2(1) BEX 23 BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Services For the Year 1958 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 1958 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h.. Medical Officer of Health Borough of Bexley. Mayor: Councilor Mrs. D. M. McNamara, J.P. Deputy Mayor: Councillor J. C. Canton HEALTH COMMITTEE. Chairman: Alderman Mrs. E. M. Sheppard. Vice-Chairman: Councillor Mrs. D. A. Shearn. Alderman M. J. Corr. Councillor F. W. Archer. Alderman Mrs. K. F. Piggott. Councillor S. H. Philpot. Councillor Mrs. B. Bursill. Councillor C. Jamieson Harvey, M.B.E.. J.P. Councillor F. G. Donovan. 2 PUBLIC HEALTH STAFF, 1958. 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, *† G. Hind. M.A.P.H.I. Public Cleansing Officer and Shops Acts Inspector. Deputy Chief Public Health *† 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. Resigned 30.9.59. E. M. Pearmine (Miss) appt. 1.10.59. Clerks E. M. Pearmine (Miss). C. M. Payne (Miss) appt. 1.12.59. 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 1958 which is prepared on the lines suggested by the Minister of Health. The Registrar-General's estimate of the mid year population for the Borough is 90,330 compared with 90,020 in 1957. Generally speaking, on the basis of the statistical information available, the health of the Borough was well maintained. The standardised death rate was 11.66 per thousand of the home population compared with 11.7 for the whole of England and Wales. The birth rate at 13.6 per thousand remains considerably lower than that for the country as a whole (16.4). Sixteen infants died during the first year of life giving an infant mortality rate of 13 per thousand live births, which is the lowest rate recorded in the Borough since 1952, when the rate was 11.34. The infant mortality rate for England and Wales was 22.6 per thousand. As in previous years, the deaths were mainly associated with prematurity and congenital malformation, over which no significant degree of control is possible at present. Much research is, however, going on in regard to the possible influence of german measles and other virus illnesses as they affect the growing foetus during the early months of pregnancy. For the fifth year in succession there were no maternal deaths due to childbirth. Deaths from tuberculosis numbered 12 as against three in 1957. Deaths due to malignant disease, in general, showed a slight decrease over the previous year and cancer of the 4 lung caused 40 deaths as it did, also, in 1957. Deaths attributed to coronary disease numbered 166 compared with 138 in 1957 and 144 in 1956. For the ninth year in succession there has not been a single case of diphtheria in the Borough. There were no cases of paralytic poliomyelitis and only one case of non-paralytic disease. Sixty new cases of tuberculosis were notified during 1958 as against fifty during the previous year. The year under review was a measles year and a considerable epidemic commenced in September and continued into the early summer of 1959. During 1958, 1,246 cases were notified but only six cases were treated in hospital. Infectious diseases throughout the ages have shown a rise and fall in incidence due to many and complicated factors which are not fully understood. This matter is, however, of great significance from the administrative point of view as well as from the standpoint of the health of the community. As a result of the provision of pure water supplies in the middle of the 19th century, the enteric and diarrhoeal diseases generally were largely overcome. Scarlet fever, which in the 19th century and early part of this century was one of the main killing diseases, is, nowadays, a disease of little importance. Smallpox has been largely overcome by stringent supervision at sea and air ports and by the instrument of vaccination, although the possibility of an epidemic is always present, so that the greatest vigilance is necessary at all times. The last great epidemic of diphtheria occurred in the early 1930s and was thought to be due, largely, to an increase in the virulence of the diphtheria organism. The introduction of mass immunisation in the middle of the 1930s together with great improvements in environmental and personal health have, practically, abolished this disease, although small outbreaks of virulent type do occur from time to time in different areas. The need to keep the level of immunisation of children at a high level has often been stressed. It is, of course, possible that any deterioration in environmental conditions resulting, for example, from war conditions or other calamity might bring all or any of these diseases back in an enhanced form. Nowadays the main hazard is due to the virus diseases, of which poliomyelitis is the best known example. There are reasonable grounds, however, for optimism that the mass immunisation of the young population may, before long, in some way alter the relationship between the virus and the human organism, but it is too early, yet, to say whether 5 one can look forward with confidence to the early abolition of this disease. The antibiotics and chemo-therapeutic drugs have shorn measles of most of its terrors due, largely, to preventing the serious complications such as broncho-pneumonia, which was the main cause of death in years gone by. Much discussion is taking place at the present time as to whether the present system of notification of infectious diseases, which is founded, largely, on experience gained during the last half-century, does not need to be drastically overhauled. The notification of measles, which came into operation in 1940 when environmental conditions were seriously affected by the war, is regarded by many as being unnecessary at the present time in view of the fact that little, if any, action is taken following the receipt of notifications from general practitioners. The cost of this notification is quite considerable and there is no commensurate return from the health point of view. Scarlet fever is another disease the notification of which could, perhaps, temporarily be discontinued. It is hoped that in the future the whole position of notification of infectious disease will be rationalised in the light of present day needs. During the year poliomyelitis vaccination was vigorously carried out by the Local Health Authority and details of the numbers vaccinated are given on page 46. During 1958, the Council decided, in principle, to implement the provisions of section 11 of the Clean Air Act, 1956 relating to smoke control areas and a pilot survey was carried out 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. The area suggested for the first smoke control area is that part of the Borough bounded by Okehampton Crescent (both sides), Lodge Hill, Longleigh Lane and part of Brampton Road and is approximately 120 acres in extent. It contains 1,352 houses, of which 353 are Council houses, and 988 private dwellings. This area was chosen for its compactness and for the fact that 350 of the houses comprising the Lodge Hill Estate are already fitted with approved appliances, the remainder of the houses being modern and erected in the 1930s. The area, further, immediately adjoins the East Wickham hutments development area which the Council will, no doubt, wish to convert to a smoke control area in due course and it is comparatively near to the Abbey Wood 6 smoke control area recently declared by the Woolwich Borough Council. The Health Committee nave been much exercised in the course of their deliberations by the iack of assurance that adequate supplies of smokeless fuels other than coke will be available and have not been too happy that, in the main, authorities will have to rely on coke as the main source of smokeless fuel for some years to come. At the time of writing, arrangements are being made for the detailed survey of the area, the Minister of Housing and Local Government having given provisional clearance of the Council's proposals for their No. 1 Smoke Control Area. Arrangements are, accordingly, being made lor the maximum amount of publicity to be held in the area concerned, so that no resident affected by this order, which will come into operation in the Autumn of 1960, will be without all the information which he may require. Publicity measures wiil include public meetings, exhibitions and the distribution of explanatory leaflets. In 1956, the South East London Mass Radiography Service issued a report on the operation of the service in a report entitled "No Time for Complacency" and, althought no hard and fast conclusions could be drawn from this in regard to the incidence of pulmonary tuberculosis in this area, it was evident that a sufficient reservoir of infection was present to raise the question of the advisability of carrying out a concentrated mass radiography survey. The Councils of Bexley, Erith and Crayford have now appointed a joint committee to carry out such a survey in the Spring of 1960 and a great deal of preparatory work will be necessary in the Autumn of 1959. A house to house visitation will need to be made which, in the case of Bexley alone, may mean as many as 28,000 visits with proportionate numbers for the remaining two areas. Tuberculosis is a waning disease and it is hoped that this concentrated attack will contribute towards its final eradication. 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. It is hoped that this work may be greatly increased in the future, although this would entail a larger expenditure than has been possible in the past. Both the Local Authority and the Local Health Authority have the power to make grants for this purpose. The Fabrics (Misdescription) Regulations of 1959 are to be welcomed in this 7 connection in that they prescribe new standards of noninflammability lor textile fabrics, to which the Fabrics (Misdescription) Act, 1913 applies, namely, textile fabrics to which is attributed the quality of non-inflammability or safety from fire, or any degree of that quality. The Act places the responsibility on the local authority, who have been considering how the stringent British Standards tests prescribed by the Regulations could best be carried out. It is likely that they are too complicated to be carried out in the Health Department and the Council are considering the possibility of submitting samples of fabrics to one or other of the testing houses, recommended by the Board of Trade, who would be prepared to undertake such work on behalf of local authorities. During the year considerable progress was made by the Council in the clearance of the East Wickham Hutments and the following is a summary of the work which has been carried out. The site comprises the area roughly bounded by Wickham Street, Upper Wickham Lane and Lovel Avenue in its western section and Upper Wickham Lane, Berwick Road and Lyme Road in the east. Originally developed as temporary hutments for the housing of Woolwich Arsenal workers during the 1914-1918 war, it is now being redeveloped under the Council's slum clearance programme. The development has, in view of the need to rehouse people from the existing huts into the new houses, been divided roughly into three phases. The first and second phases concern the western area of the estate, and contracts for 165 and 116 dwellings respectively have been placed for this work. The accommodation to be provided consists of two storey development giving one and three bedroom accommodation. The first phase is already well advanced, due for completion in September, 1960, 28 houses have already been completed and occupied. The second phase is due to commence shortly and will be carried out concurrently with the contract under way. The third phase comprising the eastern section will provide approximately 200 dwellings giving a more diverse range of accommodation with one, two, three and four bedroom units in two and five storey blocks. This phase is at present in the design stage but should follow phases one and two in 1961. The future of the health services in this area is closely linked up with work of the Royal Commision on Local 8 Government in the Greater London Area. The preser' separation, in the Borough, of the environmental from the personal health services (apart from the School Health Service which is operated locally under the scheme of delegation to excepted districts under the Education Act, 1944) is an artificial one and I think one may look forward with some confidence to an improvement in the position in years to come. 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 the good work which has been done 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 313 Estimate midyear, 90,330 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1946 82 +64 rebuilt 1935 59,970 1947 19 +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 1957 90,020 1957 384 Number of inhabited houses at end of 1958 (according to Rate Books) approximately 28.200 Rateable Value £1,250,804 Sum represented by a penny rate £5,100 Unemployment. Men Women Boys Girls Total December 31st, 1957 192 68 10 6 276 December 31st, 1958 347 103 9 21 480 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, 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 1247 „ 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 1931 SUMMARY OF VITAL STATISTICS England and Wales. Borough of Bexley. Rates per 1,000 Home Population. Births- Live 16.4 13.6 Still 0.36 0.28 21.6(a) 19.9(a) Deaths— All Causes 11.7 9.48 Typhoid and Paratyphoid 0.00 — Whooping Cough 0.00 — Diphtheria 0.00 — Tuberculosis 0.11 0.13 Influenza 0.05 0.03 Smallpox 0.00 — Acute Poliomyelitis (including Polioencephalitis 0.00 — Pneumonia 0.55 0.52 Notification s (corrected) Typhoid Fever 0.00 — Paratyphoid Fever 0.00 — Meningococcal Infection 0.02 0.02 Scarlet Fever 0.86 0.93 Whooping Cough 0.74 1.30 Diphtheria 0.00 — Erysipelas 0.07 0 09 Smallpox 0.00 — Measles 5.795 2.75 Pneumonia 0.4 0.25 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.03 — Non-Paralytic 0 01 0.01 Food Poisoning 0.20 0.07 Puerperal Pyrexia 14.26(a) 7.19(a) Rates per 1,000 Live Births. Deaths All causes under one year of age 22.6 13 0 Enteritis and Diarrhoea under two years of age 0.4 Nil (a) Per 1,000 Total (Live and Still) Births. A dash (—) signifies that there were no deaths or notifications. 13 Maternal Mortality England and Wales Borough of Bexley Rates per 1,000 total live and still births Maternal causes, excluding abortion 0.35 Nil Due to abortion 0.08 Nil Total maternal mortality 0.43 Nil EXTRACTS FROM VITAL STATISTICS FOR THE Year 1958. The Registrar General's Estimate of home population for the mid-year is 90,330 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 653 574 1,227 Legitimate 641 563 1,204 Illigitimate 12 11 23 Birth Rate. Rate per 1,000 estimated home population 13.6 The following relates to the Birth Rate during the past ten years:— 1948 Birth Rate 15.36 per thousand 1949 „ 14.02 „ 1950 „ 13.13 „ 1951 „ 12.79 „ 1952 „ 12.00 „ 1953 „ 12.70 „ 1954 „ 11.80 „ 1955 „ 12.60 „ 1956 „ 13.2 „ 1957 „ 13.6 „ Rate per 1.000 for England and Wales 16.4 14 The Registrar-General has supplied a comparability factor for 1958. The standardised birth rate which allows for comparison with other parts of the country is 13.9. Stillbirths. Males Females Total Total 14 11 25 Rate per 1,000 total (live and still) births 19.9 25 Stillbirths were registered during the year. This represents a rate of 0.28 per 1,000 population against 0.27 per 1,000 population in 1957. The following relates to the Stillbirth Rate during the past ten years:— Year Rate per Thousand Total Live and Still Births Population 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 1957 19.2 0.37 Rate per 1.000 for England and Wales 1958 0.36 There were no Stillbirths registered as illegitimate. Males Females Total Total Live and Stillbirths 667 585 1,252 15 Infant Deaths. Males Females Total Deaths of Infants under one year of age 10 6 16 Legitimate 10 5 15 Illegitimate — 1 1 Death rate of Infants under one year of age: Total per 1,000 live births 13.0 Legitimate per 1,000 legitimate live births 12.5 Illegitimate per 1,000 illegitimate live births 43.5 Neonatal Deaths per 1,000 live Births 8.1 The following relates to the Infant Mortality Rate during the past ten years:— 1948 19.03 per 1,000 live births. 1949 24.0 „ „ „ „ 1950 14.48 „ „ „ „ 1951 24.76 „ „ „ „ 1952 11.34 „ „ „ „ 1953 14.36 „ „ „ „ 1954 22.1 „ „ „ „ 1955 17.0 „ „ „ „ 1956 24.6 „ „ „ „ 1957 22.9 „ „ „ „ 23 illegitimate live births were registered against 33 in 1957 giving a 1.8 per cent of total live births. 16 17 INFANT MORTALITY, 1958. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1958 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0- 1- 2- 3- 4- 5- 6- 7- 14- 21- 28- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12 Congenital Malformation 2 2 Premature Birth 3 2 Atelectasis 1 1 Capillary Bronchitis 1 1 Acute Purulent Meningitis 1 1 Hydro-cephalus, Meningitis 1 Totals 6 2 1 — — — — 1 — — — 2 — — — 1 — 1 2 — — — The number of infants under one year of age who died during the year 1958 as shown by the table is 16. 10 of these deaths, that is 62 per cent. occurred in the neonatal period (within one month of birth). In 1957, the corresponding figure was 81 per cent. Maternal Deaths. There were no maternal deaths during the year. Number of women dying in, or in consequence of, childbirth: From Puerperal and Post Abortive Sepsis Nil. From other Puerperal causes Nil. Death rate per 1,000 total (live and still) births Nil. Rates over previous years have been:— 1948 Nil per 1,000 live and stillbirths 1949 0.78 „ „ „ „ 1950 0.84 „ „ „ „ 1951 Nil „ „ „ „ 1952 0.93 „ „ „ „ 1953 2.63„ „ „ „ 1954 Nil „ „ „ „ 1955 Nil „ „ „ „ 1956 Nil „ „ „ „ 1957 Nil „ „ „ „ Deaths All Causes. Males Females Total All causes 444 413 857 Death rate per 1,000 of estimated home population 9.48 Deaths from Measles (all ages) — — — „ „ Whooping Cough (all ages) — — — „ „ Diarrhœa (under 2 years of age) — — — Cancer (all ages) 73 83 156 Death rate per 1,000 for England and Wales, 1958 11.7 18 Death Rate of Area during last ten years:— 1948 7.53 per thousand. 1949 8.15 „ „ 1950 8.56 „ „ 1951 9.6 „ „ 1952 9.14 „ „ 1953 8.8 „ „ 1954 8.1 „ „ 1955 9.1 „ „ 1956 9.4 „ „ 1957 9.2 „ „ The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1958. The standardised death rate which allows for comparison with other parts of the country is 11.66. 19 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1958. Causes of Death. M. F. Total All Causes 444 413 857 1 Tuberculosis, respiratory 10 2 12 2 Tuberculosis, other — — — 3 Syphilitic disease 1 — 1 4 Diphtheria — — — 5 Whooping Cough — — — 6 Meningococcal infections — — — 7 Acute poliomyelitis — — — 8 Measles — — — 9 Other infective and parasitic diseases — 1 1 10 Malignant neoplasm, stomach 6 15 21 11 Malignant neoplasm, lung, bronchus 37 3 40 12 Malignant neoplasm, breast — 17 17 13 Malignant neoplasm, uterus — 5 5 14 Other malignant and lymphatic neoplasms 30 43 73 15 Leukaemia, aleukaemia 2 5 7 16 Diabetes 4 — 4 17 Vascular lesions of nervous system 50 66 116 18 Coronary disease, angina 108 58 166 19 Hypertension with heart disease 16 18 34 20 Other heart disease 32 54 86 21 Other circulatory disease 26 24 50 22 Influenza 1 2 3 23 Pneumonia 17 30 47 24 Bronchitis 33 21 54 25 Other diseases of the respiratory system 3 1 4 26 Ulcer of stomach and duodenum 9 5 14 27 Gastritis, enteritis and diarrhoea 1 1 2 28 Nephritis and nephrosis 3 3 6 29 Hyperplasia of prostate 9 — 9 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 3 3 6 32 Other defined and ill-defined diseases 23 29 52 33 Motor vehicle accidents 11 1 12 34 All other accidents 7 2 9 35 Suicide 2 4 6 36 Homicide and operations of war — — — 20 21 DEATHS REGISTERED (IN AGE GROUPS) IN 1958 Under 1 year 1-4 years 5-14 years 15-24 years 25-44 years 45-64 years 65-74 years 75 years and over Total M f M f M f M f M F M F M f M f M f 1. Tuberculosis, respiratory ... ... ... ... ... ... ... ... 3 2 4 ... 2 ... 1 ... 10 2 2. Tuberculosis, other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Syphilitic disease ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 4. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Meningococcal infections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7. Acute poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Other infective and parasitic diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 10. Malignant neoplasm, stomach ... ... ... ... ... ... ... ... ... ... 1 3 2 7 3 5 6 15 11. Malignant neoplasm, lung, bronchus ... ... ... ... ... ... ... ... 1 ... 16 1 17 ... 3 2 37 3 12. Malignant neoplasm, breast ... ... ... ... ... ... ... ... ... 1 ... 12 ... 3 ... 1 ... 17 13. Malignant neoplasm, uterus ... ... ... ... ... ... ... ... ... 2 ... 1 ... 1 ... 1 ... 5 14. Other malignant and lymphatic neoplasms ... ... ... ... ... 1 ... ... ... 1 9 16 12 13 9 12 30 43 15. Leukaemia, aleukeamia ... ... ... ... 1 ... ... ... ... 2 1 ... ... 2 ... 1 2 5 16. Diabetes ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... 4 ... 17. Vascular lesions of nervous system ... ... ... ... ... ... ... ... 1 ... 17 10 11 20 21 35 50 66 18. Coronary disease, angina ... ... ... ... ... ... ... ... 2 ... 51 10 29 23 26 25 108 58 19. Hypertension with heart disease ... ... ... ... ... ... ... ... ... ... ... 2 6 1 10 15 16 18 20. Other heart disease ... ... ... ... ... ... ... 1 1 1 7 8 6 8 18 36 32 54 21. Other circulatory disease ... ... ... ... ... ... 1 ... 1 ... 8 3 7 7 9 14 26 24 22. Influenza ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 1 2 23. Pneumonia 1 1 ... ... ... ... ... ... 1 ... 2 4 4 7 9 18 17 30 24. Bronchitis ... ... ... ... ... ... ... ... ... 1 4 3 16 3 13 14 33 21 25. Other diseases of the respiratory system ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... 3 1 26. Ulcer of stomach and duodenum ... ... ... ... ... ... ... ... ... ... 4 ... 1 2 4 3 9 5 27. Gastritis, enteritis and diarrhoea ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 28. Nephritis and nephrosis ... ... ... ... ... ... ... ... 1 ... 1 1 1 ... ... 2 3 3 29. Hyperplasia of prostate ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 5 ... 9 ... 30. Pregnancey, childbirth abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital malformations 3 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 3 3 32. Other defined and ill defined diseases 6 3 ... ... ... 1 ... ... ... 1 6 7 6 6 5 11 23 29 33. Motor vehicle accidents ... ... ... ... ... ... 2 ... 4 1 2 ... 1 ... 1 ... 11 1 34. All other accidents ... ... ... ... ... ... 1 ... 2 ... 2 ... ... 1 2 1 7 2 35. Suicide ... ... ... ... ... ... ... ... ... ... 2 3 ... ... ... 1 2 4 36. Homicide and operations of war ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 10 6 ... ... 2 3 5 1 17 13 140 84 129 106 141 200 444 413 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 and in one case it was necessary to make an order under the National Assistance (Amendment) Act, 1951 for removal to hospital. 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 177 bodies were admitted and 175 post-mortem examinations were made; 25 inquests were held. 22 LABORATORY FACILITIES. Pathological and bacteriological specimens are sent to the Public Health Laboratory at Maidstone. This service ceased to be the responsibility of the County Council as from the 1st October, 1955, when it was taken over by the Public Health Laboratory Service, directed by the Medical Research Council for the Ministry of Health. NURSING HOMES. Registration of Nursing Homes, Public Health Act, 1936. (Authority of Registration transferred from Kent County Council to the Bexley Borough Council—17.4.39). No. of Homes on the Register at beginning of year 4 No. of patients provided for:— Maternity 5 Others 64 Total 69 No. of Homes first registered during year 1 No. of patients provided for:— Maternity - Others 14 Total 14 No. of Homes on the Register at end of year 5 No. of patients provided for:— Maternity 5 Others 78 Total 83 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 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 Public Libraries Act,1892-1919 Oct. 1896 Private Street Works Act, 1892 Jan. 1899 Public Health Acts Amendment Act, 1907, Parts 8 and 9 Apr. 1909 Part 2—the whole „ 6—the whole May 1909 „ 10—Sec. 95 Public Health Act, 1925, Part 2 Jan. 1926 Slaughter of Animals Act, 1933 Jan. 1934 Byelaws. Wireless Loudspeakers, Gramophones, etc. Mar. 1939 Fouling by Dogs of Footways July 1938 Baths, Wash-houses, Swimming Baths and Bathing Places Aug. 1938 Parks and Pleasure Grounds May 1939 Defacing of Pavements Nov. 1939 Deposit of Litter to the Detriment of Public amenities „ Deposit of Dangerous Substances „ Organs „ Loitering at Church Doors ,, Indecent Language, etc „ Noisy Hawking „ Touting „ Noisy Animals „ Nursing Homes June 1940 Sale of Contraceptives in Slot Machines Dec. 1949 Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air May 1950 Improper Behaviour on School Premises May 1951 The Flying of Model Aircraft Nov. 1951 Public Libraries Jan. 1953 Building Apr. 1954 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, 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 1958. 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 7 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. New drainage and sewerage schemes:— Central Avenue and Vaughan Road, 360 yards S.W.S. Highland Road, 70 yards F.S. Developing owners have constructed private sewers and drains at the following sites: — Stuart Evans Close Westerham Drive Highbanks Close Robina Close Midhurst Hill Service Road E. Rochester Way at junction with Danson Road. 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 1958. 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) 18 181 Houses inspected (defects only recorded) 119 644 Houses inspected (certificates of disrepair) 77 239 Houses inspected (improvement grants) 25 — Houses inspected (Housing Act, 1936, Overcrowding) 17 5 Houses inspected re Infectious Disease (including scabies) 111 34 Factories with mechanical power 175 14 Factories without mechancial power 15 42 Outworkers' premises 16 — Other premises under the Act 2 3 Bakehouses 103 51 Water Samples 29 — Food and Drugs Act Samples 237 — Dairies and distributors 23 1 Ice Cream premises 108 5 Restaurants, etc 187 18 Fish premises 92 11 Meat Shops 303 60 Public Houses 21 21 Shops re unsound food 303 53 Other premises where food is prepared 791 52 Offensive accumulations 41 39 Stables 12 — Keeping of Animals 19 46 Rats 243 489 Drains inspected 693 527 Drains tested (water, smoke or colour) 102 3 Dustbins 34 39 Verminous premises 32 25 Smoke observations 39 19 Tents, Vans and Sheds 20 77 Refuse Tips 398 — Refuse Removal and Salvage 553 10 Conveniences 175 — Pet Animals Act, 1951 28 12 Council House applicants 165 49 Shops Act, 1950 1,077 30 National Assistance Act, 1948—Sec. 47 9 4 Miscellaneous inspections 1,179 141 27 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 19 Provided with sufficient ashplace accomdation 13 Provided with sufficient water supply 12 Houses Improved Internally— Walls and ceilings repaired 154 Dampness in rooms remedied 85 Defective floors repaired 80 Ventilation of Rooms improved 68 Windows repaired 124 Stoves, fireplaces, etc. provided or repaired 32 Houses Improved Externally— Roofs repaired 40 Eaves gutters and down spouts fixed or repaired 63 Yards paved or repaired 3 Chimney stacks repaired 18 Walls repointed or repaired 47 Miscellaneous repairs 21 Drainage— Drains cleansed or repaired 543 New drains constructed 12 New Gullies provided 3 Ventilation of drainage system improved 1 Inspection chambers built or repaired 13 Waste pipes provided or repaired 11 New sinks provided 7 Offensive accumulation removed 1 Nuisances from animals abated 1 Other nuisances abated 6 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 21 Houses visited including revisits 145 Rooms disinfected 13 Notices delivered to Education Authorities, etc. 196 28 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered and destroyed: Corned Beef lbs. 1,028¼ Ham „ 7 Tinned Ham „ 974 Beef „ 624 Ox Cheek „ 90 Ox Kidneys „ 35¾ Pork „ 201 Pigs Spleens „ 48 Pigs Kidneys „ 14 Pork Chipolatas „ 24 Liver „ 126 Turkey „ 38 Rabbit „ 21 Lamb „ 4½ Fish „ 437 Cheese „ 298 Butter „ 105 Pork fat „ 61 Cooking fat „ 55 Margarine „ 52½ Fruit cake „ 10 Rice „ 8 Fruit pulp tins 1,020 Fruit and Fruit Juices „ 925 Preserves „ 22 Vegetables „ 602 Meat „ 408 Soup „ 42 Fish „ 83 Milk „ 281 Cream „ 7 Chinese egg „ 2 Ice cream cartons 48 Dried fruit boxes 50 Malt vinegar gallons 6½ Mallow creams 160 Meat Puddings 11 Chickens 7 Miscellaneous items 15 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 57 — — Factories with mechanical power 343 7 — *Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) *Electrical Stations should be reckoned as factories. 5 2 — Total 405 9 - 2. Defects Found. Particulars. Number ot Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.l) 3 3 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7)— Insufficient Unsuitable or defective 6 6 — — Not separate for sexes — — — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 2 2 Total 11 11 — — 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. The number of men employed in this service averages 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. In October, 1958, a serious fire occurred at the Salvage Depot, East Wickham Farm, Welling, resulting in the building being completely unusable for salvage purposes. Temporary arrangements were made to continue this service in the Council yard. Details of salvage sales for the financial year ended 31st March, 1959, are set out below. Tons. cwts. qrs. £ s. d. Waste Paper 467 18 3 3,653 8 9 Textiles 17 4 0 255 16 1 Ferrous Metals 39 0 0 143 11 6 Non-Ferrous Metals 16 2 39 1 9 Miscellaneous Items 2 15 2 20 3 4 527 14 3 4,112 1 5 Kitchen Waste. There are some 300 waste food 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. (4 mens', 4 womens'). 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. Wrotham Road, Welling. (Opened September, 1958). Westwood Lane, Blackfen. (Maintained jointly by the Chislehurst and Sidcup Urban District Council and Bexley Corporation). 32 ATMOSPHERIC POLLUTION. The Council is represented on the Thameside Advisory Committee for the Abatement of Atmospheric Pollution. By arrangement with this Committee a deposit gauge is installed on the roof of the Education Office in Brampton Road, Bexleyheath, and the following table gives the results obtained during 1958. MONTH TONS PER SQUARE MILE. Rainfall inches Total water insoluble matter Soluble in C.S.2. Ash Other combustible matter Total water soluble matter Calcium Chlorine Sulphates Total solids January 1.33 6.95 0.16 5.03 1.76 6 64 0.87 1.04 2.74 13.60 February 1.51) 7.64 0.17 5.80 1.67 7.11 0.87 0.94 2.31 14.75 March 1.00 8.72 0.12 6.87 1.73 8.59 1.24 1.01 3.10 17.31 April 1.47 8.09 0.15 6.21 1.73 5.54 0.94 0.60 2.40 13.63 May 1.64 9.41 0.08 7.92 1.41 7.45 1.48 0.60 2.28 16.86 June 5.23 1007.75 1.21 975.45 31.09 46.72 13.16 3.42 9.84 1054.47 July 1.52 6.60 0.09 4.26 2 25 4.90 0.81 0.47 2.15 11.50 August 4.62 5.76 0.13 3.31 2.32 6.71 0.94 0.67 2.71 12.47 September 5.85 9.00 0.12 5.88 3.01 14.36 3.22 1.07 4.26 23.36 October 3.79 5.53 0.08 3.87 1.58 7.92 1.48 1.14 3.76 13.45 November 0.46 2.82 0.10 1.74 0.97 6 49 1.34 0.65 3.35 9.31 December 2.49 9.73 0.13 7.15 2.45 7.82 0.81 1.07 3.25 17.55 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 so3 Collected Mg. of S03/day Collected by 100 sq cm. of Batch A Pb O2 (Louvered Cover) In Sample In Control Due to Exposure Sq. Cm. Mg. Mg. Mg. Mg /100 sq. Cm./day January 100 305.6 3.4 302.2 3.14 2.83 February 95 193.8 3.5 190.3 2.45 2.21 March 95 241.2 2.8 238.4 2.97 2.67 April 95 160.2 5.8 154.4 1.86 1.67 May 100 71.2 1.3 69.9 0.75 0.68 June 95 78.6 1.4 77.2 0.96 0.86 July 100 87.4 0.6 86.8 0.96 0.86 August 95 57.4 0.8 56.6 0.66 0.59 September 90 106.2 0.7 105.5 1.34 1.21 October 100 185.2 2.9 182.3 1.89 1.70 November 100 233.6 1.6 234.0 2.87 2.58 December 100 287.4 3.8 283.6 3.14 2.83 33 A volumetric apparatus for the measurement of sulphur dioxide and smoke has been installed at the Health Department, Brampton Road, and readings were commenced on the 1st July, 1958. A summary of the results obtained is set out below. Concentration of Smoke and Sulphur Dioxide. Smoke Cone, mg/100 m3 Sulphur Dioxide Cone. p.p. 100m Average Value Highest Value Lowest Value Average Value Highest Value Lowest Value July 2.70 9.60 0.10 2.20 7.43 Nil August 1.43 7.30 0.20 0.65 5.60 Nil September 3.41 8.89 0.52 2.83 12.80 0.2 October 9.57 22.78 1.40 3.32 9.90 0.4 November 32.11 129.82 8.25 10.01 33.60 2.4 December 29.27 77.50 1.60 9.40 35.80 1.1 Clean Air Act, 1956—Smoke Control Areas. During the year the Council approved in principle the first smoke control area in the Borough, and instructed the Medical Officer of Health and myself to arrange for a pilot survey to be carried out. The proposed area comprises 1352 dwelling houses, shops, etc. The report of the survey was considered by the Council in 1959, and the proposed area was submitted to the Minister of Housing and Local Government for approval. 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 the sewermen under the supervision of the Dept. 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. 34 Details of surface infestations dealt with during the period are set out below. Number of Properties Inspected 609 Number of Inspections 2,894 Number of Infestations found: Rats—Major Minor 286 Mice 33 Number of Properties Treated Rats Mice Local Authority's premises 2 — Dwelling Houses 253 24 Business Premises 31 9 PET ANIMALS ACT, 1951. Licences to keep pet shops were issued to 8 persons under the Act. One caution was given during the year in connection with animals displayed in such a position as to expose them to interference by persons outside the shop. 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 1,107 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. 35 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 only 2 premises were found to be infested with bed bugs and these were treated with satisfactory results. Infestations at other premises were dealt with as follows: — Moths 5, Mites 1, Fleas 2, Woodworm 2, Beetles 2, Ants 2. Wasps. The destruction of wasps nests is undertaken by the Department and during the year 14 nests were destroyed. A charge of 6s. 0d. 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 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 12 John Newton Court — 132 Marwood Estate — 22 Lodge Hill 364 Wickham Street 74 East Wickham— Glenmore Road No. 1 116 Glenmore Road No. 2 84 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 84 Faygate Estate 52 60 Bristow Road — Upton Close 14 Fairfield — 28 Tower Road — 48 Bexley— Hartford Road Estate and Victoria Road Estate 54 Royal Park Estate 114 Midhurst Hill 16 Newick Close 10 Henfield Close 7 Rye Close Extension 35 Glenhwst Avenue 27 Hurst Place Estate 143 S.D.A. Houses 8 Houses purchased 3 2,501 318 37 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) 137 (b) Number of inspections made for the purpose (including re-inspection) 962 (2) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (3) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 128 2. Remedy of Defects during the year without service of Formal Notice. Number of defective dwelling houses rendered fit in consequence of informal action 124 3. Action under Statutory Powers during the year. A. Proceedings under the Housing Act, 1957 Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners 2 (b) By local authority in default of owners — B. Prceedings under Public Health Acts— Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 1 (b) By local authority in default of owners — C. Proceedings under Sections 16 and 17 of Housing Act, 1957— (1) Number of dwelling houses in respect of which Demolition orders were made 18 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 5 (3) Number of houses in respect of which Closing Orders were made 2 D. Proceedings under Section 18 of the Housing Act, 1957— parts of buildings closed 1 38 Slum Clearance. During 1958, 30 hutments in the East Wickham Clearance Areas were demolished and the occupants rehoused by the Council. Improvement Grants. Number of applications for improvement grants 25 Number of applications approved 3 Total cost of approved expense of improvements for those three cases £661 Total approved costs on which grants were made in 12 cases (excluding the three above) £4,659 9 3 Total amount of grants made in those 12 cases £1,929 11 6 Rent Act ,1957. Number of applications for certificates of disrepair 36 Number of decisions not to issue certificates 6 Number of decisions to issue certificates 41 (a) in respect of some but not all defects 30 (b) in respect of all defects 11 Number of undertakings given by landlords 23 Number of undertakings refused by the Local Authority — Number of Certificates issued 22 Applications by landlords for cancellation of certificates 21 Objections by tenants to cancellation of certificates 7 Decisions by Local Authority to cancel in spite of tenants' objection 2 Certificates cancelled 16 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 37 Supplementary Licences:— Pasteurised Milk 6 Tuberculin Tested Milk 5 Sterilised Milk 6 15 samples of school milk were forwarded to the Public Health Laboratory for the Methylene Blue and Phosphatase Tests, and all were satisfactory. (b) Slaughterhouses. There are no slaughterhouses in the area, and the majority of the butchers obtain their supplies through Smithfield Market. 40 (c) Adulteration of Food. Food and Drugs Act, 1955. The following table summarises the 231 samples taken during the year. Formal Informal Milk 2 8 Soup, Meat Extracts 3 4 Pastes, Potted Meat 1 8 Pudding or Cake Mixture, Flour, etc. 3 8 Jellies, Custard Powders, etc 2 4 Sausages, Sausage Meat, etc 17 12 Creamed Rice - 2 Condiments, Sauces, Pickles, Spices, etc 2 34 Pure Coffee, Coffee Extracts, Coffee and Chicory 2 1 Meat Pies and Puddings 2 2 Sweets and Confectionery 3 8 Essences — 2 Butter and Fats 6 4 Ice Cream 1 — Minerals 7 3 Vegetables — 3 Fruit — 2 Preserves 1 6 Condensed Milk — 3 Ground Almonds 2 1 Cream 1 5 Dried Fruit — 9 Cheese Food — 4 Garden Peas — 1 Cakes 1 2 Biscuits — 1 Hamburgers 2 1 Tinned Meat — 4 Fish 1 3 Almond Marzipan 4 — Tea 1 — Pea Flour — 1 Dried Yeast 1 - Lemonade powder — 2 Nut Oil — 1 Olive oil — 1 Desiccated Coconut 1 — Patent medicines 2 4 Liquid frozen whole egg — 1 Mix-a-shake — 2 Pearl barley, ground rice, etc 3 — Peanut butter 1 — Mincemeat 2 1 Christmas pudding — 1 41 Legal Proceedings. (1) Meat Pie—Unfit for human consumption. Case dismissed. (2) Lemon Curd Tart—Tin tack in tart plus nine offences under the Food Hygiene Regulations. Fined £33 plus £5 15s. Od. costs. (3) Apple Turnover—Mouldy. Fined £20 plus £2 2s. Od. costs. (4) Milk—Cigarette packet in bottle. Fined £5 plus £1 2s. 6d. witness expenses plus £3 3s. Od. Advocates fee. (5) Milk—Twig in bottle. Fined £5 plus 5s. Od. witness expenses plus £3 3s. Od. Advocates fee. (6) Milk—Adulterated. Fined £20 plus £3 3s. Od. costs. (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 48 Cafes and Restaurants 27 Greengrocers 45 Sweet Shops 65 General Provision 82 Bakers and Confectioners 25 Wet and Fried Fish Shops 24 Public Houses 42 358 42 The following table is a summary of the improvements carried out as a result of action by the Department, under the Food Hygiene Regulations, 1955. Hot water supply provided or improved 6 Floors, walls, ceilings, etc., repaired 18 Infestations dealth with 1 Rooms cleansed 34 Water Closet accommodation improved 5 Accumulation of refuse removed 5 Accommodation for storage of refuse improved 4 Washing accommodation improved 6 Drainage repaired or improved 2 Food storage accommodation improved 7 Yard cleansed or repaired 5 Accommodation for clothing provided or improved 1 Sinks renewed 2 Other contraventions 3 Unsatisfactory equipment cleansed or renewed 6 Smoking offences 2 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 164 Preparation of Sausages, etc 51 43 31 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 84 cases were notified as compared with 68 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 2 During the past 15 years the character of this disease has changed from one of considerable severity to one of extreme mildness. The acute stage is, nowadays, in most cases, short and unaccompanied by high pyrexia and complications are in most cases mild or completely absent. Scarlet fever can now be disregarded as an important cause of acute endocarditis and acute nephritis which, in the past, were frequently encountered. Diphtheria. No cases were notified during the year. The following figures on Diphtheria and Whooping Cough Immunisation and Smallpox and Poliomyelitis Vaccina have been supplied by the County Medical Officer: — 44 45 Immunisation against Diphtheria and Whooping cough, and Vaccination against Smallpox, 1958. 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, (C) Whooping cough immunisation during the year ended 31st December, 1958:— (A) Diphtheria Immunisation. Year ot birth 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 Total Primary Inoculations 195 780 83 33 16 2f 34 21 9 8 6 4 1 3 — 1219 Re-inforcing Inoculations — 10 2 2 42 38t 320 64 28 489 81 15 8 1 1454 (B) Vaccination. Year of Birth 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 Before 1944 Total Primary Vaccination 428 387 16 11 7 3 2 2 4 2 3 1 — 6 3 54 929 Re vaccination — — — 4 2 3 5 2 2 3 3 3 2 87 116 (C) Whooping Cough Immunisation. Year of Birth 1958 1957 1956 1955 1954 1953 1952 1951 Total Primary Inoculations 515 881 135 46 30 24 12 4 1647 46 Immuisation against Diphtheria, 1958. The following is a return of the number of children under the age of 15 years on 31st December, 1958, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1944). Year of Birth 1944 1945 1946 1947 1947 1949 1950 l951 1952 1953 1954 1955 1956 1957 1958 Total Last complete course of injections (whether primary or booster) 1954—1958 145 12* 192 340 948 1098 942 953 938 1067 927 963 980 977 195 10789 1953 or earlier 1010 830 900 1181 585 677 428 378 385 82 — — — — — 6546 Poliomyelitis Vaccination, 1958. The following table gives the numbers of persons resident in the Borough of Bexley who received injections against poliomyelitis during the year ended 31st December, 1958:— Year of Birth 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 Others Total Given two injections 664 721 920 566 513 474 519 732 824 789 843 994 1058 1135 210 1445 12407 Given third injections 3 4 5 70 68 57 48 62 59 71 90 96 128 44 — 33 838 Typhoid Fever and Paratyphoid Fever. There were no cases notified during the year. Puerperal Pyrexia. 9 cases were notified during the year, all of which were from Bexleyheath Maternity Hospital, where they were isolated and treated. Ophthalmia Neonatorum. No cases were notified during the year, Measles. 248 cases were notified during the year. 1 case was treated in hospital. Whooping Cough. 117 cases were notified, all being treated at home. Acute Poliomyelitis. One non-paralytic case was notified and treated in hospital. No paralytic cases were notified. Scabies. 4 cases were notified during the year. Food Poisoning. 6 cases were notified during the year, 3 were treated in hospital. Malaria. No cases were notified during the year. 47 48 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 1958. 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 84 — — 5 3 8 50 12 3 3 — 2 — Diphtheria — — — — — — — — — — — — — Puerperal Pyrexia 9 — — — — — — — 4 5 — 9 — Ophthalmia Neonatorum — — — — — — — — — — — — — Acute Paralytic Poliomyelitis — — — — — — — — — — — — — Acute Non-Paralytic Poliomyelitis 1 — — — — — — — — 1 — 1 — Pneumonia 23 — — 1 1 2 2 — 2 15 — 2 — Erysipelas 8 — — — — — — — — 8 — — — Pood Poisoning 6 — — — — — 1 — 1 4 — 3 — Dysentery 2 — — — — — — — 1 1 — 1 — Typhoid Fever — — — — — — — — — — — — — Paratyphoid Fever — — — — — — — — — — — — — Meningococcal Infection 2 1 — — — — 1 — — — — 2 — Measles 248 6 15 38 35 32 118 1 1 2 — 1 — Whooping Cough 117 4 3 15 18 15 59 2 — 1 — — — Scabies 4 — — — — — 3 — — 1 — — — Encephalitis — — — — — — — — — — — — — Totals 504 11 18 59 57 57 234 15 12 41 — 21 — TUBERCULOSIS. During the year 60 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1958 are contained in the following table:— Age Period New Cases Deaths Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. Under 5 — 2 1 — — — — — 5—14 3 1 — 1 — — — — 15—24 6 6 — — — — — — 25—44 11 5 1 3 3 2 — — 45—64 7 5 — — 4 — — — 65 and over 4 3 — 1 3 — — — Totals 31 22 2 5 10 2 — — The number of non-notified Tuberculosis deaths was 4. 49 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1958 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 W. P. Webster. Vice-Chairman: Miss M. Woodward, L.L.A., L.G.S.M. Alderman J. Cronin Councillor J. C. Canton Councillor N. H. Antenbring Councillor F. W. Archer Alderman Mrs. E. M. Sheppard Councillor Mrs. B. Bursill Councillor Mrs. D. M. McNamara, J.P. 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.), 52 Health Visitors Mrs. A. E. Matthews, S.R.N., S.C.M., S.R.F.N. Miss W. M. Humphries, S.R.N., S.C.M., S.R.F.N. Miss L. G. Exley, S.R.N.. S.C.M., and Health Visitor's Certificate (Part-time). Mrs. Flatman, S.R.N. (Part-time) (Resigned June, 1958). 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. Wright, S.R.N., S.C.M., and Health Visitor's Certificate. (Part-time) Miss E. C. Richardson, S.R.N., S.C.M., Health Visitor's Certificate. (Part-time). 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. (Resigned 31.12.58) (Part-time). Mrs. T. Grove, L.C.S.T. (Appointed 12.1.59) (Part-time). Dental Attendants Miss K. Dunkley. Mrs. V. Sproul. Miss S. Whiting (Part-time). 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 1958. To the Chairman and Members of the Bexley Committee for Education. Mr. Chairman Ladies and Gentlemen, I have the honour to submit my Annual Report on the School Health Service for the year 1958, the twelfth which it has been my privilege to present. The golden jubilee of the School Health Service fell in December 1957, and a retrospective glance may, therefore, not be out of place. The service was brought into being by the Education (Administrative Provisions) Act, 1907 following the report of the Interdepartmental Committee on Physical Deterioration in 1904, the latter having been appointed by the Privy Council in 1903 to investigate the allegation that 40 to 60 per cent of the Army recruits were physically unfit for military service. It is a matter of history that the Interdepartmental Committee carried out its task with such extraordinary thoroughness and vision that their recommendations laid the foundations of much of the practice of social medicine as we understand it today. The Act of 1907 imposed on local education authorities the duty to provide for the medical examination of children in public elementary schools and to attend to their health and physical condition. From the beginning it was made clear that this service also aimed at the mental and moral improvement of coming generations. This is the spirit which has animated the School Health Service during the past 50 years so that, not only is it concerned with the discovery of defects and their treatment and with the prevention of ill-health, but with the promotion of the physical mental and emotional development of the child. It is, therefore, fully identified with the aims of education as a whole of which it is an integral part. These are, as I see it, to help the schoolchild by the cultivation of his body and his mind to realise the full promise of his genetic endowment and, as far as we are concerned, to assist him to overcome the physical, mental and psychological difficulties which he will encounter on the road to maturity and social integration. The health of the schoolchild has improved out of all knowledge in the past half-century. The death rate per 1,000 54 children aged 5 to 9 years fell from 3.5 in 1901—10 to 0.4 in 1957 with an even greater fall in the case of the older children. Deaths from scarlet lever and diphtheria have become a rarity; verminous conditions and malnutrition have fallen to small proportions and children are taller, heavier, better clothed and reach physical maturity earier than their predecessors of 50 years ago. Improved standards of physical health are no longer enougth and increasing attention is being paid to emotional well-being and to the total health of the schoolchild as an individual in society. In all this the School Health Service has played its part and teachers and doctors and many others have been engaged in a joint enterprise in helping to produce sound, happy and adequate citizens of the future. Psychological difficulties appear to have increased but whether this a true increase or whether we are, nowadays, able to pay more attention to these conditions because of the recession of much overt physical disease, is a matter of opinion. Suffice it to say that a great deal of time and effort is expended annually in dealing with these problems and, in this connection, our thanks are due, not only to the Teachers whose insight and co-operation is of the first importance, but also to the Director and Staff of the Crayford Child Guidance Clinic whose specialist help is so readily available to us. At the end of June, 1958, Dr. Zausmer resigned his appointment as Director to take up an appointment in Cheshire and I wish to place on record the great help which we received from him during his term of office. The needs of handicapped children (i.e. blind and partially-sighted pupils, deaf and partially-deaf pupils, educationally subnormal, epileptic, maladjusted and physically handicapped pupils, pupils suffering from speech defects and delicate pupils) take up a considerable amount of time and recommendations have to be made in regard to any special provisions which may be necessary for the care and education of these children. They are supervised throughout their school lives and, on leaving school, they may need to register under the Disabled Persons (Employment) Act, 1944 and so become entitled to further training and help in finding suitable employement. In Circular 276, 1954, the Minister of Education emphasised that "no handicapped pupil should be sent to special school who can be satisfactorily educated in an ordinary school "and this remains a cardinal rule of practice in this area. 55 As a result of provision by the Local Education Authority and by co-operation with other authorities, notably the London County Council, a suitable placement is usually possible. Children with dual or multiple disabilities present special difficulties but there is a small number of Schools in the country which specialise in the educaton of such children, e.g. deaf children with defective vision or educational retardation or pnysically nanaicapped children suffering also, from epilepsy and educational subnormality. In connection with physically handicapped children I am happy to record that, in early 1959, a cerebral palsy (spastic) unit was opened at Farnborough Hospitals Kent, for a small group of the more severely affected children in the area (those with athetosis, diplegia, severe speech defects, etc.). A teacher has been provided by the Kent Education Committee and the unit has the services of a physiotherapist, occupational therapist and speech therapist. The age range is 4 to 12 years but children are considered for training at an even earlier age if it is considered that they may present an educational problem on reaching school age. The unit is non-residential but, because it is attached to the Children's Department of the Hospital, admission to hospital for short periods in exceptional cases will be possible. It has become established in recent years that disability in children, especially defective hearing and certain forms of physical defect e.g. cerebral palsy must be detected in infancy if maximum benefit is to be obtained from treatment, training and education. Parents, too, have a vital part to play in the early treatment and management of their handicapped child. Emphasis on this aspect is made in the Report of the Chief Medical Officer of the Ministry of Education for the years 1956 and 1957. As I stated in my 1957 report, an improved staffing position has made it possible for greater attention to be given to preventive dentistry although we are still some way removed from the ideal of yearly dental inspection followed by early treatment. In view of the high rate of retirement of dentists and inadequate replacement by new blood, I feel I should repeat what I said in 1955—that the Government should give urgent consideration to the need for the fluoridation of water supplies with a view to preventing the onset of dental disease. It is not sufficiently recognised that the water supply of this area is practically devoid of fluorine while there is ample experimental evidence that the presence of this element in the proportion of about one part per million 56 in the water supply may make children much less liable to dental decay. I should like to refer again to the danger of the excessive consumption of sweets and other carbohydrate foods especially between meals which is considered by those best qualified to judge to be the cause of the increase in dental decay among children experienced in the past 15 years. It is reported by one of our dental surgeons that, during 1958, 1.8 per cent of the children aged 11-15 years treated in her clinic required dentures. In the majority of these cases the latter consisted of between one and five teeth partial dentures and in one case (a boy of 15) a 12 tooth denture both upper and lower. So far, in 1959, until the end of July, 3.4 per cent of children attending the dental clinic required dentures representing a considerable increase over the year under review. During the year a considerable amount of time was spent in the immunisation of schoolchildren against poliomyelitis and tuberculosis (B.C.G. vaccination). That there was no loss of efficiency in the general health supervision of the children is due, entirely, to the hard work and devotion to duty of the staff concerned, both medical and non-medical. It may justifiably be said that, in the Borough of Bexley, a full range of services is provided and is referred to in the body of the report. New developments come slowly and progress cannot be judged solely by new methods of treatment or ascertainment or by the provision of new buildings and equipment important as these are. The efficiency of the School Health Service depends, in the main, on the breadth of outlook of its practitioners and on a full appreciation of the complex hereditary and environmental factors affecting the emotional, intellectual and physical development of the child; on a recognition that normality is not a fixed point but a range of variability which may be quite wide. Seen in this way, differing rates of growth and development, body build and patterns of behaviour may all come within the ambit of what is normal. There is need, therefore, for a sense of proportion, to know when action is required and when it is wise and safe not to interfere in the knowledge that conditions will straighten themselves out given patience and a guiding hand. Progress depends, therefore, among other things, on our getting to know more and more about children in health and disease and the watch for the beginnings of disturbed function which may be the forerunners of disease. This may not be spectacular work but who would deny its paramount importance? 57 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 Officer and his Department. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, JOHN LANDON, Medical Officer of Health. 58 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Bexley Grammar School. Average number on Roll at 31st December, 1958 457 Bexley County Technical School for Girls. Average number on Roll. Bexley 858 Wilmington Annex 160 Eight County Secondary Schools. Average number on Roll 3,608 Twenty-five County Primary Schools. Average number on Roll 7,054 Clinics. Minor Ailments. Welling—Little Danson, Dansington Road. Tuesday and Wednesday, 2-4 p.m. Saturday, 9.30-11 a.m. Doctor in attendance — Wednesday and Saturday. Welling—Wrotham Road. Tuesday and Thursday, 9.30-11 a.m. Doctor in attendance—Thursday. Bexleyheath—315, Broadway. Tuesday, 2-4 p.m. Monday 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. 59 Dental. Welling—Little Danson, Dansington Road. Daily—9.30-11 a.m., 2-4 p.m. Bexley heath—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. 60 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 A. 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 71 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—1958. Average number of pupils in attendance:— Primary School 7,054 Secondary School 5,083 Average number of dinners served to children daily: — Paid Free Total Primary 2,815 44 2,859 Secondary 3,353 75 3,425 61 Milk. Average number of pupils taking milk daily:— Primary 6,255 Secondary 3,215 9,470 School Dental Service. Report on Little Danson Clinic Year ending 1958 (Contributed by Mrs. A. B. Perkins, L.D.S., R.S.P.S., (Glas.). During the year the surgery was equipped with a new dental unit and was redecorated. Approximately 50% of the school population allotted to the surgery were inspected in school and 86% of these required treatment. Owing to the amount of conservative treatment required, a great number of orthodontic deformities did not receive treatment and it would appear that specialist assistance in this field is fast becoming a necessity. The following is a table of work for the year. Number inspected at School 1934 Number requiring treatment 1665 Number treated 797 Number of sessions (a) Inspection 14 (b) Treatment 481 Number of fillings (a) Permanent teeth 2,031 (b) Temporary teeth 399 Number of teeth conserved (a) Permanent teeth 1,642 (b) Temporary teeth 352 Number of extractions (a) Permanent teeth 267 (b) Temporary teeth 655 Number of attendances for treatment (including attendances for orthodontics) 3,803 Number of general anaesthetics 375 Orthodontics Cases commenced during year 30 Number completed 16 Number of attendances 388 Number of appliances 40 62 Orthopaedic Clinics. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report:— The Welling Orthopaedic Clinic has continued on Wednesday mornings as before. There has been a decline in the number of cases referred but the general pattern remains the same and defects in posture still largely predominate. Since my last report there have been structural alterations to the building in Station Approach which have resulted in a little more room and more pleasant surroundings and although these improvements fail far short of the requirements of the clinic, what has been done so far is appreciated. Miss Cheeseman has continued to supervise the physiotherapy throughout the year and her work and services are gratefully acknowledged. And to Mr. B. Lawson, F.R.C.S., for the following: — The Murchison Avenue clinic has continued to run efficiently and well and there has been no marked change since my previous report. The general state of health of the children seemed to be good and the orthopaedic conditions presented were not severe, most being treated conservatively by exercises and adjustments to shoes, only a small percentage requiring operative treatment. Ophthalmic Clinic (Mr. R. M. Chambers. M.B.. B.S.. D.O.M.S.). Cases seen at Little Danson Clinic other than refractive errors during 1958. Congenital. Ptosis 5 Nystagmus 7 Lens opacities 4 Epicanthus 6 Colour Defectives: Safe 35 Unsafe 21 Albinism 1 79 63 Acquired. Constitutional Migraine 20 Anxiety states 15 Infective Styes 9 Acute conjunctivitis 8 Blepharitis 18 Cyclitis 1 71 Others. Coat's Disease 1 Melanoma conjunctivae 2 Macula lesion 2 Corneal scarring 3 Epiphora 4 12 Referred to hospital = 43. Speech Therapy. I am indebted to Miss Joan Pollitt, Senior Speech Therapist to the Kent Education Committee for the following report:— The cases of fifty-four children who are under the care of the Bexley Authority have been closed during 1958. Forty-seven of these children have attended at the Bexley Clinic and seven have attended at Sidcup. 64 The cases of these fifty four children have been closed for the following reasons:— Satisfactory progress following appointments at the clinics 39 Little, if any, change following treatment 1 Treatment incomplete owing to patient leaving district or for other reason 9 Treatment continued elsewhere 2 Reported to have improved prior to appointments being offered 1 Appointment offered but never kept 2 54 Forty-six children, under the care of the Bexley authority, who were attending at the clinic at the end of 1958, will continue to attend into 1959. Forty-two of these children attend at Bexley and four at Sidcup. Thirteen children under the care of the Bexley authority were awaiting appointments at the end of 1958. Twelve of these children were on the waiting list at Bexley and one at Sidcup. Sweep Frequency Pure Tone Audiometry. During 1958, 1,055 children were tested during their last year in the Infants' school, i.e., during their seventh year. Of this number 902 passed and 153 failed. The latter children were referred to the School Medical Officers for investigation and any minor conditions causing temporary deafness were treated. In addition, 342 children of all age groups were tested as special cases referred from various sources including teachers, and of this number 207 passed and 135 failed. The 342 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 135 failed children were referred back to the School Medical Officers who, after further examination and treatment where necessary referred 117 children back for a final audiometric test. Of this number 54 passed and 63 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. 65 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 D). 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:— During 1958 much good work was seen in the Borough Schools. The syllabus tends to get wider each year and no longer is it true that the children are only taught exercises. In the Borough it is possible during the appropriate season to see football, cricket, hockey, basketball, modern educational dance, folk dancing; weight and circuit training, cross country running, boxing, rounders, netball, athletics and swimming. This wide field is covered by allotting a definite number of training sessions to the practice of a particular game or skill and during this short "season" nothing else is allowed to interfere with this concentration of effort. Naturally the performance obtained in such a short time is not of the highest quality, but standards are obtained which are good enough to give the boy or girl a working knowledge of the game or skill involved. By giving the pupils a broad training it is hoped that sufficient will have been taught to enable them to practise and perfect any particular branch of Physical Education in which they take a keen interest. The perfecting of various skills such as are needed for football, cricket, hockey, gymnastics, fencing and netball, are often done as club activities when teachers and pupils gather together after school or in the dinner hour as specialist 66 groups, and practise not because they must, but because they want to be better than average at that particular game. The changing and washing facilities, ancillary to the playing of games, especially of the kind that covers players with mud, are not as good as is necessary, and improvements in this respect would do much to clinch the enjoyment that players get from taking part. The feeling of contentment coming from a hard game, a hot shower and good fellowship are great factors in social education. Fencing has been adopted by two Secondary boys schools and congratulations are due to Bexleyheath Secondary Boy's School who this year produced the Kent Champion. Swimming Swimming suffered considerably this year owing to the 'bus strike which made it impossible for many children to attend the baths for seven weeks. As a result the total of certificates gained dropped from 357 to 206. Baths used were at Plumstead, Eltham (both closed and open air), Crayford and Bexley (Open air). Eleven primary and five secondary schools attended each week, the average being about 870 pupils while transport was available to Plumstead. This year an event of some importance occurred when East Wickham C.P. Junior Mixed School opened its own swimming pool and so was able to carry out a teaching programme under almost ideal conditions—no dislocation of time-table, no long journeys, no fear of deep water, no restriction on the number of visits to the bath. When it is remembered that other children in the borough are expected to learn to swim in about ten lessons during the summer it can be readily understood what an advantage has been gained for the children of this school. If more of these baths would be built the dream of "every child a swimmer" could soon be realised. As a result of this effort, 140 children at East Wickham learned to swim 10 yards or more out of a total school roll of 380. This means that by the time the child is in the top class of this Junior school he or she should be able to swim. The Headmaster, Parents, Staff and all concerned are to be congratulated on their vision and enterprise in providing this amenity. 67 SCHOOL HEALTH SERVICES. Statistical Tables. Part 1 — Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. Table A. Periodic Medical Inspections. B. Pupils found to require treatment. C. Other Inspections. D. Infestation with Vermin. Part II — Return of Defccts found by Medical Inspection. Table A. Periodic Inspections. B. Special Inspections. Part III — Treatment Tables. Table A. Eye Diseases, Defective Vision and Squint. B. Diseases and Defects of Ear, Nose and Throat. C. Orthopaedic and Postural Defects. D. Diseases of the Skin. E. Other Treatment given. Part IV — Dental Inspection and Treatment including Orthodontics. Part V — Handicapped Children. 68 PART I. Medical Inspection of Pupils Attending Maintained and Assisted Primary and Secondary Schools. Number of pupils on registers of maintained and assisted primary and secondary schools (including nursery and special schools) in January, 1959 12,137 A.— Periodic Medical Inspections. Age Groups Inspected (By years of birth) Number of Pupils Inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory No. % of Col. (2) No. % of Col. (2) (1) (2) (3) (4) (5) (6) 1954 & later 37 37 100 – – 1953 451 444 98.5 7 1.5 1952 612 606 99 6 1 1951 83 81 97.6 2 2.4 1950 645 642 99.5 3 .5 1949 433 431 99.5 2 .5 1948 66 66 100 – – 1947 748 742 99.2 6 .8 1946 370 368 99.5 2 .5 1945 186 186 100 – – 1944 37 37 100 – – 1943 & earlier 1055 1048 99.3 7 .7 Total 4723 4688 99.3 35 .7 69 B.—Pupils Found to Require Treatment at Periodical Medical Inspections. Age Groups Inspected (by year of birth) For defective vision (excluding squint) For any of the other conditions recorded in Part II Total individual pupils (1) (2) (3) (4) 1954 & later 2 2 1953 29 87 85 1952 33 143 129 1951 5 18 16 1950 69 98 132 1949 47 58 80 1948 9 15 17 1947 91 105 170 1946 40 56 74 1945 26 16 37 1944 6 10 12 1943 & earlier 99 150 204 Total 454 758 958 C.—Other Inspections. Number of Special Inspections 1,672 Number of re-inspections 1,558 Total 3,230 D.—Infestation with Vermin. (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons. 2,646 (b) Total number of individual pupils found to be infested 11 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 6 (d) Number of individual pupils in respect of whom cleasing orders were issued (Section 54(3), Education Act, 1944)\ – 70 71 PART II.—Return of Defects Found by Medical Inspection in the Year Defect Defect Code or No. Disease A. PERIODIC INSPECTIONS B. SPECIAL INSPECTIONS Entrants Leavers Others TOTAL Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation 4. Skin 14 27 68 37 70 76 152 140 47 9 5. Eyes— a. Vision 67 91 99 115 288 238 454 444 67 18 b. Squint 36 35 8 8 47 29 91 72 11 3 c. Other 7 17 11 19 39 53 57 89 18 4 6. Ears— a. Hearing 25 114 6 34 14 145 45 293 47 85 b. Otitis media 3 22 1 9 – 32 4 63 4 10 c. Other 2 33 7 14 17 18 26 65 4 5 7. Nose and Throat 48 293 14 36 47 233 109 562 52 50 8. Speech 11 40 – 8 15 38 26 86 20 11 9. Lymphatic Glands 9 89 – 8 2 108 11 205 6 6 10. Heart 5 33 3 23 3 47 11 103 4 22 11. Lungs 13 131 3 32 7 142 23 305 23 68 12. Developmental— a. Hernia 6 6 4 1 3 13 13 20 2 – b. Other 3 14 – 9 13 61 16 84 1 2 13. Orhopædic— a. Posture 10 26 7 35 25 83 42 144 1 3 b. Feet 35 101 3 31 22 171 60 303 26 6 c. Other 12 53 9 93 18 182 39 328 27 20 14. Nervous System— a. Epilepsy 1 6 – 4 – 16 1 26 16 11 b. Other 1 5 2 3 1 16 4 24 4 14 15. Psychological— a. Development 1 19 5 3 47 4 71 52 44 b. Stability – 76 2 23 9 219 11 318 98 100 16. Abdomen 8 26 2 10 3 45 13 81 10 16 17. Other 3 12 12 16 18 60 33 88 66 79 PART III. A.—Eye Diseases, Defective Vission and Squint. Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 162 Errors of refraction (including squint) 2,157 Total 2,319 Number of pupils for whom spectacles were prescribed 907 B.—Diseases and Defects of Ear, Nose and Throat. Number of cases known to have been dealt with Received operative treatment (a) for diseases of the ear 2 (b) For adenoids and chronic tonsillitis 20 (c) for other nose and throat conditions 2 Received other forms of treatment 103 Total 127 Total number of pupils in schools who are known to have been provided with hearing aids (a) in 1958 2 (b) in previous years 18 C—Orthopaedic and Postural Defects. Number of cases known to have been treated (a) Pupils treated at clinics or out-patients departments 289 (b) Pupils treated at school for postural defects – 289 72 D.—Diseases of the Skin. Number of cases known to have been treated Ringworm— Scalp – Body – Scabies – Impetigo 1 Other skin diseases 60 Total 61 E.—Other Treatment Given. Number of cases known to have been dealt with (a) Pupils with minor ailments 596 (b) Pupils who received convalescent treatment under School Health Service arrangements – (c) Pupils who received B.C.G. vaccination 790 (d) Other than above – Total 1,386 73 PART IV—Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic inspections 3,142 (b) Specials 1,030 Total (1) 4,172 (2) Number found to require treatment 3,160 (3) Number offered treatment 3,160 (4) Number actually treated 1,717 (5) Attendances made by pupils for treatment, Including those recorded at heading 11(h) below 7,863 (6) Half days devoted to: Inspection 22 Treatment 1,049 Total (6) 1,071 (7) Fillings: Permanent Teeth 3,525 Temporary Teeth 1,136 Total (7) 4,661 (8) Number of teeth filled: Permanent Teeth 2,947 Temporary Teeth 1,095 Total (8) 4,042 (9) Extractions: Permanent Teeth 396 Temporary Teeth 1,088 Total (9) 1,484 (10) Administration of general anaesthetics for extraction 562 (11) Orthodontics: (a) Cases commenced during the year 130 (b) Cases carried forward from previous year 112 (c) Cases completed during the year 56 (d) Cases discontinued during the year 19 (e) Pupils treated with appliances 139 (f) Removable appliances fitted 139 (g) Fixed appliances fitted – (h) Total attendances 1,478 (12) Number of pupils supplied with artificial dentures 15 (13) Other operations: Permanent Teeth 2,271 Temporary Teeth 172 Total (13) 2,443 74 PART V Handicapped Pupils requiring Education at special Schools or boarding in Boarding Homes. (1) Blind (2) Partially sighted (3) Deaf (4) Partially Deaf (5) Delicate (6) Physically Handicapped (7) Educationally sub-normal (8) Maladjusted (9) Epileptic Total (1) to (9) During the year ending 31-12-58 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Special Schools or Boarding Homes – 4 2 1 28 2 9 4 – 50 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes – 3 1 – 32 5 3 3 – 47 On or about 31st January, 1959 :— C. Number of Handicapped Pupils from the area:— (i) attending Special Schools as: 13 19 42 (a) Day Pupils – 6 2 2 – – – (b) Boarding Pupils 3 – (5 2 19 2 4 13 – 49 (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 6 8 4 19 15 23 13 – 91 D. Were being educated under arrangements made under Section 56 of the Education Act, 1944:— (i) In hospitals – – – – – – – – – – (ii) In other groups (e.g. units for spastics) – – – – – 1 – – – 1 (iii) At home – – – – 2 2 – 1 – 5 E. Were requiring places in special schools:— (i) TOTAL (a) day – 1 – – – – 4 – – 5 (b) Boarding 1 – – – 7 – 1 2 – 11 ' 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 – – – – – – 2 – – 2 (b) awaiting boarding places – – – – 2 – – 1 – 3 F. Were on the Registers of hospita Special Schools 1 Number of children reported during the year:— (a) Under Section 57(3) (excluding any returned under (b) ) 4 (b) „ „ „ relying on Section 57(4) — (c) 57(5) of the Education Act, 1944. 3 75 INDEX. ITEM PAGE Health Committee 2 Public Health Staff 3 Foreword 4—9 STATISTICS AND SOCIAL CONDITIONS. Acreage 10 Population 10 New Houses Erected 10 Unemployment 10 Social Conditions and Amenities 10—11 Population Graph 12 Summary of Vital Statistics 13—14 Extracts from Vital Statistics— Births and Birth Rates 14—15 Stillbirths and Stillbirth Rates 15 Total Live and Still Births 15 Infant Deaths and Death Rates 16—17 Maternal Deaths 18 Death All causes 18—20 Causes of Death in Age Groups 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 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—34 Clean Air Act, 1956 Smoke Control Area 34 Prevention of Damage by Pests Act, 1949 34—35 Pet Animals Act, 1951 35 Shops Act. 1950 35 Swimming Pool 36 Verminous Premises 36 Wasp Destruction 36 Schools 36 76 ITEM PAGE HOUSING. Council Estates 37 Inspection of Dwelling Houses 38 Remedy of Defects without formal notice 38 Action under Statutory Powers 38 Clearance Schemes 39 Improvement Grants 39 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 Food Hygiene Regulations, 1955 43 Registration of Premises 43 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 44 Diphtheria 44 Diphtheria and Whooping Cough Immunisation, 45—46 Smallpox and Poliomyelitis Vaccination 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—58 Schools 59 Clinics 59—60 Co-ordination— Periodic Medical Inspections 61 School Meals and Milk 61—62 School Dental Service 62 Orthopaedic Clinic 63 Ophthalmic Clinic 63—64 Speech Therapy 64—65 Sweep Frequency Pure Tone Audiometry 65—66 Cleanliness Inspections 66 Physical Education 66—67 Swimming 67 Statistical Tables 68—75 77