- BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Services For the Year 1957 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 1957 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h.. Medical Officer of Health Borough of Bexley. Mayor: Alderman Mrs. H. F. Piggott, J.P. Deputy Mayor: Alderman J. M. Pawson. HEALTH COMMITTEE. Chairman: Alderman Mrs. H. F. Piggott, J.P. Vice-Chairman: Councillor S. H. Philpot. Alderman M. J. Corr. Councillor N. S. Harrild. Alderman J. M. Pawson. Councillor Mrs. D. A. Shearn. Councillor Mrs. B. Bursill. Councillor Mrs. E. M. Sheppard. Councillor F. G. Donovan. Councillor Mrs. J. Tatham. 2 PUBLIC HEALTH STAFF, 1957. 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, *t G. Hind. M.A.P.H.I. Public Cleansing Officer and Shops Acts Inspector. Deputy Chief Public Health *f J. T. Boocock. Inspector. District Public Health Inspectors *† W. E. Moses. *† W. C. B. Gilhespy. *† D. T. Rees. Chief Clerk G. A. Pearson. Senior Clerk R. V. Hoad. Clerks E. M. Pearmine (Miss). I. D. Dashfield (Mrs.) (Shorthand Typist). 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. † 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, 1957. As in previous years, in attempting to assess the health of the Borough it is necessary to consider the vital statistics for the area. The infant mortality rate of 1957 was 22.9 per 1,000 live births, compared with 24.6 in 1956 and a rate for England and Wales of 23. For the fourth year in succession no mother died as a result of childbirth and for the eighth year there has not been a case of diphtheria in the Borough. The standardized birth rate remains practically stationary at 13.9 per 1,000 of the population compared with a rate of 16.1 per 1,000 for England and Wales while the standardized death rate at 11.3 per 1,000 is almost the same as that for the country as a whole (11.5 per 1,000). There is nothing in these figures to warrant either concern or undue complacency. When one observes the great changes wrought in our civilization by the industrial, social, educational and scientific developments of the past 50 years and their profound influence on our whole way of life, one cannot help feeling that the yardsticks used in the past to measure the health of a community need to be interpreted with great caution. Designed as they originally were for conditions of widespread poverty and disease and the absence of medical care they served, in bygone years, not only as a measure of environmental hazards but, also, as a spur to their amelioration. Nowadays, however, having overcome the gross hazards of environment, we can turn our attention to the more insidious and subtle ones which remain, as well as to the new hazards which are constantly arising as a result of the application of scientific developments as, for example in the field of electronics and nuclear physics. A good example of the subjection of present-day vital statistics to the high power of the microscope is afforded by the study of infant mortality where the emphasis has shifted 4 from the main causes of death during the first year of life (which at one time were gastro-enteritis and bronchopneumonia) to deaths during the neo-natal period (the first four weeks of life, the commonest causes of death being congenital malformations and prematurity) and, latterly, to the perinatal period in which the deaths during the first week of life are studied alongside with stillbirths. The latter highlights the combined effects of toxaemia of pregnancy and prematurity and, in a few cases, obstetrical difficulties and it will be seen on analysis of the Table on page 20 that the perinatal mortality during 1957 was 36.8 per 1,000 related births. It is, indeed, remarkable that of the 27 Bexley babies on whom the infant mortality rate is based, no less than 22 died within the first week of life. It is clear that a closer study needs, now, to be made of the causes of toxaemia and of the significance of maternal infections in early pregnancy (particularly german measles and, possibly, other virus diseases as well) in relation both to prematurity and congenital malformations. The fall in deaths during the perinatal period has not kept pace over the past 25 years with the fall in infant mortality generally and further improvements in the infant mortality rate depend on further research on these lines as well as on the maintenance of satisfactory conditions of living and levels of child care generally. The number of deaths from cancer of the lung during 1957 was 40 as against 28 in 1956 and 48 in 1955. The fact that there is an association between smoking and cancer of the lung has received very wide publicity and is now. I think, accepted by most reasonable people. There is no evidence, however, that this has had much effect on the smoking habits of people in general although one does meet individuals, here and there, who have given up cigarette smoking as a direct result of this newly-gained knowledge. It appears that the general attitude among the majority of smokers is a fatalistic acceptance of the risk; which can only mean that the smoking habit may fulfil a deep physical and psychological need in the stressful world in which we live. It is good to learn, therefore, that attempts are being made, by selective cultivation of particular varieties of tobacco leaf and by other means, to reduce the amount of carcinogenic substances in tobacco and I believe that some progress is being made in this respect. I have given a number of talks on this subject to senior schoolchildren and have been impressed by the grasp shown by them in regard to the hazard of lung cancer in relation to smoking. Nevertheless, although they received the information in a responsible way, one could not help feeling that the remoteness of the risk 5 in point of time tended to reduce its impact for, to a boy or girl of 15, to talk of what may happen in 30 or 40 years time is somewhat akin to a voyage into eternity. However, this particular form of health education must continue, and teachers as well as doctors and health visitors have their responsibilities, particularly when one bears in mind the seductive advertisements on television and in the Press which are designed to inculcate, in the adolescent mind, the impression that smoking is a sign of emancipation and growing up and stepping-stone to social ease and acceptance. In considering lung diseases in general and perhaps chronic brochitis in particular, one must not forget that the abatement of atmospheric pollution is one of the most important tasks facing both central and local government at the present time. In a way this problem is comparable in its complexity with the cleaning up of urban water supplies in the 19th century and just as important. The Clean Air Act, 1956 grants, among its many provisions, permissive power to local authorities to declare smoke control areas in which only smokelesss fuels will be burnt in suitable boilers and domestic heating appliances. In Bexley a beginning has been made, the Council having authorised a pilot survey to be carried out in a selected area with a view to obtaining reliable information as to the cost of replacing unsuitable appliances and adapting others to make them capable of burning smokeless fuels. It took over 50 years to provide a clean and safe water supply to the great towns thus ridding the population of such diseases as cholera, typhoid and dysentery. By sustained and determined action in regard to clean air one may similarly see, in years to come, a reduction in lung diseases which are responsible for so much mortality and ill-health, as well as the removal from the atmosphere of pollution which causes much unnecessary work for the harassed housewife and does untold damage to vegetation and the fabric of buildings. We have now installed, in the Health Department, a volumetric apparatus for the daily estimation of sulphur dioxide (one of the most lethal constituents of smoke) and figures are being collected which will serve as a guide to future action in regard to smoke abatement. It is unfortunate, to say the least of it, that the time when the prevention of atmospheric pollution is becoming a matter of major policy should coincide with the introduction of yet another serious hazard from nuclear and allied radiations resulting from the peaceful uses of atomic energy in industry including the use of x-rays and of radioactive isotopes and from international efforts to build up 6 the " atomic deterrent." The addition of these radiations to those occurring, naturally, from certain heavy elements in the earth's crust and from cosmic rays reaching us from outer space may one day, and before long, induce a level of radioactivity in our surroundings harmful to the maintenance of health and, by causing undesirable genetic mutations, constitute a threat to future generations. Indeed, one can forsee the time when the Geiger counter will become as important a piece of public health equipment as the sampling bottle or deposit gauge is today. During the year steady progress was made in regard to the implementation of the Food Hygiene Regulations, 1955. Much work and constant vigilance is necessary to ensure that satisfactory standards of production and handling of food are not only achieved but, also, maintained. Even when cleanliness, repair of food premises, the supply of wash hand basins, hot and cold water and facilities for washing food and equipment are of a satisfactory standard, real cleanliness depends, ultimately, on the acceptance by food handlers, both management and staff, of a personal responsibility to the public; and we cannot say that this is invariably the case. During the year 2779 inspections of food and food preparing premises were carried out by the Public Health Inspectors and improvements were carried out or defects remedied under the Regulations at 93 premises. Twelve premises were dealt with for infestations by rats and mice. During the year the Housing Act, 1957 and the Rent Act, 1957 came into operation. The former was largely a consolidating Act, while the latter, in that it aimed, among other things, at the preservation of the structure of existing houses, placed a good deal of extra work on the Chief Public Health Inspector and his colleagues, particularly in connection with certificates of disrepair. Steady progress has been made during the year in the clearance of unfit houses within the framework of the five year plan submitted to the Ministry of Housing and Local Government in 1955. The work of the Bexley, Erith and Crayford Home Safety Committee continued during the year, with steady propaganda in the interests of the reduction of accidents in the home, chiefly through falls and burns and scalds. Officially this responsibility lies with the Local Health Authority under Section 28 of the National Health Service Act, 1948. In practice, the local voluntary committee, closely linked with the district Health Department and the local Council is in a far better strategic position to increase the 7 public awareness of a problem, the magnitude of which, both as regards morbidity and mortality, exceeds that of accidents on the roads. During 1957, seven cases of paralytic poliomyelitis were notified in the Borough. The number of children resident in the Borough who received a course of two injections against this disease, under arrangements made by the local Health Authority, was 3,172. The extension of vaccination to all children of school age and possibly, in due course, to members of the public generally may, it is hoped, in years to come, considerably reduce the ill effects of this annual visitation. Although, broadly speaking, the incidence of pulmonary tuberculosis is on the wane, there is evidence to show that much still remains to be done in the abolition of this incapacitating and killing disease. The chronic open case in the community and the undiagnosed case, often in middleaged and elderly people, remain two potent sources of infection. The main spearheads in the attack against this disease are the unremitting tracing of sources of infection, the protection of contacts and young children by B.C.G. inoculation and a more intensive search for new cases by means of mass miniature radiography. During the latter part of the year influenza of the Asian type reached epidemic proportions in the Borough, this being part of a world epidemic. Although widespread, the disease did not reach the severity which had been anticipated and most cases were of a relatively mild type, necessitating a few days in bed followed by a short period of convalescence. Much absenteeism resulted in factories and in schools from this cause in the area. No deaths were recorded as due to influenza during the year. So much for these objective factors for which figures are available, but this is by no means the whole story. There are no statistics by which we can study the health of the individual and of the community in the sense of happy and successful living as integrated members of society which is the essence of true health. It is, I think, true that, despite the great advances in clinical medicine over the past 40 years and the operation of the National Health Service for 10 years, there has been no reduction in the total incidence of disease although the pattern of disease has changed. The oldfashioned epidemics have been largely brought under control but have been largely offset by the increase in the incidence of the so-called phychosomatic diseases such as coronary thrombosis, peptic ulcer, certain forms of cancer, the psychoneuroses and by the new endemics, accidents on the 8 roads and in the home. Most disturbing of all is the great increase, in the last few decades, of mental ill-health as shown by the high proportion of hospital beds taken up by the mentally sick. The causes of this social malaise are very complex and have their roots in the rapid changes which our society has undergone in recent years. Prevention and cure of disease is not enough to ensure true health in a modern society. The promotion of health by a consciouslydirected policy based, not only on the causes of disease, but on the causes of health remains, as always, the greatest challenge to statesmanship at the present time. 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 devoted service during the year. I am, Your obedient Servant, JOHN LANDON, Medical Officer of Health 9 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. New Dwellings Erected. Registrar General's Houses 384 Estimate midyear, 90,020 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1946 82+ 64rebuilt 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 1956 89,300 1956 423 Number of inhabited houses at end of 1957 (according to Rate Books) approximately 27,842 Rateable Value £1,219,267 Sum represented by a penny rate £4,975 Unemployment. Men Women Boys Girls Total December, 31st 1956 172 85 10 7 274 December 31st, 1957 192 68 10 6 276 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. 10 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 185.9 Danson Mead, Welling 1.1042 „ 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 12.787 „ Rutland Shaw, Bexley 4.85 „ St. Mary's Recreation Ground, Bexley 9.925 „ 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 510.4025 , Facilities for outdoor games are provided in many of these open spaces, including the large Swimming Pool in Danson Park, opened in July, 1936. 11 GRAPH SHOWING RISE IN POPULATION SINCE 1031 SUMMARY OF VITAL STATISTICS England and Wales. Borough of Bexley. per 1,000 Home Population. Births- Live 16.1 13.6 Still 0.37 0.27 22.4(a) 19.2(a) Deaths- All Causes 11.5 9.2 Typhoid and Paratyphoid 0.00 — Whooping Cough 0.00 — Diphtheria 0.00 — Tuberculosis 0.11 0.03 Influenza 0.16 0.04 Smallpox 0.00 — Acute Poliomyelitis (including Polioencephalitis) 0.01 0 01 Pneumonia 0.56 0.53 Notifications (corrected) Typhoid Fever 0.00 — Paratyphoid Fever 0.01 — Meningococcal Infection 0.02 0.02 Scarlet Fever 0.66 0.76 Whooping Cough 1.89 1.98 Diphtheria 0.00 — Erysipelas 0.08 0.08 Smallpox 0.00 — Measles 14.11 13.84 Pneumonia 0.73 0.34 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.07 0.08 Non-Paralytic 0.04 — Food Poisoning 0.20 0.09 Puerperal Pyrexia 16.00(a) 12.81(a) Rates per 1,000 Live Births. Deaths All causes under one year of age 23.0 22.9 Enteritis and Diarrhœa under two years of age .5 Nil (a) Per 1,000 Total (Live and Still) Births. A dash (—) signifies that there were no deaths. 13 Maternal Mortality England and Wales Boruugh of Bexley Rates per 1,000 total live and still births Maternal causes, excluding abortion 0.39 Nil Due to abortion 0.08 Nil Total maternal mortality 0.47 Nil EXTRACTS FROM VITAL STATISTICS FOR THE Year 1957. The Registrar General's Estimate of home population for the mid-year is 90,020 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 612 613 1,225 Legitimate 595 597 1,192 Illigitimate 17 16 33 Birth Rate. Rate per 1,000 estimated home population 13.6 The following relates to the Birth Rate during the past ten years: — 1947 Birth Rate 18.72 per thousand 1948 „ „ 15.36 „ 1949 „ „ 14.02 „ 1950 „ „ 13.13 „ 1951 „ „ 12.79 „ 1952 „ „ 12.00 „ 1953 „ „ 12.70 „ 1954 „ „ 11.80 „ 1955 „ „ 12.60 „ 1956 „ „ 13.2 „ Rate per 1,000 for England and Wales 16.1 14 33 illegitimate live births were registered against 34 in 1956. The Registrar-General has supplied a comparability factor for 1957. The standardised birth rate which allows for comparison with other parts of the country is 13.9. Stillbirths. Males Females Total Total 11 13 24 Rate per 1,000 total (live and still) births 19.2 24 Stillbirths were registered during the year. This represents a rate of 0.27 per 1,000 population against 0.28 per 1,000 population in 1956. The following relates to the Stillbirth Rate during the past ten years: — Year Rate per Thousand Total Live and Still Births Population 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 1956 20.8 0.28 Rate per 1.000 for England and Wales 1957 0.37 There was one Stillbirth registered as illegitimate. 15 Deaths. Males Females Total All causes 418 410 828 Death rate per 1,000 of estimated home population 9.2 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 13 15 28 Legitimate 13 15 28 Illegitimate — — — Death rate of Infants under one year of age: Total per 1,000 live births 22.9 Legitimate per 1,000 legitimate live births 23.5 Illegitimate per 1,000 illegitimate live births — Deaths from Measles (all ages) — — — Whooping Cough (all ages) — — — „ „ Diarrhoea (under 2 years of age) — — — „ „ Cancer (all ages) 93 85 178 Rate per 1,000 for England and Wales, 1957 11.5 16 Death Rate of Area during last ten years: — 1947 9.17 per thousand. 1948 7.53 „ ,, 1949 8.15 „ ,, 1950 8.56 „ ,, 1951 9.6 „ ,, 1952 9.14 „ ,, 1953 8.8 „ ,, 1954 8.1 „ ,, 1955 9.1 „ ,, 1956 9.4 „ ,, The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1957. The standardised death rate which allows for comparison with other parts of the country is 11.3. 17 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1957. Causes of Death. M. F. Total All Causes 418 410 828 1 Tuberculosis, respiratory 2 1 3 2 Tuberculosis, other — — — 3 Syphilitic disease — 1 1 4 Diphtheria — — — 5 Whooping Cough — — — 6 Meningococcal infections — — — 7 Acute poliomyelitis 1 — 1 8 Measles — — — 9 Other infective and parasitic diseases 2 — 2 10 Malignant neoplasm, stomach 12 11 23 11 Malignant neoplasm, lung, bronchus 36 4 40 12 Malignant neoplasm, breast 1 25 26 13 Malignant neoplasm, uterus — 9 9 14 Other malignant and lymphatic neoplasms 44 36 80 15 Leukaemia, aleukaemia 2 1 3 16 Diabetes 1 3 4 17 Vascular lesions of nervous system 43 53 96 18 Coronary disease, angina 90 48 138 19 Hypertension with heart disease 10 10 20 20 Other heart disease 26 46 72 21 Other circulatory disease 12 23 35 22 Influenza — 4 4 23 Pneumonia 20 28 48 24 Bronchitis 33 23 56 25 Other diseases of the respiratory system 4 2 6 26 Ulcer of stomach and duodenum 8 3 11 27 Gastritis enteritis and diarrhoea 2 1 8 28 Nephritis and nephrosis 4 3 7 29 Hyperplasia of prostate 5 — 5 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 4 4 8 32 Other defined and ill-defined diseases 34 57 91 33 Motor vehicle accidents 15 2 17 34 All other accidents 3 7 10 35 Suicide 4 5 9 36 Homicide and operations of war — — — 18 19 DEATHS REGISTERED (IN AGE GROUPS) IN 1957. Under 1 year 1-4 years 5-14 years 15-24 years 25-44 years 45-64 years 65-74 years 75 years and ove Total M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... 2 1 2. Tuberculosis, other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Syphilitic disease ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 4. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Meningococcal infections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7. Acute poliomyelitis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 8. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Other infective and parasitic diseases ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 9 ... 10. Malignant neoplasm, stomach ... ... ... ... ... ... ... ... 2 3 5 4 1 3 5 12 11 11. Malignant neoplasm, lung, bronchus ... ... ... ... ... ... ... ... 2 1 22 ... 10 2 2 1 36 4 12. Malignant neoplasm, breast ... ... ... ... ... ... ... ... ... 2 ... 15 ... 6 1 2 1 25 13. Malignant neoplasm, uterus ... ... ... ... ... ... ... ... ... 2 ... 2 ... 3 ... 2 ... 9 14. Other malignant and lymphatic neoplasms ... ... ... ... ... ... ... ... ... 3 20 13 16 8 8 11 44 36 15. Leukaemia, aleukeamia ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... 2 1 16. Diabetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 3 17. Vascular lesions of nervous system ... ... ... ... ... ... ... ... ... ... 10 12 16 14 16 27 43 53 18. Coronary disease, angina ... ... ... ... ... ... ... ... 7 1 36 ... 29 14 18 33 9O 48 19. Hypertension with heart disease ... ... ... ... ... ... ... ... 1 ... 2 ... 3 3 4 6 10 10 20. Other heart disease ... ... ... ... ... ... ... ... 1 1 5 6 7 9 13 30 26 46 21. Other circulatory disease ... ... ... ... ... ... ... ... ... 1 3 2 4 3 5 17 12 23 22. Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 23. Pneumonia 3 l ... ... ... ... ... ... ... ... ... 2 5 3 10 22 20 28 24. Bronchitis 1 2 ... ... ... ... ... ... ... ... 10 ... 8 3 14 18 33 23 25. Other diseases of the respiratory system ... ... ... ... ... ... ... ... ... ... ... ... 2 1 2 1 4 2 26. Ulcer of stomach and duodenum ... ... ... ... ... ... ... ... ... ... 2 1 4 1 2 1 8 3 27. Gastritis, enteritis and diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 2 1 28. Nephritis and nephrosis ... ... ... ... ... ... ... ... 1 ... 1 2 1 ... 1 1 4 3 29. Hyperplasia of prostate ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 4 ... 5 ... 30. Pregnancy, childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital malformations 2 2 ... l ... ... 2 ... ... ... ... ... ... ... ... ... 4 4 32. Other defined and ill defined diseases 7 10 ... 1 ... ... ... ... 2 ... 8 7 7 9 10 26 34 57 33. Motor vehicle accidents ... ... ... ... 1 ... 3 ... 4 ... 4 ... 1 ... 2 2 15 2 34. All other accidents ... ... ... ... 1 ... 1 1 ... ... ... 1 1 2 ... 3 3 7 35. Suicide ... ... ... ... ... ... ... 1 2 ... 1 2 ... ... 1 1 4 5 36. Homicide and operations of war ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 13 15 ... 2 2 2 7 2 25 18 132 72 120 84 119 215 418 410 20 INFANT MORTALITY, 1957 DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1957 but not necessarily registered in that year. Causes or 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 Premature Birth 3 1 1 1 Atelectasis, Prematurity 2 Atelectasis 1 2 Pneumonia, Prematurity 1 Bronchopneumonia 1 1 Acute Tracheo Bronchitis 1 Umbilical Haemorrhage 1 Atelectasis, Congenital abnormalities of lingers, toes, trachca and frontal bones 1 Tentorial tear and subtentorial haematoma Difficult breach extraction, Dystocia 1 Atelectasis, Caesarian section for concealed ante partum haemorrhage, Severe preeclampsia of mother 1 Diarrhoea, Pancreatic dysfunction, retropharyngeal abcess, Pneumonia 1 Pulmonary atelectasis, Pneumonia Prematurity, Severe pre lamptio toxaemia of mother 1 Prematurity,Congenital heart disease (Interventricular septal defect) 1 Hydro-cephalus, Sub-arachnoid haemorrhage Haemorrhagic disease of the new born 1 Hyaline membrane disease, Erythroblastosis 1 Totals 3 4 3 1 2 1 2 2 1 1 — 1 — The number of infants under one year of age who died during the year 1957 as shown by the table is 27.22 of these deaths, that is 81 per cent. occurred in the neonatal period (within one month of birth). In 1956, the corresponding figure was 73 per cent. 28 were registered during the year giving an infantile mortality rate per 1,000 live births of 22.9. Rates over previous years have been:— 1947 28.6 per 1,000 live births. 1948 19.03 „ „ „ „ 1949 24.0 „ „ „ „ 1950 14.48 „ „ „ „ 1951 24.76 „ „ „ „ 1952 11.34 „ „ „ „ 1953 14.36 „ „ „ „ 1954 22.1 ,, ,, ,, ,, 1955 17.0 „ „ „ „ 1956 24.6„ „ „ „ Maternal Deaths. There were no maternal deaths during the year. Rates over previous years have been:— 1947 1.19 per 1,000 live and stillbirths 1948 Nil „ „ ,, „ „ 1949 0.78 „ „ ,, „ „ 1950 0.84 „ „ ,, „ „ 1951 Nil „ „ ,, „ „ 1952 0.93 „ „ ,, „ „ 1953 2.63 „ „ ,, „ „ 1954 Nil „ „ ,, „ „ 1955 Nil „ „ ,, „ „ 1956 Nil „ „ ,, „ „ 21 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 142 occasions and 142 post-mortem examinations were made; 19 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 22 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 23 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. List of Adoptive Acts, etc., in force. Date Acts. Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5Apr. 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 „ 10—Sec. 95 May 1909 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 24 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 1957. 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 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 10 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 269 lin. yards. Highbanks Close. S.W. Sewers 290 lin. yards. Tower Road. S.W. Sewers 160 lin. yards. Yew Tree Close. S.W. Sewers 373 lin. yards. Broom Mead. Foul Sewers 63 lin. yards. Broom Mead. Foul Sewers 43 lin. yards. Latham Road. S.W. Sewers 170 lin. yards. Rokesby Close S.W. Sewers 1,044 lin. yards. East Wickham Hutments. In addition to the above developing owners have constructed private sewers on the following estates:— Highbanks Close. Hurst Road. Otford Close. Grangewood. Rokesby Close. Broom Mead. Tower Road. Kemsing Close. These sewers are of the back drainage system and have not as yet been taken over as Public Sewers. 2. Rivers and Streams. No serious pollution was found in rivers or streams during the year. 25 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 1957. The report consists mainly of a tabulated record of work carried out by the Public Health Inspectors. 26 TABLE No. 1. Details of Inspection Work Carried Out. Inspections Re-inspections Houses inspected (all particulars recorded) 12 195 Houses inspected (defects only recorded) 124 642 Houses inspected (certificates of disrepair) 148 139 Houses inspected (improvement grants) 30 — Houses inspected (Housing Act, 1936, Overcrowding) 42 7 Houses inspected re Infectious Disease (including scabies) 134 79 Factories with mechanical power 192 23 Factories without mechancial power 31 2 Outworkers' premises 56 — Other premises under the Act 19 13 Bakehouses 81 59 Water Samples 18 4 Food and Drugs Act Samples 287 Dairies and distributors 43 12 Ice Cream premises 257 16 Restaurants, etc 235 137 Fish premises 122 42 Meat Shops 373 124 Public Houses 23 15 Shops re unsound food 392 40 Other premises where food is prepared 802 279 Offensive accumulations 79 51 Stables 27 38 Keeping of Animals 35 18 Rats 369 522 Drains inspected 728 761 Drains tested (water, smoke or colour) 119 25 Dustbins 42 40 Verminous premises 37 55 Smoke observations 112 19 Tents, Vans and Sheds 4 — Refuse Tips 491 — Refuse Removal and Salvage 503 3 Conveniences 208 2 Pet Animals Act, 1951 33 7 Council House applicants 217 75 Shops Act, 1950 1,042 12 National Assistance Act, 1948—Sec. 47 9 2 Miscellaneous inspections 1,041 84 27 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 14 Provided with sufficient ashplace accomdation 8 Provided with sufficient water supply 3 Houses Improved Internally— Walls and ceilings repaired 3 Dampness in rooms remedied 46 Defective floors repaired 22 Ventilation of Rooms improved 11 Windows repaired 23 Stoves, fireplaces, etc. provided or repaired 13 Houses Improved Externally— Roofs repaired 17 Eaves gutters and down spouts fixed or repaired 25 Yards paved or repaired 3 Chimney stacks repaired 7 Walls repointed or repaired 17 Miscellaneous repairs 14 Drainage— Drains cleansed or repaired 634 New drains constructed 6 New Gullies provided 7 Ventilation of drainage system improved 3 Inspection chambers built or repaired 18 Waste pipes provided or repaired 9 New sinks provided 1 Offensive accumulation removed 8 Nuisances from animals abated 2 Other nuisances abated 6 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 41 Houses visited including revisits 213 Rooms disinfected 14 Notices delivered to Education Authorities, etc. 172 28 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered and destroyed: Corned Beef lbs. 1,215¾ Beef Sausages 99 10 Ham 99 32¼ Tinned Ham 99 40¼ Chicken 99 120 Beef 99 1,197 Pork 99 9¾ Cheese 99 219 Cereals 99 40 Veal 99 137 Bacon 99 2¾ Rabbit 99 38 Pigs Kidneys 99 97 Ox Kidneys 99 1½ Liver 99 163½ Sweetbreads 99 15 Pigs Spleens 99 84 Fish 99 865 Flour 99 13¾ Biscuits 99 15½ Dried Fruit 99 79½ Dripping 99 57 Potatoes 99 616 Meat tins 393 Fish 99 62 Soup 99 23 Milk 99 547 Vegetables 99 1,353 Fruit and Fruit Juices 99 883 Preserves 99 32 Puddings 99. 4 Pickles and Sauces jars 17 Paste 99 5 Pork Pies 99 88 Miscellaneous items 99 61 29 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 75 — — Factories with mechanical power 313 3 — "Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) •Electrical Stations should be reckoned as factories. 32 3 — Total 420 6 — 2. Defects Found. Particulars. Number of Defects. Number of Prose- cutions Found. Remedied. Referred to H.M. 1 2 3 4 5. Want of cleanliness (S.1) 3 3 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7)— Insufficient 5 5 Unsuitable or defective 2 2 — Not separate for sexes — — — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, ' 1937.) 3 3 Total 13 13 — — 30 PUBLIC CLEANSING SERVICE. The Health Committee is responsible for the collection and disposal of house and trade refuse, the collection and sale of salvageable materials and the cleansing and maintenance of public conveniences. Refuse Collection and Disposal. The collection and disposal of refuse is carried out by direct labour, and a weekly collection is made. Trade refuse is cleared from shops and factories by arrangement with the occupiers at an appropriate charge, based on the average quantity to be removed each week. Refuse is collected from over 29,000 premises, and whilst no actual weights are available, the estimated tonnage collected yearly is 21,500 tons. The Council also operate a salvage scheme, and waste paper, textiles, scrap metal, etc. is collected by means of trailers attached to the refuse collection vehicles. The following transport is used on collection work:— 2 Karrier Loadmasters (20-25 cu. yds. capacity). 4 Shelvoke and Drewry Fore and Aft Tippers (16-18 cu. yds. capacity). 8 Shelvoke and Drewery Side Loading Freighters (11 cu. yds. capacity). 1 Commer lorry, 4 cu. yds. capacity. 1 Ford Van (used by General Foreman). 12 Trailers. One additional fore and aft tipper was purchased during the year, and one freighter withdrawn from service. The number of men employed in this service is 48, made up as follows:— 1 General Foreman. 14 Drivers. 28 Ashbinmen. 5 Salvage Sorters. All refuse collected was disposed of by controlled tipping at East Wickham, the average haul to the disposal point being 2½ miles. A muledozer is used for levelling and consolidating the refuse, and covering material is obtained partly from the tip site and partly from outside sources. 31 Salvage. Details of salvage sales for the financial year ended 31st March, 1958, are set out below. Tons. cwts. qrs. £ s. d. Waste Paper 497 4 2 3,906 5 1 Textiles 15 10 0 302 17 5 Ferrous Metals 32 1 1 130 9 11 Non-Ferrous Metals 18 3 45 6 9 Miscellaneous Items 4 8 0 26 16 0 550 2 2 4,411 15 2 Kitchen Waste. There are some 300 waste tood bins in various roads in the Borough for the reception of kitchen waste, and these are cleared 2-3 times weekly by a contractor. 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. Hall Place, Bourne Road, 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). 32 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 1957. MONTH TONS PER SQUARE MILE. IRainfall inches Total water insoluble matter Soluble in C.S.2. Ash Other combustible matter Total water soluble matter Calcium Chlorine Sulphates Total solids January 0.84 4.93 0.14 3.77 1.03 4.09 0.37 0.74 1.42 9.03 February 2.51 5.36 0.08 3.81 1.47 6.44 0.91 1.01 2.65 11.80 March 0.72 5.13 0.08 4.10 0.95 5.92 1.07 0.52 2.49 11.03 April 0.23 10.52 0.13 8.37 2.01 7.69 1.64 0.65 3.35 IS.2(1 May 0.99 8. 15 0.10 6.17 1.88 5.24 0,81 0.67 1.89 13.39 June 0.79 9.90 0.12 6.97 2.81 6.38 1.11 0.67 2.07 16.28 July 3.98 10.62 0.15 7.54 2.93 19.46 1.61 0.94 4.64 30.08 August 2.02 8.10 0.10 6.03 1.97 7.79 1.34 0.81 2.40 15.89 September 2.32 6.63 0.08 5.39 1.17 7.85 1.14 1.01 2.62 14.49 October 1.51 7.50 0.15 6.24 2.12 5.64 0.94 0.67 2.69 13.14 November 2.31 8.94 0.12 6.60 2.22 8.66 1.21 1.75 2.62 17.60 December 1.54 5.39 0.13 3.70 1.56 6.18 0.60 1.07 2.51 11.67 A Lead Peroxide instrument for estimating atmospheric sulphur-dioxide is situate near the deposit gauge and the results for the year are set out below.— MONTH Area Exposed Weight of Ba SO* Wt. of SO., Collected Mg. of SOa/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 95 164.6 2.9 161.7 1.88 1.69 February 95 172.0 3.1 168.9 2.18 1.96 March 105 175.4 3.8 171.6 1.81 1.63 April 100 136.4 3.2 133.2 1.52 1.37 May 95 103.2 1.9 101.3 1.18 1.06 June 95 87.2 1.6 85.6 1.03 0.93 July 95 110.4 3.8 106.6 1.24 1.12 August 95 121.6 1.8 119.8 1.35 1.21 September 100 104.4 3.2 101.2 1.20 1.08 October 95 159.6 1.5 158.1 1.84 1.66 November 100 239.6 3.2 236.4 2.62 2.36 December 90 237.0 5.0 232.0 2.95 2.65 33 atmospheric pollution. The Council is represented on the Thameside Advisory Committee for the Abatement of Atmospheric Pollution. 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 812 Number of Inspections 2,651 Number of Infestations found: Rats — Major Minor 235 Mice 21 Number of Properties Treated Rats Mice Local Authority's premises 3 Dwelling Houses 214 17 Business Premises 18 4 PET ANIMALS ACT, 1951. Licences to keep pet shops were issued to 6 persons under the Act. SHOPS ACT, 1950. The following Closing Orders are in operation in the area:— Bexley Urban District (Butchers) No. 6 Order, 1920. Bexley Urban District (Grocers and Provisions Merchants) No. 7 Order, 1923. Bexley Urban District (Miscellaneous Trades) No. 8 Order, 1923. The Bexley Hairdressers and Barbers Shops Closing Order, 1946. There were approximately 800 shops on the Council's Register at the end of the year. During the year 1,054 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. 34 Swimming Pool. The only swimming pool in the Borough open to the Public is in Danson Park and is owned by the Council. The layout includes three open-air pools, one large for adults and two small pools for children. Showers and foot baths are provided for the pre-cleansing of bathers. The water is kept pure by continuous filtration and sterilisation by means of the latest method of break-point chlorination. Samples of water 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 7 premises found to be infested with bed bugs were treated with satisfactory results. Infestations at other premises were dealt with as follows:— Cockroaches 1, Flies 2, Moths 1, Mites 3, Fleas 3, Earwigs 1, Woodworm 1, Beetles 2. Wasps. The destruction of wasps nests is undertaken by the Department and during the year 17 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 35 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 Merlin Road 1 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 S.D.A. Houses 8 Hurst Place Estate 143 Rochester Way 9 2,443 250 36 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) 136 (b) Number of inspections made for the purpose (including re-inspection) 973 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 12 (b) Number of inspections made for the purpose (including re-inspections) 207 (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 10 under the preceding subhead) found not to be in all respects reasonably fit for human habitation 124 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 138 3. Action under Statutory Powers during the year. A. Proceedings under Section 9, 10 and 16 of the Housing Act, 1936— (1) Number of dwelling houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners 1 (b) By local authority in default of owners — B. Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 8 37 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 7 (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 6 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 23 (3) Number of houses in respect of which Closing Orders were made 2 D. Proceedings under Section 12 of the Housing Act, 1936— parts of buildings closed 1 Slum Clearance. During 1957, 12 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 71 Number of applications approved 27 Total cost of approved expense of improvements in 27 approved cases £7,244 11 6 Total costs on which grants actually made in 22 of these cases £6,056 11 6 Total amount of grants in the 22 cases £3,028 6 6 Housing Repairs and Rents Act, 1954. Only four applications were received for certificates of disrepair under the above Act during the year, and three certificates were issued. 3 certificates were revoked on the application of the owners. 38 Rent Act, 1957 This Act came into operation on the 6th July, 1957 and the following Table gives particulars of applications for Certificates of Disrepair and subsequent action taken. Number of applications for cetificates of disrepair 87 Number of decisions not to issue certificates 1 Number of decisions to issue certificates 75 (a) in respect of some but not all defects 47 (b) in respect of all defects 28 Number of undertakings given by landlords 31 Number of undertakings refused by the Local Authority Nil Number of Certificates issued 39 Applications by landlords for cancellation of certificates 1 Objections by tenants to cancellation of certificates Nil Decisions by Local Authority to cancel in spite of tenants' objection Nil Certificates cancelled 1 39 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 13 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. 40 (c) Adulteration of Food. Food and Drugs Act, 1955. The following table summarises the 231 samples taken during the year. Formal Informal Milk 6 2 Soup, Meat Extracts 4 8 Pastes, Potted Meat 2 2 Pudding or Cake Mixture, Flour, etc. 5 6 Jellies, Custard Powders, etc. 4 9 Patent Medicines 1 2 Sausages, Sausage Meat, etc. 15 1 Creamed Rice — 3 Condiments, Sauces, Pickles, Spices, et 1 19 Pure Coffee, Coffee Extracts, Coffee an Chicory 6 2 Meat Pies and Puddings 2 4 Sweets and Confectionery 13 15 Essences — 4 Butter and Fats 11 2 Ice Cream 1 — Minerals 3 6 Beer 3 — Wines and Spirits 5 — Fruit and Fruit Juices — 7 Fruit Pies and Puddings — 1 Preserves 2 7 Condensed Milk — 2 Ground Almonds 2 — Cream 1 3 Dried Fruit l 1 Cakes 3 1 Fish — 3 Tinned Meat 1 6 Desiccated Coconut — 1 Fish Cakes 1 2 Cheese Food — 2 Garden Peas 1 — Pease Pudding — 1 Ready-Mix Ice Cream — 1 Bread 1 1 Icing Sugar 1 2 Dandelion Coffee 1 — Nut Oil — 1 Mousse 1 — Biscuits — 5 Salted Pea Nuts 98 1 133 41 Legal Proceedings. The following legal proceedings were instituted during the year:— (1) Sausage Roll—Mouldy. Fined £5 plus £2 2s. Od. costs. (2) Arrowroot—Not genuine arrowroot. Fined £10 plus £5 5s. 0d. costs. (3) Currant bun—Nail in bun. Fined £5 plus 2s. Od. witness expenses. (d) Food Shops and Food Manufacturing Premises. The classification of the various food shops and food manufacturing premises in the Borough is as follows:— Butchers 46 Cafes and Restaurants 23 Greengrocers 49 Sweet Shops 61 General Provision 91 Bakers and Confectioners 31 Wet and Fried Fish Shops 24 Public Houses 42 367 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. 42 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 44 Floors, walls, ceilings, etc., repaired 14 Cockroach infestation dealt with 1 Rooms cleansed 60 Water Closet accommodation improved 14 Additional protection provided for foodstaffs 4 Accumulation of refuse removed 5 Accommodation for storage of refuse improved 1 Food preparing room improved 4 Washing accommodation improved 28 Drainage repaired or improved 8 Food storage accommodation improved 6 Yard cleansed 3 Accommodation for clothing provided or improved 6 Sinks renewed 10 Other contraventions 19 Unsatisfactory equipment renewed 4 Cautions re smoking 1 Ventilation improved 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 154 Preparation of Sausages, etc. 47 43 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. 43 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 68 cases were notified as compared with 81 the previous year. 2 cases were treated in hospital. No. of deaths Nil Return cases from Hospital cases Nil Return cases from home nursed cases Nil During the past 15 years the character of this disease has changed from one of considerable severity to one of extreme mildness. The acute stage is, nowadays, in most cases, short and unaccompanied by high pyrexia and complications are in most cases mild or completely absent. Scarlet fever can now be disregarded as an important cause of acute endocarditis and acute nephritis which, in the past, were frequently encountered. Diphtheria. No cases were notified during the year. The following figures on Diphtheria Immunisation. Smallpox and Poliomyelitis Vaccination have been supplied by the County Medical Officer:— 44 Immunisation against Diphtheria and Vaccination against Smallpox, 1957. 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, 1957:— (A) Diphtheria Immunisation. Year of Birth 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 Total Primary Inoculations 175 727 104 27 11 19 13 7 3 6 — 2 — 1 — 1095 Re-inforcing Inoculations — — — 3 34 419 235 43 70 409 55 11 19 1 1 1330 (B) Vaccination. Year of Birth 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 Before 1943 Total Primary Vaccination 488 285 17 12 10 7 2 3 4 3 4 4 6 2 1 75 923 Re vaccination — — 2 1 4 1 1 2 3 3 2 4 2 2 3 135 165 45 Immunisation against Diphtheria, 1957. The following is a return of the number of children under the age of 15 years on 31st December, 1957, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1943). Year of birth 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Total Last complete course of injections (whether primary or booster) 1953—1957 82 201 200 294 687 1231 974 928 909 1063 1011 893 929 897 175 10474 1952 or earlier 757 954 750 882 826 276 679 421 380 73 — — — — — 5998 Poliomyelitis Vaccination, 1957. The following table gives the numbers of children resident in the Borough of Bexley who received a course of two injections against poliomyelitis during the year ended 31st December, 1957:— 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Total 712 647 592 497 231 191 169 129 3 1 — 3 172 46 Typhoid Fever and Paratyphoid Fever. There were no cases notified during the year. Puerperal Pyrexia. 16 cases were notified during the year, all of which were from Bexleyhearh Maternity Hospital, where they were isolated and treated. Ophthalmia Neonatorum. No cases were notified during the year, Measles. 1,246 cases were notified during the year. 6 cases were treated in hospital. Whooping Cough. 178 cases were notified, 1 of which was treated in hospital. Acute Poliomyelitis. 7 Paralytic cases were notified and all were treated in hospital. There was 1 death. No non-paralytic cases were notified. Scabies. 5 cases notified during the year. Food Poisoning. 8 cases were notified during the year, all were treated at home. Malaria. There were no cases notified during the year. 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 1957. 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 68 — 1 3 4 6 43 8 1 2 — 2 — Diphtheria — — — — — — — — — — — — — Puerperal Pyrexia 16 — — — — — — — 4 12 — 16 — Ophthalmia Neonatorum — — — — — — — — — — — — — Acute Paralytic Poliomyelitis 7 — — 1 — 1 — 1 1 3 — 7 1 Acute Non-Paralytic Poliomyelitis — — — — — — — — — — — — — Pneumonia 31 1 — — — 1 2 1 2 24 — 4 1 Erysipelas 7 — — — — — — — — 7 — — — Food Poisoning 8 — — — — — — — 2 6 — — — Dysentery 1 — — — — — — — — 1 — 1 — Typhoid Fever — — — — — — — — — — — — — Paratyphoid Fever — — — — — — — — — — — — — Meningococcal Infection 2 — — — — — — — 1 1 — 2 1 Measles 1246 24 84 120 141 182 667 19 5 4 — 6 — Whooping Cough 178 16 11 26 17 24 66 11 1 6 — 1 — Scabies 5 — 1 — 1 — — — — 3 — — — Encephalitis 2 — — 1 — — 1 — — — — 2 1 Totals 1571 41 97 151 163 214 779 40 17 69 — 41 4 48 TUBERCULOSIS. During the year 50 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1957 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 — — — — — — — — 5—14 2 2 — — — — — — 15—24 5 4 1 1 — — — — 25—44 13 8 — 1 — 1 — — 45—64 7 1 — — — — — — 65 and over — 1 1 — 2 — — — Totals 27 16 2 2 2 1 — — Rehousing. 4 cases were referred to me by the Chest Physician for rehousing and during the year, two cases were rehoused by the Housing Committee. 49 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1957 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 Councillor W. P. Webster Councillor N. S. Harrild Alderman Mrs. H. F. Piggott Councillor Mrs. E. M. Sheppard Councillor N. H. Antenbring. Councillor Mrs. B. Bursill Co-opted Members: Revd. E. Maynard Wilson Revd. A. E. Ramsbottom, B.D. Borough Education Officer W. E. D. Stephens, M.A. Deputy Borough Education Officer R. R. Sutton SCHOOL HEALTH SERVICE Medical Officer of Health 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. Mrs. A. B. Perkins, L.D.S., R.S.P.S. (Glas.), (Appointed 1.6.57). 52 Health Visitors Miss K. P. Hart, S.R.N., S.C.M., and Health Visitor's Certificate. (Retired 31.7.57). Mrs. A. E. Matthews, S.R.N., S.C.M., S.R.F.N. (Temporary). Miss W. M. Humphries, S.R.N., S.C.M., S.R.F.N. (Appointed 1.8.57). Miss L. G. Exley, S.R.N., S.C.M., and Health Visitor's Certificate (Part-time). Mrs. Flatman, S.R.N. (Part-time) (Appointed September, 1957). 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). Mrs. C. R. C. Cullimore, S.R.N., S.C.M., and Health Visitor's Certificate (Part-time). Mrs. P. Webb, S.R.N., S.C.M., and Health Visitor's Certificate. (Part-time) (Resigned 27.11.57). Mrs. Wright, S.R.N., S.C.M., and Health Visitor's Certificate. Miss E. C. Richardson, S.R.N.. S.C.M., Health Visitor's Certificate. (Appointed 2.12.57) (Parttime). Physiotherapist Miss R. Cheeseman, M.C.S.P. Mrs. I. O. M. Poynder. C.S.P. Speech Therapists Mrs. D. Rant, L.C.S.T. Mrs. A. Pyett, L.C.S.T. Dental Attendants Miss K. Dunkley. Mrs. V. Sproul. Miss S. Whiting. 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. 53 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1957. 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 1957, the eleventh which it has been my privilege to present. In spite of the great advances in curative medicine during the first half of the 20th century and, particularly, the great extension of medical services resulting from the National Health Service Act, 1948. the School Health Service has maintained its unique position in the prevention and promotion of the health of the schoolchildren. As a result of the virtual disappearance of many of the acute infections of childhood the discovery of the chemotherapeutic and antibiotic drugs and improvement in nutrition and in environmental conditions generally, the gross defects which were so common among schoolchildren in the past are now rarely met with in an area such as this and, in the main, our schoolchildren reflect the improved economic and social background in their nutritional state, clothing and parental care. As in any community, there are exceptions to this general rule and such children require a degree of special attention out of all proportion to their numbers. The School Health Service has had to adapt itself to these changed conditions and the service, designed 50 years ago to discover defects such as faulty vision and hearing, uncleanliness, skin diseases, malnutrition and the like, is now concerned more and more with the discovery of early departures from normality, and before serious symptoms have arisen. The service in this respect is, therefore, truly preventive and the good link which exists with the general practitioner ensures that any treatment which may be necessary is promptly and effectively given. The fact, also, that the School Health Service involves a partnership between doctor, health visitors, parents, teachers, youth employment officers and many other agencies, does in fact, make it an instrument of social medicine which has no counterpart in the Health Services of the country and is quite indispensable. The periodic medical inspection has, during recent years, come in for some criticism, often by people with the 54 best interests of the School Health Service at heart, on the grounds that it is not the best or most economical means cf supervising the health of the schoolchildren. Indeed, under Regulation 10(l)a of the School Health Service and Handicapped Pupils Regulations, 1953, the Minister may approve arrangements which do not provide for as many as three general medical inspections during the period of compulsory school age. This provision has been included to enable authorities, who wish to do so, to experiment with other arrangements not based on periodic medical inspection. Our own experience continues to be that the periodic medical inspection not only reveals a large number of defects not previously ascertained, but provides, also, a most valuable link with parents and teachers by means of which the physical, mental and emotional needs of the child can be reviewed at regular intervals during his school life. In regard to emotional defects a question raised at periodic medical inspection is often followed up at a consultative clinic when the medical officer can give more detailed attention to the problems involved. It is felt that these periodic " health audits " of the child should remain the spearhead of the School Health Service. They have undergone a re-orientation in recent years to meet the changing psychological needs of the child and the parents in a complex society in which the welfare state, a high standard of living, technological advances generally and an altered scale of priorities and values, have brought new problems of adjustment. The School Dental Service reached a greater stability than in previous years by the appointment of a further wholetime dental officer. This has meant that more attention has been possible during the year to preventive dentistry, although much remains to be done in this respect. We are still not in sight of the ideal expressed in the School Health Service and Handicapped Pupils Regulations, 1953, that "the objective should be to inspect the teeth of every pupil at least once a year—preferably more frequently and to offer treatment to such children as are found to need it." Certain procedures have now become a matter of routine in the School Health Service in this area. These include poliomyelitis vaccination, B.C.G. inoculation and pure tone audiometry, the latter being applied as an individual hearing test to all schoolchildren as soon as possible after their seventh birthday. Extension of the clinic premises at 315, Broadway and the new dental unit installed at the Little Danson Clinic are both contributing to an increased efficiency of the service in general. 55 As in previous years, I wish 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 wish to record the excellent team work of all members of the staff on which the success of the School Health Service so largely depends and 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 Officers and his Department. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, JOHN LANDON, Medical Officer of Health. 56 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Bexley Grammar School. Average number on Roll at 31st December, 1957 371 Bexley County Technical School for Girls. Average number on Roll. Bexley 855 Wilmington Annex 191 Eight County Secondary Schools. Average number on Roll 3,681 Twenty-five County Primary Schools. Average number on Roll 7,087 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. Bexley heath—315, Broadway. Tuesday, 2-4 p.m. Monday and Friday 9-10 a.m. Wednesday and Saturday 9-11.30 a.m. Doctor in attendance—Tuesday and Saturday Bexley—Murchison Avenue. Tuesday and Friday, 9.30-11 a.m. Doctor in attendance—Friday. 57 Dental. Welling—Little Danson, Dansington Road. Daily—9.30-11 a.m., 2-4 p.m. Bexleyheath—315, Broadway. Thursday, Friday, Saturday, 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. Bexley—Murchison Avenue. Monday and Thursday, 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. Tuesday and Thursday morning 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. 58 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 70 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—1957. Average number of pupils in attendance:— Primary School 7,087 Secondary School 5,098 Average number of dinners served to children daily:— Paid Free Total Primary 2,865 50 2,915 Secondary 2,756 71 2,827 59 Milk. Average number of pupils taking milk daily:— Primary 5,789 Secondary 3,181 Total 8,970 School Dental Service. I am indebted to Mr. P. G. Arnold, L.D.S., R.C.S.(Eng.) for the following report: — As you know this Dental Clinic has only been operating since June and then only on two days a week. Despite this we have been able to inspect and treat three schools already. At these inspections I have noticed that many children are receiving conservation treatment of a very high standard from private practitioners (mainly in Bexleyheath and Sidcup). On the other hand many of these children have orthodontic deformities for which they do not seem to be receiving treatment, possibly because many private practitioners feel they cannot provide this more specialised treatment and there are long waiting lists at many of the hospitals. I hope to have inspected and treated all the schools allotted to me by about midsummer. Thereafter, for the majority of the patients in these schools, treatment will be for the maintenance of a mouth made dentally healthy, assuming of course, that the patient is seen at sufficiently short intervals. I think, therefore, that provided circumstances remain the same the outlook for 1958 is good. And to Mrs. A. B. Perkins L.D.S., R.S.P.S., (Glas.) for the following: — The dental surgery at Little Danson Clinic has been operating full time since June 1957. Since then, 1,090 children have been inspected at school which is 28% of the school population allotted to this surgery. Of these, it was found that 88% required treatment. The number actually treated was 541. The following is a table of work done during the period June to December. Number inspected at School 1,090 Number requiring treatment 961 Number treated 541 Number of sessions (a) Inspection 7 (b) Treatment 277 Number of fillings (a) Permanent teeth 1,377 (b) Temporary teeth 277 60 Number of teeth conserved (a) Permanent teeth 1,093 (b) Temporary teeth 241 Number of extractions (a) Permanent teeth 151 (b) Temporary teeth 631 Number of attendances for treatment (including attendances for orthodontics) 2,209 Number of general anaesthetics 294 Orthodontics Cases commenced during year 7 Number completed 6 Number of attendances 163 Number of appliances 13 Orthopaedic Clinic. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on the Orthopedic Clinic:— The Welling Orthopaedic Clinic has continued on the 1st and 3rd Wednesday morning throughout the year in spite of the handicaps of accommodation which are now acute. There has been no change in the kind of cases attending, which are still very largely postural, back and foot deformities. These could be much more easily handled with better co-operation from the Physical Education Department of the schools and this would save a lot of time taken off for attending for special exercises. Miss Cheeseman has continued her service as Physiotherapist and we are greatly indebted to her for all that she has done. And to Mr. B. Lawson, F.R.C.S., for the following: — I see approximately between thirty to forty children at the Bexley Orthopaedic Clinic once a month on a Saturday morning. Of these about one third are below school age. In recent months it has become noticeable that local doctors are referring their cases directly to the Clinic. There will be several reasons for this but I think it is due particularly to the fact that the doctors have become aware that their cases can be seen by me at the Clinia as well as at the hospital; but in a large measure it is due to the splendid co-operation by Mrs. Poynder, the Physiotherapist, who is largely responsible for the success and the running of the Clinic. Her quiet efficiency and indulgence makes the Clinic a pleasant place for the staff to work in, as well as for the patients to come to. 61 The most successful type of operation seems to be, in my opinion, the flexor extensor transplantation for clawed toes (Curly toes). The toes are always straight after the operation and symptoms are relieved and further deformity is prevented. However, as least one very attentive mother was able to prove to me that clawed toes, even at the age of twelve years, could be improved without operation by the use of Lambrinudi splints. Some at least of those who are not helped by splintage, was due to insufficient attention and perseverance. Finally, the rooms at Murchison Avenue are ideal to work in. Ophthalmic Clinic. I am indebted to Mr. R. M. Chambers, M.B., B.S.. D.O.M.S., for the following report:— The attendance at the Eye Clinic for the year showed no significant difference from former years. The total number of examinations was 2,411, of which 537 were new cases. A co-operative spirit was shown by the vast majority of parents, so permitting the restoration of normal sight in very many cases. Occlusion by the direct skin-patch was employed wherever possible, as it was both comfortable and effective. An essential condition of this treatment of amblyopia is the active mental effort to see more, each day, with the weak eye a point stressed by me at the start of occlusion in all cases. Though school work may suffer a little, this is the most essential part of the treatment of amblyopia and must be followed rigidly. Occasionally I have come across children who have been excused some their lessions because they can't see. This well-intentioned practice is in fact a disservice to the child, who should be given every encouragement to try to use the weak eye, allowances, of course, being made for a temporary drop in academic achievement. The treatment may take many months before the maximum restoration of sight is effected. Children's hour of T.V. is a most potent advantage so long as the patch is not removed. 36 cases were referred to hospital for surgery and /or orthoptic training. 62 The difficulties involved in weekly visits to orthoptic centres, (Dartford and London) place a great burden on many parents, some of whom stop attending before they should. As a result of this, I have seen a number of cases deteriorate after initial improvement, the final state being only slightly better than when first seen. I feel that if an orthoptist were able to attend this and other clinics in the district, say once a week, in which to instruct and supervise those (supposed to be) doing home exercises, still better results would be achieved. The following tables illustrate some of the special cases seen at the clinic during the year:— Infective. Blepharitis 8 Conjuctivitis 14 Styes 7 Meibomian Cysts 6 Non-Infective. Corneal Opacities 4 Colour Defective Safe 21 Unsafe 7 Melanosis Conjunctivae 1 Congenital Len Opacities 4 Pseudoglioma 1 Coloboma of disc 1 Ptosis 4 Nerve Palsy 3 Epicanthus 18 Others. Migraine 28 Contusion of eye 2 Sinusitis 5 Voluntary nystagmus 1 Acute Choronditis 1 Referred to hospital: 36 Sptech Therapy. I am indebted to Miss Joan Pollitt, Chief Speech Therapist to the Kent Education Committee for the following report:— The cases of forty-eight children who are under the care of the Bexley Authority have been closed during 1957. 63 Forty-six of these children have attended at the Bexley clinic and two have attended at the Sidcup clinic. The cases of these forty-eight children have been closed for the following reasons:— Satisfactory results following appointments at the clinic 38 Little, if any, change following treatment 1 Treatment incomplete owing to patient leaving district, or for other reason 6 Found to have improved when first seen at clinic 3 48 Sixty children, under the care of the Bexley authority, who were attending at the clinics during 1957, will continue to attend into 1958. Fifty-one of these children are attending at the Bexley Clinic and nine at the Sidcup Clinic. Ten children under the care of the Bexley Authority were waiting appointments at the end of 1957. These children were on the waiting list at the Bexley Clinic. Sweep Frequency Pure Tone Audiometry. During 1957, 1,093 children were tested during their last year in the Infants' school, i.e., during their seventh year. Of this number 971 passed and 122 failed. The latter children were referred to the School Medical Officers for investigation and any minor conditions causing temporary deafness were treated. In addition, 315 children of all age groups were tested as special cases referred from various sources including teachers, and of this number 176 passed and 139 failed. The 315 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 otherwise. The 139 failed children were referred back to the School Medical Officers who, after further examination and treatment where necessary, referred 68 children back for a final audiometric test. Of this number 35 passed and 33 failed. Further treatment was instituted for the latter children either at the School Clinics or at the Ear, Nose and Throat Department of the West Hill Hospital, Dartford, or other hospitals in the metropolis. 64 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. Hopkins and Miss J. Hulton for the following report: — Physical Education in the Borough Schools has continued to develop during 1957, and on the whole, further progress towards a good standard of performance and physical development has been made. In many Primary Schools the greater understanding of modern work by the teachers, has resulted in a steady development of the normal physical education lesson. It is hoped that, in the future it may be possible to foster a wider application of similar principles in both games and dancing, where at present the standard is far more variable. In July, a class from one School was chosen to give a demonstration of Educational Dance in the Junior School, at the International Congress of Physical Education held in London. This selection was a very great honour for the school. Physical Education in the Secondary Schools has shown a gradual improvement in all directions, although in most schools the limited changing accommodation available and the lack of facilities for showers after lessons, make the wider training envisaged in the term "physical education," rather more difficult to develop. The provision of suitable clothing and footwear, especially for games, has been better than in previous years, but a really good general standard has still to be reached. 65 Swimming The Baths at Plumstead, Eltham, Eltham Park and Danson Park were used by four Secondary and twelve Primary Schools during the summer term. Attendances were:— Schools. Attendances. No. of Children. 4 secondary 10 classes of 2530 children each week. 268 (approx) per week. 12 primary 26 classes of 3035 children each week. 900 (approx) per week. A total of 357 swimming certificates for distances between 25 yards and one mile, were issued during the year 1957. Two Primary schools and one Secondary school 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:— 1. Educational Dance Movement—for teachers in Junior Schools. Demonstration evening held in summer term. Course of six sessions in Autumn Term. 2. Netball—for Primary and Secondary teachers. One evening in the autumn term for explanation and demonstration of the new rules. 3. Swimming—for Primary and Secondary teachers. Spring Term—series of theory lectures based on the syllabus for the A.S.A. Teachers' Certificate. Summer term—practical work, concluded with the opportunity of taking the A.S.A. examination. 66 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. 67 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. V. — Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants, 1950-1954 790 Second Age Group, 1946 866 Third Age Group, 1942 940 Total 2,596 Additional Periodic Inspections, 1943-4-5-7-8-9 1,598 Grand Total 4,194 B. — Other Inspections. Number of Special Inspections 1,793 Number of Re-inspections 2,948 Total 4,741 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 IIIA Total individual pupils (1) (2) (3) (4) Entrants 45 99 124 Second Age Group 82 129 191 Third Age Group 80 120 185 Total (prescribed groups) 207 348 500 Other Periodic Inspections 192 193 338 Grand Total 399 541 838 68 D.—Classification of the Physical Condition of Pupils Inspected during the Year in the Age Groups. Age Groups Inspected N umber of Pupils Inspected Satisfactory Unsatisfactory No. % of Col. (2; No. % of Col. (2) (1) Entrants (2) 790 (3) 781 (4) 98.9 (5) 9 (6) 1.1 Second Age Group 866 850 98.2 16 1.8 Third Age Group 940 935 99.5 5 .5 Additional Periodic Inspections 1598 1579 98.8 19 1.2 Total 4194 4145 98.8 49 1.2 TABLE II. Infestation with Vermin. (i) Total number of examinations in the schools by the school nurses or other authorised persons 4,891 (ii) Total number of individual pupils found to be infested 11 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 2 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) - 69 70 TABLE III.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1957. Defect Code No. Defect or Disease A. PERIODIC INSPECTIONS B. SPECIAL INSPECTIONS Entrants Leavers TOTAL (including all other age groups) Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation 4. Skin 18 23 58 36 159 131 47 8 5. Eyes— a. Vision 45 101 80 121 399 487 62 28 b. Squint 18 16 3 2 54 49 12 — c. Other 8 7 11 6 58 55 26 15 6. Ears— a. Hearing 9 89 4 53 24 269 19 66 b. Otitis media 2 23 2 9 5 51 9 10 c. Other 1 6 5 4 19 28 1 4 7. Nose and Throat 26 188 9 26 74 385 44 63 8. Speech 4 35 — 3 13 57 12 5 9. Lymphatic Glands 3 72 — 11 4 156 1 5 10. Heart 2 20 — 15 3 79 1 26 11. Lungs 7 63 2 28 17 205 29 89 12. Developmental— a. Hernia 1 8 — 1 3 20 — — b. Other — 13 1 21 2 79 — 3 13. Orthopaedic— a. Posture 5 11 3 29 34 159 2 3 b. Feet 8 38 13 36 70 238 18 9 c. Other 3 58 11 42 33 290 17 34 14. Nervous System— a. Epilepsy — 2 1 1 3 8 1 7 b. Other — 3 6 1 9 11 5 12 15. Psychological— a. Development — 14 1 5 1 57 24 117 b. Stability 1 57 — 14 11 235 104 100 16. Abdomen 3 14 — 4 6 58 8 23 17. Other 4 9 5 22 17 78 84 133 TABLE IV.—Treatment Tables. Group I.—Eye Diseases, Defective Vision and Squint. No. of Cases dealt with by the Authority otherwise External and other, excluding errors of refraction and squint 136 — Errors of refraction (including squint) 2,275 36 Total 2,411 36 Number of pupils for whom spectacles were prescribed 933 — Group II.—Diseases and Defects of Ear, Nose and Throat. Number of cases treated by the Authority otherwise Received operative treatment (a) for diseases of the ear — — (b) for adenoids and chronic tonsilitis — 18 (c) for other nose and throat conditions — 8 Received other forms of treatment 70 14 Total 70 40 Total number of pupils in schools who are known to have been provided with hearing aids (a) in 1957 — — (b) in previous years — 16 Number of children found, during periodic school medical inspections during 1957 to have undergone tonsillectomy at any time previously:— Boys 275; Girls 468; Total 743. 71 Group III.—Orthopaedic and Postural Defects. by the Authority otherwise Number treated at clinics or outpatients departments 232 28 Group IV.—Diseases of the Skin. Number of cases treated or under treatment during the year by the Authority. Ringworm—(i) Scalp — —(ii) Body 1 Scabies — Impetigo 3 Other skin diseases 69 Total 73 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 treated by the Authority 706 (b) Other than above Minor Eye Defects 69 Minor Injuries 4 72 TABLE V Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 3,365 (b) Specials 1,208 Total (1) 4,573 (2) Number found to require treatment 3,288 (3) Number offered treatment 3,288 (4) Number actually treated 1,758 (5) Attendances made by pupils for treatment, Including those recorded at heading 11(h) below 7,117 (6) Half days devoted to: Inspection 25 Treatment 860 Total (6) 885 (7) Fillings: Permanent Teeth 2,920 Temporary Teeth 1,237 Total (7) 4,157 (8) Number of teeth filled: Permanent Teeth 2,505 Temporary Teeth 1,181 Total (8) 3686 (9) Extractions: Permanent Teeth 339 Temporary Teeth 1,224 Total (9) 1,563 (10) Administration of general anaesthetics for extraction 575 (11) Orthodontics: (a) Cases commenced during the year 70 (b) Cases carried forward from previous year 118 (c) Cases completed during the year 42 (d) Cases discontinued during the year 2 (e) Pupils treated with appliances 78 (f) Removable appliances fitted 78 (g) Fixed appliances fitted — (h) Total attendances 1,175 (12) Number of pupils supplied with artificial dentures 14 (13) Other operations: Permanent Teeth 1,908 Temporary Teeth 174 Total (13) 2,082 73 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-not mal (8) Maladjusted (9) Epileptic Total (1) to (9) During the year ending 31-12-57 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Day Special Schools or Boarding Homes — — — 2 — 6 4 4 — 16 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes 1 1 — 1 43 5 7 6 — 64 On or about 3ist January, 1968:— C. Number of Handicapped Pupils from the area:— (i) attending Special Schools as: (a) Day Pupils — 2 — 5 — 12 23 — — 42 (b) Boarding Pupils 3 — 3 3 24 1 3 10 — 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) 3 2 3 8 24 13 26 10 — 89 D. Were being educated under arrangements made under Section 56 of the Education Act, 1944:— (i) In hospitals — — — — 2 1 — — — 3 (ii) In other groups (e.g. units for spastics) — — — — — — — — — — (iii) At home — 1 — — — 2 — — — 3 E. Were requiring places in special schools:— (i) TOTAL (a) day — 1 — — — — 2 — — 3 (b) Boarding 1 — — 1 2 3 — 1 — 8 Pupils included in the totals above:— (ii) who had not reached the age of 5: (a) awaiting day places — 1 — — — — — — — 1 (b) awaiting boarding places 1 — — — — — — — — 1 (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 — — — — — — 1 — — 1 (b) awaiting boarding places — — — — 5 — — 1 b F. Were on the Registers of Hospital Special Schools 2 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) 5 of the Education Act, 1944. 74 INDEX. item page Health Committee 2 Public Health Staff 3 Foreword 4—9 STATISTICS AND SOCIAL CONDITIONS. Acreage 10 Population 10 New Houses Erected 10 Unemployment 10 Social Conditions and Amenities 10—11 Population Graph 12 Summary of Vital Statistics 1'—14 Extracts from Vital Statistics— Births and Birth Rates 14—15 Stillbirths and Stillbirth Rates 15 Deaths and Death Rates 16—17 Causes of Death 18 Causes of Death in Age Groups 19 Inlantile Mortality 20—21 Maternal Deaths 21 GENERAL PROVISIONS OF HEALTH SERVICES. Isolation Hospital Accommodation 22 General Hospitals 22 Ambulance Facilities 22 National Assistance Act, 1948 22 Public Mortuary 22 Laboratory Facilities 22—23 Registration of Nursing Homes 23 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 24 Water Supply 25 Drainage and Sewerage 25 Rivers and Streams 25 Chief Public Health Inspector's Report— Tables of Inspections and Improvements, etc. 27—28 Food Inspection 29 Tables—Factories Act, 1937 and 1948 30 Public Cleansing Service 31 Refuse Collection and Disposal 31 Salvage 32 Kitchen Waste 32 Public Conveniences 32 Atmospheric Pollution 33 Prevention of Damage by Pests Act, 1949 34 Pet Animals Act, 1951 34 Shops Act. 1950 34 Swimming Pool 35 Verminous Premises 35 Wasp Destruction 35 Schools 35 75 item page HOUSING. Council Estates 36 Inspection of Dwelling Houses 37 Remedy of Defects without formal notice 37 Action under Statutory Powers 37—38 Clearance Schemes 38 Improvement Grants 38 Housing Repairs and Rents Act, 1954 38 Rent Act, 1957 39 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 40 Slaughterhouses 40 Adulteration of Food—Food & Drugs Act, 1955 41—42 Food Shops and Food Manufacturing Premises 42—43 Registration of Premises 43 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 44 Diphtheria 44 Diphtheria Immunisation, Smallpox and Poliomyelitis, Vaccination 45—46 Typhoid Fever and Para Typhoid Fever 47 Puerperal Pyrexia 47 Ophthalmia Neonatorum 47 Measles 47 Whooping Cough 47 Acute Poliomyelitis 47 Scabies 47 Food Poisoning 47 Malaria 47 Tables of Infectious Diseases Notified 48 Tuberculosis 49 SCHOOL HEALTH SERVICES REPORT, 1954. Welfare and School Attendance Sub-Committee 52 Staff 52—53 Foreword 54—56 Schools 57 Clinics 57—58 Co-ordination Periodic Medical Inspections 59 School Meals and Milk 59—60 School Dental Service 60—61 Orthopaedic Clinic 61—62 Ophthalmic Clinic 62—63 Speech Therapy 63—64 Sweep Frequency Pure Tone Audiometry 64—65 Cleanliness Inspections 65 Physical Education 65—66 Statistical Tables 67—74 76