2 Library BEX 25 Ac .44 12(1) BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Services For the Year 1960 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 1960 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health Borough of Bexley. Mayor: Councillor H. W. Friend, J.P. Deputy Mayor: Councillor W. E. Wicks. HEALTH COMMITTEE. Chairman: Alderman Mrs. H. F. Piggott. Vice-Chairman: Councillor S. H. Philpot. Alderman M. J. Corr. Alderman Mrs. E. M. Sheppard. Councillor Mrs. J. T. Barker. Councillor F. G. Donovan. Councillor N. S. Harrild, M.B.E. Councillor C. Jamieson Harvey, M.B.E., J.P. Councillor Mrs. R. Hone. 2 PUBLIC HEALTH STAFF, 1960. 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. Resigned 10.1.60 *† D. T. Rees. † K. E. Doubleday. Appt. 2.5.60 Administrative Assistant G. A. Pearson. Senior Clerk E. M. Pearmine (Miss). Clerks C. M. Payne (Miss) Resigned 12.6.60 M. E. Pratt (Miss) Appt. 11.7.60 Resigned 13.7.60 A. Frostick (Miss) Appt. 2.8.60 I. D. Dashfield (Mrs.) (Shorthand Typist). Resigned 31.7.60 I. A. Counter (Mrs.) (Shorthand Typist). Appt. 2.8.60. Resigned 30.8.60 E. F. Terry (Miss) (Shorthand Typist). Appt. 19.9.60 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 1960 which has been prepared on the lines set out in Circular 1/61 of the Ministry of Health. The Registrar-General's estimate of the mid year population is 91,000 (90,500 in 1959). The vital statistics supplied, annually, by the General Register Office, and dealt with below indicate that, broadly speaking, the health of the Borough was well maintained. The standardised death rate for 1960 was 10.7 per thousand of the home population (10.8 in 1959) compared with 11.5 per thousand for England and Wales. The standardised birth rate was 14.8 per thousand estimated home population (14.7 in 1959) compared with a rate of 17.1 per thousand for the country as a whole. As in 1959, 17 infants died during the first year of life giving an infant mortality rate of 12.9 per thousand live births (13.1 in 1959) compared with 21.9 per thousand in England and Wales. All but two of the infantile deaths were due to congenital abnormalities and prematurity over which there is little control at present. For the fourth successive year there was no maternal death associated with childbirth. Bearing in mind that during this period there were 5,163 total births in the area, it may be said with some confidence that the result reflects the efficiency of the antenatal and obstetrical services as well as the greater degree of control over puerperal infections made possible by the use of the antibiotics and chemotherapeutic substances. In regard to the infectious diseases, it is pleasing to report that, for the eleventh year in succession, there has been no case of diphtheria in the Borough. It is, nevertheless, a duty that the public should be constantly reminded of the possible return of this disease should the level of immunisation fall to a sufficiently low level. Already there have been signs of a recrudescence of the disease in various parts of the country and, while there were no deaths from this cause in England and Wales during 1959, there were two 4 deaths in 1960 and seven deaths in the first seven months of 1961. Parents would be well advised to heed this warning and ensure that their children are kept fully immunised. For the second year in succession no case of poliomyelitis occurred in the Borough. There can be little doubt that this satisfactory result is, substantially, due to the intensive poliomyelitis vaccination of children and young adults in recent years. A further interesting development which may have far-reaching consequences is the introduction of a new type of vaccine which is given by the mouth (oral vaccine). It is evident from extensive trials carried out in various parts of the world that it is both safe and effective. In the meantime, it behoves all parents and all adults within the approved age limit (at present 40 years) to avail themselves to the fullest extent, both for their children and for themselves, of the fully-tried procedure at present in use which is known to be at least 90 per cent effective for those persons receiving three or more doses. During 1960, there were 50 deaths from cancer of the lung—the highest number recorded in the Borough in any one year. The annual figures for the previous nine years were 40, 30, 37, 32, 48, 28, 40, 40 and 42. The increased incidence and associated mortality are, of course, a national problem. It is now ten years since the first publication of evidence, in this country, of the close association between cancer of the lung and heavy cigarette smoking and there must be few people from the age of 15 years and upwards who are not aware of the danger; and yet the consumption of cigarettes goes up and up. The report of the Commissioners of H.M. Customs and Excise, for the year ended 31st March, 1960, indicates that a big increase in tobacco smoking in Britain sent the Customs and Excise revenue up, during that year, by £52 million to £788 million—the department's highest single revenue rise. Tobacco clearances for consumption rose by more than 17 million lbs. to 262 million lbs. and the report makes it clear that the increase was due, in the main, to an increase in consumer demand. It may be of some use to re-state the facts. The consumption of tobacco rose from 11½ million lbs. in 1900 to over 225 million lbs. in 1958. In 1900 deaths from lung cancer were eight per million of the population—in 1958, 440 per million. In the past eight years 125,000 deaths have occurred from lung cancer in England and Wales alone— many more than all accidental deaths on the roads, in the home and in industry. 5 Publicity has failed. In any case it has been quite inadequate when compared with the skilful and sustained propaganda for smoking conducted by the tobacco industry much of it directed at the adolescent boy and girl to whom smoking is presented as something fine and glamorous and a sign of maturity. It would be wrong, in spite of public apathy, to drop this subject and accept the consequences. It is hoped that the wise person will, progressively, cut down his cigarettes or, better still, give them up altogether, or change over to a pipe which is considered to be less dangerous. During 1960 a concentrated mass x-ray survey was carried out in Bexley, Erith and Crayford (total population 166,800) in conjunction with the South-East Metropolitan Regional Hospital Board. The results of this survey are given in the body of the report. It will be seen that 35,250 people were x-rayed (Bexley 16,640) but it should be stated that an additional seven thousand were x-rayed in factories just prior to the campaign in order to free the units from some of their routine work. Further, the fact that a high proportion of local residents work in London ensures that many are x-rayed by units operating in different parts of the metropolis. A diagnosis of pulmonary tuberculosis was made in 169 cases (Bexley 78) of which 57 (Bexley 28) required close supervision or treatment—an incidence of 1.6 per thousand x-rayed. The total number x-rayed, however, includes 16,040 persons who had not previously been x-rayed and these show an incidence for tuberculosis of 2.7 per thousand x-rayed. One can agree, therefore, with the statement made in the Survey report by Dr. J. M. Morgan, Director of the South-East London Mass X-Ray Service that "an important step has been made in reducing the number of unrecognised cases in the area surveyed." He continues, "It seems unlikely, however, that more than 60 per cent of adult residents in the areas have been examined in the last five years, including those who have been x-rayed elsewhere and, in an effort to reach the remaining 40 per cent. a mass radiography unit is visiting Bexleyheath, weekly, and it is hoped that it will prove possible to persuade a substantial number of this unexamined group to attend." Persons attending this weekly session are, in the main, referred by their private doctors and these attendances are, therefore, more selective than is the case in ordinary mass radiography sessions. One finding of the 1960 X-Ray Survey in regard to the number of cases of cancer of the lung per thousand 6 ined in the Borough of Bexley needs further comment. It will be seen that, of the 16 cases of cancer of the lung detected in the Survey (0.45 per thousand persons examined), 11 are included in the Bexley figure (0.66 per thousand examined). The breakdown of these figures in the sub-divisions of the area surveyed, to show the incidence in persons over the age of 45, gives the impression that there is an unduly high incidence in Bexley; but it must be remembered that incidence rates in mass x-ray surveys refer only to the population surveyed and not, necessarily, to the total population. Therefore, while it may be taken that the figures for Bexley are statistically significant, one should look first for some factor or factors which may have influenced the results. Firstly, there may have been some unconscious selection of individuals for examination and, secondly, the broad equality of the figures for deaths from cancer of the lung in the three towns does not support the hypothesis of a higher incidence for Bexley unless some future change in mortality has been anticipated. I should like to take this opportunity of thanking the Council for their encouragement and assistance in carrying out this survey and the innumerable people who worked so hard on the organisation of the campaign. For a fuller account of the latter reference is made to the report issued by the Director of the South-East London Mass X-Ray Service from the New Cross General Hospital, S.E.14. The work of the Bexley, Erith and Crayford Home Safety Committee continued during the year and, with the grant now being received from the Local Health Authority, has increased in scope. However, this is time consuming work and must, at present, be fitted into the general work of the Health Department. This makes a really sustained effort a matter of some difficulty. It may be that the appointment of a part-time Home Safety Organiser for the three areas covered by the Committee would be one way of solving the difficulty. 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 367 Estimate midyear. 91,000 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1931 (Census) 33,150 1946 82+ 64rebuilt 1940 77,670 1948 334+ 286 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 1959 90,500 1959 287 Number of inhabited houses at the end of 1960 (according to Rate Books) approximately 28,669 Rateable Value £1,329,630 Sum represented by a penny rate £5,425 Unemployment. Men Women Boys Girls Total December 31st, 1959 242 95 29 8 374 December 31st, 1960 178 43 19 10 250 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 graph showing rise iw population SINCE 1931 SUMMARY OF VITAL STATISTICS England and Wales. Borough of Bexley. Rates per 1,000 Home Population. Births Live 17.1 14.5 Still 0.34 0.22 19.8(a) 14.9(a) Deaths All Causes 11.5 8.7 Typhoid and Paratyphoid 0.00 — Whooping Cough 0.00 — Diphtheria 0.00 — Tuberculosis 0.07 0.04 Influenza 0.02 0.03 Smallpox — — Acute Poliomyelitis (including encephalitis 0.00 - Pneumonia 0.56 0.44 Notifications (corrected) Typhoid Fever 0.00 — Paratyphoid Fever 0.00 — Meningococcal Infection 0.01 0.02 Scarlet Fever 0.70 0.64 Whooping Cough 1.27 0.63 Diphtheria 0.00 — Erysipelas 0.06 0.16 Smallpox 0.00 — Measles 3.48 0.47 Pneumonia 0.32 0.16 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.01 — Non-Paralytic 0.00 — Food Poisoning 0.17 0.01 Puerperal Pyrexia 11.03(a) 11.9(a) Deaths Rates per 1,000 Live Births. All causes under one year of ago 21.9 12.9 Enteritis and Diarrhoea under two years of age 0.5 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 0.31 Nil Due to abortion 0.08 Nil Total maternal mortality 0.39 Nil EXTRACTS FROM VITAL STATISTICS FOR THE Year 1960. The Registrar General's Estimate of home population for the mid-year is 91,000 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 656 665 1,321 Legitimate 638 649 1,287 Illigitimate 18 16 34 Birth Rate. Rate per 1,000 estimated home population 14.5 The following relates to the Birth Rate during the past ten years:— 1950 Birth Rate 13.13 per thousand 1951 „ „ 12.79 „ „ 1952 „ „ 12.00 „ „ 1953 „ „ 12.70 „ „ 1954 „ 11.80 „ „ 1955 „ „ 12.60 „ „ 1956 „ „ 13.2 „ „ 1957 „ „ 13.6 „ „ 1958 „ „ 13.6 „ „ 1959 „ „ 14.4 „ „ Rate per 1,000 for England and Wales 17.1 12 The Registrar-General has supplied a comparability factor for 1960. The standardised birth rate which allows for comparison with other parts of the country is 14.8. 34 illegitimate live births were registered against 37 in 1959 giving a 2.6 per cent of total live births. Stillbirths. Males Females Total Total 10 10 20 Rate per 1,000 total (live and still) births 14.9 20 Stillbirths were registered during the year. This represents a rate of 0.22 per 1,000 population against 0.22 per 1,000 population in 1959. The following relates to the Stillbirth Rate during the past ten years:— Year Rate per Thousand Total Live and Still Births Population 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 1959 15.2 0.22 Rate per 1,000 for England and Wales 1960 0.35 There were two Stillbirths registered as illegitimate. Males Females Total Total Live and Stillbirths 666 675 1,341 13 Infant Deaths. Males Females Total Deaths of Infants under one year of age 11 6 17 Legitimate 11 6 17 Illegitimate — — — Death rate of Infants under one year of age: Total per 1,000 live births 12.9 Legitimate per 1,000 legitimate live births 13.2 Illegitimate per 1,000 illegitimate live births Nil Neo-natal Deaths per 1,000 live births 6.8 Early Neo-natal Deaths 5.3 Perinatal Deaths 20.1 The following relates to the Infant Mortality Rate during the past ten years:— 1950 14.48 per 1,000 live births. 1951 24.76 „ „ „ „ 1952 11.34 „ „ „ „ 1953 14.36 „ „ „ „ 1954 22.1 „ „ „ „ 1955 17.0 „ „ „ „ 1956 24.6 „ „ „ „ 1957 22.9 „ „ „ „ 1958 13.0 „ „ „ „ 1959 13.1 „ „ „ „ 14 15 INFANT MORTALITY, 1960. DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1960 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0- 1- 2- 3- 4- 5- 6- 7- 14- 21- 28- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12 Congenital Malformation 1 1 1 1 1 Premature Birth 1 1 1 Atelectasis 1 Acute Bronchitis 3 Broncho Pneumonia 1 1 1 Acute Otitis Media, Marasmus 1 Meconium Peritonitis, Perforated Meconium Ileus, Fibrocystic disease of Pancreas 1 Staphylococcal Pneumonia, Fibrocystic disease of Pancreas 1 Totals 1 — 1 1 1 1 1 2 — 1 — 6 — 1 — — 1 1 — — — — The number of infants under one year of age who died during the year 1960 as shown by the table is 18.9 of these deaths, that is 50 per cent. occurred in the neonatal period (within one month of birth). In 1959, the corresponding figure was 70 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:— 1950 0.84 per 1,000 live and stillbirths 1951 Nil „ „ „ „ 1952 0.93 „ „ „ „ 1953 2.63 „ „ „ „ 1954 Nil „ „ „ „ 1955 0.88 „ „ „ „ 1956 Nil „ „ „ „ 1957 Nil „ „ „ „ 1958 Nil „ „ „ „ 1959 Nil „ „ ,. „ Deaths All Causes. Males Females Total All causes 400 395 795 Death rate per 1,000 of estimated home population 8.7 Deaths from Measles (all ages) — — - „ „ Whooping Cough (all ages) — — — „ „ Diarrhœa (under 2 years of age) — — — „ „ Cancer (all ages) 124 97 221 Death rate per 1,000 for England and Wales, 1960 11.5 16 Death Rate of Area during last ten years: — 1950 8.56 per thousand. 1951 9.6 „ „ 1952 9.14 „ „ 1953 8.8 „ „ 1954 8.1 „ „ 1955 9.1 „ „ 1956 9.4 „ „ 1957 9.2 „ „ 1958 9.48 „ „ 1959 8.76 „ „ The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1960. The standardised death rate which allows for comparison with other parts of the country is 10.7. 17 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1960. Causes of Death. M. F. Total All Causes 400 395 795 1 Tuberculosis, respiratory 1 3 4 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 2 2 10 Malignant neoplasm, stomach 19 9 28 11 Malignant neoplasm, lung, bronchus 44 6 50 12 Malignant neoplasm, breast — 24 24 13 Malignant neoplasm, uterus — 9 9 14 Other malignant and lymphatic neoplasms 61 49 110 15 Leukaemia, aleukaemia 1 2 3 16 Diabetes 2 5 7 17 Vascular lesions of nervous system 31 62 93 18 Coronary disease, angina 96 60 156 19 Hypertension with heart disease 9 9 18 20 Other heart disease 28 47 75 21 Other circulatory disease 18 18 36 22 Influenza — 3 3 23 Pneumonia 22 18 40 24 Bronchitis 19 12 31 25 Other diseases of the respiratory system 3 4 7 26 Ulcer of stomach and duodenum 5 2 7 27 Gastritis, enteritis and diarrhoea — 1 1 28 Nephritis and nephrosis 5 1 6 29 Hyperplasia of prostate 2 — 2 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 3 3 6 32 Other defined and ill-defined diseases 17 34 51 33 Motor vehicle accidents 4 2 6 34 All other accidents 5 6 11 35 Suicide 3 6 9 36 Homicide and operations of war — — — 18 19 DEATHS REGISTERED (IN AGE GROUPS) IN 1960. 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 1. Tuberculosis, respiratory M F M F M F M F M F M F M F M F M F ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... 1 3 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 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... 10. Malignant neoplasm, stomach ... ... ... ... ... ... ... ... 3 ... 9 2 4 4 ... 3 19 9 11. Malignant neoplasm, lung, bronchus ... ... ... ... ... ... ... ... ... ... 24 3 11 2 3 1 44 g 12. Malignant neoplasm, breast ... ... ... ... ... ... ... ... ... 2 ... 13 ... 6 9 3 ... 24 13. Malignant neoplasm, uterus ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... 3 ... 9 14. Other malignant and lymphatic neoplasms ... ... ... ... ... ... ... ... ... 1 25 18 17 11 19 19 61 49 15. Leukaemia, aleukaemia ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... 1 2 16. Diabetes ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 4 2 5 17. Vascular lesions of nervous system ... ... ... ... ... ... ... ... 1 ... 8 9 9 12 13 41 31 62 18. Coronary disease, angina ... ... ... ... ... ... ... ... 4 ... 38 10 29 23 25 27 96 60 19. Hypertension with heart disease ... ... ... ... ... ... ... ... ... ... ... 2 2 1 7 6 9 9 20. Other heart disease ... ... ... ... ... ... ... ... 1 1 7 7 4 9 16 30 28 47 21. Other circulatory disease ... ... ... ... ... ... ... ... ... 1 4 6 4 ... 10 11 18 18 22. Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 3 23. Pneumonia 5 1 ... 1 ... ... ... ... ... ... 2 2 5 3 10 12 22 18 24. Bronchitis ... ... ... 1 ... ... ... ... ... ... 5 1 8 ... 6 9 19 12 25. Other diseases of the respiratory system ... ... ... ... ... ... ... ... ... 1 ... 1 2 2 1 ... 3 4 26. Ulcer of stomach and duodenum ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 1 2 5 2 27. Gastritis, enteritis and diarrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 28. Nephritis and nephrosis ... ... ... ... 1 ... ... ... ... ... 2 1 1 ... 1 ... 5 1 29. Hyperplasia of prostate ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 30. Pregnancy, childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital malformations 2 2 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 3 3 32. Other defined and ill defined diseases 4 3 ... ... ... ... ... ... ... ... 7 8 3 9 3 14 17 34 33. Motor vehicle accidents ... ... ... ... ... ... ... ... 3 ... 1 1 ... ... ... 1 4 2 34. All other accidents ... ... ... ... 1 ... 1 ... ... ... ... 1 1 ... 2 5 5 6 35. Suicide ... ... ... ... ... ... ... ... ... 2 1 2 2 1 ... 1 3 6 36. Homicide and operations of war ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 11 6 1 2 2 - 1 - 14 10 136 94 106 88 129 195 400 395 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 necessary in one case for action to be taken under the Act. Action taken under Section 50. It was necessary to arrange one burial 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. Owing to the non-availability of technical assistance for the pathologists it was decided by H.M. Coroner to direct bodies early in April to the West Hill Hospital. 20 and this arrangement continued until July 1st, 1961 when the Bexley Mortuary returned to normal operation. During the period 1st January, 1960 to 23rd July. 1960, 52 bodies were admitted and 52 post-mortem examinations were made; 12 inquests were held. LABORATORY FACILITIES. Pathological and bacteriological specimens are sent to the Public Health Laboratory at Maidstone. This service ceased to be the responsibility of the County Council as from the 1st October, 1955, when it was taken over by the Public Health Laboratory Service, directed by the Medical Research Council for the Ministry of Health. NURSING HOMES. Registration of Nursing Homes, Public Health Act, 1936. (Authority of Registration transferred from Kent County Council to the Bexley Borough Council—17.4.39). No. of Homes on the Register at beginning of year 5 No. of patients provided for:— Maternity 5 Others 78 Total 83 No. of Homes first registered during year Nil No. of patients provided for:— Maternity — Others — Total — No. of Homes on the Register at end of year 3 No. of patients provided for:— Maternity - Others 52 Total 52 21 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH. List of Adoptive Acts, etc., in force. Acts. Date Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 ... Apr. 1891 Public Libraries Act.l892-1919 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 } May 1909 „ 6—the whole Public Health Act, 1925, Part 2 Jan. 1926 Slaughter of Animals Act, 1933 Jan. 1934 Byelaws. Wireless Loudspeakers, Gramophones, etc. ... Mar. 1939 Baths, Wash-houses, Swimming Baths and Bathing Places Aug. 1938 Parks and Pleasure Grounds May and 1939 1959 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. and 1954 1961 Parking Places for Vehicles May 1960 Fouling by Dogs of Footways Oct. 1960 22 1. (i) Water Supply. The water to the district is supplied by the Metropolitan Water Board and is derived from several sources namely Bexley, Crayford, Darenth and Wilmington wells together with River Thames derived filtered water. The water supply to this area has been satisfactory in quality and also in quantity except that in a few localities pressure has at times been poor. It is hoped to provide remedial measures in future planning. 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 all water is chlorinated before it leaves the works. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically. There have been no specific cases of contamination and the waters are not liable to have a plumbo-solvent action. During the year 6 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. During the year some 3,C'D0 yards of surface water sewer have been laid ranging from 9 ins. to 54 ins. dia. The streets sewered or part sewered are Orchard Rise East, Chester Road, Danson Crescent, Upper Wiokham Lane, High Street, Welling and Wickham Lane. Number of cesspools emptied—14. The total number of emptyings—38. 2. Rivers and Streams. No serious pollution was found in rivers or streams during the year. 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 1960. 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) 41 89 Houses inspected (defects only recorded) 81 447 Houses inspected (certificates of disrepair) 22 38 Houses inspected (improvement grants) 79 4 Houses inspected (Housing Act, 1936, Overcrowding) 15 7 Houses inspected re Infectious Disease (including scabies) 105 50 Factories with mechanical power 162 51 Factories without mechanical power 5 — Outworkers' premises 21 — Other premises under the Act 5 5 Bakehouses 38 29 Water Samples 16 1 Food and Drugs Act Samples 201 23 Dairies and distributors 12 3 Ice Cream premises 60 1 Restaurants, etc 152 48 Fish premises 83 43 Meat Shops 224 49 Public Houses 12 2 Shops re unsound food 306 88 Other premises where food is prepared 540 130 Offensive accumulations 60 40 Stables y 2 Keeping of Animals 38 27 Rats 159 115 Drains inspected 544 553 Drains tested (water, smoke or colour) 88 19 Dustbins 15 10 Verminous premises 40 57 Smoke observations 45 18 Tents, Vans and Sheds 13 36 Refuse Tips 330 2 Refuse Removal and Salvage 599 5 Conveniences 108 — Pet Animals Act, 1951 11 3 Council House applicants 272 118 Shops Act, 1950 513 8 National Assistance Act, 1948—Sec. 47 3 - Miscellaneous inspections 824 109 Clean Air Act 313 244 25 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 6 Provided with sufficient ashplace accomdation 11 Provided with sufficient water supply 7 Houses Improved Internally— Walls and ceilings repaired 41 Dampness in rooms remedied 57 Defective floors repaired 6 Ventilation of Rooms improved 15 Windows repaired 26 Stoves, fireplaces, etc. provided or repaired 6 Houses Improved Externally— Roofs repaired 20 Eaves gutters and down spouts fixed or repaired 24 Yards paved or repaired 1 Chimney stacks repaired 2 Walls repointed or repaired 35 Miscellaneous repairs 9 Drainage— Drains cleansed or repaired 596 New drains constructed 2 New Gullies provided I Ventilation of drainage system improved 1 Inspection chambers built or repaired 11 Waste pipes provided or repaired 2 New sinks provided 1 Offensive accumulations removed 4 Nuisances from animals abated 1 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 29 Houses visited including revisits 155 Rooms disinfected 3 Notices delivered to Education Authorities, etc. 143 26 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered and destroyed: Corned Beef lbs. 1,158¾ Tinned Ham ,, 712¾ Beef ,, l,006¼ Pork ,, 785½ Chicken ,, 1,502 Offal ,, 710¾ Bacon „ 123½ Rabbit „ 298¾ Tea ,, ¾ Raisins ,, 5½ Fish „ 182 Cake,, 378 Cheese ,, 114½ Butter ,, 365¾ Cooking Fats ,, 145 ½ Potatoes „ 224 Fruit and Fruit Juices tins 863 Vegetables 1,176 Meat 1,429 Soup 9 Fish and Fish Pastes „ 253 Milk ,, 336 Coffee ,, 17 Creamed Rice ,, 19 Preserves jars 47 Pickles ,, 4 Cheese Spread „ 26 Cheese boxes 66 Frozen Foods pkts 923 Biscuits ,, 93 Confectionery ,, 509 Meat Pies ,, 26 Miscellaneous items ,, 13 27 TABLE No. 5. Factories Act, 1937 and 1948. 1. Inspections for Purposes of Provisions as to Health Including Inspections made by Public Health Inspectors Premises. 1 N umber of : Inspections. 2 W ritten Notices. 3 Prosecutions 4 Factories without mechanical power 26 — — Factories with mechanical power 280 7 — 'Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 10 •Electrical Stations should be reckoned as factories. Total ... 316 7 2. Defects Found. Particulars. N umber ot Defects. . Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Want of cleanliness (S.l) 8 8 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) — — — — Sanitarv Conveniences (S.7)— Insufficient — — — — Unsuitable or defective 4 4 — — Not separate for sexes — — — — Other Offences 5 5 — — (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) Total 17 17 — — 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 collections were in arrears due to shortage of labour, and a considerable amount of overtime had to be worked in order to clear the area in a week. The rate of pay for ashbinmen is in my opinion not sufficient to attract suitable men for this type of work, and towards the end of the year the Council gave consideration to a bonus scheme which it is hoped will result in an improved service. The Council operate a salvage scheme, and waste paper, textiles, scrap metal etc. are collected by means of trailers attached to the refuse collection vehicles. Four new Shelvoke and Drewry Fore and Aft Tippers were purchased during the year to replace the existing side loading freighters. All refuse is disposed of by controlled tipping. The tip at East Wickham is now filled, and tipping was commenced at Stone in March, 1960. The average haul to the Stone tip is 1\ miles as compared with 2½ miles to East Wickham, and this will, of course, considerably increase the cost of disposal. 29 Salvage. Details of salvage sales for the financial year ended 31st March, 1961, are set out below. Tons. cwts. qrs. £ s. d. Waste Paper 385 5 1 2,806 2 9 Textiles 9 6 1 125 8 9 Ferrous Metals 5 16 0 44 15 3 Non-Ferrous Metals 1 1 6 9 Miscellaneous 1 0 2 10 5 0 401 8 1 2,987 18 6 Kitchen Waste. There are some 250 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. Falconwood Parade, The Green, 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 Committtee for the Abatement of Atmospheric Pollution. BY arrrangement with this Committee a deposit gauge is installed on the roof of the Education Office in Bramton Road, Bexleyheath, and the following tabel gives the results obtained during 1960. TONS PER SQUARE MILE. MONTH Rainfall inches 1 Totai water 1 insoluble matter Soluble in C.S.2. Ash Other combustible matter Total water soluble matter Calcium Chlorine Sulphates Total solids January 1.25 7.87 0.17 5.96 1.75 7.05 1.01 1.17 3 29 14.92 February 1.38 7.20 0.11 5.12 1,97 5.74 0.81 0.97 2.28 12.94 March 1.26 10.85 0.09 8.10 2.66 13.89 2.68 1.17 6.26 24.75 April 0.34 7.46 0.11 5.42 1.93 5.24 0.97 0.55 2.19 12.63 May 1.96 9.48 0.12 7.07 2.28 10.00 2.03 0.67 3.72 19.48 June 1.33 7. 17 0.16 4.88 2.13 7.69 1.63 0.64 2.71 14.85 July 3.12 4.52 0.17 3.10 1.25 5.03 0.46 0.67 1.71 9.55 August 3.82 5.45 0.14 3.29 2.02 8.19 1.11 0.60 3.24 13.64 September 4.37 7.48 0.11 5.72 1.64 12.69 2.55 0.87 4.76 20.16 October 5.00 8.46 0.11 6.26 2.09 11.75 2.10 1.14 5.39 20.21 November 3.21 3.73 0.09 2.44 1.19 4.97 0.31 1.28 1.10 8.70 December 2.55 9.75 0.14 6.96 2.65 7.25 0.83 1.14 2.90 17.00 A Lead Peroxide instrument for estunatubg atnisogeruc 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 January Sq. Cm. Mg. Mg. Mg. Mg /100 sq. Cm. /day 100 297.4 1.9 293.5 3.27 2.94 February 95 176.4 2.0 174.4 2.17 1.95 March 100 209.2 1.0 208.2 2.30 2.07 April 95 140.4 1.7 138.7 1.62 1.46 May 95 153.8 1.0 152.8 1.84 1.66 June 100 124.0 1.5 122.5 1.40 1.26 July 100 64.2 1.0 63.2 0.68 0.61 August 100 67.0 3.0 64.0 0.73 0.66 September 100 149.8 1.2 148.6 1.59 1.43 October 95 166.8 1.1 165.7 2.06 1.85 November 90 155.0 1.1 153.9 1.96 1.76 December 95 225.8 2.0 223.8 2.53 2.28 31 A volumetric apparatus for the measurement of sulphur dioxide and smoke is installed at the Health Department, Bramptcn 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 20 107 2 9.3 34.9 1.4 February 17 94 1 6.0 26.4 0.0 March 8 20 1 6.5 15.6 0.9 April 6 20 1 4.1 10.6 1.2 May 3 9 0 4.8 15.3 1.2 June 2 3 0 3.8 11.9 1.2 luly 2 5 0 1.5 6.2 0.0 August 3 8 0 1.8 4.2 0.5 September 5 9 0 2.7 7.2 0.5 October 11 27 2 5.1 10.2 1.3 November 11 70 0 4.4 18.9 0.8 December 22 62 1 9.2 31.9 0.9 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 arc charged for disinfestation work. 32 Details of surface infestations dealt with during the year are set out below. Number of Properties Inspected 604 Number of Inspections 2,321 Number of Infestations found: Rats—Major — Minor 226 Mice 48 Number of Properties Treated Rats Mice Local Authority's premises 1 1 Dwelling Houses 207 37 Business Premises 18 10 PET ANIMALS ACT, 1951. Licences 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, 521 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 4 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:— Mite 1, Fleas 1, Cockroaches 2. Wasps. The destruction of wasps nests is undertaken by the Department and during the year 55 nests were destroyed. A charge of 6s. Od. was made for this service. Schools. Them 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 426 Westwood Lane Estate 126 Carlton Road 16 Dovedale Close 11 John Newton Court — 132 Marwood Estate — 22 Lodge Hill 353 Wickham Street 74 East Wickham— Re-development Phase 1 247 Glenmore Road No. 1 115 Glenmore Road No. 2 84 Bexleyheath— Highland Road Estate and Pickford Road Estate 303 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 53 Royal Park Estate 114 Midhurst Hill 16 Newick Close 10 Henfield Close 7 Rye Close Extension 35 Glenhuist Avenue 27 Hurst Place Estate 207 S.D.A Houses 7 Houses Purchased 6 2,797 318 35 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 122 (b) Number of inspections made for the purpose (including re-inspection) 658 (2) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 41 (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 81 2. Remedy of Defects during the year without service of Formal Notice. Number of defective dwelling houses rendered fit in consequence of informal action 128 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. Proceedings under Public Health Acts— Number of dwelling houses in which defects were remedied after service of formal notices— (b) By owners 2 (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 12 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 1 (3) Number of houses in respect of which Closing Orders were made 3 D. Proceedings under Section 18 of the Housing Act, 1957— parts of buildings closed 36 Slum Clearance. During I960, 63 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 37 48 Number of applications approved 11 34 Total cost of approved expense of improvements £7,330 1 4 £2,509 15 7 Total approved costs on which grants were made in 16 cases (excluding the 11 approved cases) £2,661 18 4 £1,029 11 7 (12 cases) Total amount of grants made in those 16 cases £3,025 2 5 £454 15 1 12 cases) Rent Act, 1957. Number of applications for certificates of disrepair 9 Number of decisions not to issue certificates — Number of decisions to issue certificates 9 (a) in respect of some but not all defects 3 (b) in respect of all defects 6 Number of undertakings given by landlords 4 Number of undertakings refused by the Local Authority Number of Certificates issued 5 Applications by landlords for cancellation of certificates 3 Objections by tenants to cancellation of certificates Decisions by Local Authority to cancel in spite of tenants' objection Certificates cancelled 5 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 Mi'ik) Regulations. 1949 to 1953.— Dealers' Licences:— Pasteurised Milk 30 Tuberculin Tested Milk 29 Sterilised Milk 36 Supplementary Licences:— Pasteurised Milk 5 Tuberculin Tested Milk 4 Sterilised Milk 5 6 samples of milk were forwarded to the Public Health Laboratory for the Methylene Blue and Phosphatase Tests, and all were satisfactory. (b) Slaughterhouses. There are no slaughterhouses in the area, and the majority of the butchers obtain their supplies through Smithfield Market. 38 (c) Adulteration of Food. Food and Drugs Act, 1955. The following table summarises the 167 samples taken during the year. Formal Informal Milk 1 1 Meat Pies and Puddings 1 1 Sausages 1 2 Biscuits — 3 Cream of Tartar, Arrowroot — 2 Condiments, Sauces, Pickles, Spices, etc. — 33 Butter and Fats, Cooking Oil, etc. 2 15 Soups, Meat Extracts 1 5 Minerals and Cordials, etc. — 10 Liver and Bacon Croquets — 1 Glace Cherries — 2 Sweets and Confectionery — 3 Pure Coffee, Coffee Extracts, Coffee and Chicory 2 2 Pudding or Cake Mixture, Flour, etc. ... 2 12 Preserves — 4 Cream — 3 Pastes, Spreads, Potted Meat and Fish ... — 7 Angelica — 1 Glucose — 1 Flavouring and Essences — 7 Alcohol 2 1 Ground Almonds — 2 Boneless Chicken — 1 Fruit Juice — 5 Fish — 4 Dried Fruit — 1 Condensed and Evaporated Milks — 3 Milo Food Drink — 1 Marrow — I Cakes —. 1 Desiccated Coconut — ? Jellies, Custard Powders, etc — 2 Luncheon Meat — 1 Processed Cheese — 6 Processed Peas — 1 Devilled Ham — 1 Beans with Ham — 1 Walnuts — 1 Instant Tea — 1 Strained Foods — 3 Fruit — 1 12 155 39 Legal Proceedings. (1) Sausages—Unfit for human consumption. Fined £20 plus £5 5s. costs. (2) Custard Tart—Mouldy. Case Dismissed. (3) Bread—Foreign matter in bread. Fined £20 plus £2 2s. Advocates fee, plus 3s. lOd. witness expenses. (4) Bread—Nail in bread. Fined £20 plus £2 2s. Advocates fee. (5) Sponge flans—Mouldy. Fined £8 plus £2 2s. Advocates fee, plus 7s. 4d. witness expenses. (6) Steak and Kidney Pie—Mouldy. Fined £8 plus £2 2s. Advocates fee. (7) Pork Pie—Mouldy. Fined £5 5s. plus £2 2s. Advocates fee, plus Is. 6d. witness expenses. (8) Macaroon—Foreign matter in macaroon. Fined £5 plus £1 Is. Advocates fee. (9) Black Pudding—Mouldy. Case Dismissed. (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 49 Cafes and Restaurants 27 Greengrocers 48 Sweet Shops 65 General Provision 80 Bakers and Confectioners 25 Wet and Fried Fish Shops 23 Public Houses 42 359 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 7 Floors, walls, ceilings, etc., repaired 6 Infestations dealt with — Rooms cleansed 47 Water Closet accommodation improved 16 Accumulation of refuse removed 3 Accommodation for storage of refuse improved 3 Washing accommodation improved 5 Drainage repaired or improved 1 Food storage accommodation improved 4 Yard cleansed or repaired 2 Sinks renewed 1 Other contraventions 11 Unsatisfactory equipment cleansed or renewed 3 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 172 Preparation of Sausages, etc 52 21 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 58 cases were notified as compared with 105 the previous year. No 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 notified0 during the year. The following figures on Diphtheria and Whooping Cough Immunisation and Smallpox and Poliomyelitis Vaccination have been supplied by the County Medical Officer:— 42 43 Immunisation against Diphtheria and Whooping cough, and Vaccination against Smallpox, 1960. 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, 1960: — (A) Diphtheria Immunisation. Year of Birth 1960 1959 1958 1957 1956 !955jl954 1953 1952 1951 1950 19 V9 1948 1947 1946 Before 1946 Total Primary Inoculations 616 798 90 33 23 32 22 18 6 3 7 2 3 1 — — 1653 Re-inforcing Inoculations I 2 36 23 75 4871 203 87 30 31 59 14 6 1 1 2 1058 (B) Vaccination. Year of Birth 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 19(9 1948 1917 1946 Before 1946 Total Primary Vaccination 483 493 36 10 13 1 6 5 — 2 5 1 2 — — 19 1076 Re-vaccination . — 1 — 1 5 — 2 2 1 1 1 .— 3 17 (C) Whooping Cough Immunisation. Year of Birth 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 I94S 1947 1916 Before 1946 Total Primary Inoculations 620 645 60 29 28 33 9 5 6 I 5 2 1 1 — 1 1 116 44 Immunisation against Diphtheria, 1960. The following is a return of the number of children under the age of 15 years on 31st December, 1960, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1946). Year of Birth 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 Total Last complete course of injections (whether primary or booster) 1956—1960 117 246 652 551 574 928 976 714 770 1155 1039 1086 1048 1075 617 11548 1955 or earlier 1068 1280 888 1222 834 396 389 553 379 14 — — — — — 7023 Poliomyelitis Vaccination, 1960. The following table gives (A) the number of second injections and (B) the number of third injections given during the year ended 31st December, 1960: — Born 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 19331942 Before 1933 Others Total (A) 245 756 88 23 20 26 21 5 8 7 12 14 9 10 5 4 6 17 375 2109 138 3898 (B) 10 596 535 204 139 141 147 154 143 126 105 139 15 160 101 87 101 113 2435 771 453 6818 Typhoid Fever and Paratyphoid Fever. There were no cases notified during the year. Puerperal Pyrexia. 16 cases were notified during the year, all of which were from Bexleyheaih Maternity Hospital, where they were isolated and treated. Ophthalmia Neonatorum. No cases were notified during the year. Measles. 43 cases were notified during the year. No cases were treated in hospital. Whooping Cough. 57 cases were notified during the year. 1 case was treated in hospital. Acute Poliomyelitis. No cases were notified during the year. Scabies. 1 case was notified during the year. Food Poisoning. 1 case was notified during the year and was treated in hospital. 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 1960. 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 Dftatto Smallpox — — — — — — — — — — — — Scarlet Fever 58 3 3 4 38 8 2 — — — — Diphtheria — — — — — — — — — Puerperal Pyrexia 16 __ — — — 6 10 — 16 — Ophthalmia Neonatorum — — — — — — — Acute Paralytic Poliomyelitis — — — — — — — Acute Non-Paralytic Poliomyelitis _ — — — — — — — Pneumonia 15 1 — 2 — 1 11 — 4 — Erysipelas 15 — 15 — 1 — Food Poisoning 1 — 1 — — — — — — — — 1 — Dysentery 8 1 — 4 1 2 — 4 — Typhoid Fever — — — — — — — — — Paratyphoid Fever — — — — — — — — — — — — — Meningococcal Infection 2 — — 1 — — — — — 1 — 2 — Measles 43 1 2 3 4 3 29 1 — — — — Whooping Cough 57 2 4 2 5 9 30 2 1 2 — 1 — Scabies 1 — — — — 1 — — — — — — — Encephalitis — — — — — — — — — — — — — Totals 216 4 7 14 12 18 99 11 12 39 — 29 — TUBERCULOSIS. During the year 57 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1960 are contained in the following table:— Age Period New Cases Deaths Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. Under 5 — 2 — — — — — — 5—14 2 — 1 — — — — — 15—24 3 4 — — — — — — 25—44 8 5 1 4 — 1 — — 45—64 14 6 1 1 — 1 — — 65 and over 3 2 — — 1 1 — — Totals 30 19 3 5 1 3 — — There were no deaths from non-notified cases during the year. 47 BEXLEY, ERITH and CRAYFORD MASS X-RAY CAMPAIGN May 23rd to June 30th, I960. The idea of a Mass X-Ray Campaign for the Boroughs of Bexley and Erith and the Urban District of Crayford arose out of a report entitled "No Time for Complacency," issued in May, 1958 by the South East London Mass Radiography Service and which covered the area of South East London and North West Kent. The report indicated that, although great improvements had taken place in recent years in the treatment of tuberculosis, there was little evidence that this progress had yet effected a material decrease in the incidence of new cases of tuberculosis or in the size of the reservoir of long-standing tuberculosis cases within the community. The figure relating to the incidence of tuberculosis per 1,000 x-rayed for the three towns appeared to provide "prima facie" evidence that further action was indicated and the Councils of Bexley, Erith and Crayford readily agreed to co-operate with the Mass Radiography Service in planning a comprehensive survey on the lines of the one carried out in Glasgow in 1957. The area under review. Bexley, Erith and Crayford are three contiguous towns forming part of Metropolitan Kent. The mid-year populations (as estimated by the Registrar General) were:— Bexley 90,500 Erith 45,700 Crayford 30,600 Total 166,800 These figures are for the total population in the area, but the Mass X-Ray Campaign was only concerned with the ambulant adult population. A full account of the Campaign has been published as a separate report and may be obtained from Dr. J. M. Morgan, Director, South-East London Mass X-Ray Service, New Cross General Hospital, Avonley Road, London, S.E.14. The following statistics relating to the Survey are extracted from the main report. Certain observations on these findings are made in the Foreward on page 6. 48 49 TUBERCULOSIS AND NEOPLASMS OF LUNG Borough of Residence Totals X-rayed Tuberculous cases requiring close supervision or treatment Tuberculous cases requiring occasional supervision. Total of tuberculous cases. Total number proved cases of carcinoma of lung. Total number non-malignant neoplasms. cases Incidence per 1,000 cases Incidence per 1,000 cases Incidence per 1,000 cases Incidence per 1,000 Bexley 16640 28 50 78 a 9 Crayford 5950 10 16 26 2 2 Erith 9690 18 43 61 1 4 Elsewhere 2970 1 3 4 2 1 35250 57 1.6 112 3.2 169 4.8 16 0.45 16 BEXLEY MEN AND WOMEN Age Groups Total No. Examined Total Number tuberculous cases requiring close supsrvision. Total Number tuberculous cases requiring occasional supervision. Total Number proved cases of carcinoma of lung. Total Number Non-manlignant neoplasms M. F. M. F. M. F. M. F. 15—19 1,270 — 1 — — — — — — 20—24 1,300 1 1 — — — — — — 25—34 3,100 3 4 3 3 — — 1 — 35—44 3,280 1 2 4 5 — — 1 — 45—54 3,290 4 4 4 7 1 — 1 2 55—59 1,370 2 1 3 2 6 — — 1 60—64 970 — 1 3 6 1 — 1 2 65 + 1,520 2 1 9 1 1 — — — TOTAL 16,640 13 15 26 24 9 2 4 5 28 Incidcnce per 1,000 = 1.7 50 Incidence per 1,000 = 3.0 4.7 per 1.000 CRAYFORD MEN AND WOMEN Age Groups Total No. Examined Total Number tuberculous cases requiring occasional supervision. Total Number tuberculous cases requiring close supervision. Total Number proved cases of carcinoma of lung. Total Number Non-manignant neoplasma M. F. M. F M. F. M. F. 15—19 540 — 1 — — — — — — 20—24 430 — 1 — — — — — — 25—34 1.670 2 2 — 1 — — — — 35—44 1,180 — 1 — 1 — — — — 45—54 1.030 1 1 3 5 — — — — 55—59 440 — 1 1 — — — — — 60 —64 350 — — — 2 — — — 1 65 + 310 — — 2 1 1 — — 1 TOTAL (All ages) 5,950 3 7 6 10 1 1 2 10 Incidence per 1,000 = 1.7 16 Incidence per 1,000 = 2.7 4.4 per 1.000 50 ERITH MEN AND WOMEN Age Groups Total No. Examined Total Number tuberculous cases requiring close supervision. Total Number tuberculous cases requiring occasional supervision. Total Number proved cases of carcinoma of lung. Total Number Non-manlignant neoplasms. M. F. M. F. M. F. M. F. 15-19 1,040 — 1 — — 20-24 700 — — — — — — — — 25-34 1,880 1 2 3 1 — — — — 35-44 2,230 — 4 2 6 — — — — 45-54 1,810 1 5 4 11 1 — — 1 55-59 740 — 1 1 1 — — — — 60-64 530 1 — — 4 — — — — 65+ 760 — — 4 6 — — — 4 Total (All ages 9,690 5 13 14 29 1 — — 4 18 Incidence per 1,000 = 1.9 43 Incidence per 1,000 = 4.4 6.3 per 1,000 ELSEWHERE MEN AND WOMEN Age Groups Total No. Examined Total Number tuberculous cases requiring close supervision. Total Number tuberculous cases requiring occasional supervision. Total Number proved cases of carcinoma of lung. Total Number Non-manlignant neoplasms. M. F. M. F. M. F. M. F. 15-19 380 — — — — — — — — 20-24 290 — — 1 — — — — — 25-34 780 — — — 1 — — — 1 35-44 700 1 — 1 — — — — — 45-54 500 — — — — — — — — 55-59 120 — — — — — 1 — — 60-64 120 — — — — — 1 — — 65+ 80 — — — — — — — — 2,970 1 — 2 1 — 2 — 1 Total (All ages) 1 Incidence per 1,000 =0.3 3 Incidence per 1,000 = 1.0 1.3 per 1,000 51 52 INCIDENCE OF TUBERCULOUS DISEASE AMONGST THOSE NOT PREVIOUSLY X-RAYED Total NOT previously X-rayed Tuberculous cases requiring close supervision or treatment Tuberculous cases requiring occasional supervision 16,040 44 (incidence of 2.7 per 1,000) 86 (incidence of 5.4 per 1,000) 53 CARCINOMA OF BRONCHUS Borough MEN OVER 45 WOMEN OVER 45 MEN & WOMEN Cases Found Total X-rayed Cases Found Total X-rayed Cases Found Bexley 2,550 9 (3.5 per 1,000) 4,600 2(0.4 per 1,000) 11 Crayford 760 1 (1.3 per 1.000) 1,370 1 (0.7 per 1,000) 2 Erith 1,150 1 (0.9 per 1,000) 2,690 — 1 Elsewhere 390 — 430 2(4.7 per 1,000) 2 4,850 11 (2.3 per 1.000) 9,090 5 (0.6 per 1,000) 16(1.1 per 1,000) BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Services For the Year 1960 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 S. H. Philpot. Vice-Chairman: Miss M. Woodward, L.L.A., L.G.S.M.(Eloc.) Alderman Mrs. E. M. Sheppard. Councillor C. Jamieson Harvey, Councillor Mrs. R. Hone. M.B.E., J.P. Councillor N. H. Antenbnng Councillor A. S. Melbourne. Councillor N. S; Harrild, M.B.E. Councillor J. C. Canton, J.P. Co-opted Members: Revd. E. Maynard Wilson. Revd. A. E. Ramsbottom, B.D. Borough Education Officer W. E. D. Stephens, M.A., Ph.D. 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. Orthopædic Surgeons K. F. Hulbert, F.R.C.S. B. Lawson, F.R.C.S. Dental Officers G. Wilson Lawrence, L.D.S., R.C.S. Mrs. A. B. Perkins, L.D.S., R.S.P.S. (Glas.), Miss G. M. Abrahamson. (Appointed 28.3.1960) (Resigned 25.5.1960) 56 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). (Resigned 5.4.60). 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). (Resigned March 1960). 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). Miss Abia-Oken, S.R.N., S.C.M., and Health Visitor's Certificate (Part-time) (Appointed April 1960) (Resigned September 1960. Mrs. V. E. Gurnett, S.R.N. (Appointed April 1960). 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. (Died October I960). Mrs. T. Grove, L.C.S.T. Dental Attendants Miss K. Dunkley. Mrs. V. Sproul. Mrs. E. Brooks, (Appointed 28.3.60). (Transferred 25.5.60). Miss J. A. Smith — Hygienist. School Health Service Clerk Miss M. C. A. Smith. General Clerks Miss O. G. Turnbull. Miss R. Thomas (Resigned 22.7.60) Miss E. Turner. Mrs. D. Starling (Appointed 8.8.60), 57 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1960. 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 for the year 1960. 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. There were, however, a number of new developments which are dealt with in the following paragraphs. One of the most important was the coming into operation, as from April 1st, 1960 of the School Psychological Service. For many years teachers have been able to call on the Child Guidance Clinic, and particularly on the Educational Psychologist, for advice on specific learning difficulties of children in school. Such children often need remedial teaching and the object of the new service is to extend these advisory facilities and to make them an integral part of schooling. It should be borne in mind, however, that although the Child Guidance Clinic is regarded as a medical service and the School Psychological Service as an educational one, there is only a thin dividing line between the two if, indeed, there is any line at all. The Chief Medical Officer of the Ministry of Education in his report for 1958/ 1959 expresses the view that the two services "must work closely together—the one is complementary to the other, not a competitor." I think one can say that in Bexley this viewpoint is fully accepted. Closely linked with the establishment of the School Psychological Service are plans to provide two further special classes in Junior Schools, making four in all—the last two being in Infants Schools. These special classes cater for educationally retarded children who require more individual tuition in smaller classes and we may now expect a further reduction in the number of children who fail to make satisfactory progress. These classes do much to promote the psychological health of the children in addition to the educational advantages they bestow. Admissions are often the result of recommendations from the School Medical Officers and this exemplifies the usefulness of a health service so closely integrated with education. In fact it is this unique feature of the School Health Service which has ensured its survival notwithstanding the great changes brought about by health legislation during the past 50 years. 58 Further, the removal of the Child Guidance Clinic into the Borough has made direct personal contact much easier between the Education and Heaith departments and the Clinic and facilitated the case conference approach which is so important to the welfare of the child. The Borough Education Officer has pointed out in a letter to the Headteachers of Primary Schools, in regard to retarded pupils, that the next few years offer a particularly favourable opportunity in Bexley to make a further advance and that, "The first essential is that the earliest possible diagnosis should be made so that the child can be assisted in whatever way may be most appropriate to overcome his difficulties before he becomes discouraged." In this process the School Health Service plays an important part both in carrying out the intelligence assessments of the children and in advising in regard to medico-social factors affecting their physical and emotional health. As in previous years considerable time has been devoted to the needs of other categories of "handicapped" children —the blind, the deaf, the epileptic, the physically handicapped, the maladjusted and children suffering from speech defects. The medical supervision of such children involves a close liaison with hospital consultants, almoners, general practitioners, teachers, Youth Officers and many others. The parents, also, have a decisive part to play and it is essential that they be brought into full partnership and kept fully informed, at all stages, of what is proposed for their children. Their acceptance of what is often a difficult decision may well depend on this. Audiometric examination of all children around the age of seven, with a view to detecting defects of hearing, is now a routine procedure in the School Health Service and has been facilitated by the introduction of the new transistor apparatus which is very easily portable and can be operated independently of an electricity supply. Immunisation against diphtheria, poliomyelitis and tuberculosis again took up a good deal of the time of doctors and Health Visitors. During the past ten years there has been a considerable increase in the number of schools in the Borough and, with the impending opening of the new Bexley/Erith Technical School, it is likely that the need will arise for an increase in medical staffing to meet the additional work entailed. In regard to the Dental Servicc, the staffing position of somewhat less than two whole-time Dental Surgeons was maintained. During the past few years there has been a notable increase in the dental inspection of schoolchildren, 59 namely, 9,498 in 1960 as compared with 5,581 in 1959 and 4,172 in 1958. There has, also, been a further decrease in the percentage of children found at these inspections to require treatment—75% in 1958, 64% in 1959 and 57% in 1960. These figures are, of course, still far too high but, at least, they suggest that we are not losing ground and that there is room, perhaps, for a guarded optimism. The development of schemes for the training of dental auxiliaries may, in the future, relieve the pressure on the dental staffing position. The questior of the fluoridation of water supplies still awaits the results of the pilot surveys which are being carried out in a few selected areas in the country and which are being carefully watched by governmental and other agencies. A further development in the School Dental Service has been the introduction of the new aii rotor high speed drill which not only makes dental treatment a much more comfortable experience for the patient but also, I am informed, enables more children to be treated per session. I have to report, with deep regret, the death of Mrs. Rant, the Speech Therapist, who had been responsible for this work in the Borough for many years. This matter is referred to in greater detail on page 66. I have, also, to report the impending retirement of Miss M. C. A. Smith, Senior Clerk in the School Health Department, on September 30th, 1961. Miss Smith has spent 40 years in the School Health Service—15 years in Bexley and the remaining 25 years in the Borough of Erith. Bearing in mind that the Service came into being in this country only 54 years ago, such a long period of unbroken service must be comparatively rare. I should like to take this opportunity of thanking Miss Smith for the great work which she has done during these many years of loyal and devoted service and to wish her a long and happy retirement. 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. 60 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY. Schools. Bexley Grammar School. Average number on Roll at 31st December, 1960 585 Bexley County Technical School for Girls. Average number on Roll 838 Eight County Secondary Schools. Average number on Roll 3,719 Twenty-four County Primary Schools. Average number on Roll 6,710 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. 61 Dental. Welling—Little Danson, Dansington Road. Daily—9.30-11 a.m., 2-4 p.m. Bexleyheath—315, Broadway. Wednesday, Thursday, Friday, 9.30-11 a.m. Wednesday, Thursday, Friday afternoons, 2-4 p.m. Crayford—Woodside Road. Monday and Tuesday, 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. Orthopædic. 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. Woodside Road, Crayford. Clinics held daily. Appointments made through County Medical Officer by the Borough Medical Officer of Health. 62 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 is discovered and where a great deal of information .s 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 74 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—1960. Average number of pupils in attendance:— Primary School 6,710 Secondary School 5,142 Average number of dinners served to children daily: — Paid Free Total Primary 2,740 53 2.793 Secondary 3,387 62 3,449 Milk. Average number of pupils taking milk daily:— Primary 5,523 Secondary 3,126 8,649 63 School Dental Service. In 1960, all the children allotted to the Danson Surgery were inspected and 70 per cent were found to require treatment. This shows a reduction of 10 per cent on last year. In September another two schools were transferred to Danson from the Broadway clinic and these had been inspected and treated before transference. In addition to the work done at Danson, all the schools allotted to Murchison Avenue clinic were inspected and some sessions were spent there on treatment. In September these schools were transferred to the Broadway and Murchison Avenue Clinic was closed. Orthopaedic Clinics. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report:— The Orthopaedic Clinics have continued on Wednesday mornings at the Welling Orthopaedic Clinic, but there has been considerable falling off this year in the number of attendances. Postural deformities of the back and feet still predominate over all others and still present us with a considerable problem. The fact that the onset of these conditions so often coincides with the eleven plus examinations and the entry into adolescence means that effective treatment cannot be instituted without sometimes seriously interfering with the education of the child. This should emphasize the importance of encouraging facilities for postural exercises in secondary schools where remedial treatment could be undertaken without interfering so much with education. I wish to thank Miss Cheeseman, the physiotherapist, for her continued help throughout the year. And to Mr. B. Lawson, F.R.C.S., for the following: — A total of 74 new cases were seen in the Murchison Avenue Orthopaedic Clinic, about one quarter of which were referred directly by the local General Practitioners. A few patients were transferred temporarily to hospital for further investigation and those requiring operations were operated on in the Dartford Group of Hospitals. Problems of errors of rotational development of the lower limbs are seen fairly frequently but the general health and nutrition of the children is good. 64 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 1960. Congenital. Ptosis 8 Nystagmus 10 Lens opacities 10 Colour Defectives: Unsafe 45 Safe 15 Acquired. 88 Constitutional Migraine 60 Retinitis Pigmentosa 1 Myopic Degeneration 2 63 Infective Blepharitis 45 Conjunctivitis 15 Choroiditis 1 61 Others. Dermato-Lipoma 1 Pseudoglioma Retinae 1 Eclipse Scotoma 1 3 Cases referred to hospital—26 Number of appointments kept 2,290 Prescriptions for Spectacles 774 New Cases 368 Child Guidance Clinic. Number of children referred during 1960. 1959 1960 Boys Girls Total Boys Girls Total Under 5 — — — — — — 5—7 10 1 11 5 3 8 8—10 15 1 16 7 5 12 11 and over 10 7 17 4 6 10 35 9 44 16 14 30 65 Speech Therapy. I am indebted to Miss Joan Pollitt, Senior Speech Therapist to the Kent Education Committee for the following report:— The Bexley Speech Therapy Clinic suffered a grave loss through the death of Mrs. Rant in October, 1960. Mrs. Rant had been one of the most enthusiastic members of the County's staff for fifteen years. She had been in charge of the Bexley Speech Therapy Clinic in the days when the clinic was held at Wrotham Road, Welling. She had continued to be in charge of the clinic when it moved to its present premises at Murchison Avenue. She had to have a short period of sick leave in June 1960. She returned to her duties but shortly afterwards had to go into hospital. During the remainder of the summer and early autumn she remained on sick leave, recuperating at home and in convalescent homes. Not until two weeks before her death did she return to hospital, and, only then, was the seriousness of her condition realised. Her death came as a great shock to her colleagues and patients and she has been greatly missed by all who knew her. Mrs. Grove has continued to work for two sessions each week at Murchison Avenue. It will be appreciated that as Mrs. Rant was not able to do any work at that clinic after July, the figures in this annual report are the smallest submitted since Mrs. Rant began working at Bexley for eight sessions per week. Fifty-eight children, who are under the care of the Bexley Education Authority, have been dealt with within the County's Speech Therapy Services during the year. The cases of nineteen of these children have been closed and thirty-nine will continue to attend into 1961. Of the nineteen closed cases, seventeen have attended at the Murchison Avenue Clinic and two have attended at Sidcup. The cases of the nineteen children have been closed for the following reasons:— Satisfactory results following appointments at the clinic 14 Treatment incomplete—considerable progress made—appointments then rejected 1 Treatment continued elsewhere:— At Child Guidance Clinic 1 At a hospital Speech Therapy Clinic (following Mrs. Rant's death) 1 At Special School for E.S.N. Children 1 Appointments offered but never kept 1 19 66 Thirty-five of the thirty-nine children, who will continue to attend into 1961, are on the Murchison Avenue "open" lists and four are being seen at the Sidcup Speech Therapy Clinic. Fifty-three Bexley children were awaiting appointments at the end of the year. By the end of 1960 there had been no applicants to fill the vacancy occasioned by Mrs. Rant's death. The post continues to be advertised and it is hoped that it will be possible to appoint a successor to Mrs. Rant in the near future. Sweep Frequency Pure Tone Audiometry. During 1960, 975 children were tested during their last year in the Infants' school, i.e., during their seventh year. Of this number, 875 passed and 100 failed. The latter children were referred to the School Medical Officers for investigation and any minor conditions causing temporary deafness were treated. In addition, 158 children of all age groups were tested as special cases referred from various sources including teachers, and of this number 90 passed and 68 failed. The 158 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 168 failed children were referred back to the School Medical Officers for further examination and treatment. Lastly, 199 children attended for a final audiometric test and this number included children seen in 1959 who had been referred by the School Medical Officers for a final test in 6 to 12 months time. Of these 199 children, 115 passed and 84 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 67 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 E. A. Osgathorp for the following report:— General. There is a noticeable tendency for children to be bigger and stronger than their counterparts of earlier generations. The figure for Kent seems to indicate that children are physically a year older than their predecessors of a decade ago. On the boys' side, this is often observed as the selection of younger and younger youths to play in national sides; on the girls' side, by an earlier onset of periodicity which very often begins nowadays at the primary stage. The average junior school is ill-equipped to deal with this problem but whatever is done for more ancient schools it is certain that new planning must take this factor into consideration when making hygiene arrangements. Primary Schools. The work of the Borough's Primary Schools continues to develop along three main avenues. Some schools make play and games the means by which fitness is achieved, others use traditional gymnastics, while others make use of creative free dance as the means to gain poise and the control of all the body's movements. It is good to find this varied approach. Schools should not confine themselves to the idea that only one road leads to the ideal but, whatever the method used, the final question, " Has the child benefited physically? Is he or she happier, more skilul and wants more of the same kind of lesson?" must be answered positively. The equipment in the Primary Schools is first class and is added to constructively each year. It is pleasing to observe the good use the Borough's teachers make of this material. Skill of a very high order is frequently observed among the primary children as a result of this happy combination of good teaching and good apparatus. The teaching of swimming is often hampered for lack of facilities within the Borough for young children. One noticeable exception is the school with its own teaching pool and it is commendable that from this school 96% of the children go forward to the secondary stage able to swim twenty-five yards or more. If an all round the year heated swimming pool was available in the Borough, these early swimmers could develop in the secondary stage into 68 formers of the highest quality. Though it is true that genius will out in sport today, champions are produced because the facilities exist and were provided by the wise fathers of previous generations. Secondary Schools. There is little change to report in the secondary schools, and until gymnasium or games halls are made available to counteract the vagaries of the English weather, the schools will not gain the value of continuous training because there is not enough covered space for many of the activities that are the foundations of good games playing. All the boys' schools are using weights as a means of intensive training and this is one activity which has not suffered from space shortage. There is no doubt that the strength produced makes many a gymnastic skill easier to acquire. The girls' work continues to suffer from lack of continuity of instruction. So many of the young women teachers marry early and leave the profession after one or two years to have families. In the case of many other subjects, several of the teachers on the staff are by training qualified to take over the work of say the English department, but few indeed are the women teachers able to take in like measure the work left by the departing P.E. specialist. This poses a problem which is almost insoluble unless a new approach is made to women's physical education generally. It should be desirable to train every women teacher at secondary level in some branch of this subject, so that come what may the girls are not left without instruction. Where the staffs of girls' schools are stable, excellent work is produced. It is pleasing to note that one of the Borough's Girls' Secondary Schools produced the All England Junior Girls' Badminton Champion. 1. Youth Work. During the year much interest has been aroused in the Duke of Edinburgh's Award and the Bexleyheath Boys' Brigade achieved fame by getting the first Gold Medal in Kent, and in addition the boy was honoured by being presented with it at the Palace. Two other Golds will follow, while in addition four Silver and seven Bronze medals have been gained. Other Youth organisations have begun their schemes and the future promises well in this direction. The Kent Youth Committee have made available for a small charge lightweight camping equipment for the purpose of making expeditions and many demands for the equipment have been made from units within the Borough. 69 The curriculum continues to expand and Judo, Archery, Fencing, Badminton and orienteering, now feature in youth programmes. Youth should be a time for trying every game and sport but it is hoped that something more than sampling is envisaged before adding yet another subject to an already full programme. 2. There have been many opportunities for teachers to gain more knowledge about many of the aspects of physical education, either inside the Borough of from K.E.C. courses run at various centres. These courses have been well supported and have proved beneficial to all concerned. 1. The Dance Circle, Bexleyheath and Hayes. 2. Games Evening, Pelham Road. 3. Kent Summer School, Movement, Olympic Gymnastics, Rebound Tumbling, Sailing. 4. L.T.A. Tennis Course, Chislehurst and Sidcup Grammar School for Boys. 5. C.C.P.R. Football Course, Dartford. 6. M.C.C. Cricket Course, Canterbury. 7. A.S.A. Swimming Demonstration. A. Kinnear, Darrick Wood. 8. Netball Course, Gravesend. Finally, the constant help of the Borough Education Officer and his staff is much appreciated by the advisers. Whenever they appeal on behalf of a school in need, they are treated most generously, and it is their hope that he and his staff find the children of the Borough the better for dealing with them thus. Swimming—1960. The closed-in Baths at Eltham, Plumstead and Woolwich, and the Open-Air Baths at Eltham Park South, Danson Park and Martens Grove were used during the Summer Term 1960. The attendances were:— Schools Attendances No. of children 5 Secondary 14 classes of 25-30 children 323 (approx.) each each week week 11 primary 18 classes of 30-35 children 608 (approx.) each each week week A total of 446 swimming certificates for distances between 25 yards and one mile, were issued during the year 1960. 3 Primary Schools continued winter swimming during the Spring Term 1960 and 5 Primary Schools during the Autumn Term 1960. 70 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. 71 PART I. Medical Inspection of Pupils Attending Maintained and Assisted Primary and Secondary Schools. 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) (l) (2) (3) (4) (5) (6) 1956 & later 66 66 100 — — 1955 535 534 99.8 1 .2 1954 607 603 99.3 4 .7 1953 132 132 100 — — 1952 409 409 100 — — 1951 481 480 99.8 1 2 1950 188 187 99.5 1 .5 1949 480 478 99.6 2 .4 1948 594 592 99.6 2 .4 1947 199 196 98.5 3 1.5 1946 74 73 98.7 1 1.3 1945 & earlier 1222 1217 99.6 5 .4 Total 4987 4967 99.5 20 .5 72 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) 1956 & later 3 1 3 1955 33 66 68 1954 41 91 101 1953 15 22 25 1952 44 46 70 1951 71 78 122 1950 21 36 51 1949 70 109 133 1948 82 110 160 1947 25 37 54 1946 13 31 33 1946 & earlier 182 230 332 Total 600 857 1152 C.—Other Inspections. Number of Special Inspections 1,521 Number of re-inspections 2,437 Total 3,958 D.—Infestation with Vermin. (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 6,924 (b) Total number of individual pupils found to be infested 25 (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) - 73 74 PART II.—Return of Defects Found by Medical Inspection in the Year Defect Code No. Defect or 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 10 19 80 80 90 92 180 191 42 6 5. Eyes— a. Vision 36 76 182 113 382 271 600 460 46 14 b. Squint 9 14 7 6 66 54 82 74 4 — c. Other 1 2 22 16 57 46 80 64 17 11 6. Ears— a. Hearing 13 48 7 28 44 189 64 265 52 52 b. Otitis media — 22 — 9 4 60 4 91 10 9 c. Other 1 10 7 7 15 24 23 41 5 10 7. Nose and Throat 11 150 20 56 65 445 96 651 51 64 8. Speech 6 24 2 2 18 62 26 88 15 12 9. Lymphatic Glands — 104 1 17 8 223 9 344 7 7 10. Heart 2 14 3 24 5 58 10 96 1 22 11. Lungs 2 51 3 51 15 177 20 279 23 50 12. Developmental— a. Hernia 2 7 — 3 8 10 10 20 2 1 b. Other 2 22 2 12 12 58 16 92 4 6 13. Orthopaedic— a. Posture — 11 12 44 39 98 51 153 3 4 b. Feet 2 44 21 63 38 258 61 365 17 3 c. Other 2 82 11 128 27 230 40 440 18 23 14. Nervous System- a. Epilepsy 1 J 4 3 2 6 7 10 3 4 b. Other — 4 — 10 — 16 — 30 5 8 15. Psychological— a. ment — 14 1 2 5 69 6 85 37 58 b. Stability — 47 4 42 12 284 16 373 97 62 16. Abdomen — 19 4 8 1 85 5 112 8 20 17. Other 3 4 19 60 29 81 51 145 80 96 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 275 Errors of refraction (including squint) 2,290 Total 2,565 Number of pupils for whom spectacles were prescribed 774 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 — (b) For adenoids and chronic tonsilitis 197 (c) for other nose and throat conditions — Received other forms of treatment 123 Total 320 Total number of pupils in schools who are known to have been provided with hearing aids (a) in 1960 3 (b) in previous years 25 C—Orthopaedic and Postural Defects. Number of cases known to have been treated (a) Pupils treated at clinics or out-patients departments 320 (b) Pupils treated at school for postural defects — Total 320 75 D.—Diseases of the Skin. Number of cases known to have been treated Ringworm— Scalp — Body Scabies — Impetigo — Other skin diseases 47 Total 47 E.—Other Treatment Given. Number of cases known to have been dealt with (a) Pupils with minor ailments 652 (b) Pupils who received valescent treatment under School Health Service arrangements — (c) Pupils who received B.C.G. vaccination 912 (d) Other than (a), (b) and (c) above — Total (a)—(d) 1,564 PART IV—Dental Inspection and Treatment (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic inspections 8,683 (b) Specials 815 Total (1) 9,498 (2) Number found to require treatment 5,751 (3) Number offered treatment 5,406 (4) Number actually treated 1,842 (5) Attendances made by pupils for treatment, including those recored at heading 11(h) below 8,138 (6) Half days devoted to: Inspection 56 Treatment 952 Total (6) 1,008 (7) Fillings: Permanent Teeth 3,100 Temporary Teeth 1,140 Total (7) 4,240 (8) Number of teeth filled: Permanent Teeth 2,721 Temporary Teeth 1,099 Total (8) 3,820 (9) Extractions: Permanent Teeth 311 Temporary Teeth 855 Total (9) 1,166 (10) Administration of general anaesthetics for extraction 467 (11) Orthodontics: (a) Cases commenced during the year 84 (b) Cases carried forward from previous year 126 (c) Cases completed during the year 50 (d) Cases discontinued during the year 40 (e) Pupils treated with appliances 126 (f) Removable appliances fitted 148 (g) Fixed appliances fitted — (h) Total attendances 1,910 (12) Number of pupils supplied with artificial dentures 21 (13) Other operations: Permanent Teeth 2,370 Temporary Teeth 214 Total (13) 2,584 77 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) Mal- adjusted (9) Epileptic Total. (1) 10 During the year ending 31-12-60 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Special Schools or Boarding Homes — — — 5 27 2 5 6 — 45 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes — — — 2 28 2 3 3 — 38 C. (i) were on the registers of: 1. Maintained special schools : (a) as day pupils — 6 — 7 — 8 17 — — 38 (b) as boarding pupils — — 1 1 13 6 6 1 — 28 2. Non-maintained special schools: (a) as day pupils — — — — — — — — — — (b) as boarding pupils 2 — 3 4 11 1 — 16 — 37 (ii) were on the registers of independent schools under arrangement made by the Authority — — 1 — 1 — — — — 2 (iii) were boarded in homes and not already included under (i) or (ii) (see Note (2)) — — — — — — — — — — Total (C) 2 6 5 12 25 15 23 17 — 105 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) — — — — — 2 — — — 2 (iii) At home — — — — — 1 — — — 1 E. Were requiring places in special schools:— (i) TOTAL (a) day — — — — — — 10 — — 10 (b) boarding 1 — — — 7 — 1 4 — 13 Pupils included in the totals above:— (ii) who had not reached the age of 5' (a) awaiting day places — — — — — — — — — — (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 — — — — — — — — — — ih) awaiting boarding plaops — — — — 1 — — — — 1 F. Were on the Registers of Hospital Special Schools — Number of children reported during the year: (a) Under Section 57(3) (prior to 1.11.60) 1 (b) „ „ „ — (c) ,. „ 57(5) — of the Education Act, 1944, 78 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—21 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 79 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 Bexley Erith and Crayford Mass Xray Campaign 48—53 SCHOOL HEALTH SERVICES REPORT, 1959. Welfare and School Attendance Sub-Committee 56 Staff 56—57 Foreword 58—60 Schools 61 Clinics 61—62 Co-ordination— Periodic Medical Inspections 63 School Meals and Milk 63 School Dental Service 64 Orthopaedic Clinic 64 Ophthalmic Clinic 65 Child Guidance Clinic 65 Speech Therapy 66—67 Sweep Frequency Pure Tone Audiometry 67 Cleanliness Inspections 67 Physical Education 68—70 Swimming 70 Statistical Tables 71—78