows for comparison with other parts of the country, was 13.0 and was well below that for England and Wales which was 15.0 per thousand. The still-birth rate at 16.7 per thousand total births showed an increase over 1954 (13.26), but this has no special significance and the rate was considerably lower than that for England and Wales. The death rate for the Borough rose slightly to 9.1 per thousand of the estimated whole population (8.1 in 1954) but the standardised death rate of 10.4 was below the death rate for England and Wales for 1955 which was 11.7 per thousand. Cancer of the lung was responsible for 48 deaths and showed an increase of 16 as compared with 1954. Fortytwo of the 48 deaths were in males. There has been much controversy over the part played by smoking in the causation of lung cancer and it is safe to say that, while statistical evidence does not provide definite proof that cigarette smoking directly causes cancer of the lung, the accumulated evidence is such as to denote a cause and effect relationship. In the circumstances it seems reasonable to advise young people not to take up smoking and, in the case of heavy smokers of middle age, to say that published data indicate that there may be some diminution in risk to those who give up smoking even after many years of addiction. The infant mortality rate for 1955, that is the number of children dying in the first year of life for every thousand live births, was 17.0 compared with 22.1 per thousand in 1954. The rate compares favourably with that for England and Wales, which was 24.9. There was one maternal death during the year, giving a maternal mortality rate of 0.88 per thousand live and stillbirths. In regard to infectious diseases, measles reached epidemic proportions in 1955, 1.762 cases being notified. There were no deaths from this disease and, indeed, there 6 has been no death in the Borough from this cause for four years. The year, also, saw an increased incidence of acute poliomyelitis, 8 paralytic and 3 non-paralytic cases being notified in the Borough. There were no deaths. At the time of writing, vaccination against this disease has, recently, commenced under arrangements made by the Local Health Authority and it is hoped that the development of this technique will bring this disease under some measure of control. During the year, 82 new cases of tuberculosis were notified compared with 89 in 1954 and 91 in 1953. The number of deaths from this disease increased to 13 compared with 5 in 1954 and 9 in 1953. For the seventh year in succession no case of diphtheria occurred in the Borough. A warning that diphtheria could return as a killing disease is contained in the fact that in certain parts of the country outbreaks of diphtheria have occurred, recently, resulting in the death of a number of children. Parents should take heed of this and should not fail to have their children immunised as the continued freedom from this disease depends on the maintenance of a high level of immunisation among the child population. Standards of food hygiene, while greatly improved in recent years, still leave much to be desired in many cases. The protection of food exposed for sale from dust and flies and from the hazards inherent in its preparation and handling will call for increased efforts by the Health Department, as well as the food traders; and housewives, too, have a two-fold duty, firstly, to insist on adequate standards of cleanliness in food shops and in their own homes and, also, to exercise forebearance in the unnecessary handling of food in shops prior to purchase. The new Food Hygiene Regulations strengthen the hand of the Local Authorities but their successful operation will demand a staff of sanitary inspectors adequate to the task. The present shortage of these officers is, therefore, a very serious problem. Cleanliness depends, ultimately, on an attitude of mind and the development of a sense of social responsibility and one of the results of the failure to develop the latter is the widespread litter in our streets, parks and open spaces. It may be considered that this is not primarily a health matter but its implications in regard to hygiene in general, and the mental distress which it causes to large numbers of people in the Borough, justifies a reference to it in an annual report. Adults are the worst offenders and it is not surprising, therefore, that children should follow their example. There is no doubt that much more could be done in the home and in 7 the schools to inculcate a desire to preserve local amenities which play such a large part in promoting the health of the community. Among the environmental problems which remain, the most important is, undoubtedly, the lack of adequate housing, particularly for young married couples and for the aged and this in spite of great strides which have been made in recent years by the housing authority. Problems of atmospheric pollution are coming more and more into the foreground and, although in this Borough the problem may not be so acute as it is in more highly industrialised areas, smoke emissions from the domestic grate add considerably to the impurities which are discharged into the atmosphere. Now that the Clean Air Bill has finally reached the Statute Book, the powers of local authorities are, to some extent, strengthened and, no doubt, the development of smokeless zones will have to be considered in the years to come. The work of the Bexley, Erith and Crayford Home Safety Committee continued to make progress. In an attempt to prevent accidents from poisoning in the home, display cards were sent to all doctors and chemists in the Borough for use in their waiting rooms and shops, urging parents to keep drugs and medicines in places where children would not have access to them. A brains trust and film show were, also, held which was well attended particularly by senior schoolchildren. It is hoped to intensify this propaganda by giving regular talks and demonstrations to the latter and one is driven more and more to the conclusion, in these days when television and other distractions tend to keep people tied to the homes, that in the senior schoolchildren of the Borough lies the main hope of any future development in regard to health education in general. It is pleasing, once again, to record that the Bexley Old People's Welfare Committee has continued to do 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 People's organisations in the Borough providing clubs and other recreational facilities. The work of this voluntary organisation is of immense value to the old people in the Borough. The domestic help service and more recently the night attendance and family help services provided by the Local Health 8 Authority, also play a vital part in relieving the lot of many old people who would otherwise have to be admitted to institutions. 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 excellent service during the year. I am, Your obedient servant, JOHN LANDON, Medical Officer of Health. 9 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. Registrar General's Estimate midyear, 88,780. New Dwellings Erected. Houses 529 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1945 2 1935 59,970 1946 82+ 64 rebuilt 1940 77,670 1947 199+216 rebuilt 1945 75,040 1948 334+ 286 rebuilt 1950 89,410 1949 138+ 73 rebuilt 1951 (Census) 88,420 1950 102+ 15 rebuilt 1952 88,160 1951 319 1953 87,990 1952 355 1954 88,180 1953 265 1954 503 Number of inhabited houses at end of 1955 (according to Rate Books) approximately 27,443 Rateable Value £695,649 Sum represented by a penny rate £2,695 Unemployment. Men Women Boys Girls Total December 31st, 1954 167 118 19 13 317 December 31st, 1955 120 86 13 9 228 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 a 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 rcach the optimum standards for which the Council are striving. 10 The Corporation supplied the district with electricity until the date of transfer of this service to the London Electricity Board, and the South Eastern Gas Board supplies gas. The following public open spaces have been provided by the Corporation:— Bexley Woods, Parkhill Road, Bexley 27.00 acres Bigs Hill Wood, Watling Street, Bexleyheath 8.68 Brampton Park Recreation Ground, Avenue Road, Bexleyheath 4.21 Bursted Wood, Erith Road, Bexleyheath 30.10 Danson Park, Bexleyheath 187.84 Danson Mead, Welling .1042 „ Derwent Crescent, Bexleyheath .20 „ East Wickham Land, Glenmore Road/ Wickham Street, Welling 6.80 Eastcote Gardens, Eastcote Road, Welling 1.00 Hall Place, Bourne Road, Bexley 159.67 Hudson Road Playing Ground, Long Lane, Bexleyheath .953 „ Hurst Recreation Ground, Shirley Avenue, Bexley 3.50 King George's Field, Broadway, Bexleyheath 1.235 „ Lodge Hill, Welling 1.43 Oxleas Close, Welling .13 Palmar Gardens, Bexleyheath 1.30 Parkhurst Gardens, Bexley .70 Riverside Walk, Bexley 10.50 Russell Park, Woolwich Road, Bexleyheath 13.00 Rutland Shaw. Bexley 4.85 St. Mary's Recreation Ground, Bexley 11.86 Sheldon Sports Ground, Bexleyheath 4.3883 „ Sports Ground, Park View Road, Welling 7.03 Steeple Avenue Memorial Garden, Bexleyheath 1.50 Stevens Park, Wrotham Road, Welling 9.36 The Green, Bexleyheath 1.44 The Green, Welling 2.09 The Warren, Broomfield Road, Bexleyheath 12.47 Westwood Estate Children's Playground, Welling .60 „ Total 513.9405 „ Facilities for outdoor games are provided in many of these open spaces, including the large Swimming Pool in Danson Park, opened in July, 1936. 11 GRAPH SHOWING RISE IN POPULATION0 SINCE 1931 SUMMARY OF VITAL STATISTICS England and Wales. Borough of Bexley. Births- Rates per 1,000 Home Population. Live 15.0 12.6 Still 0.35 0.21 23.1(a) 16.7(a) Deaths— All Causes 11.7 9.1 Typhoid and Paratyphoid 0.00 — Whooping Cough 0.00 — Diphtheria 0.00 — Tuberculosis 0.15 0.15 Influenza 0.07 0.01 Smallpox — — Acute Poliomyelitis (including Polioencephalitis) 0.01 Pneumonia 0.51 0.36 Notifications (corrected) Typhoid Fe0er 0.00 — Paratyphoid Fever 0.02 0.02 Meningococcal Infection 0.03 0.01 Scarlet Fever 0.73 0.54 Whooping Cough 1.78 1.98 Diphtheria 0.00 — Erysipelas 0.10 0.20 Smallpox — — Measles 15.61 19.85 Pneumonia 0.63 0.33 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.08 0.09 Non-Paralytic 0.06 0.15 Food Poisoning 0.29 0.11 Puerperal Pyrexia 17.79(a) 7.91(a) Deaths Rates per 1,000 Live Births. All causes under one year of age 24.9 17.0 Enteritis and Diarrhoea under two years of age 0.75 Nil (a) Per 1,000 Total (Live and Still) Births. (b) Per 1,000 related live births. A dash (—) signifies that there were no deaths. 13 Maternal Mortality England and Wales Borough of Bexley Rates per 1,000 total live and still births Maternal causes, excluding abortion 0.54 0.88 Due to abortion 0.10 Nil Total maternal mortality 0 64 0.88 EXTRACTS FROM VITAL STATISTICS FOR THE Year 1955. The Registrar General's Estimate of home population for the mid-year is 88,780 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 579 ' 540 1,119 Legitimate 566 523 1,089 Illegitimate 13 17 30 Birth Rate. Rate per 1,000 estimated home population 12.6 The following relates to the Birth Rate during the past ten years:— 1945 Birth Rate 18.81 per thousand 1946 „ „ 19.75 „ „ 1947 „ „ 18.72 „ „ 1948 „ „ 15.36 „ „ 1949 „ „ 14.02 „ „ 1950 „ „ 13.13 „ „ 1951 „ „ 12.79 „ „ 1952 „ „ 12.00 „ „ 1953 „ „ 12.70 „ „ 1954 „ „ 11.80 „ „ Rate per 1,000 for England and Wales 1955 15.0 14 30 illegitimate live births were registered against 35 in 1954. The Registrar-General has supplied a comparability factor for 1955. The standardised birth rate which allows for comparison with other parts of the country is 13.0. Stillbirths. Males Females Total Total 15 4 19 Rate per 1,000 total (live and still) births 16.7 19 Stillbirths were registered during the year. This represents a rate of 0.21 per 1,000 population against 0.16 per 1,000 population in 1954. The following relates to the Stillbirth Rate during the past ten years:— Rate per Thousand Year Total Live and Still Births Population 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 1954 12.94 13.26 0.28 0.16 Rate per 1,000 for England and Wales, 1955 0.35 There was 1 Stillbirth registered as illegitimate. 15 Deaths. Males Females Total All causes 416 396 812 Death rate per 1.000 of estimated home population 9.1 Number of women dying in, or in consequence of, childbirth: From Puerperal and Post Abortive Sepsis — — From other Puerperal Causes 1 1 Death rate per 1,000 total (live and still) births 0.88 Deaths of Infants under one year of age 10 9 19 Legitimate 10 9 19 Illegitimate — — — Death rate of Infants under one years of age: Total per 1,000 live births 17.0 Legitimate per 1,000 legitimate live births 17.4 Illegitimate per 1,000 illegitimate live births Nil. Deaths from Measles (all ages) — — — Whooping Cough (all ages) — — — Diarrhœa (under 2 years of age) — — — „ Cancer (all ages) 99 76 175 Rate per 1,000 for England and Wales, 1955 11.7 16 Death Rate of Area during last ten years:— 1945 9.28 per thousand. 1946 8.55 „ 1947 9.17 „ 1948 7.53 „ 1949 8.15 „ 1950 8.56 „ 1951 9.6 „ 1952 9.14 „ 1953 8.8 „ „ 1954 8.1 „ The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1955. The standardised death rate which allows for comparison with other parts of the country is 10.4. 17 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1955. Causes of Death. M. F. Total All Causes 416 396 812 1 Tuberculosis, respiratory 6 5 11 2 Tuberculosis, other 1 1 2 3 Syphilitic disease 1 — 1 4 Diphtheria — — — 5 Whooping Cough — — — 6 Meningococcal infections — — — 7 Acute poliomyelitis — — — 8 Measles — — — 9 Other infective and parasitic diseases – – – 10 Malignant neoplasm, stomach 13 13 26 11 Malignant neoplasm, lung, bronchus 42 6 48 12 Malignant neoplasm, breast — 16 16 13 Malignant neoplasm, uterus — 10 10 14 Other malignant and lymphatic neoplasms 44 31 75 15 Leukaemia, aleukaemia 3 2 5 16 Diabetes 2 5 7 17 Vascular lesions of nervous system 38 64 102 18 Coronary disease, angina 82 51 133 19 Hypertension with heart disease 6 19 25 20 Other heart disease 36 44 80 21 Other circulatory disease 19 25 44 22 Influenza — 1 1 23 Pneumonia 15 17 32 24 Bronchitis 28 16 44 25 Other diseases of the respiratory system 7 3 10 26 Ulcer of stomach and duodenum 7 6 13 27 Gastritis enteritis and diarrhœa 3 6 9 28 Nephritis and nephrosis 1 6 7 29 Hyperplasia of prostate 5 — 5 30 Pregnancy, childbirth, abortion — 1 1 31 Congenital malformations 4 5 9 32 Other defined and ill-defined diseases 28 28 56 33 Motor vehicle accidents 7 4 11 34 All other accidents 10 3 13 35 Suicide 8 8 16 36 Homicide and operations of war — — — 18 19 INFANT MORTALITY, 1955 DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1955 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0— I — 2_ 3- 4— 5— 6— 7— 14— 21— 28- 2 3— 4— 5— 6— 7— 8— 9— 10— 11— 12 Congenital Malformation, Premature Birth 1 1 1 1 2 1 1 Acute Tracheo-bronchitis 2 Anencephaly 1 Atelectasis I Atelectasis, Prematurity 1 1 Collapse of Lungs, Low Forceps Delivery for Disproportion 1 Broncho Pneumonia, Atelectasis 1 Syringomyelocele 1 Totals 7 2 2 — — — — 1 1 — 1 4 — 1 — — 1 — — — — — The number of infants under one year of age who died during the year 1955 as shown by the table is 20. 14 of these deaths, that is 70 per cent. occurred in the neonatal period (within one month of birth). In 1954 the corresponding figure was 82.6 per cent. 19 were registered during the year giving an infantile mortality rate per 1,000 live births of 17.0 Rates over previous years have been:— 1945 33.9 per 1,000 live births 1946 29.5 „ „ „ „ 1947 28.6 ,, ,, ,, ,, 1948 19.03 „ ,, ,, ,, 1949 24.0 „ „ „ „ 1950 14.48 „ „ „ „ 1951 24.76 „ „ „ „ 1952 11.34 „ „ „ „ 1953 14.36 „ ,, ,, ,, 1954 22.1 „ „ „ „ Maternal Deaths. There was one maternal death during the year giving a maternal mortality rate of 0.88 per 1,000 Live and Stillbirths. Rates over previous years have been:— 1945 Nil per 1,000 live and stillbirths 1946 1.73 „ ,, ,, ,, ,, 1947 1.19 ,, ,, ,, ,, ,, 1948 Nil ,, ,, ,, ,, „ 1949 0.78 „ „ „ „ ,, 1950 0.84 ,, ,, ,, ,, ,, 1951 Nil „ „ „ „ ,, 1952 0.93 ,, ,, ,, ,, ,, 1953 2.63 ,, ,, ,, ,, ,, 1954 Nil „ „ „ ,, ,, 2 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, but it was found necessary to invoke the National Assistance (Amendment) Act, 1951 to effect the removal of an old lady, living alone, to hospital. Action taken under Section 50. It was not necessary to arrange any burials 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 156 occasions and 153 post-mortem examinations were made. 18 inquests were held. 21 LABORATORY FACILITIES. Pathological and bacteriological specimens are sent to the Public Health Laboratory at Maidstone. This service ceased to be the responsibility of the County Council as from the 1st October, 1955, when it was taken over by the Public Health Laboratory Service, directed by the Medical Research Council for the Ministry of Health. 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 78 Total 83 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 4 No. of patients provided for:— Maternity 5 Others 64 Total 69 22 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. List of Adoptive Acts, etc., in force. Acts. Date Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 Public Libraries Act,1892-1919 Oct. 1896 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 23 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. There have been no important extensions of trunk mains and there have been no changes in the general scheme of supply to the Borough during 1955 except that the area supplied from Castlewood reservoir now has water from Bexley well and not Thames-derived and Deptford well. Bacteriological analyses are made at least five times a week from all supplies and in the case of the wells the water is sampled both before and after chlorination. The water derived from the River Thames is sampled at each stage of the purification process and tanks to provide an adequate period of contact of the chlorine with the water are now in operation at all the well stations and at Walton works. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically. During the year 12 samples of water from piped supplies were taken and submitted to the Public Health Laboratory for bacteriological examination and all were found to be satisfactory. (ii) Drainage and Sewerage. Sewers have been constructed on the following estates:— Halcot No. 3 Estate S.W. Sewers = 178 lin. yds. Foul Sewers = 104 lin. yds. Cold Blow Crescent Foul Sewer = 115 lin. yds. In addition to the above mentioned works, short lengths of sewers of back drainage system have been constructed to serve small numbers of houses erected by private developers. 2. Rivers and Streams. One case of pollution of rivers or streams was found during the year. 24 CHIEF SANITARY INSPECTOR'S REPORT. Health Department, 8, 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 1955. During the year Mr. F. W. Willington, District Sanitary Inspector, retired by reason of permanent ill-health, and Mr. G. F. Lovegrove resigned to take up an appointment in Uganda. Mr. Willington had been with the Council for 20 years, and Mr. Lovegrove, for a similar period. Their going was a distinct loss to the Department, particularly as some difficulty was experienced in filling these posts. The report consists mainly of a tabulated record of work carried out by the Sanitary Inspectors. 25 TABLE No. 1. Details of Inspection Work Carried Out. Inspections Re-inspections Houses inspected (all particulars recorded) 8 56 Houses inspected (defects only recorded) 187 722 Houses inspected (certificates of disrepair) 12 13 Houses inspected (improvement grants) 19 1 Houses inspected (Housing Act, 1936, Overcrowding) 28 15 Houses inspected re Infectious Disease (including scabies) 179 79 Factories with mechanical power 193 13 Factories without mechanical power 28 2 Outworkers' premises 54 — Other premises under the Act 18 3 Bakehouses 82 7 Water Samples 20 — Food and Drugs Act re Samples 266 — Dairies and distributors 99 — Ice Cream premises 151 21 Restaurants, etc. 225 24 Fish premises 189 17 Meat Shops 620 57 Public Houses 38 4 Shops re unsound food 300 17 Other premises where food is prepared 538 33 Offensive accumulations 36 25 Stables 39 — Keeping of Animals 26 13 Rats 345 295 Drains inspected 949 743 Drains tested (water, smoke or colour) 142 13 Dustbins 21 23 Verminous premises 40 35 Smoke observations 27 12 Tents, Vans and Sheds 2 — Refuse Tips 512 3 Refuse Removal and Salvage 617 25 Conveniences 233 3 Pet Animals Act, 1951 36 2 Cleansing Station and Mortuary 19 — Council House applicants 468 185 Shops Act, 1950 718 12 National Assistance Act, 1948—Sec. 47 17 5 Miscellaneous inspections 986 74 26 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 19 Provided with sufficient ashplace accommodation 11 Provided with sufficient water supply 4 Houses Improved Internally— Dirty rooms cleansed 17 Walls and ceilings repaired 35 Dampness in rooms remedied 72 Defective floors repaired 25 Ventilation of Rooms improved 14 Windows repaired 31 Stoves, fireplaces, etc. provided or repaired 16 Houses Improved Externally— Roofs repaired 25 Eaves gutters and down spouts fixed or repaired 27 Yards paved or repaired 1 Chimney stacks repaired 4 Walls repointed or repaired 20 Miscellaneous repairs 24 Drainage— Drains cleansed or repaired 632 New drains constructed 5 New Gullies provided 4 Ventilation of drainage system improved 2 Inspection chambers built or improved 20 Waste pipes provided or improved 5 New sinks provided 2 Offensive accumulation removed 6 Nuisances from animals abated 3 Other nuisances abated 1 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 49 Houses visited including revisits 258 Rooms disinfected 16 Notices delivered to Education Authorities, etc. 212 27 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered. Beef lbs. 1,008 Offals ,, 354½ Pork ,, 55 Bacon ,, 1151 Sausages ,, 69 Corned Beef ,, 615¾ Lamb ,, 4 Ham and Cooked Meats ,, 7234 Kidneys ,, 84 Black Pudding ,, 12 Cheese ,, 483 Flour ,, 32 Suet ,, —½ Dried Fruit ,, 72½ Biscuits ,, 85¼ Confectionery ,, 8 Fish ,, 353½ Fish Tins 149 Meat ,, 356 Milk ,, 365 Vegetables ,, 983 Fruit and Fruit Juices ,, 934 Preserves ,, 49 Soups ,, 120 Gravy Powder ,, 12 Tomatoes Boxes 87 Cereals Pkts. 24 Preserves Jars 8 Cream ,, 3 Pickles and Sauces ,, 63 Wafer and Chocolate Biscuits 159 Veal and Ham Pies 27 Miscellaneous Items 47 Condemned food is disposed of by burying at the Council's refuse tip. 28 TABLE No. 5. Factories Act, 1937. 1. Inspections for Purposes of Provisions as to Health. Including Inspections made by Sanitary Inspectors. Premises. Number of:— tions. Written Notices. cutions. 1 2 3 4 Factories without mechanical power 84 — — Factories with mechanical power 295 4 — *Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) *Electrical Stations should be reckoned as factories. 21 — — Total 400 4 – 2. Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.I) 5 4 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) 2 2 — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7)— Insufficient — – – – Unsuitable or defective 2 2 — — Not separate for sexes — — — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 1 1 – – Total 10 9 — — 29 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. Some difficulty was again experienced at certain periods of the year in maintaining a weekly collection of refuse, largely owing to shortage of labour. In these days of full employment, vacancies for refuse collectors are not easy to fill, and having regard to the nature of the work, the rate of pay is not in my opinion sufficient to attract the right type of recruit. During the year trials were held with several of the larger types of refuse collecting vehicles, and as a result of these the Council decided to purchase two Karrier Loadmasters and three Shelvoke & Drewry Fore and Aft tippers to replace old vehicles. These have now been delivered, and are proving very satisfactory. All refuse was disposed of by controlled tipping at the East Wickham Tip. A muledozer is used for consolidating and levelling the refuse, and covering material is obtained by excavating soil from the site by means of a Chaseside Shovel. The decision of the Minister of Housing and Local Government with regard to the proposal to fill certain chalk and gravel pits in the North West Kent area with house refuse has now been received, and consent has been given to fill the two gravel pits at Stone, near Dartford, in which the Council are interested. Negotiations are at present in progress with the Associated Portland Cement Manufacturers, who are the owners, for a long term agreement to fill these pits, and when completed they will provide the Council with tipping space for at least twenty years. When filling is commenced at Stone, the average haul to the disposal point will be increased from 2½ miles to 7 miles, and it is largely for this reason that the Council are replacing their existing freighters with vehicles of a larger carrying capacity. 30 Salvage. Details of salvage sales for the financial year ended 31st March, 1956, are set out below: Tons. cwts. qrs. £ s. d. Waste Paper 590 12 1 4,842 17 11 Textiles 22 16 2 463 19 0 Ferrous Metal 62 11 3 162 16 3 Non-Ferrous Metals 1 10 1 97 16 3 Miscellaneous Items 5 2 1 20 9 0 682 13 0 5,587 18 5 The arrangement whereby kitchen waste from the communal street bins in the area is collected 2-3 times weekly by a contractor was continued, and has worked satisfactorily. 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 Russell Park, Bexleyheath. 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 further conveniences at Avenue Road, Bexleyheath, and these were completed in May, 1956. 31 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 is installed on the roof of the Education Office in Brampton Road, Bexleyheath, and the following table gives the results obtained during 1955. 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 2.38 12.27 0.34 8.54 3.40 11.68 1.81 1.17 4.51 23.95 February 1.24 8.93 0.23 6.38 2.32 8.56 1.44 1.07 3.39 17.48 March 0.90 8.73 0.17 6.90 1.66 7.30 1.11 0.81 2.39 16.02 April 0.65 10.26 0.23 7.83 2.20 6.18 1.14 0.49 2.30 16.43 May 3.82 9.25 0.23 7.06 1.95 9.06 1.21 0.91 3.36 18.31 June 2.10 10.02 0.17 7.77 2.07 10.57 1.68 0.84 3.25 20.59 July 0.026 14.32 0.12 10.49 3.71 8.69 1.58 0.54 2.96 23.02 August 0.81 18.04 0.07 9.46 8.51 9.06 1.75 0.62 3.89 27.10 September 2.46 6.83 0.15 4.68 1.99 5.44 0.67 0.67 1.05 12.27 October 3.21 9.90 0.10 6.52 3.28 11.14 0.94 1.34 3.54 21.04 November 0.48 6.98 0.11 5.15 1.71 5.44 0.87 0.52 2.47 12.42 December 1.75 6.98 0.05 5.03 1.89 7.58 1.14 1.01 3.15 14.57 A Lead Peroxide instrument for estimating atmospheric sulphur-dioxide was installed on the 1st July, 1956, and the results obtained to the end of the year are set out below:— MONTH Area Exposed Weight of Ba SO4 Wt. of SO3 Collected Mg. of S03/day Collected by 100 sq. cm. of Batch A P6 O2 (Louvered Cover) In Sample In Control Due to Exposure Sq. Cm. Mg. Mg. Mg. Mg./100 sq. Cm./day July 100 99.6 3.6 96.0 1.03 0.93 August 100 112.0 6.4 105.6 1.21 1.09 September 100 109.2 6.8 102.4 1.10 0.99 October 95 190.0 4.6 185.4 2.31 2.08 November 95 197.6 5.2 192.4 2.32 2.09 December 100 191.2 3.2 188.0 2.02 1.82 32 PREVENTION OF DAMAGE BY PESTS ACT, 1949. One full time Rodent Operative is employed by the Department for the treatment of surface infestations, and the test baiting and maintenance treatment of sewers is carried out by men under the control of the Borough Engineer. No charge is made for treatment carried out at private dwelling houses, but the occupiers of business premises are charged for disinfestation work. Most of the infestations found are of minor character, and a large proportion of the cases dealt with at private dwelling houses are connected with the keeping of animals. Details of surface infestations dealt with during the period are set out below. Number of Properties Inspected 856 Number of Inspections 3,527 Number of Infestations found: Rats—Major 1 Minor 294 Mice 42 Number of Properties Treated Rats Mice Local Authority's premises 3 — Dwelling Houses 274 29 Business Premises 18 13 PET ANIMALS ACT, 1951. Licences to keep pet shops were issued to 6 persons under the above Act. One contravention of the conditions of the Licence was found and a warning issued to the person concerned. 33 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 775 shops on the Council's Register at the end of the year. During the year 730 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. 34 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 0-59 0-2 Absent Shallow end 0-69 0-6 Absent Verminous Premises. During the year a total of 17 premises found to be infested with bed bugs were treated with satisfactory results: 9 of these were Council Houses, and 8 other premises. Seven 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. These visits take up considerable time, but there is no doubt that they serve a useful purpose in preventing the spread of infestations. Infestations at other premises were dealt with as follows: Cockroaches 2, Woodworm 1, Flies 2, Moths 3. Wasps. The destruction of wasps nests is undertaken by the Department and during the year 16 nests were destroyed. A charge of 5s. Od. is made for this service. Schools. There are 32 County Modern and County Primary Schools, a Day Technical School for Girls and a Grammar School in the Borough. 35 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 306 Wickham Street 72 East Wickham— Glenmore Road No. 1 116 Glenmore Road No. 2 87 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 36 2,405 252 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) 195 (b) Number of inspections made for the purpose (including re-inspection) 973 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 8 (b) Number of inspections made for the purpose (including re-inspection) 64 (3) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (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 159 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 134 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 4 (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners 3 (b) By local authority in default of owners — B. Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 1 37 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 6 (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 4 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 1 (3) Number of dwelling houses demolished by informal action 12 D. Proceedings under Section 12 of the Housing Act, 1936— (a) Number of Closing Orders made — (b) Parts of Buildings closed Slum Clearance. In accordance with Section 1 of the Housing Repairs and Rents Act, 1954, proposals for dealing with a total of 441 houses within five years were submitted to the Minister of Housing and Local Government and were approved. 261 of these houses are the East Wickham Hutments, which are the subject of compulsory Purchase Orders, and the remaining 180 are privately owned houses which will be dealt with by action under either Section 11 or Section 25 of the Housing Act, 1936, during the five years. During 1955 the remaining seven hutments on the Lodge Lane Estate were demolished, and the re-developm'ent of the estate continued. Improvement Grants. 32 applications were made for Improvement Grants under the Housing Act, 1949, but grants were approved in three cases only up to the end of the year. The cost of the improvements in these three cases totalled £716 9s. 0d., and the grants made amounted to £331 6s. 6d. Housing Repairs and Rents Act, 1954. Only five applications were received for certificates of disrepair under the above Act during the year, and four certificates were issued. Two certificates were revoked on the application of the owners. 38 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 Milk) Regulations, 1949:— Dealers' Licences:— Pasteurised Milk 30 Tuberculin Tested Milk 29 Sterilised Milk 38 Supplementary Licences:— Pasteurised Milk 5 Tuberculin Tested Milk 5 Sterilised Milk 6 15 samples of school milk were forwarded to the Public Health Laboratory for the Methylene Blue and Phosphatase Tests, and all were satisfactory. (b) Slaughterhouses. There are no slaughterhouses in the area, and the majority of the butchers obtain their supplies through Smithfield Market. 39 (c) Adulteration of Food. Food and Drugs Act, 1938. The following table summarises the 238 samples taken during the year. Formal Informal Milk 12 — Soup, Meat Extracts 5 2 Pastes, Potted Meat — 6 Pudding or Cake Mixture, Flour, etc. ... 2 4 Jellies, Custard Powders, etc 2 6 Patent Medicines 2 4 Sausages, Sausage Meat, etc 8 3 Tea 1 2 Condiments, Sauces, Pickles, Spices, etc. 6 20 Pure Coffee, Coffee Extracts, Coffee and Chicory 3 — Meat Pies and Puddings — 1 Cereals 4 Sweets and Confectionery 21 26 Essences — 4 Butter and Fats 5 8 Water Ices 1 2 Ice Cream 10 1 Minerals 1 13 Beverages — 1 Wines and Spirits 7 — Peanut Butter — 1 Preserves 1 1 Condensed Milk — 2 Ground Almonds 1 Cream 1 5 Dried Fruit 3 1 Baking Powder — 2 Cakes 1 — Cheese and Savoury Spreads — 4 Fish — 5 Glace Cherries — Olive Oil — 2 Desiccated Coconut 3 Stewed Steak — Beans in Tomato Sauce — 1 Butter Beans and Baked Beans — 2 Biscuits 1 3 Bread — Arrowroot — 100 138 40 Legal Proceedings. The following Legal proceedings were instituted during (he year:— (1) Bread—Foreign matter in bread. Fined £20 plus £2 12s. 6d. costs. (2) Milk—Dirty Bottle. Fined £10 plus £2 12s. 6d. costs. (3) Fruit Cake—Nail in Cake. Fined £5 plus 10s. witness expenses. (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 22 Greengrocers 45 Sweet Shops 62 General Provisions 90 Bakers and Confectioners 25 Wet and Fried Fish Shops 20 Public Houses 41 349 During the year 2,422 visits were made and the following is a summary of various improvements carried out. Hot water supply provided or improved 1 Floors, walls, ceilings, etc. repaired 6 Cockroach infestation dealt with 1 Rooms Cleansed 29 Water closet accommodation improved 6 Additional protection provided for foodstuffs 2 Accumulation of refuse removed 6 Accommodation for storage of refuse improved 10 Food preparing room improved 2 Washing accommodation improved 3 Drainage repaired or improved 6 Food storage accommodation improved 1 Yard paving repaired 1 Accommodation for clothing 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 136 Preparation of Sausages, etc 47 23 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. 41 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 48 cases were notified as compared with 123 the previous year. Of these 5 were isolated in hospital and 43 were isolated at home. No. of deaths Nil Return cases from Hospital cases Nil Return cases from home nursed cases Nil 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:— 42 43 Immunisation against Diphtheria and Vaccination against Smallpox, 1955. 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, 1955:— (A) Diphtheria Immunisation. Year of Birth 1956 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 Total Primary Inoculations 32 572 58 7 8 12 48 15 7 15 3 5 — 1 — 783 Re-inforcing Inoculations — — — 1 11 354 100 29 18 17 21 65 2 3 1 622 (B) Vaccination. Year of Birth 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 Before 1941 Total Primary Vaccination 472 262 4 6 2 2 5 4 — — 2 2 — — 3 46 810 Re-vaccination 2 — 1 — 1 2 1 2 1 1 1 1 — — 3 86 102 Immunisation against Diphtheria, 1955. 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, 1955, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1941). Year of Birth 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 Total Last complete course of injections (whether p imarv or booster) 1951—1955 70 148 261 274 475 1055 1354 1049 1021 1151 1002 958 960 713 32 10523 1950 or earlier 623 588 571 853 440 86 89 290 555 8 4103 Typhoid Fever and Paratyphoid Fever. There were 2 cases of paratyphoid fever notified during the year and both were treated in hospital. Puerperal Pyrexia. 9 cases were notified during the year, of which 5 were from Bexleyheath Maternity Hospital, where they were isolated and treated. No cases were removed to other hospitals and 4 cases were isolated at home. Ophthalmia Neonatorum. There were no cases notified during the year. Measles. 1,762 cases were notified during the year. 5 cases were treated in hospital. Whooping Cough. 176 cases were notified, 1 of which was treated in hospital. Acute Poliomyelitis. 8 Paralytic cases and 13 Non-Paralytic cases were notified and with the exception of 1 Non-Paralytic case treated at home, all were treated in hospital. There were no deaths. Scabies. 5 cases notified during the year. Food Poisoning. 14 cases were notified during the year, all were treated at home. Malaria. 2 cases were notified, both were contracted abroad. 44 45 The following table gives the particulars concerning the cases of Infectious Diseases (other than Tuberculosis) notified in the area during the year. NOTIFIABLE DISEASES (Other than Tuberculosis) DURING THE YEAR 1955. DISEASE. Total cases not! fled 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 48 — 5 4 34 2 2 i 5 Diphtheria — — — — Puerperal Pyrexia 9 — — — — — 4 5 5 — Ophthalmia Neonatorum — — — — — — — Acute Paralytic Poliomyelitis 8 — 1 1 2 1 — 3 — 8 — Acute Non-Paralytic Poliomyelitis 13 — 3 2 2 5 — 1 — 12 — Pneumonia 29 — 2 3 3 — — 21 9 1 Erysipelas 18 — — — 1 — — 17 — — Food Poisoning 14 — 1 1 1 — 1 10 — Dysentery 3 1 — — 2 — — 1 — Typhoid Fever — — — — — Paratyphoid Fever 2 — — — 1 — 1 — — 2 — Meningococcal Infection 1 — — — — — — I — 1 — Measles 1,762 29 312 393 993 21 8 6 — 5 — Whooping Cough 176 10 35 48 80 2 — 1 — 1 Scabies 5 — — — 2 2 1 Malaria 2 2 — — — Totals 2,090 40 359 452 1,121 33 16 69 — 49 1 TUBERCULOSIS. During the year 82 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1955 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 1 — — — — — — 6—14 — 1 1 — — — — — 15—24 12 12 — — — — — — 25—44 15 6 2 1 1 2 — — 45—64 21 4 1 — 4 2 1 — 65 2 1 — — 1 1 — 1 Age Unknown — — — — — — — — Totals 52 25 4 1 6 5 1 1 There were no deaths from non-notified cases during the year. Pulmonary. Non-Pulmonary. Total. M F M F No. on Register at commencement of year 512 347 43 44 946 No. on Register at end of year 516 343 39 42 940 Rehousing. 6 cases were referred to me by the Chest Physician for rehousing and during the year four cases were rehoused by the Housing Committee. 46 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1955 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 J. C. Canton. Vice-Chairman: Miss M. Woodward, L.L.A., L.G.S.M. Alderman M. J. Corr Alderman Mrs. H. F. Piggott Councillor S. H. Philpot Councillor Mrs. E. M. Sheppard Councillor Mrs. J. Tatham Councillor W. P. Webster Co-opted Members: Miss D. C. Collins, O.B.E. Revd. E. Maynard Wilson Revd. A. E. Ramsbottom, B.D. Borough Education Officer ... W. E. D. Stephens, M.A. Deputy Borough Education Officer R. R. Sutton * SCHOOL HEALTH SERVICE Medical Officer of Health Assistant Medical Officers Ophthalmic Surgeon Orthopaedic Surgeons Dental Officers Orthodontist John Landon, M.R.C.S., L.R.C.P., D.P.H. 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. (Full-time from 3.10.55). Sybil R. Yeates, M.B., B.S., M.R.C.S., L.R.C.P. Roland M. Chambers, M.B., B.S.. D.O.M.S. K. F. Hulbert, F.R.C.S. B. Lawson, F.R.C.S. P. G. Arnold, L.D.S., R.C.S. (Eng.). (Part-time). G. Wilson Lawrence, L.D.S., R.C.S. Neil K. Thorn, L.D.S., R.C.S., (London). (Part-time). 48 Health Visitors Miss K. P. Hart, S.R.N., S.C.M., and Health Visitor's Certificate. Mrs. A. E. Matthews, S.R.N., S.C.M. (Temporary). Miss L. G. Exley, S.R.N., S.C.M., and Health Visitor's Certificate (Part-time). Mrs. C. A. Tucker, S.R.N., S.C.M., and Health Visitor's Certificate (Part-time). Mrs. M. T. Layton, S.R.N., S.C.M., and Health Visitor's Certificate (Part-time). Mrs. M. Avers, S.R.N. (Part-time). Physiotherapist Miss R. Cheeseman, M.C.S.P.. M.S.R. Speech Therapists Mrs. D. Rant, L.C.S.T. Mrs. R. Pyett, L.C.S.T. (from 21.3.55). Dental Attendants Mrs. Ivy Birtchnell. Miss K. Dunkley. Mrs. V. Sproul. Miss J. A. Smith — Hygienist. School Health Service Clerk Miss M. C. A. Smith. General Clerks Miss O. G. Turnbull. Miss R. Thomas. Miss E. Turner. 49 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1955. To the Chairman and Members of the Welfare and School Attendance Sub-Committee. Mr. Chairman Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1955. Once again it is my pleasant duty to report that nutritional standards among the school children were high during the year. The recognition by medical officers that some degree of subjectivity is unavoidable in such assessments ensures that no undue emphasis is placed upon them but it can be maintained that these results, which are based on height and weight, posture, muscularity and the amount of subcutaneous fat and general appearance, when combined with a knowledge of school performance and, in some cases, of the home environment of the child as well, can be a useful and practical guide. During 1955 children were classified into three groups, A. B and C, and it will be seen from Table IIB on page 68 (Classification of General Condition) that only 2.38% of the 5,003 children assessed in this way were in the lowest category. It is now 20 years since the term " malnutrition " was omitted from the return required by the Board of Education and the fourfold A, B, C, D Classification adopted. The latter has, for some years, been superseded by the three categories used in this report. As from the 1st June, 1956, the heading " General Condition" will be amended to " Physical Condition ", and it is intended that this will be a summing up of the medical officer's opinion of the child's physical condition as a whole. In addition, the A, B, C. Classification will be replaced by only two categories, " Satisfactory " and " Unsatisfactory ". The reason for this change is a practical one in that every child whose physical condition is considered unsatisfactory will be thoroughly investigated and this will include his home circumstances, sleep, diet, etc. and the appropriate remedies applied. It is, sometimes, not sufficiently appreciated that the periodic medical inspection of school children which was designed when Ihe School Health Service first came into operation in 1907 to detect, as early as possible, any physical defects which might prevent the child from profiting from his 50 education has become, with the passage of time, what has been well called " a periodic health audit of the whole child " which is taken to mean not only the physical aspects of health, but his mental and personality aspects as well. It will be evident that, in recent years, our conception of health has widened considerably and, as has been said elsewhere in this report, higher levels of health are being sought which are linked up, not merely with the discovery of overt disease but with the functional wholeness of the child and his ability to make the best use of his natural endowments and his educational opportunities. It follows from this that greater emphasis must, nowadays, be placed on the psychological health of the child, and this is well exemplified in a report which I have received from one of our medical officers. " Work in the Minor Ailment Clinic in this area, during the last year, has been remarkable for the shift of emphasis from physical disease to psychosomatic disorders and overt behaviour problems which now account for about 75% of the time spent there. The change is thought to be due to the increased awareness on the part of parents and teachers to the importance of these difficulties and their social implications. The general practitioners, too, with whom there is excellent co-operation, are usually pleased to be relieved of responsibilities in this field. The specialized training required for this very responsible work is, in the nature of things, still lacking, but increased liaison with the Child Guidance Clinic helps to bridge the gap. The Minor Ailment Clinic now corresponds, in its concern with nurture in its widest sense, to the Welfare Clinics for the pre-school child ". I should like to acknowledge the help which we receive from Dr. Zausmer, the Director of the Crayford Child Guidance Clinic, and his staff in elucidating the many problems of this nature which are so frequently encountered. During 1955, routine gramophone audiometry was continued and the 9 year age group, numbering 1,348 children, was examined. Routine audiometry will, in future, become an intrinsic part of the School Health Service in the Borough of Bexley and, at the time of writing, arrangements are in hand for the purchase of a Pure Tone Sweep Frequency Audiometer which has many advantages over the gramophone audiometer and can be applied even to the youngest school age groups as writing is not required. Further advantages are that the apparatus is easily portable and the tests can be done in a small room, thus reducing dislocation 51 of school work to a minimum. As in previous audiometric surveys, children found to have a significant hearing loss will, after examination by the medical staff, be referred, if necessary, to the Ear, Nose and Throat Clinic at the West Hill Hospital, Dartford. The services provided by this clinic leave little to be desired. Appointments are made promptly and there is an excellent liaison between the specialists and their staff and ourselves. The staffing position in the School Dental Service is still unsatisfactory, arising from the difficulty in recruiting dental staff. There is no easy solution to this nation-wide problem and relief may only be forthcoming with the appointment of dental auxiliaries in accordance with the provisions of the new Dentists Act. It may well be there are certain dental procedures which could be handed over to technicians but it will always be necessary for the latter to work under the close supervision of dental surgeons. It is regrettable that such a scheme should be necessary but the alternative appears to be an indefinite continuation of the present shortage which places great difficulties in the path of any comprehensive scheme of preventive dentistry. A second possible measure which would require governmental action is the fluoridation of water supplies with a view to preventing the onset of dental caries and if this had the desired effect, the available denial staffs would be in a better position to cope more adequately with the smaller burden of caries resulting therefrom. Il is not sufficiently recognised that the water supplying this area is, practically, devoid of fluorine while there is growing experimental evidence that the presence of this element in the proportion of about one part per million in the water supply may make the teeth of children much less liable to decay. Experimental fluoridation projects are in operation in a number of areas in the United Kingdom and it is hoped that this area will one day reap the benefit of the results of these investigations. Unfortunately, both are long term projects, which are unlikely to affect the present unsatisfactory position for a number of years to come. Of more immediate assistance would be the recognition that excess of sugar is an enemy of dental health in children. At a recent conference on preventive dentistry it was generally agreed that sugar taken at meal times is comparatively harmless to the teeth but that the frequent eating of sweets and the sucking of iced lollies in between meals were the chief dangers. Regular cleaning of the teeth is essential but one often meets cases 52 where children clean their teeth before retiring and then are allowed to eat sweets or biscuits before going to sleep. This is, undoubtedly, asking for trouble. The opening of the new Grammar School and the Gravel Hill County Primary School during the year has meant increased responsibility for the School Health Service but, with a suitable adjustment in the medical staff, the additional work has been assimilated without difficulty. A feature of the health of schoolchildren in the Borough for many years has been the exceptionally low rate of infestation of schoolchildren with vermin. This is now being recognised by a substantial reduction in the number of school inspections by Health Visitors for this purpose. In future, cleanliness inspections will be carried out in secondary schools only when they are requested by head teachers. In primary schools regular cleanliness inspections will be discontinued where, at three consecutive inspections, no cases of uncleanliness have been found but further inspections will be made if requested by the head teacher or it appears that special circumstances warrant an intensification of this work. Once again I am happy to report on the greatly improved facilities for speech therapy, arising out of the extended facilities now provided at the Murchison Avenue Clinic. Staff and parents alike are pleased that children can now be sent for within a very short time of referral. The Ophthalmic Clinic has, over the past nine years, reached a high degree of stability and for this reason has not called for any special comment. A study of the statistics of the work carried out at this clinic on page 59 will show that a considerable amount of work has been carried out during the year by Dr. Chambers and his staff. It is our intention, in future, to institute an eye examination for 5 year old as soon as possible after admission to school and this will increase still further the work of this clinic. In effect, each child will have a routine eye test on at least five occasions during his school life, which should ensure that no child experiences educational difficulty on account of defective vision. Once again, I wish to acknowledge the excellent co-operation that exists between head teachers, parents, school medical officers, health visitors and the various specialist services upon which we call. The work of the Education Welfare Officers is especially valuable and their careful case reports on individual children are often the starting point of an investigation of considerable importance to the health of the children concerned. 53 The School Health Service has, in the course of a year, to cope with an enormous amount of detail, which calls for an efficient and painstaking office administration. Particularly important is the follow-up system which ensures that the health of the school child is kept under constant review, as nothing is so calculated to forfeit the confidence of parents as a promised appointment in, shall we say, a year's time, which is not promptly made. 1 wish, therefore, to record my appreciation of the help which I have received during the year from Miss Smith, the Senior Clerk, and her assistants. I wish, also, to express my thanks to all my colleagues in the School Health Service and to the County Medical Officer and his staff and the Borough Education Officer and his department for much help and assistance. Finally, I wish to thank the Chairman and Members of the Welfare and School Attendance Sub-Committee for the great interest which they take in the work of the School Health Service and for the encouragement which I have received from them at all times. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, John Landon, Medical Officer of Health 54 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Bexley Grammar School. Average number on Roll at 31st December, 1955 155 Bexley County Technical School for Girls. Average number on Roll. Bexley 993 Wilmington Annex 213 Seven County Secondary Schools. Average number on Roll 3,191 Twenty-five County Primary Schools. Average number on Roll 7,563 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, 9.0-10.0 a.m. Doctor in attendance—Tuesday and Saturday. Bexley—Murchison Avenue. Tuesday and Friday, 9.30-11 a.m. Doctor in attendance—Friday. 55 Dental. Welling—Little Danson, Dansington Road. Monday 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 p.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 p.m. 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. 56 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. 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 67 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—1955. Average number of pupils in attendance:— Primary School 6,842 Secondary Schools 4,295 11,137 Average number of dinners served to children daily: — Paid Free Total Primary 3,181 63 3,244 Secondary 2,554 80 2,634 57 Milk. Average number of pupils taking milk daily:— Primary 6,883 Secondary 2,584 Total 9,467 Orthopaedic Clinic. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on the Orthopaedic Clinic:— The Orthopaedic Clinic at Welling has continued throughout the year on the first and third Wednesday mornings of the month. There has been some decrease in the numbers attending, but there has been no change in the type of case sent up. Miss Cheeseman has continued as Physiotherapist for the past year and her services are very much appreciated by all. The observations in my previous reports about lack of accommodation still applies, and we are still cramped in our activities. And to Mr. B. Lawson, F.R.C.S., for the following:— The Orthopaedic Clinic for 1955 has shown no great variation from 1954. The patients were referred mainly for abnormilities of the feet, legs and posture, which included three severe scolioses. Operations on the feet were mainly confined to flexor extensor transplants for claw toes and isolated operations on individual toes. One congenital dislocation of the hip was transferred to West Hill Hospital and is making satisfactory progress under my treatment there. X-Ray facilities generally would be better if nearer at hand. There is some delay between seeing the patient and reviewing the X-Rays, as clinics are only held at one monthly intervals. However, in cases of semi-urgency I have transferred these to West Hill. Dental Treatment. I am indebted to Mr. N. K. Thorn, L.D.S., R.C.S., for the following report:— 58 In a general way, orthodontic work is in great demand and is a very popular side of dentistry. Not many private practitioners are eager to do this type of treatment and therefore orthodontics should be an important part of the School Dental Service. 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 vear and the waiting list has rarely exceeded four weeks. The following tables illustrate some of the special cases seen at the clinic during the year:— Congenital. Ptosis 16 Nystagmus 12 Lens Opacities 8 Epicanthus 7 Colour Defects 45 Acquired. Constitutional. Migraine 25 Anxiety States (with ocular symptoms). 30 Infective. Styes 14 Acute Conjunctivitis 7 Corneal scars 8 Others. Meilbomian Cysts 5 Squamous Blepharitis 33 Refractions Referred to Hospital 22 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. 59 Speech Therapy. I am indebted to Miss Joan Pollitt, Chief Speech Therapist to the Kent Education Committee for the following report:— During March, 1955, the Speech Therapy Clinic was transferred from Wrotham Road to rooms adjoining the Murchison Avenue School and Maternity and Child Welfare Clinic. Two Rooms are now available for use as "fulltime "Speech Therapy Clinics. It has therefore been possible for Mrs. Rant to work at the clinic during eight sessions instead of two sessions as formerly, and for Miss Beaumont to give a further four sessions each week. Throughout the year, two students, attending Speech Therapy Training Schools in London, have gained experience in clinical practice by each attending for two sessions per week. These new arrangements have had the effect of reducing the waiting list from eighty-one at the end of 1954 to eleven at the end of 1955; of these eleven, six are "Bexley" children. One "Bexley" child is on the waiting list at the Crayford Clinic. The cases of seventy-two children, who are under the care of the Bexley Authority, have been closed during 1955. Sixty-one of these children have attended at the Bexley Clinic, eight at the Sidcup Clinic and three at the Crayford Clinic. The cases of these seventy-two children have been closed for the following reasons:— Satisfactory result 27 Treatment incomplete owing to parents discontinuing appointments or owing to family leaving the district after some progress had been made 9 Found to have improved when first seen by the therapist 7 Reported to have improved prior to appointments being offered or when appointments were offered 5 Investigation incomplete 2 Appointments offered but no appointments kept. Owing to the long waiting list which was in existence at the end of 1954, some of these cases had been referred two or more years before appointments were offered 22 72 60 Fifty-eight cases under the care of the Bexley Authority, who were attending at the clinics during 1955 will continue to attend into 1956. One of these children attends at the Crayford Clinic, three attend at the Sidcup Clinic and the remaining fifty-four children attend at the Murchison Avenue Clinic. Cleanliness Inspections. (See Table III). During the year the School Nurses carried out 12,233 examinations of children in School and 26 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. Attention is drawn to the foreword to this report for details of the new arrangements in regard to these inspections. PHYSICAL EDUCATION. I am indebted to the Physical Education Advisers, Mr. J. M. Pell and Miss J. Hulton, for the following report:— During recent years some experiments and investigation has been in progress in an effort to determine the most effective type of Physical Education for building strong healthy members of the community. It is now time to take stock to see whether our present schemes are on the right lines and whether we are achieving our aims. The realisation that a child has need of many and varied outlets for development, makes it more than ever necessary to formulate provision during the full school course for a wider range of physical activities than formerly, which will be fully developmental and which may be usefully continued as receation in adolescence and adult life. If we are to enable an individual to reach his full capacity there can be no standard formula or mass production methods that can be applied to large groups of children with their differing backgrounds and personalities, taught under widely varying conditions. But this freedom from standardised lessons does imply greater responsibility for the teacher; it places great demands on the teacher's powers of observation and requires more detailed understanding of 61 the individual pupil and of the fundamental principals underlying schemes of work. These fundamental principles must not be lost sight of in the widening programmes ahead. The growing interest in Television was generally thought to be disadvantageous to participation in practical activities and conducive to an age of physical comfort and inactivity. Instead however, it seems as though this medium can be harnessed to form a splendid ally; the sports programme, technical training series and competitions of varying physical activities have provided additional interest in techniques and generally stimulated effort to the right direction. During the year 1955 physical education in the schools in the Bexley area has been generally alive, interesting and progressive and the standard of effort at all levels has been fully maintained, despite considerable movement of teachers to schools in other areas. Gymnastics. On the boys' side, gymnastics have remained the primary means of physical education, but increased attention has been given to some non-gymnastic activities popular in the boys' post-school life. During the year under review, indoor work in boys' schools has developed along two distinct lines, and opportunities have been afforded to assess the relative merits of each:— (1) General Schemes in which individual lessons were devoted to developmental work of a gymnastic nature, together with a number of separate skills from various sports and games. (2) Blocked Schemes in which one particular facet of physical education was allocated a number of consecutive periods, the various branches of Physical Education being given due attention throughout the academic year. In Boys' Secondary Schools " circuit training " has been introduced as a means of developing strength and of providing challenge to older boys. It is hoped that this method of training will give a new incentive to the less skilful performer, since it relates an individual's performance to his physical ability. Some experiments have been made in Secondary Schools during 1955 to allow a certain amount of choice of activity to 62 older boys and girls. In doing so, recognition has been given to the wide range over which human physique can vary and to the fact that successful performance in the different fields of physical education is often closely related to physique. Where there is adequate accommodation and sufficiently qualified physical education staff, this development has proved most successful and appears worthy of closer attention in the future. Outdoor Games and Sports. Games, once again, suffered most from the vagaries of inclement weather during the early months of the year and the unsuitable footgear often worn by many pupils, especially girls, has definitely limited the scope of training. Training in the basic skills of the major games, sports and athletics has continued as part of the normal curriculum, and facilities have on the whole been well used. More attention has been paid to increasing the number of track and fiield events in athletics and to choosing more than one major game during winter and summer. With the increase in the number of outdoor activities covered there remains, in some cases, much to be done to improve teaching methods and teaching technique if the playing field activities are to be taught with the precision which has been accorded in the past to indoor gymnastics. In some cases it is anticipated that, in the future, more time will need to be given in games lessons to training individual and team skills if the different outdoor games and sports are to be grounded effectively, and the limited time available is to be used to the best advantage. An account of the physical education scheme in Schools would be incomplete without reference to its full expression in competitions and tournaments outside school hours. To this end numerous teachers have given freely of their time and energy in organising and conducting inter-bouse, interschool and inter-district matches in a variety of activities, thus enabling a host of children in the Borough to get a weekly game at their appropriate level in the seasonal sports. Swimming Instruction. It is encouraging to find in the schools of the Borough an increasing awareness of the value of the teaching of swimming. One school situated some distance from a 63 Swimming Bath, has prepared plans and collected enough money to install a small training bath on the school site; it is hoped to begin work on the project during 1956. Attendances, during the Summer Term, at Plumstead, Eltham Hill, Eltham Park and Danson Park were:— Schools. Attendances. No. of Children. 6 Secondary 15 classes (25-30 children) approx. 455 per week. 11 Primary 27 classes (25-35 children) approx. 820 per week. Total 1,275 A total of 286 Swimming Certificates for distances between 25 yards and 1 mile was issued during the year; two schools continued swimming at the Plumstead Bath throughout the Autumn and Spring Terms. Further Training of Teachers The further training of teachers is an essential factor in the introduction of new ideas and methods of teaching. During the year opportunities have been provided for attendance at the following Courses:— (i) Physical Education for men and women teachers in Junior Schools. (ii) Physical Education with special reference to climbing apparatus for women teachers in Infant Schools. (iii) Movement training for teachers in Primary Schools. (iv) Gymnastics for men teachers in Secondary Schools. All these Courses attracted encouraging support and attendances were appreciable throughout. In conclusion, I wish to express my thanks to the Borough Education Officer and his staff for their valuable support, as well as my appreciation of the good work done by the Head and Assistant Teachers in the schools. 64 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 Orthopædic and Postural Defects. Group V Other Treatment given. Table V Dental Inspection and Treatment including Orthodontics. Table VI — Handicapped Children. 65 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. — Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 1,110 Second Age Group 1,224 Third Age Group 793 Total 3,127 Number of other Periodic Inspections 1,876 Grand Total 5,003 B. — Other Inspections. Number of Special Inspections 1,792 Number of Re-Inspections 3,500 Total 5,292 C. — Pupils Found to Require Treatment. Number of Individual Pupils found at Periodic Medical Inspection to require Treatment: Group For defective vision (excluding squint) For any of the other conditions recorded in Table IIA Total Individual pupils (1) (2) (3) (4) Entrants 48 170 182 Second Age Group 116 237 299 Third Age Group 68 126 174 Total (prescribed groups) 232 533 655 Other Periodc Inspections 190 283 396 Grand Total 422 816 1051 66 TABLE II. A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1955. Defect Code Defector Disease No. PERIODIC INSPECTIONS SPECIAL INSPECTIONS No. of defects No. of defects Repairing 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 136 169 80 13 5. Eyes— a. Vision 422 534 64 15 b. Squint 85 78 10 3 c. Other 80 51 38 9 6. Ears— a. Hearing 37 275 37 64 b. Otitis media 12 71 6 3 c. Other 52 75 8 5 7. Nose or Throat 121 583 99 69 8. Speech 18 53 19 4 9. Cervical Glands 11 286 4 7 10. Heart and Circulation 10 104 11 34 11. Lungs 23 318 42 78 12. Developmental— a. Hernia 11 23 — 1 b. Other 26 159 4 3 13. Orthopædic— a. Posture 89 163 2 4 b. Flat Foot 132 203 10 5 c. Other 73 419 35 28 14. Nervous System— a. Epilepsy 6 25 2 14 b. Other 4 34 14 22 15. Psychological— a. Development 5 79 31 103 b. Stability 12 321 90 77 16. Other 48 157 174 176 67 B. — Classification of the General Condition of Pupils Inspected during the Year in the Age Groups. Ago Groups No. of Pupils Inspected A. (Good) B. (Fair) C. (Poor) No. % of col. 2 No. % of col. 2 No. % of col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 1110 428 38.56 653 58.83 29 2.61 Second Age Group 1224 602 49.19 598 48.85 24 1.96 Third Age Group 793 405 52.00 379 47.00 9 1.00 Other Periodic Inspections 1876 792 42.22 1010 53.84 74 3.94 Total ... 5003 2227 45.49 2640 52.13 136 2.38 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 12,233 (ii) Total number of pupils on roll of schools visited 10,122 (iii) Total number of individual pupils found to be infested 26 (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) - 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 - 68 (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 8 — (ii) Body 10 — Scabies 5 — Impetigo 4 — Other skin diseases ... 109 — Total 136 — Group II.—Eye Diseases, Defective Vision and Squint. No. of Cases dealt with by the Authority otherwise External and other, excluding errors of refraction and squint ... 210 — Errors of refraction (including squint) 1,922 22 Total 2,132 22 Number of pupils for whom spectacles were (a) Prescribed 667 — (b) Obtained 538 — 69 Group III.—Diseases and Defects of Ear, Nose and Throat. Number of cases treated by the Received operative treatment Authority otherwise (a) for diseases of the ear — — (b) for adenoids and chronictonsilitis — 75 (c) for other nose and throat condition — 4 Received other forms of treatment — 12 Total — 91 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 188 25 Group V.—Other Treatment Given. Number of cases treated by the Authority otherwise (a) Miscellaneous minor ailments 806 — (b) Other 1. Minor Eye Defects 114 — 2. Minor Ear Defects 114 — 3. Minor Injuries 30 — Total 1,064 — 70 TABLE V. Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 1,660 (b) Specials 1,712 Total (1) 3,372 (2) Number found to require treatment 2,450 (3) Number referred for treatment 2,450 (4) Number actually treated 1,646* (5) Attendances made by pupils for treatment 4,013* (6) Half days devoted to: Inspection 11 Treatment 688 Total (6) 699 (7) Fillings: Permanent Teeth 1,574 Temporary Teeth 1,511 Total (7) 3,085 (8) Number of teeth filled: Permanent Teeth 1,467 Temporary Teeth 1,477 Total (8) 2,944 (9) Extractions: Permanent Teeth 267 Temporary Teeth 772 Total (9) 1,039 (10) Administration of general anaesthetics for extraction 375 (11) Other operations: Permanent Teeth 1,057* Temporary Teeth 178 Total (11) 1,235 * These figures include orthodontic work. 71 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) PhysicallyHandicapped (7) Educationally sub-normal (8) Maladjusted (9) Epileptic Total (1) to (9) On or about 31 January, 1956:— (1) (2) (3) (4) (5) («) (7) («) (9) (10) A. Handicapped Pupils newly placed in Day Special Schools or Boarding Homes - - - 3 - 4 9 1 - 17 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes 1 - - 2 39 4 6 5 - 57 On or about 31st January, 1950 :— C. Number of Handicapped Pupils from the area:— (i) attending Special Schools as: (a) Day Pupils — 3 4 1 — 11 23 - - 42 (b) Boarding Pupils 3 1 1 1 16 5 5 6 - 38 (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) 3 4 5 3 16 16 28 6 - 81 D. Were being educated under arrangements made under Section 56 of the Education Act, 1944:— (i) In hospitals - - - - - 1 - - - 1 (ii) In other groups (e.g. units for spastics) - - - - - - - - - - (iii) At home 1 - - - 1 5 1 - - 8 E. Were requiring places in special schools:— (i) TOTAL (a) day 7 (b) Boarding — — — — — 4 2 — 6 Please state how many pupils are included in the totals above:— (ii) who had not reached the age of 5: (a) awaiting day places - - - - - - - - - - (b) awaiting boarding places - - - - - - - - - - (iii) who had reached the age of 5, but whose parents had not consented to their admission to a special school: (a) awaiting day places - - - - - - 2 - - 2 (b) awaiting boarding places - - - - - - - - - - Number of children reported during the year :— (a) Under Section 57(3) (excluding any returned under (b) ) 3 (b) „ „ „ relying on Section 57(4) (c) „ 57(5) 3 of the Education Act, 1944, 72 INDEX. item page Health Committee 2 Public Health Staff 3 Foreword 4— 9 STATISTICS AND SOCIAL CONDITIONS. Acreage 10 Population 10 New Houses Erected 10 Unemployment 10 Social Conditions and Amenities 10—11 Population Graph 12 Summary of Vital Statistics 13—14 Extracts from Vital Statistics— Births and Birth Rates 14—15 Stillbirths and Stillbirth Rates 15 Deaths and Death Rates 16—17 Causes of Death 18 Infantile Mortality 19—20 Maternal Deaths 20 GENERAL PROVISIONS OF HEALTH SERVICES. Isolation Hospital Accommodation 21 General Hospitals 21 Ambulance Facilities 21 National Assistance Act, 1948 21 Public Mortuary 21 Laboratory Facilities 22 Registration of Nursing Homes 22 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 23 Water Supply 24 Drainage and Sewerage 24 Rivers and Streams 24 Chief Sanitary Inspector's Report— Tables of Inspections and Improvements, etc. 26—27 Food Inspection 28 Tables—Factories Act, 1937 29 Closet Accommodation 30 Public Cleansing Service 30 Refuse Collection and Disposal 30 Salvage 31 Public Conveniences 31 Atmospheric Pollution 32 Prevention of Damage by Pests Act, 1949 33 Pet Animals Act, 1951 33 Shops Act, 1950 34 Swimming Pool 35 Verminous Premises 35 Wasp Destruction 35 Schools 35 73 ITEM PAGE HOUSING. Council Estates 36 Inspection of Dwelling Houses 37 Remedy of Defects without formal notice 37 Action under Statutory Powers 37—38 Clearance Schemes 38 Improvement Grants 38 Housing Repairs and Rents Act, 1954 38 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 39 Slaughterhouses 39 Adulteration of Food—Food & Drugs Act, 1938 40—41 Food Shops and Food Manufacturing Premises 41 Registration of Premises 41 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 42 Diphtheria 42 Diphtheria Immunisation and Smallpox Vaccination 43 Typhoid Fever and Para Typhoid Fever 44 Puerperal Pyrexia 44 Ophthalmia Neonatorum 44 Measles 44 Whooping Cough 44 Acute Anterior Poliomyelitis 44 Scabies 44 Food Poisoning 44 Malaria 44 Tables of Infectious Diseases Notified 45 Tuberculosis 46 SCHOOL HEALTH SERVICES REPORT, 1954. Welfare and School Attendance Sub-Committee 48 Staff 48—49 Foreword 50—54 Schools 55 Clinics 55—56 Co-ordination— Periodic Medical Inspections 57 School Meals and Milk 57—58 Orthopaedic Clinic 58 Dental Treatment 58—59 Ophthalmic Clinic 59 Speech Therapy 60—61 Cleanliness Inspections 61 Physical Education 61—64 Statistical Tables 65—72 74