BEX 24 BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Services For the Year 1959 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 1959 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h.. Medical Officer of Health Borough of Bexley. Mayor: Councillor J. C. Canton, J.P. Deputy Mayor: Councillor N. J. H. Williams. HEALTH COMMITTEE. Chairman: Alderman Mrs. H. F. Piggott. Vice-Chairman: Councillor S. H. Philpot. Alderman M. J. Corr. Councillor H. W. T. Coomes. Alderman Mrs. E. M. Sheppard. Councillor N. S. Harrild, M.B.E. Councillor Mrs. B. Bursill. Councillor C. Jamieson Harvey, M.B.E.. J.P. Councillor F. G. Donovan. 2 PUBLIC HEALTH STAFF, 1959. 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. Administrative Assistant G. A. Pearson. Senior Clerk E. M. Pearmine (Miss). Clerks C. M. Payne (Miss) I. D. Dashfield (Mrs.) (Shorthand Typist). Public Analyst H. E. Monk, B.Sc., F.R.I.C. Refuse Foreman G. E. Packman. Public Health General Assistant A. C. Ward. * Certificate for Inspection of Meat and other Foods. † Certificate of Royal Sanitary Institute and Sanitary Inspectors Joint Board. 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH To the Mayor, Aldermen and Councillors of the Borough of Bexley. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1959 which is prepared on the lines set out in Circular 1/60 of the Ministry of Health. The Registrar-General's estimate of the mid year population for the Borough is 90,500 (90,330 in 1958). On the basis of the statistical information available, the health of the Borough was well maintained. Although, as I have indicated in the past, these figures give only a partial picture of the health situation of the area, they do present collectively a conspectus of the position which is at least objective and capable of comparison with other areas in the country as a whole. The environmental services operated by the Council under a wide range of health legislation and the School Health Service delegated to them by virtue of the Excepted District Status of the Borough are, of course, complementary to the Health and Welfare Services operated by the Kent County Council under the National Health Service Act, 1946 and the National Assistance Act, 1948 and comprise a wide range of personal health services vital to the health of every section of the community—the young, the old, the infirm and those who are physically or mentally handicapped. During the year the Borough Council gave evidence before the Royal Commission on Local Government in Greater London and it is hoped the recommendations of the latter will achieve a degree of unification of all the health services in the area which is so much to be desired. 4 The standardised death rate for 1959 was 10.8 per thousand of the home population compared with 11.6 for the whole of England and Wales. In 1958 the comparable death rate was 11.66 the practical point being that there were 64 fewer deaths during 1959 than in 1958. The standardised birth rate was 14.7 per thousand estimated home population compared with 16.5 per thousand for the country as a whole. Seventeen infants died during the first year of life giving an infant mortality rate of 13.1 per thousand live births compared with a rate for England and Wales of 22.2 per thousand. This low rate for Bexley reflects the relatively favourable environmental and social conditions obtaining in the Borough. It is worthy of note that 12 of the 17 infantile deaths occurred during the first week of life and come within the category of early neo-natal deaths and were due to prematurity, congenital malformation, and atelectasis (collapse of the lung). In regard to the infectious disease, apart from the biennial measles epidemic which began in 1958 (1246 cases) and continued into 1959 (983 cases), we had much to be thankful for. For the tenth year in succession no case of diphtheria occurred in the Borough but it is, however, essential that the public should be constantly reminded of the fact that diphtheria has only been contained by immunisation—it has not been abolished and its return as a killing disease is quite likely should the level of immunisation be allowed to fall to a sufficiently low level. The duty of parents is plain. They should have their children immunised without fail at the age of 8 to 9 months with booster doses at 5 years and 10 years. It is estimated that, at present, about half the children under the age of 15 years are at risk through non-immunisation should the disease light up again in our midst. In my report for 1958 I reported that there had only been one case of poliomyelitis (non-paralytic) and expressed the hope that the mass immunisation of children and young persons might result in the gradual overcoming of this disease. While over-optimism would be out of place, it is recorded with satisfaction that no case of poliomyelitis occurred during 1959. As in the case of diphtheria, parents and young adults must ensure that the younger section of the population is kept at a high stage of vaccination against this disease. It is authoritatively accepted that the effectiveness of the vaccines now used exceeds 90% for those persons receiving three or more doses of vaccine. 5 Tuberculosis is generally recognised to be a waning disease and it is at this stage in the natural history of a disease that most effective measures towards its eradicaton can be taken. The number of new cases of tuberculosis notified during 1959 was 56 compared with 60 cases in 1958 and 50 in 1957. In view of this obvious reservoir of infection, the Councils of Bexley, Erith and Crayford, in conjunction with the South East London Mass Radiography Service, in the latter part of 1959, set up the necessary machinery to carry out a concentrated mass radiography survey in the area of the three Authorities in the Summer of 1960. A full account of this survey will be given in the report for 1960 but it can be said, at the time of writing, that approximately 43,000 persons were X-rayed as part of this campaign. Added to the fact that) many thousands of residents in this area have, in addition, been X-rayed in nearby London, where they work, it is safe to assume that the special measures which have been taken may have made a significent contribution towards a reduction of mortality from tuberculosis. This is however only one aspect of the measures against tuberculosis. The vaccination of older school children (thirteen years and over), the constant search for unsuspected cases through the tracing of contacts of known sources of infection and, as far as the housing situation will allow, the amelioration of living conditions of tuberculous families, have an equally important part to play. During 1959 there were 42 deaths from cancer of the lung compared with 40 deaths in each of the two preceding years. Approximately half the cases occurred in persons between the ages of 45 and 60 years and this mortality in the prime of life is particularly deplorable at a time when the expectation of life in general is said to be increasing. There are no signs that recent publicity relating to the association between heavy cigarette smoking and this form of cancer, which is regarded by responsible authorities as proved, has resulted in any significant reduction of the smoking habit. Deaths from coronary heart diseases numbered 154 (compared with 166, 138 and 144 in the three preceding years). Here again, the majority of these deaths occurred in the fifth and sixth decades of life, men being far more affected than women. During 1959, 107 hutments in the East Wickham Clearance Areas were demolished and the occupants rehoused by the Council. 6 During 1959 the Health Committee gave consideration to Ministry of Housing and Local Government Circular 57/59 which set out the proposed division of responsibility between the various central departments concerned with the control of radioactivity. It is clear that the Government are of the opinion that little active part will be played by the local authorities in the oversight, in their own areas, of hazards arising from this source. Nevertheless, it is hardly to be expected that local authorities will not feel that they are bound to consider with some anxiety the environmental hazards which may effect their districts and, notwithstanding the complexity of the subject, they may well turn to their medical officers of health to interpret any local developments in this field. The training of appropriate members of public health staffs is therefore, a matter of great importance. This has been recognised by the Veale Committee which reported in February 1960. In 1958, the Council decided to implement Section 11 of the Clean Air Act, 1956 relating to smoke control areas and, following a pilot survey of the area in question (bounded by Okehampton Crescent, Lodge Lane, Longleigh Lane and part of Brampton Road) and the receipt of provisional approval of the Council's proposals by the Minister of Housing and Local Government arrangements were made for the detailed survey of the area which is nearing completion. The work of the Bexley, Erith and Crayford Home Safety Committee continued during the year and now that their funds are augmented by grant from the Local Health Authority this work will be extended in the near future. 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, Administrative Assistant, 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. 7 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area. 4,869 acres. Population. New Dwellings Erected. Registrar General's Houses 287 Estimate midyear, 90,500 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1946 82+ 64 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 1958 90,330 1958 313 Number of inhabited houses at the end of 1959 (according to Rate Books) approximately 28,281 Rateable Value £1,309,665 Sum represented by a penny rate £5,350 Unemployment. Men Women Boys Girls Total December 31st, 1958 347 103 9 21 480 December 31st, 1959 242 95 29 8 374 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. 8 The following public open spaces have been provided by the Corporation:— Bexley Woods, Parkhill Road, Bexley 27.00 acres Bigs Hill Wood, Watling Street, Bexleyheath 8.68 " Brampton Park Recreation Ground, Avenue Road, Bexleyheath 4.21 „ Bursted Wood, Erith Road, Bexleyheath 30.10 „ Danson Park, Bexleyheath 185.9 Danson Mead, Welling 1.1042 „ Derwent Crescent, Bexleyheath .20 „ East Wickham Land, Glenmore Road/ Wickham Street, Welling 6.80 „ Eastcote Gardens, Eastcote Road, Welling 1.00 „ Hall Place, Bourne Road, Bexley 159.67 . Hudson Road Playing Ground, Long Lane, Bexleyheath .953 „ Hurst Recreation Ground, Shirley Avenue, Bexley 3.50 „ King George's Field, Broadway, Bexleyheath 1.235 „ Lodge Hill, Welling 1.43 „ Oxleas Close, Welling .13 „ Palmar Gardens, Bexleyheath 1.30 „ Parkhurst Gardens, Bexley .70 „ Riverside Walk, Bexley 10.50 ,. Russell Park, Woolwich Road, Bexleyheath 12.787 Rutland Shaw, Bexley 4.85 ., St. Mary's Recreation Ground, Bexley 9.925 ,. Sheldon Sports Ground, Bexleyheath 4.3883 „ Sports Ground, Park View Road, Welling 7.03 „ Steeple Avenue Memorial Garden, Bexleyheath 1.50 „ Stevens Park, Wrotham Road, Welling 9.36 The Green, Bexleyheath 1.44 „ The Green, Welling 1.64 „ The Warren, Broomfield Road, Bexleyheath 12.47 „ Westwood Estate Children's Playground, .60 „ Welling 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. 9 SUMMARY OF VITAL STATISTICS England and Wales. Borough of Bexley. Rates per 1,000 Home Population. Births— Live 16.5 14.4 Still 10.35 0.22 121.0(a) 15.2(a) Deaths— All Causes 11.6 8.76 Typhoid and Paratyphoid 0.00 — Whooping Cough 0.00 — Diphtheria — — Tuberculosis 0.09 0.05 Influenza 0.18 0.11 Smallpox — — Acute Poliomyelitis (including encephalitis) 0.00 — Pneumonia 0.61 0.51 Notifications (corrected) Typhoid Fever 0.00 — Paratyphoid Fever 0.01 — Meningococcal Infection 0.02 0.01 Scarlet Fever 1.05 1.16 Whooping Cough 0.73 1.41 Diphtheria 0.00 — Erysipelas 0.07 0.12 Smallpox 0.00 — Measles 11.88 10.93 Pneumonia 0.59 0.26 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.02 — Non-Paralytic 0.01 — Food Poisoning 0.22 0.02 Puerperal Pyrexia 13.9(a) 5.3(a) Deaths Rates per 1,000 Live Births. All causes under one year of age 22.2 13.1 Enteritis and Diarrhœ 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. 11 Maternal Mortality England and Wales Borough of Bexley Rates per 1,000 total live and still births Maternal causes, excluding abortion 0.32 Nil Due to abortion 0.06 Nil Total maternal mortality 0.38 Nil EXTRACTS FROM VITAL STATISTICS FOR THE Year 1959. The Registrar General's Estimate of home population for the mid-year is 90,500 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 657 643 1,300 Legitimate 632 631 1,263 Illigitimate 25 12 37 Birth Rate. Rate per 1,000 estimated home population 14.4 The following relates to the Birth Rate during the past ten years:- 1949 Birth Rate 14.02 per thousand 1950 „ „ 13.13 „ 1951 „ „ 12.79 „ 1952 „ „ 12.00 „ 1953 „ „ 12.70 „ 1954 „ „ 11.80 „ 1955 „ „ 12.60 „ 1956 „ „ 13.2 „ 1957 „ „ 13.6 „ 1958 „ „ 13.6 „ Rate per 1,000 for England and Wales 16.5 12 The Registrar-General has supplied a comparability factor for 1959. The standardised birth rate which allows for comparison with other parts of the country is 14.7. 37 illegitimate live births were registered against 23 in 1958 giving a 2.8 per cent of total live births. Stillbirths. Males Females Total Total 14 6 20 Rate per 1,000 total (live and still) births 15.2 20 Stillbirths were registered during the year. This represents a rate of 0.22 per 1,000 population against 0.28 per 1,000 population in 1958. The following relates to the Stillbirth Rate during the past ten years:- Rate per Thousand Year Total Live and Still Births Population 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 1958 19.9 0.28 Rate per 1,000 for England and Wales 1959 0.35 There was one Stillbirth registered as illegitimate. Males Females Total Total Live and Stillbirths 671 649 1.320 13 Infant Deaths. Males Females Total Deaths of Infants under one year of age 7 10 17 Legitimate 7 10 17 Illigitimate — — — Death rate of Infants under one year of age: Total per 1,000 live births 13.1 Legitimate per 1,000 legitimate live births 13.5 Illegitimate per 1,000 illegitimate live births Nil Neo-natal Deaths per 1,000 live births 9.2 Early Neo-natal Deaths 9.2 Perinatal Deaths 24.2 The following relates to the Infant Mortality Rate during the past ten years:- 1949 24.0 per 1,000 live births. 1950 14.48 " " " " 1951 24.76 " " " " 1952 11.34 " " " " 1953 14.36 " " " " 1954 22.1 " " " " 1955 17.0 " " " " 1956 24.6 " " " " 1957 22.9 " " " " 1958 13.0 " " " " 14 15 INFANT MORTALITY, 1959. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1959 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0- 1- 2— 3- 4- 5- 6- 7- 14- 21- 28- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12 Congenital Malformation 1 1 Premature Birth 2 3 1 Atelectasis 2 1 1 Acute Bronchitis 1 1 Asphyxia, Maternal ante-partum haemorrhage 1 Status epilepticus, Microcephaly 1 Cardiac failure, obstructive bronchitis cystic fibrosis of pancreas 1 Totals 5 5 - 2 - — - - — - 1 1 — — 1 - 1 — 1 — — The number of infants under one year of age who died during the year 1959 as shown by the table is 17. 12 of these deaths, that is 70 per cent. occurred in the neonatal period (within one month of birth). In 1958, the corresponding figure was 62 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:- 1949 0.78 per 1,000 live and stillbirths 1950 0.84 " " " " " 1951 Nil " " " " " 1952 0.93 " " " " " 1953 2.63 " " " " " 1954 Nil " " " " " 1955 0.88 " " " " " 1956 Nil 1957 Nil 1958 Nil " " " " " Deaths All Causes. Males Females Total All causes 421 372 793 Death rate per 1,000 of estimated home population 8.76 Deaths from Measles (all ages) — — — Whooping Cough (all ages) — — — Diarrhoea (under 2 years of age) — — — Cancer (all ages) 85 80 165 Death rate per 1,000 for England and Wales, 1959 11.6 16 Death Rate of Area during last ten years:- 1949 8.15 per thousand. 1950 8.56 " " 1951 9.6 „ 1952 9.14 „ 1953 8.8 „ 1954 8.1 „ 1955 9.1 „ 1956 9.4 „ 1957 9.2 1958 9.48 „ The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1959. The standardised death rate which allows for comparison with other parts of the country is 10.8. 17 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1959. Causes of Death. M. F. Total All Causes 421 372 793 1 Tuberculosis, respiratory 4 1 5 2 Tuberculosis, other — — — 3 Syphilitic disease — — — 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 10 15 25 11 Malignant neoplasm, lung, bronchus 35 7 42 12 Malignant neoplasm, breast — 15 15 13 Malignant neoplasm, uterus — 5 5 14 Other malignant and lymphatic neoplasms 40 38 78 15 Leukaemia, aleukaemia 4 5 9 16 Diabetes 3 1 4 17 Vascular lesions of nervous system 44 52 96 18 Coronary disease, angina 108 46 154 19 Hypertension with heart disease 7 19 26 20 Other heart disease 30 57 87 21 Other circulatory disease 20 21 41 22 Influenza 3 7 10 23 Pneumonia 25 21 46 24 Bronchitis 20 13 33 25 Other diseases of the respiratory system 2 2 4 26 Ulcer of stomach and duodenum 7 1 8 27 Gastritis, enteritis and diarrhoea 2 1 3 28 Nephritis and nephrosis 4 4 8 29 Hyperplasia of prostate 2 — 2 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 2 4 6 32 Other defined and ill-defined diseases 24 28 52 33 Motor vehicle accidents 14 2 16 34 All other accidents 2 2 4 35 Suicide 8 4 12 36 Homicide and operations of war — 1 1 18 19 DEATHS REGISTERED (IN AGE GROUPS) IN 1959. Under 1 year 1-+ years 5-14 years 15-24 years 25-44 years 45-64 years 65-74 years 75 years and ovei Total M F M F M F M F M F M F M F F M F 1. Tuberculosis, respiratory ... ... ... ... ... ... ... ... 1 ... 1 1 1 ... ... ... 4 1 2. Tuberculosis, other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Syphilitic disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 1 3 4 5 6 10 15 11. Malignant neoplasm, lung, bronchus ... ... ... ... ... ... ... ... ... ... 16 3 11 3 6 1 35 7 12. Malignant neoplasm, breast ... ... ... ... ... ... ... ... ... 1 ... 7 ... 5 ... 2 ... 15 13. Malignant neoplasm, uterus ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 1 ... 5 14. Other malignant and lymphatic neoplasms ... ... ... ... ... ... ... ... 2 2 17 15 10 12 11 9 40 33 15. Leukaemia, aleukeamia ... ... ... ... 1 1 ... ... 1 2 1 1 1 1 ... ... 4 5 16. Diabetes ... ... ... ... l ... ... ... ... ... ... ... ... 1 2 ... 3 1 17. Vascular lesions of nervous system ... ... ... ... ... ... ... ... ... 1 8 9 16 14 70 28 41 52 18. Coronary disease, angina ... ... ... ... ... ... ... ... ... 1 52 9 28 10 21 2d 108 46 19. Hypertension with heart disease ... ... ... ... ... ... ... ... ... ... ... 1 4 4 3 14 7 19 20. Other heart disease ... ... ... ... ... ... ... ... ... 2 2 4 9 8 18 43 30 57 21. Other circulatory disease ... ... ... ... ... ... ... ... ... 1 5 2 4 2 11 16 20 21 22. Influenza ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 1 6 3 7 23. Pneumonia ... 1 ... ... ... ... ... ... ... ... 6 3 7 3 10 14 25 21 24. Bronchitis ... 1 ... ... ... ... ... ... ... ... 5 1 6 1 9 10 20 15 25. Other diseases of the respiratory system ... ... ... ... ... ... ... ... ... ... 1 2 1 ... ... ... ... 2 26. Ulcer of stomach and duodenum ... ... ... ... ... ... ... ... ... ... 5 ... ... 1 2 ... 7 1 27. Gastritis, enteritis and diarrhoea ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... 1 28. Nephritis and nephrosis ... ... ... ... ... ... ... ... ... 1 1 1 2 ... 1 2 4 4 29. Hyperplasia of prostate ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... 30. Pregnancy, childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital malformations 1 1 ... 1 ... ... ... ... ... ... 1 2 ... ... ... ... 2 4 32. Other defined and ill defined diseases 6 7 ... ... ... ... ... ... 3 1 6 4 3 6 6 10 24 28 33. Motor vehicle accidents ... ... ... ... ... ... 3 2 3 ... 4 ... 3 ... 1 ... 11 2 34. All other accidents ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 2 2 2 35. Suicide ... ... ... ... ... ... ... ... l 2 6 1 1 1 ... ... 8 4 36. Homicide and operations of war ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Total 7 10 ... 1 2 2 4 2 16 15 145 70 111 81 136 191 421 372 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 rests 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. It was not necessary in any of the cases for action to be taken under the Act. 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 141 bodies were admitted and 139 post-mortem examinations were made; 23 inquests were held. 20 LABORATORY FACILITIES. Pathological and bacteriological specimens are sent to the Public Health Laboratory at Maidstone. This service ceased to be the responsibility of the County Council as from the 1st October, 1955, when it was taken over by the Public Health Laboratory Service, directed by the Medical Research Council for the Ministry of Health. NURSING HOMES. Registration of Nursing Homes, Public Health Act, 1936. (Authority of Registration transferred from Kent County Council to the Bexley Borough Council—17.4.39). No. of Homes on the Register at beginning of year 5 No. of patients provided for:— Maternity 5 Others 78 Total 33 No. of Homes first registered during year Nil No. of patients provided for:— Maternity — Others — Total— No. of Homes on the Register at end of year ... 5 No. of patients provided for:— Maternity 5 Others 78 Total 83 21 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 Public Health Act, 1925, Part 2 Jan. 1926 Slaughter of Animals Act, 1933 Jan. 1934 Byelaws. Wireless Loudspeakers, Gramophones, etc. Mar. 1939 Fouling by Dogs of Footways July 1938 Baths, Wash-houses, Swimming Baths and Bathing Places Aug. 1938 Parks and Pleasure Grounds May 1939 Defacing of Pavements Nov. 1939 Deposit of Litter to the Detriment of Public amenities „ Deposit of Dangerous Substances „ Organs Loitering at Church Doors „ Indecent Language, etc „ Noisy Hawking „ Touting „ Noisy Animals „ Nursing Homes June 1940 Sale of Contraceptives in Slot Machines Dec. 1949 Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air May 1950 Improper Behaviour on School Premises May 1951 The Flying of Model Aircraft Nov. 1951 Public Libraries Jan. 1953 Building Apr. 1954 22 1. (i) Water Supply. The water to the district is supplied by the Metropolitan Water Board and is derived from several sources namely, Wilmington, Darenth, 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 1959. 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:— Danson Crescent S.W. Scheme 300 yards—being part of scheme only. Bellegrove Road 100 yards S.W.S. Developing owners have constructed private sewers and drains at the following sites: — Mera Drive Clifton Road extension Oakhouse Road extension Hilary Close. Number of cesspools emptied—16; Total number of emptyings—43. 2. Rivers and Streams. Two samples of lake water were taken from Danson Park LaJ e as the result of a complaint but no indication of sewerage pollution was found and in each case the water was satisfactorily oxygenated. 23 CHIEF PUBLIC HEALTH INSPECTOR'S REPORT. Health Department, 8, Brampton Road, Bexleyheath. To the Mayor, Aldermen and Councillors of the Borough of Bexley. Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting my Annual Report as Chief Public Health Inspector and Public Cleansing Officer to your Council for the year 1959. The report consists mainly of a tabulated record of work carried out by the Public Health Inspectors. 24 TABLE No. 1. Details of Inspection Work Carried Out. Inspections Re-inspections Houses inspected (all particulars recorded) 25 157 Houses inspected (defects only recorded) 102 508 Houses inspected (certificates of disrepair) 24 55 Houses inspected (improvement grants) 51 1 Houses inspected (Housing Act, 1936, Overcrowding) 38 7 Houses inspected re Infectious Disease (including scabies) 151 94 Factories with mechanical power 131 47 Factories without mechanical power 9 9 Outworkers' premises 10 — Other premises under the Act 7 3 Bakehouses 66 29 Water Samples 21 — Food and Drugs Act Samples 284 3 Dairies and distributors 16 2 Ice Cream premises 102 2 Restaurants, etc 167 33 Fish premises 107 11 Meat Shops 306 69 Public Houses 13 3 Shops re unsound food 305 44 Other premises where food is prepared 668 197 Offensive accumulations 87 70 Stables 3 — Keeping of Animals 33 48 Rats 183 184 Drains inspected 837 554 Drains tested (water, smoke or colour) 60 44 Dustbins 10 45 Verminous premises 46 72 Smoke observations 22 21 Tents, Vans and Sheds 18 55 Refuse Tips 434 — Refuse Removal and Salvage 446 28 Conveniences 173 — Pet Animals Act, 1951 16 — Council House applicants 182 62 Shops Act, 1950 820 14 National Assistance Act, 1948—Sec. 47 4 — Miscellaneous inspections 1117 72 Clean Air Act 928 789 25 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 24 Provided with sufficient ashplace accom- dation 19 Provided with sufficient water supply 4 Houses Improved Internally— Walls and ceilings repaired 117 Dampness in rooms remedied 82 Defective floors repaired 22 Ventilation of Rooms improved 26 Windows repaired 44 Stoves, fireplaces, etc. provided or repaired 8 Houses Improved Externally— Roofs repaired 42 Eaves gutters and down spouts fixed or repaired 42 Yards paved or repaired — Chimney stacks repaired 8 Walls repointed or repaired 17 Miscellaneous repairs 8 Drainage— Drains cleansed or repaired 601 New drains constructed 3 New Gullies provided 2 Ventilation of drainage system improved 3 Inspection chambers built or repaired 11- Waste pipes provided or repaired lfi New sinks provided 3 Offensive accumulation removed 10 Nuisances from animals abated 1 Other nuisances abated 4 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 15 Houses visited including revisits 245 Rooms disinfected 5 Notices delivered to Education Authorities, etc. 252 26 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered and destroyed: Corned Beef lbs. 1.006¼ Tinned Ham 99 842¼ Beef 742½ Pork 99 393½ Mutton and Lamb 99 30½ Offal 99 358½ Bacon 99 24 Liver Sausage 99 8½ Sausages »• 18╜ Veal 99 21 Fish 99 1,155 Shell Fish 99 60 Cheese 99 106 Butter 99 29½ Suet 99 2½ Black Pudding 99 32 Potatoes 99 3,864 Flour 99 3 Sweetbreads 99 28 Fruit and Fruit Juices tins 671 Preserves 99 3 Vegetables 99 287 Meat 99 367 Soup 99 4 Fish and Fish Pastes 99 168 Milk 99 307 Cream 99 59 Creamed Rice 99 7 Preserves jars 149 Peanut Butter 99 5 Meat Pastes 99 14 Suet pkts 3 Baking Powder 99 9 Biscuits 99 11 Chocolate Cream bars 28 Miscellaneous items 38 27 TABLE No. 5. Factories Act. 1937 and 1948. i. Inspections for Purposes of Provisions as to Health. Including Inspections made by Public Health Inspectors. Premises. 1 S umber of : Inspections. 2 Written Notices. 3 Prosecutions 4 Factories without mechanical power 273 — — Factories with mechanical power 28 3 — ♦other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) ♦Electrical Stations should be reckoned as factories. 10 — — Total 311 3 — 2. Defects Found. Particulars. 1 Number of Defects. Number of Prosecutions. 5 Found. 2 Remedied. 3 Referred to H.M. Inspector. 4 Want of cleanliness (S.l) 5 5 — — 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 Not separate for sexes 1 I — — 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.) 4 4 Total 10 10 — — 28 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 house 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. A charge is made for this service, based on the average quantity to be removed each week. On several occasions during the year difficulty was experienced in maintaining a weekly collection of refuse, due to shortage of manpower. The recruitment of suitable men for this work is becoming increasingly difficult, and it does seem that if a satisfactory labour force is to be maintained, the rate of pay will have to be made to compare favourably with the rates at present paid in industry. Refuse is collected from over 30,000 premises, and whilst no actual weights are available, it is estimated that the tonnage collected yearly is 22,700 tons. The Council operate a salvage scheme, and waste paper, textiles, scrap metal, etc., is collected by means of trailers attached to the refuse collection vehicles. Four new Shelvoke & Drewry Fore and Aft Tippers (16-18 cu. yds. capacity) were ordered in December, 1959 to replace existing Side Loading Freighters. All refuse collected was disposed of by controlled tipping at East Wickham, the average haul to the disposal point being 2\ miles. During the year the muledozer used for levelling and consolidating the refuse was replaced by a Bristol Duplex tractor, and this machine has given excellent service. It was intended to open up the new tip at Stone during the year, but manpower and transport difficulties made it impossible to do so without the risk of falling seriously behind with collections. 29 Salvage. Details of salvage sales for the financial year ended 31st March, 1960, are set out below. Tons. cwts. qrs. £ s. d. Waste Paper 424 11 0 3,113 11 6 Textiles 14 4 0 210 1 10 Ferrous Metals 13 14 2 93 16 8 Non-Ferrous Metals 3 0 5 4 9 Miscellaneous 1 14 0 17 0 0 454 6 2 3,439 14 9 Kitchen Waste. There are some 275 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. Westwood Lane, Blackfen. (Maintained jointly by the Chislehurst and Sidcup Urban District Council and Bexley Corporation). 30 ATMOSPHERIC POLLUTION. The Council is represented on the Thameside Advisory Committee for the Abatement of Atmospheric Pollution. By arrangement with this Committee a deposit gauge is installed on the roof of the Education Office in Brampton Road, Bexleyheath, and the following table gives the results obtained during 1959. 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 1.82 9.31 0.12 6.55 2 64 9 63 1.14 1.51 3 99 18.94 February 0.08 7.11 0.15 5.11 1.84 9.72 2.15 0.65 5.13 16.83 March 1.64 8.16 0.17 5.91 2.07 7.92 1.28 0 94 3.54 16.08 April 1.68 6.28 0.08 4.52 1.68 7.75 1.34 0.94 3.39 14.03 May 1.03 10.59 0.02 8.15 2 42 9.80 2 18 0.64 3.86 20.39 June 0.72 8.87 0.10 6.69 2.08 7.15 1.54 0.67 3.54 16.01 July 1.66 6.98 0.10 5.07 1.81 5.91 1.21 0.70 1.77 12.88 August 0.54 6.44 0.06 4.80 1.57 6.01 1.24 0.44 2.00 12.44 September 0.015 9.29 0.05 7.22 2.02 9.26 1.85 0.70 3.11 18.55 October 1.86 9.06 0.06 7.01 1.98 13.42 2.28 1.34 4.41 22.48 November 2.71 5.01 0.11 3.49 1.41 6.98 1.61 1.48 3.24 11.99 December 2.79 3.83 0.07 2.75 1.02 6.85 0.67 1.68 2.68 10.68 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 SOs Collected Mg. of SOs/day Collected by 100 sq cm of Batch A Pb 02 (Louvered Cover) In Sample In Control Due to Exposure Sq. Cm. Mg. Mg. Mg. Mg /100 sq. Cm./day January 105 506.4 2.8 503.6 M4 4.63 February 95 238.4 6.5 231.9 2.99 2.69 March 105 165.4 2.1 163.3 1.78 1.60 April 95 185.4 1.6 183.8 2.21 1.99 May 100 141.0 1.9 139.1 1.54 1.38 June 100 114.2 1.4 112.8 1.29 1.16 July 90 01.6 4.9 87.6 0.98 0.88 August 94.5 124.8 1.6 123.2 1.6 1.44 September 95 138.2 6.6 131.6 1.58 1.42 i October 100 205.6 2.5 203.1 2.18 1.96 November 95 176.4 1.0 175.4 2.18 1.96 December 100 183.6 1.7 181.9 2.01 1.81 31 A volumetric apparatus for the measurement of sulphur dioxide and smoke is installed at the Health Department, Brampton Road, and a summary of the results obtained is set out lelow. 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 January 34 126 1 17.93 134.5 0.4 February 26 68 0 10.20 39.5 1.5 March 12 33 2 4.8 13.1 0.9 April 7 17 1 5.0 26.4 0.8 May 4 9 1 3.9 12.5 0.4 June 3 6 1 2.8 8.0 0.5 July 2 5 0 1.7 4.1 0.4 August 3 6 0 3.6 11.3 0.2 September 4 11 1 3.9 10.4 0.9 October 8 26 1 5.2 11.7 0.7 November 18 66 1 7.15 22.2 0.7 December 11 58 3 4.2 29.8 1.3 Clean Air Act, 1956—Smoke Control Areas. During 1958 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, which was received. The detailed Survey was then commenced and at the time of writing is nearing completion. 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. 32 Details of surface infestations dealt with during the period 1st April—31st December, 1959, are set out below. Number of Properties Inspected 456 Number of Inspections 1,917 Number of Infestations found: Rats—Major Minor 206 Mice 27 Number of Properties Treated Rats Mice Local Authority's premises 2 — Dwelling Houses 185 21 Business Premises 19 6 PET ANIMALS ACT, 1951. Liconces to keep pet shops were issued to 7 persons under the Act. No contraventions were observed during the year. 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, 834 inspections were made under the Shops Act, 1950, and no legal proceedings were instituted I am, Ladies and Gentlemen, Yours obediently, G. HIND, Chief Public Health Inspector. 33 Swimming Pool. The only swimming pool in the Borough open to the Public is in Danson Park and is owned by the Council. The layout includes three open-air pools, one large for adults and two small pools for children. Showers and foot baths are provided for the pre-cleansing of bathers. The water is kept pure by continuous filtration and sterilisation by means of the latest method of break-point chlorination. Samples of water are taken by this department monthly during the time the pool is open and the results of bacteriological examinations have been satisfactory on each occasion. Verminous Premises. During the year 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 4, Fleas 5, Ants 3, Cockroaches 2, Crickets 1. Wasps. The destruction of wasps nests is undertaken by the Department and during the year 111 nests were destroyed. A charge of 6s. Od. is made for this service. Schools. There are 32 County Secondary and County Primary Schools, a Day Technical School for Girls and a Grammar School in the Borough 34 SECTION D — HOUSING. The following particulars relate to the houses owned by the Council on the various Estates: — Houses Flats Welling— Welling Estate 428 Westwood Lane Estate 126 Carlton Road 16 Dovedale Close 12 John Newton Court — 132 Marwood Estate — 22 Lodge Hill 364 Wickham Street 74 East Wickham— Re-development Phase 1 147 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 Bristow Road — 60 Upton Close 14 Fairfield Road — 28 Tower Road — 48 Bexley— Hartford Road Estate and Albert Road Estate 54 Royal Park Estate 114 Midhurst Hill 16 Newick Close 10 Henfield Close 7 Rye Close Extension 35 Glenhuvst Avenue 27 Hurst Place Estate 143 S.D.A Houses 7 Houses purchased 3 2,647 318 35 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses spected for housing defects (under Public Health or Housing Acts) 127 (b) Number of inspections made for the purpose (including re-inspection) ... 792 (2) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 11 (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 116 2. Remedy of Defects during the year without service of Formal Notice. Number of defective dwelling houses rendered fit in consequence of informal action 118 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 6 (b) By local authority in default of owners — B. Proceedings under Public Health Acts— Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 9 (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 11 (2) Number of dwelling houses demolished in pursuance of Demolition Orders (3) Number of houses in respect of which Closing Orders were made D. Proceedings under Section 18 of the Housing Act, 1957— parts of buildings closed — 36 Slum Clearance. Duting 1959, 107 hutments in the East Wickham Clearance Areas were demolished and the occupants rehoused by the Council. Improvement Grants. Discretionary Standard Number of applications for improvement grants 41 21 Number of applications approved 9 10 Total cost of approved expense of improvements £4,999 12 4 £805 Total approved costs on which grants were made in 16 cases (excluding the nine above) £3,556 13 3 — Total amount of grants made in those 16 cases £1,778 6 7 — Rent Act, 1957. Number of applications for certificates of disrepair 7 Number of decisions not to issue certificates 1 Number of decisions to issue certificates 6 (a) in respect of some but not all defects 2 (b) in respect of all defects 4 Number of undertakings given by landlords 3 Number of undertakings refused by the Local Authority — Number of Certificates issued 3 Applications by landlords for cancellation of certificates 4 Objections by tenants to cancellation of certificates 1 Decisions by Local Authority to cancel in spite of tenants' objection — Certificates cancelled 3 37 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The milk retailed for consumption in the area is all pasteurised and bottled. No. of Distributors with Dairy Premises 5 No. of Distributors with Shop Premises. 30 No. of Distributors from outside area 7 Licences granted by the Council under the Milk (Special Designation) (Raw Milk) Regulations, 1949 to 1954, and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949 to 1953.— Dealers' Licences:— Pasteurised Milk 30 Tuberculin Tested Milk 29 Sterilised Milk 36 Supplementary Licences:— Pasteurised Milk 6 Tuberculin Tested Milk 5 Sterilised Milk 6 15 samples of milk were forwarded to the Public Health Laboratory for the Methylene Blue and Phosphatase Tests, and all were satisfactory with the exception of two samples which were unsatisfactory owing to the atmospheric shade temperature being 72°C. (b) Slaughterhouses. There are no slaughterhouses in the area, and the majority of the butchers obtain their supplies through Smithfield Market. 38 (c) Adulteration of Food. Food and Drugs Act, 1955. The following table summarises the 216 samples taken during the year. Formal Informal Milk 1 1 Soups, Meat Extracts 1 9 Pastes, Potted Meat - 7 Pudding or Cake Mixture, Flour, etc. 2 8 Jellies, Custard Powders, etc 1 6 Sausages, Sausage Meat, etc 5 4 Condiments, Sauces, Pickles, Spices,etc. — and Pure Coffee, Coffee Extracts, Coffee - 26 Chicory 2 2 Meat Pies and Puddings 1 7 Sweets and Confectionery 2 6 Essences - 3 Butter and Fats 5 5 Minerals 3 5 Vegetables - 14 Fruit - 2 Preserves 5 13 Condensed and Evaporated Milks - 1 Ground Almonds 2 - Cream 1 6 Dried Fruit - 3 Cheese Food 2 2 Cakes 1 3 Biscuits 2 2 Tinned Meat - 10 Fish - 8 Almond Marzipan - 1 Tea 1 2 Dried Yeast - 1 Lemonade powder 1 - Nut Oil 1 1 Desiccated Coconut - 2 Patent medicines 1 1 Mix-a-shake - 2 Lemon Juice 1 1 Sago - 1 Rice Pudding - 1 Demerara Sugar 1 - Glucose 1 - Gin ... 1 - Drinking Chocolate 1 - Scotch Egg - 1 Carraway Seeds - 1 Meatendra - 1 Coffee Spread - 1 Kool-ah - 1 45 171 Legal Proceedings. (1) Sausages—Unfit for human consumption. Fined £10 plus £2 2s. 0d. costs. (2) Sausage Rolls—Unfit for human consumption. Fined £10 plus £2 2s. 0d. costs. (3) Pork Pie—Unfit for human consumption. Fined £10 plus £2 2s. 0d. Advocates fee, plus 10s. 0d. witness expenses. (4) Apple Pie—Unfit for human consumption. Fined £10 plus £3 3s. 0d. costs. (5) Meat Pie—Unfit for human consumption. Fined £10 plus £2 2s. 0d. costs. (6) Bread—Foreign Matter in bread. Fined £10 10s. 0d. plus £3 3s. 0d. Advocates fee. (7) Cream Buns—Not "cream." Fined £10 plus £2 2s. 0d. 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 46 Sweet Shops 65 General Provision 82 Bakers and Confectioners 25 Wet and Fried Fish Shops 23 Public Houses 42 358 40 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 20 Floors, walls, ceilings, etc., repaired 10 Infestations dealt with 3 Rooms cleansed 30 Water Closet accommodation improved 11 Accumulation of refuse removed 3 Accommodation for storage of refuse improved 3 Washing accommodation improved 8 Drainage repaired or improved 5 Food storage accomodation improved 4 Yard cleansed or repaired i Accommodation for clothing provided or improved 4 Sinks renewed 4 Other contraventions 10 Unsatisfactory equipment cleansed or renewed 1 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 169 Preparation of Sausages, etc. 51 28 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. 41 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 105 cases were notified as compared with 84 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 1 During the past 15 years the character of this disease has changed from one of considerable severity to one of extreme mildness. The acute stage is, nowadays, in most cases, short and unaccompanied by high pyrexia and complications are in most cases mild or completely absent. Scarlet fever can now be disregarded as an important cause of acute endocarditis and acute nephritis which, in the past, were frequently encountered. Diphtheria. No cases were notified during the year. The following figures on Diphtheria and Whooping Cough Immunisation and Smallpox and Poliomyelitis Vaccina have been supplied by the County Medical Officer: — 42 43 Immunisation against Diphtheria and Whooping cough, and Vaccination against Smallpox, 1959. 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, 1959:— (A) Diphtheria Immunisation. Year of birth 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 Total Primary Inoculations 275 755 69 15 8 14 11 9 — 3 — — 1 — — 1160 Re-inforcing Inoculations — — 1 2 55 364 135 45 8 13 28 2 3 3 1 660 (B) Vaccination. Year of Birth 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 Before 1945 Total Primary Vaccination 448 468 8 8 9 4 4 1 1 2 1 3 — 1 — 35 988 Re-vaccination — — — — 1 — 2 — 1 — — 1 1 51 57 (C) Whooping Cough Immunisation. Year of Birth 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 194£ 1948 1947 1946 1945 Before 1945 Total Primary Inoculations 643 562 36 16 22 19 6 5 2 1 — — 1 — — 1 1316 44 Immunisation against Diphtheria, 1959. The following is a return of the number of children under the age of 15 years on 31st December, 1959, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1945). Year of Birth 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 Total Last complete course of injections (whether primary or booster) 1955—1959 96 148 267 686 649 888 938 948 677 952 983 99b 1047 950 275 10500 1954 or earlier 859 1037 1257 847 1128 489 397 398 522 94 - — - - - 7028 Poliomyelitis Vaccination, 1959. 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, 1959:— Year of Birth Before 1943 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 Others Total Given two injections 3879 177 135 98 125 189 148 134 98 117 148 155 92 115 116 231 1037 239 674 7907 Given third injections 1452 539 889 750 1201 1082 965 924 863 837 805 800 648 624 694 816 525 — 358 14772 Typhoid Fever and Paratyphoid Fever. There were no cases notified during the year. Puerperal Pyrexia. 7 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. 985 cases were notified during the year. 3 cases were treated in hospital. Whooping Cough. 128 cases were notified during the year. 2 cases were treated in hospital. Acute Poliomyelitis. No cases were notified during the year. Scabies. 3 cases were notified during the year. Food Poisoning. 2 cases were notified during the year. Malaria. No cases were notified during the year. 45 46 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 1959. 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 105 — — 1 5 7 65 21 6 — 2 — Diphtheria — — — — — — — — — — — — — Puerperal Pyrexia 7 — — — — — — — 3 4 — 7 — Ophthalmia Neonatorum - - - - - - - - - - - - - Acute Paralytic Poliomyelitis — — — — — — — — — — — — — Acute Non-Paralytic Poliomyelitis — — — — — — — — — — — — — Pneumonia 24 — — 1 — 2 1 — 1 19 — 3 2 Erysipelas 11 — — — — — — — 1 10 — — — Food Poisoning 2 — — — — — 1 — — 1 — — — Dysentery 2 - - - - - - - - 2 — — — Typhoid Fever — — — — — — — — — — — — — Paratyphoid Fever — — — — — — - - - - - — — Meningococcal Infection 1 — — 1 — — — — — — — 1 — Measles 985 23 72 98 117 133 521 13 6 2 — 3 — Whooping Cough 128 8 9 11 16 16 59 5 1 3 — 2 — Scabies 3 — — — — 1 2 — — — — — — Encephalitis — — — — — — — - - - - - — Totals 1268 31 81 112 138 159 649 39 18 41 — 18 2 TUBERCULOSIS. During the year 56 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1959 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 1 2 - - - - - - 5—14 — 1 1 - - - - - 15—24 4 7 - - - - - - 25—44 10 11 2 2 1 — — — 45—64 10 4 1 — 1 1 — — 65 and over — — — — 2 — — — Totals 25 25 4 2 4 1 — — The number of non-notified Tuberculosis deaths was 3. 47 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1959 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: Alderman Mrs. H. F. Piggott. Vice-Chairman: Miss M. Woodward, L.L.A., L.G.S.M.(Eloc.) Alderman Mrs. E. M. Shqppard. Councillor J. C. Canton, J.P. Councillor N. H. Antenbring. Councillor Mrs. B. Bursill. Councillor C. Jamieson Harvey, M.B.E., J.P. Councillor N. S. Harrild, M.B.E. Councillor W. P. Webster. 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). (Resigned 31.8.59). G. Wilson Lawrence, L.D.S., R.C.S. Mrs. A. B. Perkins, L.D.S., R.S.P.S. (Glas.), 50 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. 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). Physiotherapists 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. 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). (Resigned May, 1959). Miss J. A. Smith — Hygienist. School Health Service Clerk Miss M. C. A. Smith. General Clerks Miss O. G. Turnbull. Miss R. Thomas. Miss E. Turner. 51 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1959 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 1959, the thirteenth which it has been my privilege to present. During the year the School Health Service continued to provide a full range of services, details of which are set out in the body of the report. It will be noted that pure-tone audiometric sweep frequency tests and B.C.G. vaccination have now become a regular feature of the School Health Service. As in previous years, the care of handicapped children has proved both a rewarding and onerous task and details of the work carried out may be found in part 5 of the Statistical Tables on Page 73. Apart from a physical and, if necessary, a psychological assessment by the School Medical Officers, consultation has to be made in each case with parents, general practitioners, specialist departments of hospitals and close liaison is maintained with the County Medical Officer and the Borough Education Officer to ensure that all relative information is available before a recommendation is made for the educational placement of the child. If the handicapped child is to be dealt with to the best advantage he must be afforded the fullest opportunity compatible with his degree of handicap for living a normal life. He should not be withdrawn from a normal environment at home or at school unless his condition, after the most careful assessment, warrants such a withdrawal. The enlightened help and co-operation of teaching staffs makes it more and more possible for this ideal to be realised. The general physical status of Bexley schoolchildren, as ascertained during periodic medical inspection, was found to be satisfactory. Reference to Table A on page 67 shows that, of 4,126 children examined, only 18 or approximately 52 0.5% were found to be unsatisfactory from a physical or nutritional point of view. Of 4,456 children inspected by the Health Visitors, only 31 or approximately 0.75% were found to be infested with vermin. Most of these cases were mild and were soon cleared up by informal action. The figure in regard to infestation for the country as a whole is around 4% so that, on the whole, infestation has ceased to be a serious problem in the Bexley schools although constant vigilance is always necessary. The number of children referred to the Child Guidance Clinic is worthy of note and it is my impression that we are now referring more children than, say, ten years ago. Whether this is due to an increase in significant psychological difficulties or an ever-growing interest in the mental health of children is debatable. It may well be that both these factors have contributed to the increased emphasis on the psychological health of schoolchildren. The report of the Committee on Maladjusted Children stressed the importance of the young child not yet in school, since the early years are of paramount importance in shaping the future psychological development of the child. Although, under the Educaion Act, 1944, education may be provided for children from the age of two years and upwards it is only rarely that a child under five years of age is referred to the Child Guidance Clinic through the School Health Service notwithstanding the fact, to quote the Report of the Chief Medical Officer of the Ministry of Education for the years 1956 and 1957 "that it is usually towards the end of the third year—the first critical period when the child asserts its personality— that signs of disturbance, if present are recognisable as such." The difficulty is, primarily, one of ascertainment and there are, no doubt, many young children in adverse home conditions whose future would be better assured if their parents could obtain expert help with these early psychological difficulties. In these days, when so many mothers go out to work, there is much to be said for the provision of a nursery school in the area, or at least some nursery classes, where any potentially disturbed children may be observed, guided and helped to overcome their difficulties. As the Chief Medical Officer points out, "It is at this time that the nursery school, specially planned both in size and in the life it provides for the children, can be of help in easing the process of separation from the mother; it can give relief when there 53 is undue strain and it provides a gradual transition from the family to the school environment." Certainly some provision of this nature is urgently needed in the Borough of Bexley. A relatively stable position was maintained in the School Dental Service by the staff consisting of two whole-time Dental Surgeons and one part time officer, although the latter resigned on the 31st August 1959. Since 1956 there has been a steady increase in the number of schoolchildren inspected by the dental officers. The figure of 5,581 for 1959 exceedes the figure for 1958 by 1008. Similarly, the percentage of children found to require treatment fell from 75% in 1958 to 64% in 1959 while the number of children offered treatment was somewhat higher in 1959 than in 1958 and, further, the number of children actually treated was greater in the year under review. It is encouraging to note, from the report of Mrs. Perkins L.D.S., that it will be possible in the near future to inspect each school at least once a year and that there is also an observed tendency for more parents to seek treatment for their children through the General Dental Services provided under the National Health Service Act, 1946. The School Health Service, nevertheless, remains understaffed to the extent of at least one whole-time dental surgeon but the shortage of these officers is, of course, a national problem and we are in fact more fortunate in our staffing position in Bexley than are many Local Education Authority areas in many parts of the country. The statistics relating to immunisation against diphtheria, smallpox, whooping-cough and poliomyelitis are contained in the general section on the health of the Borough on page 43. It cannot be too often pointed out that, although there has been no case of diphtheria in the Borough for ten years, the disease is still present in our midst and every now and again there is a recrudescence in different parts of the country. Parents should, therefore, realise their responsibility to have their children immunised against this disease in spite of the present favourable position and notwthstanding the other immunisation procedures, for example B.C.G. and poliomyelitis vaccinations, which have assumed a relatively greater importance in recent years. The School Health Service, with 50 years of achievement behind it, has never been a static service and its techniques have changed pari passu with advances in knowledge 54 and with the requirements of the child in a world which has undergone a social and cultural revolution and has seen the relaxation of many forms of traditional discipline which were, no doubt, stabilising factors in the production of balanced and sound individuals. The School Health Service has always been preventive in concept and practice although the remedial and therapeutic sides of its work have also been considerable. In the confusing and rather bewildering world in which we nowadays live it is becoming more and more difficult to lay down any general rules for healthy living. Mere insistance on personal hygiene is no longer adequate and note must be taken, at all times, of the whole child physically, mentally, and psychologically, to ensure his sound development and emotional equilibrium in the face of the abnormal pressures and fears with which society is beset. The tasks of Health Education are greater now and more complicated than ever before, and I may say that far more could be done in this respect given the necessary staff and financial resources. 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 also, the excellent team work of all members of the staff on which the success of the School Health Service so largely depends and 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. 55 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Bexley Grammar School. Average number on Roll at 31st December, 1959 553 Bexley County Technical School for Girls. Average number on Roll. Bexley 816 Wilmington Annex 164 Eight County Secondary Schools. Average number on Roll 3,675 Twenty-four County Primary Schools. Average number on Roll 6,809 Clinics. Minor Ailments. Welling—Little Danson, Dansington Road. Tuesday and Wednesday, 2-4 p.m. Doctor in attendance—Wednesday. Welling—Wrotham Road. Tuesday, 9.30-11 a.m. Thursday, 1.30-4 p.m. Doctor in attendance—Thursday. Bexleyheath—315, Broadway. Tuesday, 2-4 p.m. Monday and Friday 9-10 a.m. Wednesday, 9-11.30 a.m. Doctor in attendance—Tuesday. Bexley—Murchison Avenue. Tuesday and Friday, 9.30-11 a.m. Doctor in attendance—Friday. 56 Dental. Welling—Little Danson, Dansington Road. Daily—9.30-11 a.m., 2-4 p.m. Bexleyheath—315, Broadway. Thursday, Friday, 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. By special arrangement. 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. Orthopcedic. 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, 2-4 p.m. Thursday 9.30-11 a.m. Specialist in attendance once per month by special arrangement. Speech. Bexley—Murchison Avenue. Each morning, except Thursday and Saturday, 9.30-12.30 p.m. Each afternoon, except Thursday and 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. 57 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 69 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—1959. Average number of pupils in attendance:— Primary School 6,809 Secondary School 5,208 Average number of dinners served to children daily:— Paid Free Total Primary 2,742 56 2,798 Secondary 3,526 68 3,324 58 Milk. Average number of pupils taking milk daily:— Primary 5,994 Secondary 3,460 9,454 School Dental Service. Report on Little Danson Clinic year ending 1959 (Contributed by Mrs. A. B. Perkins, L.D.S., R.S.P.S., (Glas.)). During 1959 approximately half the number of children allotted to the surgery were inspected and 80% of these required treatment. It is encouraging to note that in the near future it will be possible to inspect each school at least once per year and that the number requiring treatment is being reduced. This, is due not only to some reduction in caries but to the fact that more parents are seeking treatment for their children privately as well as at the clinic. From October until December, due to shortage of staff, one session per week was spent at Murchison Avenue Dental Clinic. Orthopaedic Clinics. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report:— The Orthopaedic Clinics have continued on one Wednesday every month throughout the past year. There has been a general falling off in the number of cases attending and there has been no marked alteration in the type of cases referred. Postural defects of the spine and the feet still form a large proportion of the cases seen. There has been some improvement in the accommodation provided during the past year, but this still falls far short of what is really necessary. And to Mr. B. Lawson, F.R.C.S., for the following:— During 1959, I saw 35 new school children and 16 children under school age, making a total of 51. The clinics were fairly large as these patients are seen at repeated intervals as most of them require observation for minor 59 deformities. Treatment has consisted mostly of exercises in the Foot and Back Class, together with alterations and appliances related to shoes. The general health of the children was good. Most of the conditions were minor deviations from normal, any major ones being referred for further observation at the Hospital. Ophthalmic Clinic. I am indebted to Mr. R. M. Chambers, M.B., B.S., D.O.M.S. for the following report:— Cases seen at Little Danson Clinic other than refractive errors during 1959. Congenital. Ptosis 14 Nystagmus 18 Lens opacities 6 Epicanthus 18 Naso-lachrymol obstruction 5 Colour Defectives: Unsafe 30 Safe12 93 acquired. Constitutional Migraine 42 Anxiety states 35 Infective Styes 35 Blepharitis 40 Conjunctivitis 10 162 Others. Myopic degeneration 12 Maculopathy 4 Orthopaedic torticollis 2 Puberty goitre 3 21 Cases referred to hospital—39. 60 Child Guidance Clinic. Number of children referred during 1959. 1958 1959 Boys Girls Total Boys Girls Total Under 5 1 — 1 — — — 5—7 4 2 6 10 1 11 8- 10 3 2 5 15 1 16 11 and over 3 5 8 10 7 17 11 9 20 35 9 44 Speech Therapy. I am indebted to Miss Joan Pollitt, Senior Speech Therapist to the Kent Education Committee for the following report:— Ninety children, who are under the care of the Bexley Authority, have been dealt with within the Speech Therapy Services during the year. The cases of thirty-nine children have been closed and fifty are continuing to attend into 1960. Of the thirty-nine closed cases, thirty-seven have been under the care of the Murchison Avenue Clinic and two have attended at Sidcup. The cases of the thirty-nine children have been closed for the following reasons:— Satisfactory results following appointments at the clinic 29 Treatment incomplete; owing to the family leaving the district or for other reason 5 Consultation followed by appropriate recommendation 1 Found to have improved when first seen by therapist 1 Appointments offered but never kept 1 Left district prior to appointments being offered 2 39 Forty-seven of the fifty-one children who continue to attend into 1960, are being seen at the Murchison Avenue Clinic and four are being seen at the Sidcup Clinic. 61 Nine children under the care of the Bexley authority were awaiting appointments at the end of 1959. Eight of these children are on the Murchison Avenue Clinic waiting list and one is on the Sidcup waiting list. Sweep Frequency Pure Tone Audiometry. During 1959, 955 children were tested during their last year in the Infants' school, i.e., during their seventh year. Of this number, 847 passed and 108 failed. The latter children were referred to the School Medical Officers for investigation and any minor conditions causing temporary deafness were treated. In addition, 195 children of all age groups were tested as special cases referred from various sources including teachers, and of this number 106 passed and 89 failed. The 195 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 197 failed children were referred back to the School Medical Officers who, after further examination and treatment where necessary, referred 178 children back for a final audiometric test. Of this number, 92 passed and 86 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. 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. 62 PHYSICAL EDUCATION. I am indebted to the Physical Education Advisers, Mr J. Hopkins and Miss J. Hulton for the following report:— During 1959 the work in the schools has continued to reveal the great potential of the children now growing up. During their primary years they show quite a remarkable ability to run, jump, twist and turn in increasingly complex ways, and opportunities for extending this range is provided by the wide range of apparatus supplied for this purpose. It is no exaggeration to say that the Junior Schools of the Borough are as well equipped for Physical Education as any in the County. At Secondary level the difficulties met, when there is not the best of accommodation, hamper the progress made, and although there is no lack of good work it is achieved in spite of the conditions and not because of them. Physical Education is not only the acquisition of skill at games and gymnastics; it is also an attitude of mind towards personal habits, cleanliness, clothes, physical surroundings, comradeship, leadership and the good life. Many of these are achieved under present conditions but only as the result of many improvisations. In the Borough there are only two gymnasia where there should be ten for secondary education. In eight of the schools, halls are used which serve a dual purpose for assembly and gymnastics. To keep a floor clean when hundreds of shoes shed their dust and dirt on it as soon as school begins is not a reasonable proposition for the teacher of Physical Education. This lack of gymnasia means that much of the good achieved in the primary stage is not capitalised in the secondary school, and the outside observer does not get the impression that the work continues to expand in complexity and intensity throughout the school years, except in games and athletics. Again Basket Ball, which has developed as a fine indoor game in other areas, has not flourished in the Bexley Schools for the same reason that the halls cannot be equipped for the game because they lack size or have unsuitable back walls. Many of the secondary schools now extend their physical education programme into holiday time and one has developed ski-ing in Switzerland as a desirable pursuit. Many of the 63 boys gain their Bronze Medallion while there, and some after several visits gain their Silver. This adventurous attitude says much for the masters and boys concerned. Bexley Schools have developed fencing to a very high standard and have produced several Kent Schoolboy Champions and one National Champion. It is hoped that the gap between fencing at secondary school level and fencing as an adult will be bridged by encouraging the sport in the various Youth Clubs. The two years between sixteen and eighteen are not catered for at present and could mean the loss of interest and the loss of a great local asset. Swimming 4 secondary and 11 primary schools attended the closedin baths at Plumstead and Eltham and the open-air baths at Eltham Park South, Danson Park and Martens Grove. Schools Attendances No. of children 4 secondary 13 classes—25-30 children 394 approx. each each week week 11 primary 19 classes—30-35 children 628 approx. each each week week A total of 399 swimming certificates for distances between 25 yards and one mile were gained and issued during the year 1959. Three primary schools continued swimming throughout the Autumn and Spring Terms. It is interesting at this stage to compare the results with a primary school possessing its own teaching pool:— School Roll—330 (age 7-11 years) Number able to swim one length or more 213 Number learning to swim last year 144 Number of Bexley Certificates issued 115 The results show that a quarter of the certificates issued were gained by one school. One could hardly wish for a better illustration of what can be achieved when the conditions are nearly perfect for good instruction. Outdoor Pursuits. There is a growing desire to take part in the various activities connected with the Duke of Edinburgh's Award, particularly for canoeing and sailing, and it is hoped that 64 facilities and instruction will become available for teachers and pupils in the near future. Danson Park already supplies some of the opportunity, but this can only be a training ground for a few. What is wanted is an area of unrestricted water where boats and canoes can be used under instruction throughout the year so that those embarking on expeditions can do so knowing that they have been properly trained to meet any emergency. This year Miss Joy Hulton who has been the part-time Adviser for Physical Education for Bexley and Dartford, relinquished her post to go to Birmingham and was recently married. The good wishes of all go with her in her new double occupation. Finally the Advisers wish to thank the Borough Education Officer and his staff for their constant support and unfailing ability to supply the day to day needs of Physical Education in the Borough. 65 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 Defects 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. 66 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 394 389 98.7 5 1.3 1953 576 573 99.5 3 .5 1952 184 184 100 — — 1951 415 413 99.5 2 .5 1950 286 286 100 — — 1949 220 217 98.6 3 1.4 1948 475 472 99.4 3 .6 1947 342 342 100 — — 1946 180 178 98.9 2 1.1 1945 36 36 100 — — 1944 825 825 100 — — 1943 & earlier 193 193 100 — — Total 4126 4108 99.5 18 .5 67 B.—Pupils Found to Require Treatment at Periodical Medical Inspections. Ago 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 37 51 72 1953 49 88 113 1952 12 11 20 1951 48 38 75 1950 33 46 72 1949 40 40 71 1948 40 72 100 1947 40 44 77 1946 33 14 44 1945 7 10 14 1944 81 148 182 1943 & earlier 54 21 66 Total 474 583 806 C.—Other Inspections. Number of Special Inspections 1,758 Number of re-inspections 1,999 Total 3,757 D.—Infestation with Vermin. (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 4,456 (b) Total number of individual pupils found to be infested 31 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) — (d) Number of individual pupils in respect of whom cleasing orders were issued (Section 54(3), Education Act, 1944) — 68 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 1 18 55 31 86 121 142 170 46 3 5. Eyes— a. Vision 37 46 135 113 302 325 474 484 46 18 b. Squint 16 6 10 12 65 71 91 89 13 2 c. Other 6 1 15 16 48 52 69 69 26 8 6. Ears— a. Hearing 9 36 10 32 22 144 41 212 55 92 b. Otitis media 3 3 1 9 3 45 7 57 3 7 c. Other 2 3 12 4 9 19 23 26 4 9 7. Nose and Throat 14 103 21 43 61 421 96 567 60 31 8. Speech 5 17 3 7 10 49 18 73 9 7 9. Lymphatic Glands — 41 — 6 5 191 5 238 6 3 10. Heart 1 9 1 13 2 56 4 78 4 16 11. Lungs 2 31 2 17 16 174 20 222 35 58 12. Developmental— a. Hernia 1 1 — 1 2 13 3 15 — — b. Other 2 6 3 9 9 47 14 62 8 5 13. Orthopaedic— a. Posture — 3 9 30 22 86 31 119 5 2 b. Feet 2 29 10 28 34 129 46 186 21 11 c. Other 1 32 17 118 21 310 39 460 32 17 14. Nervous System— a. Epilepsy — — 2 2 1 13 3 15 7 5 b. Other 2 — 1 1 — 7 3 8 8 3 15. Psychological— a. Development — 3 1 9 2 43 3 55 47 54 b. Stability 1 16 2 21 7 159 10 196 86 93 16. Abdomen — 5 2 8 5 59 7 72 4 18 17. Other 1 4 6 25 4 52 11 81 107 115 PART III. A.—Eye Diseases, Defective Vision and Squint. Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 276 Errors of refraction (including squint 2,158 Total 2,434 Number of pupils for whom spectacles were prescribed 750 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 13 (c) for other nose and throat conditions — Received other forms of treatment 97 Total 112 Total number of pupils in schools who are known to have been provided with hearing aids (a) in 1959 Nil (b) in previous years 20 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 70 D.—Diseases of the Skin. Number of cases kno to have been treate Ringworm— Scalp — Body — Scabies — Impetigo 3 Other skin diseases 37 Total 40 E.—Other Treatment Given. Number of cases known to have been dealt with (a) Pupils with minor ailments 674 (b) Pupils who received valescent treatment under School Health Service arrangements — (c) Pupils who received B.C.G. vaccination 651 (d) Other than (a), (b) and (c) above — Total (a)—(d) 1,325 71 PART IV—Dental Inspection and Treatment (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic inspections 4,617 (b) Specials 964 Total (1) 5,581 (2) Number found to require treatment 3,522 (3) Number offered treatment 3,511 (4) Number actually treated 1,842 (5) Attendances made by pupils for treatment, including those recored at heading 11(h) below 8,422 (6) Half days devoted to: Inspection 36 Treatment 1,101 Total (6) 1,137 (7) Fillings: Permanent Teeth 3,219 Temporary Teeth 1,101 Total (7) 4,320 (8) Number of teeth filled: Permanent Teeth 2,837 Temporary Teeth 1,055 Total (8) 3,892 (9) Extractions: Permanent Teeth 271 Temporary Teeth 1,025 Total (9) 1,296 (10) Administration of general anaesthetics for extraction 482 (11) Orthodontics: (a) Cases commenced during the year 90 (b) Cases carried forward from previous year 199 (c) Cases completed during the year 69 (d) Cases discontinued during the year 94 (e) Pupils treated with appliances 128 (f) Removable appliances fitted 160 (g) Fixed appliances fitted — (h) Total attendances 2,068 (12) Number of pupils supplied with artificial dentures 21 (13) Other operations: Permanent Teeth 2,584 Temporary Teeth 233 Total (13) 2,807 72 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 31.12-59 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Special Schools or Boarding Homes — 1 — 1 11 5 3 3 — 24 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Home 1 — — 1 14 4 8 9 — 37 C. (i)were on the registers of: 1. Maintained special schools: (a) as day pupils — 7 2 3 — 13 14 — — 39 (b) as boarding pupils 1 — 2 — 6 4 4 1 — 18 2. Non maintained special schools: (a) as day pupils — — — — — — — — — — (b) as boarding pupils 1 — 3 2 5 1 — 2 — 14 (ii) were on the registers of dent schools under arrangement made by the Authority — — 1 — 1 — — 12 — 14 (iii) were boarded in homes and not already included under (i) or (ii) (see Note (2)) — — — — — — — 1 — 1 Total (C) 2 7 8 5 12 18 18 16 — 86 D. Were being educated under arrangemants made under Section 56 of the Education Act,1944:— (i) In hospitals — — — — — 1 — — — 1 (ii) In other groups (e.g. units for spastics) — — — — — 1 — — — 1 (iii) At home 7 — — — 1 3 1 — — 6 E. Were requiring places in special schools:— (i)TOTAL (a) day — — 1 — — 1 10 — — 12 (b) boarding 3 — — — 4 1 — 7 — 15 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 2 — — — — — — — — 2 (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 — — — — — — — — — — (b) awaiting boarding places — — — — — — — — — — F. Ware on the Registers of Hospital Special Schools — Number of children reported during the year:— (a) Under Section 57(3) (excluding any returned under (b) ) 3 (b) „ „ „ relying on Section 57(4) — (c) „ „ 57(5) 3 of the Education Act, 1944 73 INDEX. item page Health Committee 2 Public Health Staff 3 Foreword 4—7 STATISTICS AND SOCIAL CONDITIONS. Acreage 8 Population 8 New Houses Erected 8 Unemployment 8 Social Conditions and Amenities 8—9 Population Graph 10 Summary of Vital Statistics 11—12 Extracts from Vital Statistics— Births and Birth Rates 12—13 Stillbirths and Stillbirth Rates 13 Total Live and Still Births 13 Infant Deaths and Death Rates 14—15 Maternal Deaths 16 Death All causes 16—18 Causes of Death in Age Groups 19 GENERAL PROVISIONS OF HEALTH SERVICES. Isolation Hospital Accommodation 20 General Hospitals 20 Ambulance Facilities 20 National Assistance Act, 1948 20 Public Mortuary 20 Laboratory Facilities 21 Registration of Nursing Homes 21 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 22 Water Supply 23 Drainage and Sewerage 23 Rivers and Streams 23 Chief Public Health Inspector's Report— Tables of Inspections and Improvements, etc. 25—26 Food Inspection 27 Tables—Factories Act, 1937 and 1948 28 Public Cleansing Service 29 Refuse Collection and Disposal 29 Salvage 30 Kitchen Waste 30 Public Conveniences 30 Atmospheric Pollution 31—32 Clean Air Act, 1956 Smoke Control Area 32 Prevention of Damage by Pests Act, 1949 32—33 Pet Animals Act, 1951 33 Shops Act. 1950 33 Swimming Pool 34 Verminous Premises 34 Wasp Destruction 34 Schools 34 74 item page HOUSING. Council Estates 35 Inspection of Dwelling Houses 36 Remedy of Defects without formal notice 36 Action under Statutory Powers 36 Clearance Schemes 37 Improvement Grants 37 Rent Act, 1957 37 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 38 Slaughterhouses 38 Adulteration of Food—Food & Drugs Act, 1955 39—40 Food Shops and Food Manufacturing Premises 40 Food Hygiene Regulations, 1955 41 Registration of Premises 41 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 42 Diphtheria 42 Diphtheria and Whooping Cough Immunisation, 43—44 Smallpox and Poliomyelitis Vaccination Typhoid Fever and Para Typhoid Fever 45 Puerperal Pyrexia 45 Ophthalmia Neonatorum 45 Measles 45 Whooping Cough 45 Acute Poliomyelitis 45 Scabies 45 Food Poisoning 45 Malaria 45 Tables of Infectious Diseases Notified 46 Tuberculosis 47 SCHOOL HEALTH SERVICES REPORT, 1959. Welfare and School Attendance Sub-Committee 50 Staff 50—51 Foreword 52—55 Schools 56 Clinics 56—57 Co-ordination— Periodic Medical Inspections 58 School Meals and Milk 58—59 School Dental Service 59 Orthopaedic Clinic 59—63 Child Guidance Clinic 60 Ophthalmic Clinic 61 Speech Therapy 61—62 Sweep Frequency Pure Tone Audiometry 62 Cleanliness Inspections 62 Physical Education 63—64 Swimming 64 Outdoor Pursuits 64—65 Statistical Tables 66—73 75