BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Services For the Year 1956 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health For the Year 1956 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health Borough of Bexley. Mayor: Councillor Dudley C. Clarke, J.P. Deputy Mayor: Councillor G. C. Morton. HEALTH COMMITTEE. Chairman: Alderman Mrs. H. F. Piggott. Vice-Chairman: Alderman M. J. Corr. Alderman J. M. Pawson. Councillor N. S. Harrild. Councillor F. G. Donovan. Councillor S. H. Philpot. Councillor Mrs. D. A. Shearn, Councillor Mrs. J. Tatham. Councillor Mrs. E. M. Sheppard. 2 PUBLIC HEALTH STAFF, 1956. 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 Public Health Inspector, Public Cleansing Officer and Shops Acts Inspector. *† G. Hind, M.S.I.A. Deputy Chief Public Health Inspector. *† J. T. Boocock. District Public Health Inspectors *† W. E. Moses. *† W. C. B. Gilhespy (Appointed 20.8.56). *† D.T. Rees (Appointed 19.11.56). *† D. W. Townsend (Resigned 15.7.56). *† J. R. Greig (Resigned 15.4.56). Chief Clerk G. A. Pearson. Senior Clerk R. V. Hoad. Clerks E. M. Pearmine (Miss). M. E. Smith (Miss) (Shorthand Typist). Left 31.1.56. I. D. Dashfield (Mrs.) (Shorthand Typist) (Appointed 17.3.56). Public Analyst H. E. Monk, B.Sc., F.R.I.C. Refuse Foreman G. E. Packman. Public Health General Assistant A. C. Ward. * Certificate for Inspection of Meat and other Foods. t 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 1956. From the standpoint of the customary vital statistics, the health of the Borough has been well maintained. The infant mortality rate for 1956 was 26.64 per thousand live births compared with 17.0 per thousand in 1955 and an analysis of these deaths shows that 22 deaths occurred during the first month of life (neo-natal deaths) the causes of which were associated with prematurity and congenital malformation, over which no significant degree of control is possible at present. Of the 8 deaths occurring after the neo-natal period 7 were due to respiratory infections complicated in 2 cases by congenital defects. The vital statistics are fully set out on pages 11-19, together with comparisons for each year in the past decade. In regard to infectious disease, poliomyelitis constitutes the main challenge at the present time and little is known as to the conditions which determine whether any particular year will experience a heavy or mild incidence. In the present state of knowledge, the most direct way of eliminating cases or, alternatively, of preventing serious paralysis, is the vaccination of as many individuals as possible, and it must be borne in mind that, although children must be given priority, all age groups in the population are susceptible and vaccination may well have to be extended to adults as well. This, obviously, would introduce problems of the supply of vaccine and, also, of medical and nursing manpower to cope with the large scale of operations required. In Bexley, 578 registered children in the age group of 2 to 9 years were inoculated during 1956 under arrangements made by the Local Health Authority. These facilities are now being extended to include children between the ages of one and two years. 4 Tuberculosis is a disease which, from the national point of view, is diminishing both in incidence and mortality and, by a combination of B.C.G. vaccination, mass radiography and modern medical and surgical treatment combined with the close supervision of infective cases within the community, it is likely that the risks from this disease could be reduced in the next quarter of a century to a very considerable degree. In the Borough of Bexley a study of the figures for notifications and deaths over the past 20 years shows that, while deaths have fallen considerably, notifications of new cases have not decreased to the same extent but this may be due to better methods of ascertainment, e.g. by Mass Miniature Radiography. It cannot be stressed too often that tuberculosis, when associated with a serious degree of overcrowding and the presence of susceptible children, is a hazard which must constantly be borne in mind. During 1956, a small outbreak of paratyphoid B infection was experienced in the Borough, a small number of cases occurring also, in the Borough of Erith and the Urban District of Crayford. Full details of this outbreak are given on page 43. Cancer of the lung, which has attracted much attention in recent years because of its apparent association, inter alia, with smoking, caused fewer deaths in the Borough in 1956 (28 cases) than in 1955 (48 cases) but there is no cause for complacency as statistics show that, taking the country as a whole, the mortality from this disease continues to rise. In my 1955 Report I stated, " 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." I think this is a warning which deserves to be repeated in view of the evidence, on good authority, that smoking among late schoolagers, in many parts of the country, is by no means inconsiderable. With the passing of the Clean Air Act, 1956, the prevention of atmospheric pollution received its main legislative impetus, although one should not minimise the long term nature of the project which the Act envisages and the difficult technical problems which are involved. Locally, of course, the main emphasis is on the establishment and 5 gradual expansion of smoke control areas and the need to work in close collaboration with neighbouring authorities has already been recognised by the Council. Although the Borough of Bexley does not experience the worst effect of atmospheric pollution, it will be recalled that about 50 per cent of such pollution results from the domestic hearth and much foresight will be called for in the installation, in new housing estates, of heating appliances capable of burning smokeless fuels. The availability of these fuels is an important aspect which is, no doubt, receiving the attention both of the Government and the various agencies concerned with their production. The implementation of the Clean Air Act, also, raises problems of staffing and it has not yet been decided whether the public health inspectors will be called upon to undertake, not only the considerable task of detection of smoke nuisances (which they already exercise as a Public Health Act function), but also the task of examining and reporting upon existing fuel appliances in the home and advising on the types of appliances by which they should be replaced in appropriate cases. The problem of health education of the public in connection with the declaration of smokeless zones is another matter which introduces the problem of staffing, and indeed, this applies to health education in general. In my 1954 report I stated, " A good case could be made for the appointment of a Health Education Officer to serve the Borough or such wider area as appeared to be indicated," and I am becoming more than ever convinced that such a development may be necessary. A comprehensive policy of health education is a fairly costly matter and one of the main difficulties is the fact that health education is regarded in governmental circles as a matter for the Local Health Authority (The Kent County Council) under Section 28 of the National Health Service Act, 1946 dealing with Prevention of Illness Care and After Care, and it is often forgotten that county districts, also, have a responsibility for this matter under Section 179 of the Public Health Act of 1936. This dichotomy of function is a real stumbling block from the point of view of instituting a full programme of health education in the Borough. The need to disseminate accurate information on personal hygiene, on the prevention of accidents in the home and on the principles of healthy living in general, as well as on the nature and meaning of health, is becoming one of the most important aspects of 6 health administration. This is dictated, not only by the needs of the individual, but by the need also for economy in the use of the National Health Service, the cost of which continues to rise from year to year. The work of the Bexley, Erith and Crayford Home Safety Committee continued with the task of spreading information in regard to causes and prevention of accidents in the home. The Rotary Club of Bexley, during the year, presented an exhibition stand to this Committee which is being used to disseminate propaganda in the form of leaflets and posters over the area. The stand was made by the Staff and boys of the Westwood County Secondary School and our thanks are due both to the Rotary Club and the School for their help. The future of the health services in the Borough is closely linked up with the White paper of May, 1957 on Functions of County Councils and County District Councils in England and Wales. The automatic right to delegation of local health and welfare services to non-county boroughs and urban districts of 60,000 or more would, if translated into legislation, bring about a valuable integration of the personal and environmental services and provide a more local administration—a matter which has been constantly in the mind of the Council since the coming into operation of the National Health Service Act, 1946, on July 5th 1948. In conclusion, I wish to thank the Chairman and Members of the Health Committee for their support and encouragement, and the Chief Public Health 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. 7 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. New Dwellings Erected. Registrar General's Houses 423 Estimate midyear, 89,300. Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1946 82+ 64 rebuilt 1935 59,970 1947 199+ 216 rebuilt 1940 77,670 1948 334+ 286 rebuilt 1945 75,040 1949 138+ 73 rebuilt 1950 89,410 1950 102+ 15 rebuilt 1951 (Census) 88,420 1951 319 1952 88,160 1952 355 1953 87,990 1953 265 1954 88,180 1954 503 1955 88,780 1955 529 Number of inhabited houses at end of 1956 (according to Rate Books) approximately 27,469 Rateable Value £1,250,166 Sum represented by a penny rate £5,080 Unemployment. Men Women Boys Girls Total December 31st, 1955 120 86 13 9 228 December, 31st 1956 172 85 10 7 274 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 reach the optimum standards for which the Council are striving. 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 1.64 „ The Warren, Broomfield Road, Bexleyheath 12.47 „ Westwood Estate Children's Playground, Welling .60 „ Total 513.4905 „ Facilities for outdoor games are provided in many of these open spaces, including the large Swimming Pool in Danson Park, opened in July, 1936. 9 GRAPH SHOWING RISE IN POPULATION SINCE 1931 SUMMARY OF VITAL STATISTICS England and Wales. Borough of Bexley. Rates per 1,000 Home Population. Birtht— Live 15.6 13.2 Still 10.37 0.28 (23.0(a) 20.8(a) Deaths— All Causes 11.7 9.4 Typhoid and Paratyphoid 0.00 — Whooping Cough 0.00 — Diphtheria 0.00 — Tuberculosis 0.12 0.11 Influenza 0.06 0.01 Smallpox — — Acute Poliomyelitis (including Polioencephalitis) 0.00 – Pneumonia 0.52 0.44 Notifications (corrected) Typhoid Fever 0.00 — Paratyphoid Fever 0.01 0.20 Meningococcal Infection 0.03 — Scarlet Fever 0.74 0.91 Whooping Cough 2.07 1.32 Diphtheria 0.00 — Erysipelas 0.10 0.10 Smallpox — — Measles 3.59 1.39 Pneumonia 0.57 0.26 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.04 0.01 Non-Paralytic 0.03 0.03 Food Poisoning 0.25 0.08 Puerperal Pyrexia 16.31(a) 11.65(a) Rates per 1,000 Live Births. Deaths All causes under one year of age 23.8(b) 24.6 Enteritis and Diarrhœa under two years of age 0.51 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. 11 Maternal Mortality England and Wales Borough of Bexley Rates per 1,000 total live and still births Maternal causes, excluding abortion 0.46 Nil Due to abortion 0.10 Nil Total maternal mortality 0.56 Nil EXTRACTS FROM VITAL STATISTICS FOR THE Year 1956, The Registrar General's Estimate of home population for the mid-year is 89,300 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 596 581 1,177 Legitimate 576 567 1,143 Illegitimate 20 14 34 Birth Rate. Rate per 1,000 estimated home population 13.2 The following relates to the Birth Rate during the past ten years: — 1946 Birth Rate 19.75 per thousand 1947 „ „ 18.72 ,, „ 1948 „ „ 15.36 „ ,, 1949 „ „ 14.02 „ „ 1950 „ „ 13.13 „ „ 1951 „ „ 12.79 „ „ 1952 „ „ 12.00 „ „ 1953 „ „ 12.70 „ „ 1954 „ „ 11.80 „ „ 1955 „ „ 12.60 „ „ Rate per 1,000 for England and Wales 15.6 12 34 illegitimate live births were registered against 30 in 1955. The Registrar-General has supplied a comparability factor for 1956. The standardised birth rate which allows for comparison with other parts of the country is 13.6. Stillbirths. Males Females Total Total 6 19 25 Rate per 1,000 total (live and still) births 20.8 25 Stillbirths were registered during the year. This represents a rate of 0.28 per 1,000 population against 0.21 per 1,000 population in 1955. The following relates to the Stillbirth Rate during the past ten years: — Year Rate per Thousand Total Live and Still Births Population 1946 23.6 0.48 1947 21.5 0.41 1948 21.5 0.34 1949 31.01 0.45 1950 11.78 0.16 1951 18.23 0.24 1952 12.18 0.18 1953 12.94 0.28 1954 13.26 0.16 1955 16.7 0.21 Rate per 1,000 for England and Wales 1956 0.37 There were no Stillbirths registered as illegitimate. 13 Deaths. Males Females Total All causes 440 398 838 Death rate per 1,000 of estimated home population 9.4 Number of women dying in, or in consequence of, childbirth: From Puerperal and Post Abortive Sepsis — — From other Puerperal causes — — Death rate per 1,000 total (live and still) births — Deaths of Infants under one year of age 17 12 29 Legitimate 16 12 28 Illegitimate 1 — 1 Death rate of Infants under one year of age: Total per 1,000 live births 24.6 Legitimate per 1,000 legitimate live births 24.5 Illegitimate per 1,000 illegitimate live births 29.4 Deaths from Measles (all ages) — — — Whooping Cough (all ages) — — — „ „ Diarrhoea (under 2 years of age) — — — Cancer (all ages) 77 89 166 Rate per 1,000 for England and Wales, 1956 11.7 14 Death Rate of Area during last ten years: — 1946 8.55 per thousand. 1947 9.17 „ „ 1948 7.53 „ „ 1949 8.15 „ ,, 1950 8.56 „ „ 1951 9.6 „ „ 1952 9.14 „ „ 1953 8.8 „ „ 1954 8.1 „ „ 1955 9.1 „ „ The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1956. The standardised death rate which allows for comparison with other parts of the country is 11.6. 15 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1956. Causes of Death. M. F. Total All Causes 440 398 838 1 Tuberculosis, respiratory 7 2 9 2 Tuberculosis, other — 1 1 3 Syphilitic disease 2 1 3 4 Diphtheria — — — 5 Whooping Cough — — — 6 Meningococcal infections — — — 7 Acute poliomyelitis — — — 8 Measles — — — 9 Other infective and parasitic diseases — 1 1 10 Malignant neoplasm, stomach 13 9 22 11 Malignant neoplasm, lung, bronchus 21 7 28 12 Malignant neoplasm, breast — 15 15 13 Malignant neoplasm, uterus — 7 7 14 Other malignant and lymphatic neoplasms 43 51 94 15 Leukaemia, aleukaemia 5 3 8 16 Diabetes 2 2 4 17 Vascular lesions of nervous system 53 59 112 18 Coronary disease, angina 99 45 144 19 Hypertension with heart disease 7 8 15 20 Other heart disease 33 64 97 21 Other circulatory disease 12 25 37 22 Influenza — 1 1 23 Pneumonia 23 16 39 24 Bronchitis 35 20 55 25 Other diseases of the respiratory system 5 4 9 26 Ulcer of stomach and duodenum 8 2 10 27 Gastritis enteritis and diarrhoea 2 4 6 28 Nephritis and nephrosis 12 6 18 29 Hyperplasia of prostate 4 -— 4 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 4 2 6 32 Other defined and ill-defined diseases 30 35 65 33 Motor vehicle accidents 10 1 11 34 All other accidents 4 1 5 35 Suicide 6 6 12 36 Homicide and operations of war — — — 16 17 DEATHS REGISTERED (IN AGE GROUPS) IN 1956. Under 1 year 1-4 years 5-14 years 15-24 years 25-44 years 45-64 years 65-74 years 75 years and over Total M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory ... ... ... ... ... ... ... ... 1 2 4 ... 2 ... ... ... 7 2 2. Tuberculosis, other ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 3. Syphilitic disease ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... 2 1 4. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Meningococcal infections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7. Acute poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Other infective and parasitic diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 10. Malignant neoplasm, stomach ... ... ... ... ... ... ... ... ... ... 3 1 6 4 4 4 13 9 11. Malignant neoplasm, lung, bronchus ... ... ... ... ... ... ... ... 1 ... 11 4 9 1 ... 2 21 7 12. Malignant neoplasm, breast ... ... ... ... ... ... ... ... ... 1 ... 7 ... 4 ... 3 ... 15 13. Malignant neoplasm, uterus ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 ... 1 ... 7 14. Other malignant and lymphatic neoplasms ... ... ... 1 ... 1 ... ... ... 4 ... 19 13 15 19 11 43 51 15. Leukaemia, aleukeamia ... ... 1 ... ... 1 ... ... ... 1 3 ... ... 1 1 ... 5 3 16. Diabetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 2 17. Vascular lesions of nervous system 1 ... ... ... ... ... ... ... ... ... 16 12 16 21 20 26 53 59 18. Coronary disease, angina ... ... ... ... ... ... ... ... 1 3 35 10 37 13 26 19 99 45 19. Hypertension with heart disease ... ... ... ... ... ... ... ... ... ... 5 ... 1 3 1 5 7 8 20. Other heart disease ... ... ... ... ... ... 1 1 ... 5 5 13 10 9 17 36 33 64 21. Other circulatory disease ... ... ... ... ... ... ... 1 ... ... ... 2 6 4 6 18 12 25 22. Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 23. Pneumonia 2 ... ... ... ... ... ... ... ... ... 3 1 5 3 13 11 23 18 24. Bronchitis 2 1 ... ... ... ... ... ... ... ... 7 4 13 4 13 11 35 20 25. Other diseases of the respiratory system ... 1 ... ... ... ... ... ... ... ... 2 2 ... ... 3 1 5 4 26. Ulcer of stomach and duodenum ... ... ... ... ... ... ... ... 1 ... 3 ... 3 ... 1 2 8 2 27. Gastritis, enteritis and diarrhoea ... ... ... ... ... ... ... ... ... ... 1 2 1 1 ... 1 2 4 28. Nephritis and nephrosis ... ... ... ... ... ... 2 ... 3 ... 6 2 ... 1 1 3 12 6 29. Hyperplasia of prostate ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... 1 ... 30. Pregnancy, childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital malformations 4 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 4 2 32. Other defined and ill defined diseases 8 9 1 1 ... ... 1 1 1 ... 7 5 3 5 9 14 30 35 33. Motor vehicle accidents ... ... ... ... 1 ... 2 ... 3 ... 2 ... 1 1 1 ... 10 1 34. All other accidents ... ... 1 ... ... ... 1 ... ... ... 1 ... 1 ... ... 1 4 1 35. Suicide ... ... ... ... ... ... ... 1 2 1 ... 4 4 ... ... ... 6 6 36. Homicide and operations of war ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 17 12 3 3 1 2 7 4 13 20 125 93 137 92 137 172 440 398 18 INFANT MORTALITY, 1956 DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1956 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0- 1- 2- 3- 4- 5- 6- 7- 14- 21- 28- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12 Congenital Malformation 1 1 1 1 Premature Birth 3 2 1 1 1 Atelectasis, Prematurity 5 1 Pneumonia, Prematurity 1 Bronchopneumonia,Congenital Heart Disease 1 Acute Tracheo Bronchitis 1 1 1 Hæmolvtic Disease of Newborn 1 Pyocephalus Meningitis 1 Empyema at side of Chest 1 Acute Broncho Pneumonia 1 Asthenia, under weight at Birth 1 Broncho Pneumonia, Bronchitis, Mongolism with Congenital Heart Malformation of Uncertain Form 1 Cerebral Oedema, Cerebral Thrombosis, Patent Ductus Arteriosus, Patent Foramen Ovale 1 Totals 9 2 — 3 — 1 1 4 1 — 1 2 1 — — 1 1 1 2 — — — The number of infants under one year of age who died during the year 1956 as shown by the table is 30. 22 of these deaths, that is 73 per cent. occurred in the neonatal period (within one month of birth). In 1955 the corresponding figure was 70 per cent. 29 were registered during the year giving an infantile mortality rate per 1,000 live births of 24.6. Rates over previous years have been:— 1946 29.5 per 1,000 live births 1947 28.6 „ „ „ „ 1948 19.03 „ „ „ „ 1949 24.0 „ „ „ „ 1950 14.48 „ „ „ „ 1951 24.76 „ „ „ „ 1952 11.34 „ „ „ „ 1953 14.36 „ „ „ „ 1954 22.1 „ „ „ „ 1955 17.0 „ „ „ „ Maternal Deaths. There were no maternal deaths during the year. Rates over previous years have been:— 1946 1.73 per 1,000 live and stillbirths 1947 1.19 „ „ „ „ „ „ 1948 Nil „ „ „ „ „ 1949 0.78 „ „ „ „ „ 1950 0.84 „ „ „ „ „ 1951 Nil ,, „ „ „ „ 1952 0.93 „ „ „ „ „ 1953 2.63 „ „ „ „ „ 1954 Nil „ „ „ „ „ 1955 Nil „ „ „ „ „ 19 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Isolation Hospital Accommodation. Patients suffering from infectious disease are 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. During the year a number of cases of elderly persons not receiving proper care and attention (reported to the department) were visited but no statutory action was found to be necessary. Action taken under Section 50. It was not necessary to arrange any burials under this Section during the year. PUBLIC MORTUARY. In 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 139 occasions and 138 post-mortem examinations were made; 20 inquests were held. 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 20 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 4 No. of patients provided for:— Maternity 5 Others 64 Total 69 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 21 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 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 „ 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 Improper Behaviour on School Premises May 1951 The Flying of Model Aircraft Nov. 1951 Public Libraries Jan. 1953 Building Apr. 1954 22 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 filtered water. 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 1956. 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 11 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:— S.W. Sewers 285 lin. yards. Brasted Close. Foul Sewers 53 lin. yards. Fairfield Road. In addition to the above developing owners have constructed private sewers on the following estates: — Stevens No. 10 Estate. Yew Tree Nurseries, Welling. Marina Drive, Welling. Brasted Close, Bexley. South View Close, Bexley Thanet Road, Bexley. Woodstock Close, Bexley. Dane Close, Bexley. These sewers are of the back drainage system and have not as yet been taken over as Public Sewers. 2. Rivers and Streams. One case of pollution of the River Shuttle was found during the year. The cause of the pollution was found to be certain drains which were connected to the storm water sewer instead of the foul sewer. This was remedied, and the pollution ceased. 23 CHIEF PUBLIC HEALTH 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 Public Health Inspector and Public Cleansing Officer to your Council for the year 1956. The report consists mainly of a tabulated record of work carried out by the Public Health Inspectors. 24 TABLE No. 1. Details of Inspection Work Carried Oat. Inspections Re-inspections Houses inspected (all particulars recorded) 22 132 Houses inspected (defects only recorded) 195 672 Houses inspected (certificates of disrepair) 3 6 Houses inspected (improvement grants) 15 3 Houses inspected (Housing Act, 1936, Overcrowding) 22 9 Houses inspected re Infectious Disease (including scabies) 207 193 Factories with mechanical power 82 20 Factories without mechanical power 4 — Outworkers' premises 19 — Other premises under the Act 1 — Bakehouses 132 14 Water Samples 19 1 Food and Drugs Act Samples 323 — Dairies and distributors 44 2 Ice Cream premises 38 11 Restaurants, etc. 168 17 Fish premises 124 32 Meat Shops 296 63 Public Houses 17 4 Shops re unsound food 282 43 Other premises where food is prepared 515 27 Offensive accumulations 59 27 Stables 15 1 Keeping of Animals 18 3 Rats 262 861 Drains inspected 924 537 Drains tested (water, smoke or colour) 137 32 Dustbins 22 14 Verminous premises 33 34 Smoke observations 35 12 Tents, Vans and Sheds 1 1 Refuse Tips 478 3 Refuse Removal and Salvage 610 8 Conveniences 272 1 Pet Animals Act, 1951 25 4 Council House applicants 219 81 Shops Act, 1950 663 21 National Assistance Act, 1948—Sec. 47 9 1 Miscellaneous inspections 1,157 94 25 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses- No. Provided with sufficient w.c. accommodation 40 Provided with sufficient ashplace accomdation 14 Provided with sufficient water supply 14 Houses Improved Internally— Dirty rooms cleansed 10 Walls and ceilings repaired 61 Dampness in rooms remedied 76 Defective floors repaired 12 Ventilation of Rooms improved 36 Windows repaired 49 Stoves, fireplaces, etc. provided or repaired 14 Houses Improved Externally— Roofs repaired 36 Eaves gutters and down spouts fixed or repaired 45 Yards paved or repaired 3 Chimney stacks repaired 4 Walls repointed or repaired 13 Miscellaneous repairs 26 Drainage— Drains cleansed or repaired 724 New drains constructed 2 New Gullies provided — Ventilation of drainage system improved 2 Inspection chambers built or repaired 17 Waste pipes provided or repaired 3 New sinks provided 1 Offensive accumulation removed 6 Nuisances from animals abated — Other nuisances abated 6 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 57 Houses visited including revisits 400 Rooms disinfected 19 Notices delivered to Education Authorities, etc. 268 26 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered and destroyed: Corned Beef lbs. 765¾ Pork Sausages „ 21 Ham „ 128 Tinned Ham „ 306 Pork Luncheon Meat „ 53¾ Beef „ 2,039 Pork „ 39½ Cheese „ 342¼ Cereals „ 7 Veal „ 34 Lamb „ 85½ Liver „ 193 Bacon „ 61 Tongue „ 6 Rabbit „ 30 Ox Kidney „ 22 Fish „ 448 Flour „ 18 Tomatoes „ 1,620 Biscuits „ 2½ Dried Apricots „ 27½ Meat tins 775 Fish „ 71 Soup „ 70 Milk „ 402 Vegetables „ 1,063 Fruit and Fruit Juices „ 1,204 88 Preserves „ Pastes „ 1 Pickles and Sauces jars 17 Preserves „ 4 Custard Powder pkts. 25 Meat Pies „ 24 Miscellaneous items „ 48 27 TABLE No. 5. Factories Act, 1937 and 1948. 1. Inspections for Purposes of Provisions as to Health. Including Inspections made by Public Health Inspectors. Premises. Number of:— Inspections. Written Notices. Prosecutions 1 2 3 4 Factories without mechanical power 23 — — Factories with mechanical power 248 2 — *Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) •Electrical Stations should be reckoned as factories. 1 — — Total 272 2 — 2. Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.1) 4 5 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) 1 — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7)— Insufficient Unsuitable or defective 4 3 — — Not separate for sexes — — — — Other Offences (Not Including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) — — — — Total 9 8 — — 28 Closet Accommodation. With the exception of a few houses, all the closet accommodation in the Borough is on the water carriage system. PUBLIC CLEANSING SERVICE. The Health Committee is responsible for the collection and disposal of house and trade refuse, the collection and sale of salvageable materials and the cleansing and maintenance of public conveniences. Refuse Collection and Disposal. During the early part of the year difficulty was experienced in maintaining a weekly collection of refuse owing to shortage of labour. The Ministry of Labour and National Service were unable to find suitable men, and it was found necessary to advertise in the local press. By this means several men were recruited and a weekly collection was maintained for the remainder of the year. Three Shelvoke and Drewry Fore and Aft Tippers and two Karrier Loadmasters were purchased during the year, and have proved to be very satisfactory. Two open lorries and three side loading Shelvoke and Drewry Freighters were withdrawn from service. All refuse was disposed of by controlled tipping at the East Wickham Tip. The muledozer continues to give good service in levelling and consolidating the refuse, and covering material is obtained partly from outside sources and partly by excavating soil on the site. An agreement was completed with the Associated Portland Cement Manufacturers Ltd. giving the Council exclusive tipping rights in respect of two gravel pits at Stone, near Dartford. The agreement is for a term of twenty one years, and the pits will provide adequate tipping space for this period. When tipping is commenced at these pits, the average haul to the disposal point will be increased from 2\ miles to 7 miles, and it is for this reason that the Council are replacing existing freighters with larger type vehicles. 29 Salvage. Details of salvage sales for the financial year ended 31st March, 1957, are set out below: Tons. cwts. qrs. £ s. d. Waste Paper 583 4 2 4,502 11 8 Textiles 20 12 1 430 4 11 Ferrous Metal 38 15 1 111 9 0 Non-Ferrous Metals 1 12 2 85 9 2 Miscellaneous Items 4 6 0 18 10 0 648 10 2 5,148 4 9 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. Avenue Road, Bexleyheath. Westwood Lane, Blackfen. (Maintained jointly by the Chislehurst and Sidcup Urban District Council and Bexley Corporation). 30 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 1956. 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 SPECIMEN BROKEN IN TRANSIT February 0.10 7.22 0.15 5.40 1.67 4.73 0.70 0.74 1.74 11.95 March 0.87 12.23 0.10 9.72 2.41 11.71 2.48 0.82. 4.88 23.94 April 1.40 14.21 0.13 11.28 2.81 9.98 1.92 0.84 4.13 24.20 May 0.65 8.44 0.03 5.98 2.42 5.13 1.04 0.49 2.06 13.57 June 2.51 6.93 0.13 4.91 1.89 5.64 0.54 0.64 1.91 12.56 July 3.91 6.80 0.09 4.65 2.06 6.85 1.34 0.81 2.98 13.65 August 5.16 7.92 0.13 5.96 1.83 8.86 1.48 1.14 3.21 16.78 September 2.08 6.54 0.14 4.77 1.64 8.32 2.01 0.67 3.62 14.87 October 1.02 6.24 0.10 4.32 1.81 6.68 1.01 0.67 2.82 12.91 November 0.60 7.79 0.02 5.06 2.70 6.31 0.87 0.86 2.53 14.10 December 2.17 10.42 0.11 7.13 3.71 8.12 0.81 1.11 2.71 18.54 A Lead Peroxide instrument for estimating atmospheric sulphur-dioxide was installed on the 1st July, 1956, and the results for the year are set out below.— MONTH Area Exposed Weight of Ba SO4 Wt. of SO4 Collected Mg. of S03/day Collected by 100 sq cm. of Batch A Pb O2 (Louvered Cover) In Sample In Control Due to Exposure Sq. Cm. Mg. Mg Mg. Mg /100 sq. Cm./day January 100 228.0 4.4 223.6 2.56 2.30 February 100 282.4 3.4 279.0 3.30 2.97 March 100 238.4 4.0 234.4 2.44 2.20 April 100 181.6 7.4 174.2 2.13 1.92 May 95 118.8 4.0 114.8 1.34 1.21 June 100 103.6 2.6 101.0 1.12 1.01 July 95 80.0 2.0 78.0 0.94 0.85 August 100 68.0 1.0 67.0 0.70 0.63 September 95 94.0 1.2 92.8 1.20 1.08 October 100 174.8 2.2 172.6 1.91 1.72 November 99.75 316.0 2.4 313.6 3.37 3.03 December 95 176.0 1.5 174.5 2.17 1.95 31 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 891 Number of Inspections 3,341 Number of Infestations found: Rats — Major — Minor 245 Mice 43 Number of Properties Treated Rats Mice Local Authority's premises 2 — Dwelling Houses 227 31 Business Premises 16 13 PET ANIMALS ACT, 1951. Licenses to keep pet shops were issued to 5 persons under the above Act. Two minor contraventions were found during the year. 32 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 784 shops on the Council's Register at the end of the year. During the year 684 inspections were made under the Shops Act, 1950, and no legal proceedings were instituted. I am, Ladies and Gentlemen, Yours obediently, G. HIND, Chief Public Health Inspector. 33 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 are taken by this department monthly during the time the pool is open and the results of bacteriological examinations have been satisfactory on each occasion. Verminous Premises. During the year 6 premises found to be infested with bed bugs were treated with satisfactory results. Infestations at other premises were dealt with as follows:— Cockroaches 3, Flies 1, Moths 3. Wasps. The destruction of wasps nests is undertaken by the Department and during the year 16 nests were destroyed. A charge of 6s. Od. is made for this service. Schools. There are 33 County Modern and County Primary Schools, a Day Technical School for Girls and a Grammar School in the Borough. 34 SECTION D—HOUSING. The following particulars relate to the houses owned by the Council on the various Estates:— 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 348 Wickham Street 74 East Wickham— Glenmore Road No. 1 116 Glenmore Road No. 2 85 Bexleyheath— Highland Road Estate and Pickford Road Estate 304 Cannon Road — 28 Alers Road 84 Halcot Estate No. 1 200 Halcot Estate No. 2 (including Bungalows) 126 Halcot Estate No. 3. 28 Faygate Estate 56 Bristow Road — 60 Upton Close 14 Fairfield — 8 Bexley— Hartford Road Estate and Victoria Road Estate 54 Royal Park Estate No. 1 43 Royal Park Estate No. 2 74 Midhurst Hill 18 Newick Close 2 Henfield Close 7 Rye Close Extension 35 Glenhurst Avenue 30 Merlin Road 1 S.D.A. Houses 8 Hurst Place Estate 143 Rochester Way 9 2,443 250 35 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) 223 (b) Number of inspections made for the purpose (including re-inspection) 1,027 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 28 (b) Number of inspections made for the purpose (including re-inspection) 160 (3) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (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 182 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 174 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 5 (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners 4 (b) By local authority in default of owners 1 B. Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 5 36 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 5 (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 14 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 4 Slum Clearance. During 1956, 34 hutments in the East Wickham Clearance Areas were demolished and the occupants rehoused by the Council in preparation for the redevelopment of the estate. Improvement Grants. Number of applications for improvement grants 43 Number of applications approved 14 Total cost of approved expense of improvements in 14 approved cases £3,520 11 6 Total costs on which grants actually made in 9 of these cases £1,829 11 6 Total amount of grants in the 9 cases £914 16 6 Housing Repairs and Rents Act, 1954. Only three applications were received for certificates of disrepair under the above Act during the year, and three certificates were issued. No certificates were revoked on the application of the owners. 37 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 7 Licences granted by the Council under the Milk (Special Designation) (Raw Milk) Regulations, 1949 to 1954, and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949 to 1953.— Dealers' Licences:— Pasteurised Milk 30 Tuberculin Tested Milk 29 Sterilised Milk 38 Supplementary Licences:— Pasteurised Milk 6 Tuberculin Tested Milk 5 Sterilised Milk 6 16 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. 38 (c) Adulteration of Food. Food and Drugs Act, 1955. The following table summarises the 211 samples taken during the year. Formal Informal Milk 6 — Soup, Meat Extracts 2 5 Pastes, Potted Meat 2 7 Pudding or Cake Mixture, Flour, etc. 2 3 Jellies, Custard Powders, etc. 5 5 Patent Medicines 1 3 Sausages, Sausage Meat, etc. 6 3 Tea 2 1 Condiments, Sauces, Pickles, Spices, etc. 5 11 Pure Coffee, Coffee Extracts, Coffee and Chicory 3 — Meat Pies and Puddings 1 4 Cereals 1 3 Sweets and Confectionery 19 24 Essences — 2 Butter and Fats 13 3 Ice Cream 3 — Minerals 2 4 Beverages 2 1 Wines and Spirits 3 2 Fruit and Fruit Juices 4 5 Fruit Pies and Puddings 2 2 Preserves 4 3 Condensed Milk — 2 Ground Almonds 3 — Cream 2 4 Dried Fruit 2 — Cakes 2 1 Fish 2 6 Tinned Meat 1 6 Coconut 1 — Beans in Tomato Sauce — 2 Biscuits — 1 94 106 In addition to the above, 46 samples of foodstuffs, including Chinese egg, egg albumen, and cakes containing synthetic cream were taken for pathological examination in connection with the paratyphoid outbreak mentioned elsewhere in the Report. Legal Proceedings. Legal proceedings were instituted during the year in respect of Bread containing foreign matter and the vendors were fined £5 plus £3 3s. Od. 39 (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 46 Cafes and Restaurants 23 Greengrocers 49 Sweet Shops 61 General Provisions 91 Bakers and Confectioners 25 Wet and Fried Fish Shops 21 Public Houses42 358 The Food Hygiene Regulations, 1955 came into operation on the 1st January, 1956. All food traders were sent a summary of the main provisions of the Regulations and as a result a large number of improvements were carried out voluntarily. The Regulations necessitated an inspection being made of all food premises. The following table is a summary of the improvements carried out as a result of action by the Department. Hot water supply provided or improved 18 Floors, walls, ceilings, etc., repaired 4 Cockroach infestation dealt with 3 Rooms cleansed 26 Water Closet accommodation improved2 Additional protection provided for foodstuffs 7 Accumulation of refuse removed 4 Accommodation for storage of refuse improved 5 Food preparing room improved 4 Washing accommodation improved 18 Drainage repaired or improved 6 Food storage accommodation improved – Yard cleansed 1 Accommodation for clothing provided or improved Sinks renewed 4 Other contraventions 4 Registration of Premises under Food and Drugs Act, 1955. No. of premises registered for:— Manufacture and Sale of Ice Cream 1 Sale of Ice Cream 144 Preparation of Sausages, etc. 41 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. 40 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 81 cases were notified as compared with 48 the previous year. All were isolated at home. No. of deaths Nil Return cases from Hospital cases Nil Return cases from home nursed cases 2 During the past 15 years the character of this disease has changed from one of considerable severity to one 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:— 41 42 Immunisation again Diphtheria and Vaccination against Smallpox, 1956. 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, 1956:— (A) Diphtheria Immunisation. Year of Birth 1956 1956 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 Total Primary Inoculations 168 793 150 29 13 27 35 11 12 5 4 1 1 — — 1249 Re-inforcing Inoculations — — — 5 60 556 394 76 127 165 88 46 51 6 — 1574 (B) Vaccination. Year of Birth 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 Before 1941 Total Primary Vaccination 619 345 12 5 8 6 1 4 4 1 — 3 1 — 1 46 1056 Re-vaccination — 1 3 3 2 3 2 1 3 1 1 3 — 2 4 103 132 Immunisation against Diphtheria, 1956. 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, 1956, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1942). Year of Birth.. 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 Total Last complete course of injections (whether primary or booster) 1952—1956 65 129 287 316 553 1342 1116 946 915 1105 989 993 863 825 168 10612 1951 or earlier 671 709 866 627 617 154 267 680 405 66 5062 Typhoid Fever and Paratyphoid Fever. A small outbreak of paratyphoid B occurred in the Borough of Bexley (18 confirmed cases), the Urban District of Crayford (four cases) and the Borough of Erith (two cases) in the months of June and July, 1956. A feature of this was the relatively small number of cases, all of which appeared, from the dates of onset, to have been infected at about the same time. In 92 per cent. of the cases there was a history of confectionery having been bought at a particular bakery in the Borough of Bexley. In the remaining cases no direct association with the bakery was discovered, but there was a distinct possibility that confectionery may have been eaten at canteens supplied from this source or at the house of a friend. The first intimation of the presence of paratyphoid B infection in the locality came from a medical practitioner to the effect that a patient living in Crayford had been admitted to a local hospital on 25th June, 1956, as a pyrexia of unknown origin, and had since been diagnosed as a case of paratyphoid fever. Two further cases occurred in this family. A letter was thereupon sent to all medical practitioners in the area, and, during the next fortnight, many suspected cases were visited at home and all those confirmed clinically were admitted either to the Joyce Green Hospital, Dartford, or the Brook Hospital, Shooters Hill. The association with the bakery in question soon became evident from the information brought back by the public health inspectors, and a visit was paid to these premises by the Medical Officer of Health and the Chief Public Health Inspector and all members of the staff were interviewed and the position explained to them. Instructions on the need for the most stringent care in the matter of handwashing was given and an inspection was made of all machinery and equipment used in the bakery. Specimens of faeces were taken from all members of the staff and sent for bacteriological examination. Inquiry showed that no member of the staff had any relevant past history of gastroenteritis. In view of the fact that Chinese frozen liquid egg had been implicated in various parts of the country in connection with outbreaks of paratyphoid fever, samples of this product in current use in the bakery were sent for bacteriological examination, together with samples of powdered 43 egg albumen. One of the samples of Chinese frozen liquid egg yielded salmonella paratyphi B, phage type Taunton and, on the strength of this, an unused 44-lb. tin of this product, together with a quantity of cakes about to be sold and made with Chinese egg, were taken out of circulation and destroyed, notwithstanding the fact that there was no evidence that they were, themselves, infected. In regard to the faecal specimens taken from the staff, a report was received from the Public Health Laboratory at Maidstone, that a specimen from one of the pastrycooks had yielded S. paratyphi B, and it was later ascertained that this was found to be a phage type 1. The results from the Infectious Diseases Hospitals showed that the S. paratyphi B isolated from the 24 patients in the outbreak had all proved to be phage type 1 and in view of this fact the question was raised of whether the pastrycook could have been (a) the primary cause of the outbreak (carrier), or (b) a symptomless excreter due to his having, himself, eaten infected products from the bakery. It will be recalled that a S. paratyphi B phage type Taunton had been recovered from a specimen of Chinese frozen egg taken from the bakery and it, therefore, appeared that the latter could not have been the cause of the outbreak, but I was informed that the isolation of phage type Taunton did not entirely absolve the liquid egg as the cause of the outbreak as a strongly growing organism may overgrow others in culture and that a phage type 1 may still have been present. The pastrycook in question was sent a formal notice in accordance with The Public Health (Infectious Diseases) Regulations, 1953, requiring him to discontinue his occupation until further notice. In the meantime, the Public Health Laboratory Service had been examining the remainder of the consignment of Chinese frozen liquid egg, which was under suspicion in our paratyphoid outbreak and which had been traced by the Ministry of Health to Manchester and Bermondsey. At Manchester samples obtained from 50 tins showed four positives, the species being S. paratyphi B, phage type Taunton, S. thompson, S. meleagridis and S. aberdeen. Among the 91 tins from Bermondsey salmonella had, also, been isolated and the species identified were as follows: thompson (7), aberdeen (1), Stanley (1), paratyphi B dundee (1); 3a var. 1 (1) and type 1 (1); the last, of course, being 44 identical with the strains which were isolated from our cases. Arrangements were made by the Ministry of Health for this consignment of egg to be pasteurised before being returned to circulation. It is considered that this almost removed suspicion from the pastrycook as the primary source of infection and that he probably became infected in the course of his work, although there was no definite proof of this. He could, howver, have acted as a secondary cause of the spread of infection, as he was symptomless. A number of symptomless excreters were also discovered among members of the families of patients, and these were all kept under observation until three consecutive negative stools had been obtained in each case. It is interesting to note that no cases resulted, as far as we are aware, from bakehouse products made with Chinese frozen liquid egg of the batch which had yielded the phage type Taunton, although most of this had been used before our sample was taken from the small residue which remained in the discarded tin. One may assume from this and the fact that so few cases occurred in the outbreak as a whole, that there were definite limiting factors which may have been (1) destruction of organisms in the baking process; (2) the fact that the whole of the tin of egg was not uniformly infected but only in " islands and (3) immunological factors connected with individual resistance and dose of organisms. No secondary cases occurred and the outbreak was considered at an end within four weeks of its commencement. The disease was relatively mild in most cases and showed the classical signs of the disease. All patients were admitted to hospital and made an uneventful recovery. I wish to express my thanks to the Ministry of Health and the Public Health Laboratory Service and, particularly, to the Central Enteric Laboratory, Colindale, for the phage typing. Puerperal Pyrexia. 14 cases were notified during the year, all of which were from Bexleyheath Maternity Hospital, where they were isolated and treated. 45 Ophthalmia Neonatorum. One case was notified during the year and was isolated at home. Measles. 124 cases were notified during the year. One case was treated in hospital. Whooping Cough. 118 cases were notified, 1 of which was treated in hospital. Acute Poliomyelitis. 1 Paralytic case and 3 Non-Paralytic cases were notified. 2 Non-Paralytic cases were treated in hospital. There were no deaths. Scabies. 13 cases notified during the year. Food Poisoning. 7 cases were notified during the year; 3 were treated in hospital. Malaria. 1 case contracted abroad was notified and treated in hospital. 46 47 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 1956. DISEASE. Total cases notified Under 1 1 2 3 4 5 to 9 10 to 14 15 to 24 25 & over Age unknown Cases admitted to Hospital Total Deaths Smallpox — — — — — — — — — — — — — Scarlet Fever 81 — — 6 6 7 43 16 — 3 — — — Diphtheria — — — — — — — — — — — — — Puerperal Pyrexia 14 — — — — — — — 7 7 — 14 — Ophthalmia Neonatorum 1 1 — — — — — — — — — — — Acute Paralytic Poliomyelitis 1 — — — — — — — 1 — — — — Acute Non-Paralytic Poliomyelitis 3 — — — — — 1 — — 2 — 2 — Pneumonia 23 — — — 1 — 2 — 1 19 — 6 1 Erysipelas 9 — — — — — — — — 9 — — — Pood Poisoning 7 — — — — 1 — — — 6 — 3 — Dysentery 2 — — — — — — — — 2 — — — Typhoid Fever — — — — — — — — — — — — — Paratyphoid Fever 18 — 1 — — 1 7 6 1 2 — 16 — Meningococcal Infection — — — — — — — — — — — — — Measles 124 4 8 12 12 10 69 1 2 — — 1 — Whooping Cough 118 10 7 18 19 9 52 1 — 2 — 1 — Scabies 13 — 1 — — — 4 1 — 7 — — — Malaria 1 — — — — 1 — — — — — 1 — Totals 415 15 17 36 38 35 178 25 12 59 — 44 1 TUBERCULOSIS. During the year 94 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1956 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 — — — — — — 5—14 1 — — 2 — — — — 15—24 11 4 1 2 — — — — 25—44 14 10 2 — 1 2 — 1 45—64 28 9 1 1 4 1 — — 65 and over 6 1 — — 2 — — — Totals 59 26 4 5 7 3 — 1 There were two deaths from non-notified cases during the year. Rehousing. 7 cases were referred to me by the Chest Physician for rehousing and during the year, two cases were rehoused by the Housing Committee. 48 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1956 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 W. P. Webster Councillor N. H. Antenbring. Co-opted Members: Miss D. C. Collins, O.B.E. Revd. E. Maynard Wilson Mrs. E. Statham. Borough Education Officer W. E. D. Stephens, M.A. Deputy Borough Education Officer R. R. Sutton SCHOOL HEALTH SERVICE Medical Officer of Health John Landon, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officers Nora Walter, M.B., B.Ch., B.A.O., D.C.H. (Part-time). Stella M. Ring, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H. Sybil R. Yeates, M.B., B.S., M.R.C.S., L.R.C.P. Ophthalmic Surgeon Roland M. Chambers, M.B., B.S., D.O.M.S. Orthopaedic Surgeons K. F. Hulbert, F.R.C.S. B. Lawson, F.R.C.S. Dental Officers P. G. Arnold, L.D.S., R.C.S. (Eng.). (Part-time). G. Wilson Lawrence, L.D.S., R.C.S. Orthodontist Neil K. Thorn, L.D.S., R.C.S., (London). (Part-time). (Resigned 8.2.56). 50 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 P. Martin, S.R.N., S.C.M., and Health Visitor's Certificate. (Transferred to M.&C.W. wholetime Feb. 1956). 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 (Left August, 1956) (Part-time). Mrs. M. T. Layton, S.R.N., S.C.M., and Health Visitor's Certificate (Part-time). Mrs. M. Ayers, S.R.N. (Part-time). Mrs. G. M. Blackmore, S.R.N., S.C.M., and Health Visitor's Certificate (Part-time) (Appointed 10.9.56). Mrs. C. R. C. Cullimore, S.R.N., S.C.M., and Health Visitor's Certificate (part-time) (Appointed 10.9.56). Mrs. P. Webb, S.R.N., S.C.M., and Health Visitor's Certificate. (Part-time) (Appointed 10.9.56). Mrs. Wright, S.R.N., S.C.M., and Health Visitor's Certificate. (Part-time) (Appointed 10.9.56). Physiotherapist Miss R. Checseman. M.C.S.P., M.S.R. Speech Therapists Mrs. D. Rant, L.C.S.T. Mrs. R. Pyett, L.C.S.T. Dental Attendants 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. 51 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1956. To the Chairman and Members of the Welfare and School Attendance Sub-Committee. Mr. Chairman Ladies and Gentlemen, I have the honour to submit my Annual Report on the School Health Service for the year, 1956, the tenth which it has been my privilege to present. The health and nutritional status of the schoolchildren in the Borough continued, in general, to be satisfactory. Reference to the statistics on pages 63 to 70 shows the considerable amount of work carried out by the School Health Service but it gives no indication of the team work and the sense of personal responsibility which has animated the service during the year. This is made possible by the Excepted District status of the Borough which allows for the fullest degree of co-operation between school doctors, health visitors, head teachers, education welfare officers, general practitioners and parents. Easy access through a local centre facilitates consultations between the various agencies concerned with the family aspects of health on which the well-being of the individual child so frequently depends. Often, the help of voluntary agencies has to be enlisted and cases could be quoted where a fund of goodwill from local organisations has been used to improve the environmental background of children in need. The staffing position in the School Dental Service has, at the time of writing, improved by the appointment of a further whole-time dentist and, provided this improvement can be maintained, more attention will be possible to those aspects of preventive dentistry which have had to be neglected in recent years. We are still, however, a long way removed from a staffing position which will ensure a full programme of inspection and treatment of the school population. It is pleasing to report that the dental unit at the Murchison Avenue Clinic is now in operation on a parttime basis and it is hoped that it may be possible to extend these facilities should further dental staff become available. During the year, a pure-tone audiometer was obtained and is now in regular use in the department. Our present policy is to give an individual hearing test to all schoolchildren as soon as possible after their seventh birthday. Our experi- 52 ence, so far, indicates the value of this procedure which reveals many cases of unsuspected hearing loss, at the speech frequencies, which may have prevented the children concerned from deriving the maximum benefit from the spoken word on which their educational progress so largely depends. Even minor departures from the normal are recorded and all cases are followed up and appropriate treatment instituted in school clinic or hospital as required. The co-operation of teachers in ensuring a favourable position in class is always forthcoming. It has been our practice, in the past, to examine the vision of schoolchildren at the Periodic Medical Inspections at five, eight, eleven and fourteen years but as children between these ages are, often, found to have visual defects, arrangements have now been made for additional examinations by the School Nurses at ten and thirteen years at special sessions. In addition any child may have an eye examination at any time on request of a head teacher or parent. From 1956, the third periodic Medical Examination of Schoolchildren which had previously been carried out during the last year in the Junior School will be carried out as soon as possible after the transfer of the child to the Secondary School. The main reason for this decision was that the examination was becoming increasingly burdensome to the Primary Schools as the selection tests for Secondary Education became more elaborate and prolonged and that, in any case, an additional examination at the age of eight is already carried out. The Secondary Schools on the other hand did not have a medical inspection until the children were in their last year and the new arrangement provides an additional opportunity for contact between the School Health Service and the head teachers and staff of the Secondary Schools. An important development in the School Health Service has been the extention of immunisation to include vaccination against tuberculosis and poliomyelitis. B.C.G. vaccination against tuberculosis is now being offered by the Local Health Authority to schoolchildren during their fourteenth year and poliomyelitis vaccination to children born between 1947 and 1956 whose parents decide to have them vaccinated and progress in this work will depend at all times on the availability of vaccine. Mention should, however, be made of the fact that regular vaccination of schoolchildren against diphtheria, tuberculosis and poliomyelitis makes a considerable call on the time of medical officers and health visitors 53 and much thought needs to be given to the phasing of the immunisation programme to avoid any undue dislocation of the general health supervision of the schoolchildren. One of the most important functions of the School Health Service is the ascertainment of children suffering from handicaps and their selection for special education. The categories of handicap as set out in the School Health Service and Handicapped Pupils' Regulations, 1953 are no fewer than ten and include blind, deaf, educationally sub-normal, epileptic, maladjusted, physically handicapped and delicate children. It is our constant endeavour that a handicapped child should lead as normal a life as he can and, wherever possible, attend an ordinary school. There are many cases, however, when the handicap is so severe that the child could not settle down in an ordinary school and might even be exposed to physical danger or social isolation. In these cases a special school carefully chosen to meet the needs of the child is the best solution but it should be our aim, by regular re-assessment of the child's potentialities, to transfer him back to an ordinary school as and when this becomes possible. The essence of the supervision of handicapped children is to teach them to accept and to come to terms with their disabilities and to fit them for as normal a life as possible in society when their school days are over. Once again it is my pleasure to acknowledge the excellent co-operation that exists between head teachers, parents, school medical officers and health visitors and to refer to the work of the education welfare officers whose reports on families and individual children are instrumental in bringing to our notice many departures from health as early as possible. I have already recorded the excellent team work of all members of the staff on which the success of the School Health Service so largely depends and I wish, also, to express my appreciation of the help which I have received during the year from the Chairman and Members of the Committee, from Miss Smith, the Senior Clerk, from the County Medical Officer and his staff and from the Borough Education Officer and his Department. 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, 1956 246 Bexley County Technical School for Girls. Average number on Roll. Bexley 764 Wilmington Annex 184 Eight County Secondary Schools. Average number on Roll 3,376 Twenty-five County Primary Schools. Average number on Roll 7,418 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. Orthopaedic. Welling—Station Approach. Wednesday, 2-4 p.m. Saturday, 9.30-11 a.m. Specialist in attendance 1st and 3rd Wednesday at 10 a.m. Bexley—Murchison Avenue. Monday, 2-5 p m. Thursday, 9.30-11 a m. Specialist in attendance 1st Saturday 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 66 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—1956. Average number of pupils in attendance:— Primary School 7,418 Secondary Schools 4,570 Average number of dinners served to children daily:— Paid Free Total Primary 3,089 55 3,144 Secondary 2,789 76 2,865 57 Milk. Average number of pupils taking milk daily:— Primary 6,489 Secondary 3,131 Total 9,620 Orthopaedic Clinic. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on the Orthopaedic Clinic:— The Orphopsedic Clinic has continued at Welling on the 1st and 3rd Wednesday of every month throughout the year. There has been no marked change in the number or type of case as compared with the previous years. The observations made last year about inadequate accommodation still applies, and it is still very inadequate. There is still, in this area, no special provisions for the education and treatment of spastics, the present arrangements being unsatisfactory in many respects. The present education arrangements do not allow for treatment at school, and an awful lot of time is taken up in fetching children to and from the school for their treatment. Miss Cheeseman has continued her services as Physiotherapist, and we are all indebted to her for all she does. Ophthalmic Clinic. I am indebted to Mr. R. M. Chambers, M.B., B.S., D.O.M.S., for the following report:— The attendances at the clinic have been well maintained during the year. The number of children needing examination under cyclopleagia was about 60% of new cases and I have been struck by the very small number of parents who have refused drops or ointment at the first visit, in fact, I can recall only one case during the year. The difficulties of inserting ointment into the eyes of a frightened child can be overcome by doing this when he or she is asleep, a point which is often overlooked but which is stressed at this clinic, with the result that it is very rare to find a case unsuitably prepared. I fully endorse the proposed amendment to the wording of the Forms 50 and 50a M.I. and am sure that this will 58 help in cases where parents are reluctant to attend a clinic for fear that drops will be applied automatically. The question of advice being refused by a parent, usually the one who does not accompany the child, is often a difficult one to settle fairly. Happily this is rarely met with, but if it does arise, I always try to see, or at least speak by 'phone to the one who is in doubt. I am glad to say that I have not as yet been compelled to ask the Authority to take action in any such cases, due largely to the able help and sweet reasonableness of the many individuals who contribute to the efficiency of this service. The following tables illustrate some of the special cases seen at the clinic during the year:— Infective. Blepharitis 12 Acute Conjuctivitis 6 Styes 14 Meibomian Cysts 7 Non-Infective. Infantile Glaucoma 1 Maxillary Tumour 1 Macular lesion (eclipse blindness) 1 Corneal opacities 3 Coloboma of Optic Disc 1 Neurological. Migraine 24 Congenital Ptosis 3 Nerve palsy 4 Nystagmus 4 Others. Epicanthus 14 Retrolental Fibroplasia 1 Albinism 1 Refractions Referred to Hospital 35 Speech Therapy. I am indebted to Miss Joan Pollitt, Chief Speech Therapist to the Kent Education Committee for the following report:— The cases of forty-two children who are under the care of the Bexley Authority have been closed during 1956. 59 Thirty nine of these children have attended at the Bexley Clinic and three have attended at the Sidcup Clinic. The cases of these forty-two children have been closed for the following reasons:— Satisfactory results following appointment at the clinics 31 Treatment incomplete owing to patient leaving the district or for other reasons. In three cases, great improvement had occurred; in two cases too few appointments had been kept for any appreciable change to have been made 5 Transferred to Child Guidance Clinic 1 Found to have improved whan first seen by speech therapist 1 Investigation incomplete—left district or proved un-cooperative 3 Appointments offered but never kept and no reply received to letters sent to the parents 1 42 Sixty-four children, under the care of the Bexley Authority, who were attending at the clinics during 1956 will continue to attend into 1957. Fifty-six of these children attend at the Bexley Clinic, one attends at the Crayford Clinic and seven attend at the Sidcup Clinic. Eleven children under the care of the Bexley Authority, were waiting appointments at the end of 1956. These children were on the waiting list at the Bexley Clinic. Sweep Frequency Pure Tone Audiometry. During the Educational Year, September 1956 to July 1957, 965 children were tested during their last year in the infants' schools, i.e. during their seventh year. Of this number 867 passed and 98 failed. The latter children were referred to the School Medical Officers for investigation and any minor conditions causing temporary deafness were treated. In addition, 375 children of all age groups were tested as special cases referred from various sources including teachers, and of this number 228 passed and 147 failed. The 375 children mentioned above included those children in the main survey who had been examined by the School Medical Officers and found to require a re-test following treatment or 60 otherwise. The 147 failed children were referred back to the School Medical Officers who, after further examination and treatment where necessary, referred 40 children back for a final audiometric test. Of this number, 23 passed and 17 failed. Further treatment was instituted for the latter childrein either at the School Clinics or at the Ear, Nose and Throat Department of the West Hill Hospital, Dartford, or other hospital in the metropolis. It has been our experience that the regular use of the Pure Tone Audiometer is a great help in the health supervision of the children and has now become a regular part of the work carried out by the School Health Service. Cleanliness Inspections. (See Table II). 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. Cleanliness inspections are now carried out in secondary schools only when they are requested by head teachers. In primary schools regular cleanliness inspections have been discontinued where, at three consecutive inspections, no cases of uncleanliness have been found but further inspections are made if requested by the head teacher or it appears that special circumstances warrant an intensification of this work. PHYSICAL EDUCATION. I am indebted to the Physical Education Advisers, Mr. J. M. Pell and Miss J. Hulton, for the following report:— During the year 1956, physical education in the Borough schools has, on the whole, continued the steady progress made in recent years towards higher standards, both in the actual work done and in the physical development of the children. In the Primary schools, most of which are now quite well supplied with climbing apparatus of either the fixed or portable variety, the majority of teachers are developing a greater understanding of the modern approach to physical education and this should result in a wider range and quality of movement training in the future. 61 At the secondary level, the experiments begun last year in a few schools, of allowing some choice of physical activity to older pupils, have been continued and proved worthwhile by the greater interest and enthusiasm of the participants and the improved standard of performance. Once again, the weather proved a serious deterrent to the full enjoyment of outdoor games, even during the summer term. However, in spite of this handicap, the standard of play and technique in most field games has shown some advance on previous years; but there is still much work to be done in this sphere. The need for the provision of suitable footwear for games remains; hockey, in particular, suffers as a result of this defficiency. Swimming Attendances, during the Summer Term, at Plumstead, Eltham Hill, Eltham Park and Danson Park were:— Schools. Attendances. No. of Children. 5 secondary 19 classes of 20- 575 (approx) per week. 25 children each week. 11 primary 26 classes of 30- 910 (approx) per week. 35 children each week. A total of 513 swimming certificates for distances between 25 yards and one mile, were issued during the year 1956. Two primary schools continued swimming during the spring and autumn terms. Further Training of Teachers During the year teachers have had the opportunity of attending the following courses held in the area: — 1. Simple National Dances—for teachers in junior and secondary schools. 2. Educational Dance Movement—day course for women teachers. 3. Swimming—Demonstration classes held on two evenings during the summer term, for primary and secondary teachers. 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. 62 SCHOOL HEALTH SERVICES. Statistical Tables. Table I — Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. B. Other Inspections. C. Pupils found to require treatment. D. Classification of the General Condition of Pupils Inspected during the year in the Age Groups. Table II — Infestation with Vermin. Table III — Return of Defects found by Medical Inspection. A. Periodic Inspections. B. Special Inspections. Table IV — Treatment Tables. Group 1. Eye Diseases, Defective Vision and Squint. Group 2. Diseases and Defects of Ear, Nose and Throat. Group 3. Orthopaedic and Postural Defects. Group 4. Diseases of the Skin. Group 5. Other Treatment given. Table V — Dental Inspection and Treatment including Orthodontics. Table VI — Handicapped Children. 63 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 1,104 Second Age Group 771 Third Age Group 853 Total 2,728 Number of other Periodic Inspections 2,363 Grand Total 5,091 B.—Other Inspections. Number of Special Inspections 1,853 Number of Re-Inspections 2,859 Total 4,712 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 1IIA Total individual pupils (1) (2) (3) (4) Entrants 62 122 152 Second Age Group 73 123 172 Third Age Group 88 136 191 Total (prescribed groups) 223 381 516 Other Periodic Inspections 219 338 486 Grand Total 442 719 1001 64 D.—Classification of the Physical Condition of Pupils Inspected during the Year in the Age Groups. Age Groups Inspected Number of Pupils Inspected Satisfactory Unsatisfactory No. % of Col. (2) No. % of Col. (2) (1) (2) (3) (4) (5) (6) Entrants 1104 1074 97.3 30 2.7 Second Age Group 771 760 98.6 11 1.4 Third Age Group 853 844 99.0 9 1.0 Additional Periodic Inspections 2363 2315 98.0 48 2.0 Total 5091 4993 98.2 98 1.8 TABLE II. Infestation with Vermin. (i) Total number of examinations in the schools by the school nurses or other authorised persons 6,225 (ii) Total number of individual pupils found to be infested 13 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) — (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) — 65 66 TABLE III.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1956. Defect Code No. Defect or Disease A. PERIODIC INSPECTIONS B. SPECIAL INSPECTIONS Entrants Leavers TOTAL (Including a,11 other age groups) Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation 4. Skin 15 26 71 25 192 130 68 9 5. Eyes— 62 88 a. Vision 121 132 442 660 54 18 b. Squint 21 32 — 2 52 86 7 3 c. Other 7 9 8 ii 88 74 31 10 6. Ears— a. Hearing 5 133 2 33 18 342 30 49 b. Otitis media — 35 1 3 1 78 5 14 c. Other 2 15 10 3 29 45 7 5 7. Nose and Throat 48 249 13 24 126 578 58 75 8. Speech 6 34 1 3 20 75 17 10 9. Lymphatic Glands 8 111 1 4 9 240 5 5 10. Heart 1 26 — 11 4 89 3 20 11. Lungs 11 119 — 21 20 314 38 90 12. Developmental— a. Hernia 1 9 — 1 5 22 — 2 b. Other 2 23 3 35 13 134 2 4 13. Orthopaedic— a. Posture 4 13 13 21 69 140 2 1 b. Feet 7 43 8 53 74 276 18 6 c. Other 3 93 7 31 34 333 18 25 14. Nervous System— a. Epilepsy 1 3 — — 1 16 10 11 b. Other — 3 2 3 4 27 13 12 15. Psychological— a. ment — 9 2 1 2 38 35 79 b. Stability — 91 1 4 12 330 97 88 16. Abdomen 3 21 3 8 11 79 12 12 17. Other 2 21 4 14 21 114 137 200 TABLE IV.—Treatment Tables. Group I.—Eye Diseases, Defective Vision and Squint. No. of Cases by the Authority dealt with otherwise External and other, excluding errors of refraction and squint 99 — Errors of refraction (including squint) 2,082 35 Total 2,181 35 Number of pupils for whom spectacles were Prescribed 696 — Group II.—Diseases and Defects of Ear, Nose and Throat. Number of by the Authority cases treated otherwise Received operative treatment (a) for diseases of the ear — — (b) for adenoids and chronic tonsilitis — 59 (c) for other nose and throat condition — 1 Received other forms of treatment — 12 Total — 72 Total number of pupils in schools who are known to have been provided with hearing aids (a) in 1956 — 5 (b) in previous years — 12 Number of children found, during periodic school medical inspections during 1956, to have undergone tonsillectomy at any time previously = 967. 67 Group III.—Orthopaedic and Postural Defects. by the Authority otherwise Number treated in clinics or outpatients departments 110 30 Group IV.—Diseases of the Skin. Number of cases treated or under treatment during the year by the Authority. Ringworm—(i) Scalp — (ii) Body — Scabies 1 Impetigo 16 Other skin diseases 115 Total 132 Group V.—Other Treatment Given. Number of cases treated or under treatment during the year by the Authority. (a) Number of cases of miscellaneous minor ailments 781 (b) Pupils who received convalescent treatment under School Health Service arrangements (c) Pupils who received B.C.G. vaccination 53 (d) Other than (a) (b) and (c) above 1. Minor Eye Defects (Minor Ailments Clinic) 99 2. Minor Ear Defects (Minor Ailments Clinic) 106 3. Minor Injuries (Minor Ailments Clinic) 50 68 TABLE V—Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 1,843 (b) Specials 1,590 Total (1) 3,433 (2) Number found to require treatment 2,449 (3) Number offered treatment 2,449 (4) Number actually treated 1,591 (5) Attendances made by pupils for treatment, Including those recorded at heading 11(h) below 4,778 (6) Half days devoted to: Inspection 13 Treatment 662 Total (6) 675 (7) Fillings: Permanent Teeth 1,257 Temporary Teeth 1,196 Total (7) 2,453 (8) Number of teeth filled: Permanent Teeth 1,170 Temporary Teeth 1,175 Total (8) 2,345 (9) Extractions: Permanent Teeth 231 Temporary Teeth 697 Total (9) 928 (10) Administration of general anaesthetics for extraction 522 (11) Orthodontics: (a) Cases commenced during the year 52 (b) Cases carried forward from previous year 169 (c) Cases completed during the year 44 (d) Cases discontinued during the year 4 (e) Pupils treated with appliances 69 (f) Removable appliances fitted 69 (g) Fixed appliances fitted 2 (h) Total attendances 997 (12) Number of pupils supplied with artificial dentures 197 (13) Other operations: Permanent Teeth 1,161 Temporary Teeth 180 Total 1,341 69 TABLE VL Handicapped Pupils requiring Education at special Schools or boarding in Boarding Homes. (1) Blind (2) Partially sighted (3) Deaf (4) Partially Deaf (5) Delicate (6) Physically Handicapped (7) Educationally sub-normal (8) Maladjusted (9) Epileptic Total (1) to (9) During the year ending 31-12-56 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped 1'upils newly placed in Day Special Schools or Boarding Homes 1 1 1 1 33 2 7 4 — 50 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes — 1 — 1 34 2 6 6 — 50 On or about 31st January, 1957:— C. Number of Handicapped Pupils from the area:— (i) attending Special Schools as: (a) Day Pupils — 3 3 1 — 12 24 — — 43 (b) Boarding Pupils 4 — 2 — 20 4 6 11 — 47 (ii) Attending independent schools under arrangement made by the Authority — — — — — — — — — — (iii) Boarded in Homes and not already included under (i) or (ii) — — — — — — — — — — Total (C) 4 3 5 1 20 16 30 11 — 90 D. Were being educated under arrangements made under Section 56 of the Education Act, 1944:— (i) In hospitals — — — — — — — — — — (ii) In other groups (e.g. units for spastics) — — — — — — — — — — (iii) At home — 1 — — 1 4 1 — — 7 E. Were requiring phaces in special schools:— i) TOTAL (a) day — — — — — — 6 — — 6 (b) Boarding — — — — 1 2 — 5 — 8 Pupils 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 — — — — — — — 1 — 1 F. Were on the Registers of Hospital Special Schools 1 Number of children reported during the year:— (a) Under Section 57(3) (excluding any returned under (b) ) 5 (b) „ „ relying on Section 57(4) — (c) „ 57(5) 2 of the Education Act, 1944. 70 INDEX. item page Health Committee 2 Public Health Staff 3 Foreword 47 STATISTICS AND SOCIAL CONDITIONS. Acreage 8 Population 8 New Houses Erected 8 Unemployment 8 Social Conditions and Amenities 8— 9 Population Graph 10 Summary of Vital Statistics 11—12 Extracts from Vital Statistics— Births and Birth Rates 12—13 Stillbirths and Stillbirth Rates 13 Deaths and Death Rates 14—15 Causes of Death 16 Causes of Death in Age Groups 17 Infantile Mortality 18—19 Maternal Deaths 19 GENERAL PROVISIONS OF HEALTH SERVICES. Isolation Hospital Accommodation 20 General Hospitals 20 Ambulance Facilities 20 National Assistance Act, 1948 20 Public Mortuary 20 Laboratory Facilities 20—21 Registration of Nursing Homes 21 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 22 Water Supply 23 Drainage and Sewerage 23 Rivers and Streams 23 Chief Sanitary Inspector's Report— Tables of Inspections and Improvements, etc. 25—-26 Food Inspection 27 Tables—Factories Act, 1937 28 Closet Accommodation 29 Public Cleansing Service 29 Refuse Collection and Disposal 29 Salvage 30 Public Conveniences 30 Atmospheric Pollution 31 Prevention of Damage by Pests Act, 1949 32 Pet Animals Act, 1951 32 Shops Act, 1950 33 Swimming Pool 34 Verminous Premises 34 Wasp Destruction 34 Schools 34 71 item page HOUSING. Council Estates 35 Inspection of Dwelling Houses 36 Remedy of Defects without formal notice 36 Action under Statutory Powers 36—37 Clearance Schemes 37 Improvement Grants 37 Housing Repairs and Rents Act, 1954 37 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 38 Slaughterhouses 38 Adulteration of Food—Food & Drugs Act, 1938 39 Food Shops and Food Manufacturing Premises 40 Registration of Premises 40 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 41 Diphtheria 41 Diphtheria Immunisation and Smallpox Vaccination 42 Typhoid Fever and Para Typhoid Fever 43—45 Puerperal Pyrexia 45 Ophthalmia Neonatorum 46 Measles 46 Whooping Cough 46 Acute Anterior Poliomyelitis 46 Scabies 46 Food Poisoning 46 Malaria 46 Tables of Infectious Diseases Notified 47 Tuberculosis 48 SCHOOL HEALTH SERVICES REPORT, 1954. Welfare and School Attendance Sub-Committee 50 Staff 50—51 Foreword 52—54 Schools 55 Clinics 55—56 Co-ordination— Periodic Medical Inspections 57 School Meals and Milk 57—58 Orthopaedic Clinic 58 Ophthalmic Clinic 58—59 Speech Therapy 59—60 Sweep Frequency Pure Tone Audiometry 60—61 Cleanliness Inspections 61 Physical Education 61—62 Statistical Tables 63—-70 72