BEX26 Annual Report of the Medical Officer BOROUGH of bexley of Health and Report on the School Health Service For the Year 1961 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 1961 JOHN LANDON, m.r.cs., l.r.c.p., d.p.h., Medical Officer of Health Borough of Bexley. Mayor: Councillor N. j. h. Williams, T.D., j.p. Deputy Mayor: Councillor S. A. Cover. HEALTH COMMITTE Chairman : Alderman Mrs. H. F. Piggott. Vice-Chairman: Councillor S. H. Philpot. Alderman M. J. Corr. Councillor C. Jamie,on Harvey, Alderman Mrs. E. M. Sheppard. J.P. Councillor Mrs. J. T. Barker. Councillor E. C. C. Gillman. Councillor F. G. Donovan. Councillor W. P. Webster. 2 PUBLIC HEALTH STAFF 1961 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. *†D.T. Rees. *†K.E. Doubleday Administrative Assistant G.A.Pearson. Senior Clerk E.M. Pearmine(Miss). Clerks A. Frostick(Miss) .F. Terry (Miss) (Shortand Typist) Public Analyst H.E. Monk, BSc.,F.R.I.C, Refuse Foreman G.E. Packman Public Healt General Assitant A.C. Ward W.Early. (Appointed 1.11.61) . * certificate for Inspection of Meat and Other Foods. Certificate of Royal Sanitry 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 1961 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 89,670 (91,000 in 1960). The vital statistics supplied annually by the General Register Office indicate that the general trend of the health I of the Borough remained satisfactory. The standardised death rate was 11.7 per 1,000 of the home population (10.7 in 1960) compared with 12.0 per 1,000 for England and Wales. The standardised birth rate was 15.1 per 1,000 home population (14.8 in 1960) compared with a rate of 17.4 per 1,000 for the i country as a whole. The number of infants who died during the first year of life was 18 (17 in 1960) giving an infant mortality rate of 13.7 per 1,000 live births (12.9 in 1960) compared with 21.6 per 1,000 for England and Wales. For the fifth successive year there was no maternal deathl associated with childbirth. Considering that during the past five years there were 6,495 total births in the Borough it may be said that the antenatal and obstetrical services in the area, have worked to a high standard of efficiency. 4 The number of illegitimate births rose to 45 during the year compared with 34 during the previous year. It may well be felt that this is a matter for serious concern in that it lends support to the often-made allegation that sexual promiscuity among young people is on the increase. For the twelth year in succession there has been no case of diphtheria in the Borough. There is no evidence, however, from the fatality rate of cases occurring in other parts of the country that there has been any waning of the virulence of this disease and, despite the good record of the Borough, immunisation against this disease remains a matter of great importance. One case of poliomyelitis (the first for three years) occurred in the Borough during 1961. The availability of the Sabin oral vaccine and the full co-operation of the public in accepting vaccination for all priority groups could well ensure a high degree of freedom from this disease in the years to come. In May and June, 1961, an outbreak of Sonne dysentery occurred in an infants school in the Borough. An occurrence of this kind is always a troublesome matter but, with the whole-hearted co-operation of the teaching staff and the Public Health Laboratory Service the outbreak was brought under control. A brief account of the measures which were taken is given on page 45. During 1961 there were 46 deaths from cancer of the lung in the Borough (50 in 1960). It has become a duty to re-iterate the proven association between this disease and heavy cigarette smoking and, indeed, with atmospheric pollution in general. The recent report of the Royal College of Physicians on Smoking and Health has brought this matter to the forefront as one of the outstanding public health problems of the day and some beneficial results may already be discerned. One example of this is the agreement which has been reached between the Independent Television Authority and the tobacco industry to secure modifications that will include the avoidance of those aspects of advertising which make a special appeal to young people. The smoking 5 habit is so deeply ingrained as to appear almost ineradicable but, nevertheless, the issue must be kept alive by all who are responsible for the education and health of the younger generation. During the year 182 deaths were attributed to disease of the coronary arteries and angina pectoris, this being the largest number ever recorded in the Borough in any one year. This disease has increased in all western countries since World War I and, despite an enormous amount of research into the causes of this phenomenon, very little new information has emerged. It is likely, however, that a number of factors associated with our modern civilisation operate together to form a pattern of living which tends towards the production of this disease. Overeating generally and, particularly, a diet with a high animal fat content, sedentary habits with lack of regular exercise, oversmoking and hereditary factors have all been blamed, probably with good cause, but the exact mechanism that brings about the coronary accident remains hidden. Can there be much doubt, however, that coronary thrombosis is part of the price we pay for the high standard of living which we now enjoy ? The Home Safety Act, 1961 empowers the councils of county districts to promote home safety by giving information and advice on the prevention of accidents in the home but county councils have, for many years, had this power under Section 28 of the National Health Service Act, 1946. Since 1959, the Kent County Council have made a grant to the Bexley, Erith and Crayford Home Safety Committee through the councils concerned which has facilitated this work in recent years. The new Act will enable the three authorities to determine more fully the future development of this important aspect of health education and the decision to appoint a part-time Home Safety Organiser to work under the Medical Officer of Health will, it is hoped, result in a more sustained and effective campaign against accidents in the home than has been possible heretofore. A Speakers Training Day was held on May 5th, 1961 during a fortnight of intensive home safety propaganda. 6 The time is rapidly approaching when the implementation of the recommendations of the Royal Commission on Local Government in the Greater London Area will bring about a major change in the local administration of the health and welfare services. Much thought and energy will be required to meet both the challenge and the opportunity which lie ahead. 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 246 Estimate midyear, 89,670. Relative figures for previous years. Population—Mid-Y ear. New Houses Erected. 1951 (Census) 88,420 1951 319 1952 88.160 1952 355 1953 87,990 1953 65 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 1960 91,000 1960 367 Number of inhabited houses at the end of 1961 (according to Rate Books) approximately 28,857 Rateable Value £1,346,240 Sum represented by a penny rate £5,508 Unemployment. Men Women Boys Girls Total December 31st, 1960 178 43 19 10 250 December 31st, 1961 161 60 5 14 240 Social Conditions and Amenities. The Borough of Bexley continues to be a healthy ; residential district and is specially favoured in that it has ample open spaces and recreational facilities for its inhabitants. Like other districts, however, whose population has increased considerably, housing shortages, at present, constitute the main barrier to the health of a relatively large number of its citizens. The housing programme has been accelerated as much as possible and it can only be hoped that the housing position of the Borough will gradually reach the optimum standards for which the Council are striving. 8 The following public open spaces have been provided by the Corporation:— Bexley Woods, Parkhill Road, Bexley ... 27.00 acres Bigs Hill Wood, Watling Street, Bexleyheath 8.68 Brampton Park Recreation Ground, Avenue Road, Bexleyheath 4.21 „ Bursted Wood, Erith Road, Bexleyheath 30.10 Danson Park, Bexleyheath 185.9 „ Danson Mead, Welling 1.1042 „ Derwent Crescent, Bexleyheath .20 East Wickham Land, Glenmore Road/ Wickham Street, Welling 6.80 Eastcote Gardens, Eastcote Road, Welling 1.00 Hall Place, Bourne Road, Bexley 159.67 Hudson Road Playing Ground, Long Lane, Bexleyheath .953 „ Hurst Recreation Ground, Shirley Avenue, Bexley 3.50 King George's Field, Broadway, Bexleyheath 1.235 „ Lodge Hill, Welling 1.43 „ Oxleas Close, Welling .13 Palmar Gardens, Bexleyheath 1.30 Parkhurst Gardens, Bexley .70 „ Riverside Walk, Bexley 10.50 Russell Park, Woolwich Road, Bexleyheath 12.787 ,. Rutland Shaw, Bexley 4.85 St. Mary's Recreation Ground, Bexley ... 9.925 „ Sheldon Sports Ground, Bexleyheath ... 4.3883 „ Sports Ground, Park View Road, Welling 7.03 Steeple Avenue Memorial Garden, Bexleyheath 1.50 Stevens Park, Wrotham Road, Welling ... 9.36 The Green, Bexleyheath 1.44 The Green, Welling 1.64 The Warren, Broomfield Road, Bexleyheath 12.47 „ Westwood Estate Children's Playground, .60 Welling Total 510.4025 ,. Facilities for outdoor games are provided in many of these open spaces, including the large Swimming Pool in Danson Park, opened in July, 1936. 9 summary of vital statistics England and Wales. Borough of Bexley. Kates per 1,000 Home Population. Births— Live 17.4 14.7 Still J 0.34 0.2 119.1(a) 14.9(a) Deaths All Causes 12.0 9.6 Typhoid and Paratyphoid 0.00 — Whooping Cough 0.00 — I Diphtheria 0.00 — Tuberculosis 0.07 0.04 Influenza 0.15 0.09 Smallpox — — Acute Poliomyelitis (im hiding Polioencephalitis; 0.00 _ Pneumonia 0.65 0.47 Notifications (corrected) Typhoid Fever 0.00 — Paratyphoid Fever 0.01 Meningococcal Infection 0.01 Scarlet Fever 0.43 0.41 Whooping Cough 0.53 0.41 Diphtheria 0.00 Erysipelas 0.05 0.06 Smallpox 0.00 Measles 16.54 16.21 Pneumonia 0.40 0.13 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.02 0.01 Non-Paralytio 0.00 Food Poisoning 0.17 0.06 Puerperal Pyrexia 10.17(a) 12.76(a) Rates per 1,000 Live Births. Dtaths All causes under one year of age 21.6 13.7 Enteritis and Diarrhoea under two years of age 0.6 0.76 (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 Maternal causes, excluding abortion Rates per 1,000 total live and still births 0.27 Nil Due to abortion 0.07 Nil Total maternal mortality 0.33 Nil EXTRACTS FROM VITAL STATISTICS FOR THE Year 1961 The Registrar General's Estimate of home population for the mid-year is 89,670 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 672 642 1,314 Legitimate 649 620 1,269 Illegitimate 23 22 45 Birth Rate. Rate per 1,000 estimated home population 14.7 The following relates to the Birth Rate during the past ten years: — 1951 Birth Rate 12.79 per thousand 1952 „ „ 12.00 „ 1953 „ „ 12.70 „ 1954 „ „ 11.80 „ 1955 „ „ 12.60 „ 1956 „ „ 13.2 „ 1957 „ „ 13.6 „ 1958 „ „ 13.6 1959 „ „ 14.4 „ 1960 „ „ 14.5 „ Rate per 1,000 for England and Wales 17.4 12 The Registrar-General has supplied a comparability factor for 1961. The standardised birth rate which allows for comparison with other parts of the country is 15.1. 45 illegitimate live births were registered against 34 in 1960 giving a percentage of 3.4 of total live births. Stillbirths. Males Females Total Total 9 9 18 Rate per 1,000 total (live and still) births 14.9 18 Stillbirths were registered during the year. This represents a rate of 0.2 per 1,000 population against 0.22 per 1,000 population in 1960. The following relates to the Stillbirth Rate during the past ten years: — Rate per Thousand Total Live and Year Still Births Population 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 0.38 1957 19.2 0.37 1958 19.9 0.28 1959 15.2 0.22 1960 14.9 0.22 Rate per 1,000 for England and Wales 1961 0.33 There were two Stillbirths registered as illegitimate. Males Females Total Total Live and Stillbirths ... 681 651 1332 13 Infant Deaths. Males Females Total Deaths of Infants under one year of age 8 10 18 Legitimate 8 9 17 Illegitimate — 1 1 Death rate of Infants under one year of age: Total per 1,000 live births 13.7 Legitimate per 1,000 legitimate live births 13.4 Illegitimate per 1,000 illegitimate live births 22.2 Neo-natal Deaths per 1,000 live births 8.3 Early Neo-natal Deaths 6.8 Perinatal Deaths 20.3 The following relates to the Infant Mortality Rate during the past ten years:— 1951 24.76 per 1,000 live births. 1952 11.34 1953 14.36 1954 22.1 1955 17.0 1956 24.6 1957 22.9 1958 13.0 1959 13.1 1960 12.9 14 15 INFANT MORTALITY, 1961 DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1961 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- <J- 10- 11- 12 Congenital Malformation 1 1 1 Premature Birth 4 1 1 Gastro-Enteritis 1 Broncho Pneumonia 1 1 1 Bilaterial Suprarenal Hemorrhages Septicaemia 1 Intracranial Hemorrhage Birth Injury 1 Toxoplasmosis 1 Primary Pneumococcal Peritonitis 1 Totals 7 1 — 1 — — — 1 1 — — 1 — 1 — 2 1 — — — 1 — The number of infants under one year of age who died during the year 1961 as shown by the table is 17. 11 of these deaths, that is 65 per cent, occurred in the neonatal period (within one month of birth). In 1960 the corresponding figure was 50 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:— 1951 Nil per 1,000 live and stillbirths 1952 0.93 „ „ „ „ 1953 2.63 „ „ „ „ 1954 Nil 1955 0.88 1956 Nil 1957 Nil 1958 Nil 1959 Nil 1960 Nil Deaths All Causes. Males Females Total All causes 472 390 862 Death rate per 1,000 of estimated home population Deaths from Measles (all ages) — — — Whooping Cough (all ages) — — — „ „ Diarrhoea (under 2 years of age 1 — 1 „ „ Cancer (all ages) III 69 180 Death rate per 1,000 for England and Wales, 1961. 12.0 16 Death Rate of Area during last ten years: — 1951 9.6 per thousand 1952 9.14 „ 1953 8.8 1954 8.1 „ 1955 9.1 „ 1956 9.4 „ 1957 9.2 1958 9.48 „ 1959 8.76 „ „ 1960 8.7 „ The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1961. The standardised death rate which allows for comparison with other parts of the country is 11.7. CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1961 C To'3 Causes of Death. M. g62 All Causes 472 39 3 1 Tuberculosis, respiratory ... 3 . 2 Tuberculosis, other ... ... — I ' 3 Syphilitic disease 4 Diphtheria 5 Whooping Cough — 6 Meningococcal infections 7 Acute poliomyelitis — " 8 Measles — 9 Other infective and parasitic ^ diseases — 9 10 Malignant neoplasm, stomach ... 13 11 Malignant neoplasm, lung, ( \ bronchus 40 ^ P 12 Malignant neoplasm, breast ... —■ ^ " 13 Malignant neoplasm, uterus ... — . 14 Other malignant and lymphatic ~c neoplasms 58 ^ - 15 Leukaemia, aleukaemia ... 2 ^ 16 Diabetes ... ... 3 17 Vascular lesions of nervous ro system 39 58 , 2 18 Coronary disease, angina ... 121 ^ •> 19 Hypertension with heart disease 13 o tn 20 Other heart disease 41 -q 21 Other circulatory disease ... 20 ^ 22 Influenza 3 ' 23 Pneumonia 1' j4 24 Bronchitis 46 ^ 25 Other diseases of the respiratory 4 0 system n 6 2 26 Ulcer of stomach and duodenum ' 4 27 Gastritis, enteritis and diarrhoea - 5 28 Nephritis and nephrosis ... ^ ^ ^ 29 Hyperplasia of prostate ... — 4 30 Pregnancy, childbirth, abortion 3 31 Congenital malformations ... 57 32 Other defined and ill-defined ., 41 ]o diseases !? 7 9 33 Motor vehicle accidents . 3 7 34 All other accidents . 3 ^ 35 Suicide 36 Homicide and operations of war 18 19 DEATHS REGISTERED (IN AGE GROUPS) IN 1961 Under 1 year 1-4 years 5-14 years 15-24 years 25-44 years 45-64 years 65-74 years 75 years and over Total M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 5 ... 2. Tuberculosis, other ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 3. Syphilitic disease ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 4. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Meningococcal infections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7. Acute poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Other infective and parasitic diseases ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... 3 10. Malignant neoplasm, stomach ... ... ... ... ... ... ... ... ... ... 7 4 5 2 l 3 13 9 11. Malignant neoplasm, lung, bronchus ... ... ... ... ... ... ... ... ... ... 27 4 9 ... 4 2 40 6 12. Malignant neoplasm, breast ... ... ... ... ... ... ... ... ... 1 ... 7 ... 3 ... 2 ... 13 13. Malienant neoplasm, uterus ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 3 ... ... 14. Other malignant and lymphatic neoplasms ... ... 1 ... ... ... ... ... 6 3 17 11 15 7 19 14 58 35 15. Leukaemia, aleukaemia ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 1 1 2 3 16. Diabetes ... ... ... ... ... ... ... ... ... ... ... 1 2 1 1 2 3 4 17. Vascular lesions of nervous system ... ... ... ... ... ... ... ... 1 2 12 7 11 12 13 37 39 58 18. Coronary disease, angina ... ... ... ... ... ... ... ... 5 ... 49 9 35 15 32 3/ 151 61 19. Hypertension with heart disease ... ... ... ... ... ... ... ... ... ... 1 ... 5 6 7 11 13 17 20. Other heart disease 1 ... ... ... ... 1 ... ... ... 1 10 9 6 4 24 37 41 52 21. Other circulatory disease ... ... ... ... ... ... ... ... 2 ... 11 1 2 2 5 7 20 10 22. Influenza ... ... ... ... ... ... ... ... ... ... ... ... 2 2 1 3 3 5 23. Pneumonia ... 1 ... ... ... ... ... ... ... 1 6 2 2 5 9 16 17 25 24. Bronchitis ... ... ... ... ... ... ... ... ... ... 12 2 10 3 24 9 46 15 25. Other diseases of the respiratory system ... ... ... ... ... ... ... ... ... ... 4 1 ... ... 1 3 5 4 26. Ulcer of stomacli and duodenum ... ... ... ... ... ... ... ... ... ... 3 2 1 ... 3 4 7 6 27. Gastritis, enteritis and diairhoea 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 ... 28. Nephritis and nephrosis ... ... ... ... ... ... ... ... 2 ... 1 ... 1 ... ... 4 ... 29. Hyperplasia of prostate ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 3 ... 5 ... 30. Pregnancy, childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital malformations 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 3 32. Other defined and ill defined diseases 5 7 ... ... ... 1 ... ... ... 3 4 3 1 9 6 18 16 41 33. Motor vehicle accidents ... ... ... ... ... 1 1 1 ... 1 1 2 1 1 ... 1 3 7 34. All other accidents ... ... ... ... 1 ... 1 2 1 ... 2 ... ... ... 1 1 6 3 35. Suicide ... ... ... ... ... ... 1 ... 2 ... 1 3 ... ... ... ... 4 3 36. Homicide and operations of war ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 8 10 1 2 1 3 4 4 19 12 170 71 111 77 158 211 472 390 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH Isolation Hospital Accommodation. Patients suffering from infectious disease are amitted to hospitals controlled by the Woolwich and Dartford Hospital Management Committees (S.E. Metropolitan Regional Hospital Board). General Hospitals. Provision made by S.E. Metropolitan Regional Hospital Board. AMBULANCE FACILITIES. The provision of these facilities now rests with the Kent County Council as Local Health Authority. NATIONAL ASSISTANCE ACT, 1948. Action taken under Section 47. During the year a number of cases of elderly persons not receiving proper care and attention (reported to the department) were visited. It was not necessary for acton 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 Cornoer to direct bodies in April, 1960 to the West Hill Hospital and this arrangement continued until July 1st, 1961 when the Bexley Mortuary returned to normal operaton. During the period 1st July to 31st December, 1961,94 bodies were admitted and 94 post-mortem examinatiions were made; 9 inquests were held. 20 DISINFECTION AND DISINFESTATION SERVICE The joint scheme with the Erith and Crayford Councils for the disinfection of bedding following cases of Infectious Diseases, T.B. and Cancer, and for the disinfestation of bedding of verminous persons was discontinued during the year on account of the need to replace the vertical boiler at Bexley, and the fact that the Bexley Council had plans for the demolition of the Cleansing Station. The joint application by Bexley, Erith and Crayford Councils was successfully made to the Woolwich Borough Council for the use of their facilities until further notice. 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 3 No. of patients provided for:— Maternity — Others 52 Total 52 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 2 No. of patients provided for:— Maternity Others 28 Total 28 21 SECTION C. SANITARY CIRCUMSTANCES OF THE BOROUGH List of Adoptive Acts, etc., in force. Acts. Date Adopted Public Health Acts (Amendment) Act, 1890 Parts 1, 2, 3 and 5 Apr. 1891 Infectious Diseases (Prevention) Act, 1890 Apr. 1891 Public Libraries Act, 1892-1919 Oct. 1899 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. l926 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 Now. 1959 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 Jun. 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 Now. 1951 Public Libraries Jan. 1953 Building Apr. and 1954 1961 Parking Places for Vehicles May. 1960 Fouling by Dogs of Footways Oct. 1960 Unruly Behaviour in Places of Entertainment July. 1961 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 both quality and quantity during the year. Bacteriological analyses are made at least five times a week from all supplies and in the case of the wells the water is sampled before and after chlorination. The water derived from the River Thames is sampled at each stage of the purification process and all the 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. No new source of public water supply was instituted in the Borough of Bexley during 1961. There were no important extensions of trunk mains and no change in the general scheme of supply to the area. New service mains laid extended to 1,332 yards. During the year 9 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 a start was made on the surface water drainage of Lion, Freta, Izane and Heathfield Roads and up to the end of 1961 the work was completed in Lion Road from Upton Road to Izane Road. An enlargement of the sewer in Bellegrove Road, also to places westwards of the railway bridge was made. In conjunction with the development of the hutment site on the east side of Upper Wickham Lane, surface water sewers were laid in the highways. Number of cesspools emptied, 9. The total number of emptyings, 35. Number of cesspools abolished, 1. 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, Brampt 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 1961. 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) 50 238 Houses inspected (defects only recorded) 50 295 Houses inspected (certificates of disrepair) 22 23 Houses inspected (improvement grants) 71 5 Houses inspected (Housing Act, 1936, Over- crowding) 11 15 Houses inspected re Infectious Disease (including scabies) 715 249 Factories with mechanical power 96 14 Factories without mechanical power 8 2 Otworkers' Premises 26 9 Other premises under the Act - - Wakehouses 33 13 Water Samples 22 1 Food and Drugs Act Samples 250 14 Dairies and distributors 14 4 Ice Cream Premises 98 8 Restaurants, etc. 129 48 Fish premises 83 11 Meat Shops 236 78 Punlic Houses 59 30 Shops re unsound food 306 49 Other Premises where food is prepared 597 190 Offensive accumulations 87 103 Stables 10 2 Keeping of Animals 17 12 Rats 124 56 Drains inspected 644 530 Drains tested (water, smoke or colour) 79 10 Dustbins 18 1 Verminous premises 69 40 Smoke observations 64 16 Tents, Veins and Sheds 47 58 Refuse Tips 138 - Refuse Removal and Salvage 1,138 2 Conveniences 193 4 Pet animals Act' 1951 11 - Council House applicants 181 34 Shops Act, 1950 557 26 National Assistance Act, 1948 -Sec. 47 8 10 Miscellaneous inspections 879 109 Clean Air Act, 1956 145 96 25 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 13 Provided with sufficient ashplace accomdation 7 Provided with sufficient water supply 4 Houses Improved Internally— Walls and ceilings repaired 70 Dampness in rooms remedied 48 Defective floors repaired 10 Ventilation of Rooms improved 45 Windows repaired 53 Stoves, fireplaces, etc. provided or repaired 3 Houses Improved Externally— Roofs repaired 17 Eaves gutters and down spouts fixed or repaired 26 Yards paved or repaired 1 Chimney stacks repaired 3 Walls repointed or repaired 30 Miscellaneous repairs — Drainage— Drains cleansed or repaired 701 New drains constructed — New gullies provided 2 Ventilation of drainage system improved 1 Inspection chambers built or repaired 7 Waste pipes provided or repaired 7 New sinks provided 1 Offensive accumulations removed 4 Nuisances from animals abated 1 Other nuisances abated 1 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 23 Houses visited including revisits 800 Rooms disinfected 3 Notices delivered to Education Authorities, etc. 90 26 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered and destroyed: Corned Beef lbs. 789¾ Tinned Ham „ 566¾ Cooked Ham „ 30½ Beef „ 1,136 Pork „ 91½ Lamb „ 612 Chicken „ 760 Offal „ 1,276 Bacon „ 52½ Rabbit „ 141½ Fish „ 253 Ground Nuts „ 8½ Butter „ 28 Cooking Fats „ 40½ Fruit and Fruit Juices tins 2,287 Vegetables „ 1,311 Meat „ 1,507 Fish „ 444 Milk „ 936 Meat Pies „ 12 Preserves jars 183 Pastes „ 137 Cheese pkts 10 Frozen Foods „ 3,979 Confectionery „ 1,092 Miscellaneous items „ 27 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. N umber of : Inspections. Written Notices. Prosecutions 1 2 3 4 Factories without mechanical power 45 — — Factories with mechanical power 156 4 — *Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) — — — *Electrical Stations should be reckoned as factories. Total 201 4 — 2. Defects Found. Particulars. Number ot Defects. Number of Prosecution Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 6 Want of cleanliness (S.l) 4 4 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7)— Insufficient — — — — Unsuitable or defective 5 5 — — Not separate for sexes — — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 3 3 — — Total 12 12 — — 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. In the early part of the year difficulty was experienced in maintaining a weekly collection, and considerable overtime had to be worked to keep up to schedule. The introduction of an incentive bonus scheme on September 1st changed the picture completely and it was possible from this date to maintain a weekly collection with the minimum amount of overtime. The improvement in the collection of refuse was reflected in the falling off of the number of complaints received at the office from September to the end of the year. The labour position also became more stabilised and it was found possible to recruit a better type of labour than previously. It is pleasant to be able to record that the workmen contributed admirably to the effective working of the new bonus scheme. There has been a marked increase in the amount of special refuse collected, e.g. old furniture, pianos, etc., and it would seem that the Refuse Department is regarded by many as a haulage contractor. People are finding it impossible to dispose of abnormal house discards except through the refuse service. The Council operate a Salvage Scheme, and waste paper, textiles, scrap metals, etc., are collected by means of trailers attached to the refuse vehicles. All refuse was disposed of by controlled tipping at Stone. Disposal of the refuse and covering of the tip has been more effectively carried out by the purchase of a second Bristol Duplex tractor. Now that the Department has the two tractors and the Muirhill Dumper, one tractor is used on the tip head, the other vehicles being used for digging and carrying of covering materials. 29 Salvage. Details of salvage sales for the financial year emded 31st March, 1962 are set out below. Tons. cwts. qrs. £ s. d. Waste Paper 365 12 — 2,807 19 4 Textiles 9 14 — 102 0 11 Ferrous Metals 2 8 — 17 7 6 Non-Ferrous Metals 1 — 2 17 8 Miscellaneous 16 — 4 8 2 378 11 £2,934 13 7 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 Committee for the Abatement of Atmospheric Pollution. By arrangement with this Committee a deposit gauge is installed on the roof of the education Office in Brampton Road, Baxelyheath, and the following table gives the results obtained during 1961. MONTH TONS PER SQUARE MILE. Rainfall I inches Total water insoluble matter Soluble in C.S.2. Ash Other combustible matter Total water soluble matter Calcium Chlorine Sulphates Total solids January 2.17 5.22 0.13 3.83 1.26 4.50 0.63 1.01 1.4 9 9.72 February 1.95 5.98 0.13 4.15 1.70 6.98 1.14 0.84 3 41 12.96 March 0.49 6.94 0.11 5.28 1.55 4.14 1.00 0.50 2.31 11.08 April 1.28 7.80 0.10 6.09 1.62 8.66 2.08 0.64 3.32 16.46 May 1.66 5.84 0.10 4.37 1.37 3.22 0.61 0.47 1.55 9.06 June 1.31 6.25 0.12 4.54 1.59 5.20 0.76 0.47 1.78 11.45 July 1.02 4.06 0.09 2.98 0.99 2.58 0.36 0.34 1.51 6.64 August 2.03 4.10 0.09 2.88 1.13 3.59 0.36 0.54 1.47 7.69 September 2.01 5.94 0.07 4.46 1.41 14.73 2.99 0.84 6.10 20.67 October - - - - - - - - - - November 2.27 5.21 0.13 4.24 0.84 11.28 1.82 1.41 5.03 16.49 December 2.61 7.30 0.12 5.44 1.73 13.69 2 54 1.88 5.20 20.99 A Lead Peroxide instrument for estimating atmospheric Sulphur-dioxice is situate near the deposit gauge and the results for the year are set out below.— MONTH Area Exposed Weight of Ba SO4 Wt. of SO3 Collected Mg. of SO3/day Collected by 100 sq cm. of Batch A Pb 02 (Louvered Cover) In Sample In Control Due to Exposure Sq. Cm. Mg. Mg. Mg. Mg /100 sq. Cm./day January 100 187.8 2.0 185.8 2.12 1.91 February 95 171.8 2.0 169.8 2.11 1.97 March 100 247.0 1.1 245.9 2.48 2.23 April 100 131.6 1.0 130.6 1.66 1.49 May 100 133.8 2.9 130.9 1.45 1.31 June 95 100.8 1.3 99.5 1.12 1.01 July 95 77.2 1.1 76.1 0.95 0.86 August 95 76.6 1.6 75.0 0.87 0.78 Sptember 100 103.4 1.6 101.8 1.13 1.02 October 95 135.2 2.2 133.0 1.60 1.44 November 100 208.8 1.3 207.5 2.37 2.13 December 95 195.4 2.2 193.2 2.25 2.03 31 A volumetric apparatus for the measurement 0f sulphur dioxide and smoke is installed at the Health Department, Brampton Road, and a summary of the results obtained is set out below. Concentration of Smoke and Sulphur Dioxide. Smoke Cone, mg/100 m3 Sulphur Dioxide Conc. p.p 100m. Average Value Highest Value Lowest Value Average Value Highest Value , Lowest Value January 12 67 2 5.1 21.8 1.5 February 9 23 2 4.1 12.5 0.8 March 13 32 3 7.0 17.7 1.5 April 5 10 Nil 4.6 17.5 0.4 May 32 100 10 89.2 237.4 11.4 June 28 60 10 73 186 26 July 23 50 10 62 137 11 August 18 40 Nil 46 94 11 September 26 110 10 92 309 11 October 61 270 Nil 91 340 20 November 152 467 26 180 446 23 December 184 446 33 220 641 20 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 coprises 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 deatiled survey has now been completed and work is going ahead on the preparation of the schedules prior to the order being made for confirmation by the Minister. . 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 Department No charge is made for treatment carried out at private dwelling houses, but the occupiers of business premises are charged for disinfestation work. 32 Details of surface infestations dealt with during the year are set out below. Number of Properties Inspected 402 Number of Inspections 2,292 Number of Infestations found: Rats—Major Minor 255 Mice 65 Number of Properties Treated Rats Mice Local Authority's premises 3 1 Dwelling Houses 238 49 Business Premises 14 15 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, 583 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. There are, in addition, two small swimming pools at two schools in the Borough. The purity of the water was well maintained during the yea. Samples of water are taken by this department monthy during the time the pools are open and the results of bacteriological examinations have been satisfactory on all occasions. Verminous Premises During the year only 3 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, Flies 2, Ants 5, Beetles 3, Fleas 2, spiders 1, Moths 1. Wasps The destruction of wasps nests is undertaken by the Department and during the year 57 nests were destroyed. A charge of 7s. 6d. was made for this service. Schools. There are 32 County Secondary and County Primary Schools, 2 Day Technical Schools 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 at 1st April, 1962:— Welling— Houses Plats Welling Estate 424 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 1 287 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 13 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 Glenhurst Avenue 27 Hurst Place Estate 232 S.D.A Houses 7 Houses Purchased 7 2860 318 35 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses spected for housing defects (under Public Health or Housing Acts) 100 (b) Number of inspections made for the purpose (including re-inspection) 633 (2) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 50 (3) Number of dwelling houses (exclusive of those referred to under the preceding head) found not to be in all respcects reasonably fit for human habitation 50 2. Remedy of Defects during the year without service of Formal Notice. Number of defective dwelling houses rendered fit in consequence of informal action 67 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: 4 (a) By owners 4 (b) By local authority in default of owners - B. Proceedings under Public Health Acts— Number of dwelling houses in Which defects were remedied after service of formal notices— (a) By owners - (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 (2) Number of dwelling houses demlished in pursuance of Demolition Orders 21 (3) Number of houses in respect of which Closing Orders were made 6 D. Proceedings under Section 18 of the Housing Act, 1957— parts of buildings closed - 36 Slum Clearance. During 1961 15 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 19 25 Number of applications approved 14 33 Total cost of approved expense of improvements £6,019 17 0 £3,732 6 9 Total amount of grants made £3,827 18 9 £1,717 14 9 Rent Act, 1957. Number of applications for certificates of disrepair 5 Number of decisions not to issue certificates Number of decisions to issue certificates 5 (a) in respect of some but not all defects 2 (b) in respect of all defects 3 Number of undertakings given by landlords 4 Number of undertakings refused by the Local Authority — Number of Certificates issued — Applications by landlords for cancellation of certificates 1 Objections by tenants to cancellation of certificates 1 Decisions by Local Authority to cancel in spite of tenants' objection — Certificates cancelled — 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 4 No. of Distributors with Shop Premises 27 No. of Distributors from outside area 7 Licences granted by the Council under the Milk (Special Designation) Regulations, 1960:— Dealers' Licences:— Pasteurised Milk 29 Tuberculin Tested Milk 32 Sterilised Milk 35 20 Samples of milk were forwarded to the Public Health! Laboratory for the Methylene Blue and Phosphatase Tests, and all but two 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 195 samples taken during the year. Formal Informal Milk — 9 Meat Pies and Puddings — 2 Sausages — 4 Biscuits — 1 Cream of Tartar, Arrowroot — 3 Condiments, Sauces, Pickles, Spices, etc. 2 37 Butter and Fats, Cooking Oil, etc. — 10 Soups, Meat Extracts — 9 Minerals and Cordials, etc. — 9 Bread — 3 Glace Cherries — 1 Sweets and Confectionery — 5 Pure Coffee, Coffee Extracts, Coffee and Chicory 5 Pudding or Cake Mixture, Flour, etc. — 3 Preserves 2 8 Cream — 4 Pastes, Spreads, Potted Meat and Fish — 19 Angelica — 1 Cocoa — 1 Flavouring and Essences — 4 Hamburgers — 1 Instant and Mashed Potatoes 1 2 Fruit Juice — 6 Fish and Fish Cakes — 4 Condensed and Evaporated Milks — 6 Cakes — 4 Desiccated Coconut 1 2 Jellies, Custard Powders, etc — 11 Processed Cheese — 1 Processed Peas — I Tea — 2 Strained Foods — 1 Fruit — 2 Rice Puddings, etc — 8 6 189 39 Legal Proceedings. 1. Mouldy Beef Sausages—fined £5 plus £3 9s. 0d. costs and witness expenses. 2. Foreign matter in Bread—fined £25 plus £3 3s. 0d. Advocate's fee. 3. Mouldy Pork Pies—fined £15 plus £3 3s. 0d. Advocate's fee. 4. Mouldy Steak and Kidney Pies—fined £10 plus £3 3s. 0d. Advocate's fee. 5. Mouldy Fruit Cake—fined £10 plus £3 3s. 0d. Advocate's fee. 6. Mice droppings in Ground Nuts—fined £5 0s. 0d. plus £1 1s. 0d. Advocate's fee. 7. Mouldy Chicken Vol-au-vent Pastries—Conditional discharge on payment of Advocate's fee of £7 7s. 0d. 8. Beef Sausages—Case dismissed. 9. Foreign matter in Dripping—fined £10 plus £3 3s. 0d. costs. 10. Mice droppings in Demerara Sugar—fined £15 plus £3 3s. 0d. costs. 11. Foreign matter in Bread—fined £20 plus £4 4s. 0d. Advocate's fee, plus 5s. 0d. witness expenses. 12. Foreign matter in Bread—fined £20 plus £4 4s. 0d. Advocate's fee. 13. Dirty Milk Bottle—fined £10 plus £5 5s. 0d. Advocate's fee. (d) Food Shops and Food Manufacturing Premises. The classification of the various food shops and food manufacturing premises in the Borough is as follows: — Butchers 48 Cafes and Restaurants 28 Greengrocers 47 Sweet Shops 66 General Provisions 79 Bakers and Confectioners 25 Wet and Fried Fish Shops 23 Public Houses 41 357 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, 1960. Hot water supply provided or improved 6 Floors, walls, ceilings, etc., repaired 16 Infestations dealt with 2 Rooms cleansed 28 Water Closet accommodation improved 9 Accumulation of refuse removed 3 Accommodation for storage of refuse improved 1 Washing accommodation improved 5 Drainage repaired or improved 2 Food storage accommodation improved 7 Yard cleansed or repaired — Sinks renewed 5 Other contraventions 2 Unsatisfactory equipment cleansed or renewed 3 Legal Proceedings. Failure to keep a food room in such order and condition as to prevent so far as is reasonably practicable risk of infestation by mice. Fined £20 plus £3 3s. Od. Advocate's fee. 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 175 Preparation of Sausages, etc 53 35 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. 3 samples failed the prescribed test. 41 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES Scarlet Fever. During the year 37 cases were notified as compared with 58 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 Nil During the past 15 years the character of this disease has changed from one of considerable severity to one of extreme mildness. The acute stage is, nowadays, in most cases, short and unaccompanied by high pyrexia and complications are in most cases mild or completely absent. Scarlet fever can now be disregarded as an important cause of acute endocarditis and acute nephritis which, in the past, were frequently encountered. Diphtheria. No cases were notified during the year. The following figures on Diphtheria and Whooping Cough Immunisation and Smallpox and Poliomyelitis Vaccination have been supplied by the County Medical Officer:— 42 IMMUNISATION following table shows the diphtheria immunisation the whooping cough immunisation figures for 1961 based on the returns submitted to the Ministry of Health. Year of Birth Diphtheria Immunisation (Singly or in combination) Whooping Cough Immunisation (Singly or in combination) Primary Reinforcing Primary 1961 613 — 613 1960 662 10 658 1959 91 188 69 1958 40 196 28 1957 26 108 18 1952-1956 103 889 59 1947-1951 22 107 4 Total 1557 1498 1449 POLIOMYELITIS VACCINATION The following table shows the number of injections given in the various priority groups during the year ended 31st December,1961 Priority Group 2nd Injections 3rd Injections 4th Injections 1957-1961 1230 1333 1946-1956 262 772 1943-1945 65 77 1933-1942 461 456 1921-1932 1682 2056 others 72 72 School children under 12 years — — 6254 Total 3772 4766 6254 43 SMALLPOX VACCINATION The following table shows the smallpox vaccination figures for 1961 based on the return submitted to the Ministry of Health. Age at Date of Vaccination Number Vaccinated Number Re-Vaccinated Under 1 911 1 76 2 to 4 36 2 5 to 14 31 6 15 or over 9 3 Total 1063 11 Typhoid Fever and Paratyphoid Fever. There were no cases notified during the year. Puerperal Pyrexia. 17 cases were notified during the year, all of which were from Bexleyheath Maternity Hospital, where they were isolated and treated. Ophthalmia Neonatorum. No cases were notified during the year. Measles. 1,454 cases were notified during the year. 3 cases were treated in hospital. Whooping Cough. 37 cases were notified during the year. No cases were treated in hospital. Acute Poliomyelitis. 1 case was notified during the year. Scabies. 4 cases were notified during the year. 44 Food Poisoning. 5 cases were notified during the year. 1 case was treated in hospital. Malaria. 1 case was notified during the year. Dysentery. Outbreak of Dysentery at an Infants School. On 10th May, 1961, the Head Teacher of this school reported that a number of children were away from school with vomiting and diarrhoea. An immediate visit to the school was made by the Chief Public Health Inspector and myself and a full investigation carried out. Dysentery in infant schools is generally spread among the children by hand to mouth infection, the latter occurring, primarily, in the use of toilets and the subsequent contamination of articles used in common by the children, e.g. lavatory seats, lavatory chains, towels, door knobs, pencils, books and so on. Once dysentery takes hold of a young community of this kind it can be a matter of considerable difficulty to eradicate it. The use of roller towels was discontinued and special attention was paid to the cleansing of toilets, floors, etc. The staff were instructed to ensure that the children washed their hands carefully after the use of the toilets—a matter of some difficulty where such young children are concerned. In addition, faecal (stool) specimens were taken from all children (250) and every member of the staff in the school and sent to the Public Health Laboratory at Maidstone. All children and staff showing clinical symptoms of the disease were excluded from school and this applied, also, to all those whose specimens were found to contain dysentery germs. In all, 104 children and two members of the staff were excluded and the investigation was carried outwards into the families concerned, specimens being taken from all members of the families concerned and any outside contacts. In all. over 1,000 faecal specimens were taken and examined and this involved a good deal of work in the distribution of outfits, collection of specimens and delivery to the laboratory. Full information was, also, supplied to general practitioners in the area and a large number of queries were dealt with from parents, doctors and others. Repeated specimens 45 had to be taken from all those returning positive results and liaison was maintained with other authorities to whose districts contacts of cases had proceeded. A number of cases, mostly in brothers and sisters of infants, also occurred in the Junior department of the school which was not, however, seriously affected. The closing of the school for the Whitsun holiday was welcome and during this period the school premises were thoroughly cleaned. By the 29th May, 1961, when the school re-opened, 60 of the affected children had been found to be ' negative ' and were allowed to return to school. Not all the children had actually suffered from dysentery—many were ' symptomless excreters ' or ' carriers' only. All cases of dysentery were relatively mild but the nuisance value of such an outbreak is extremely high. This type of Sonne dysentery is widespread in the country as a whole. In 1956 the notifications in England and Wales numbered 49,009 and in 1959 the number was 35,626. As I have said, hand carriage of infection, rather than food, is the main factor in transmission. Only detailed attention to personal cleanliness and, above all, the washing of hands after attendance at the toilet, combined with adequate sanitary provision in homes, schools and similar institutions will break the cycle of infection and reduce the incidence. 46 47 The following table gives the particulars concerning the cases of Infectious Diseases (other than Tuberculosis) notified in the area during the year. NOTIFIABLE DISEASES (Other than Tuberculosis) DURING THE YEAR 1961. DISEASE. Total cases notified Under 1 1 2 3 4 5 to 9 10 to 14 15 to 24 25 & over Age unknown Cases admitted to Hospital Total Deaths. Smallpox — — — — — — — — — — — — — Scarlet Fever 37 — 1 1 4 1 21 5 3 1 — — — Diphtheria — — — — — — — — — — — — — Puerperal Pyrexia 17 — — — — — — — 7 10 — 17 — Ophthalmia Neonatorum — — — — — — — — — — — — — Acute Paralytic Poliomyelitis 1 — — — — — 1 — — — — — — Acute Non-Paralytic Poliomyelitis — — — — — — — — — — — — — Pneumonia 12 — — — — — 2 — 1 9 — — 1 Erysipelas 5 — — — — — — — — — — — — Food Poisoning 5 — — 1 1 — — 1 — 2 — 1 — Dysentery 43 1 2 1 2 4 20 3 3 7 — — — Typhoid Fever — — — — — — — — — — — — — Paratyphoid Fever — — — — — — — — — — — — — Meningococcal Infection — — — — — — — — — — — — — Measles 1454 29 107 150 196 195 704 35 26 12 — 3 — Whooping Cough 37 3 1 2 — 6 20 3 — 2 — — — Scabies 4 — — — — — — — 2 2 — — — Encephalitis — — — — — — — — — — — — — Malaria 1 — — — — — — — — — — — — Totals 1616 33 111 155 203 206 768 47 42 51 — 23 1 TUBERCULOSIS. During the year 36 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1961 are contained in the following table:— Age Period New Cases Deaths Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. M. M. F. M. F. Under 5 1 — — — — — — — 5—14 — — — — — — — — 15—24 2 2 1 — — — — — 25—44 5 3 — 1 — — — — 45—64 9 — — — — — — 1 65 and over 4 2 — — 3 — — — | Totals 21 7 1 1 3 — — 1 The Non-Respiratory death was an un-notified case. 48 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Service For the Year 1961 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 Mrs. M. P. Monk. Councillor J. C. Canton. Councillor E. C. C. Gillman. Councillor A. S. Melbourne. Councillor C. Jamieson Harvey, M.B.E., J.P Councillor W. P. Webster. Co-opted Members: Revd. A. E. Ramsbottom, B.D. Revd. E. Maynard Wilson. 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. Orthopaedic Surgeons K. F. Hulbert, F.R.C.S. B. Lawson, F.R.C.S. Dental Officers G. Wilson Lawrencc. L.D.S R.C.S. (Resigned 30.11.61). Mrs. A. B. Perkins, L.D.S R.F.P.S. (Glas.). Mrs. E. A. Williams, B.D.S., L.D.S (Appointed 16.10.61). 50 Health Visitors Miss B. Hart, S.R.N., S.C.M. and Health Visitor's Certificate (Parttime). (Appointed March, 1961). 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. G. M. Blackmore, S.R.N., S.C.M., and Health Visitor's Certificate (Part-time). Mrs. Wright, S.R.N., S.C.M., and Health Visitor's Certificate. (Part-time) Miss E. C. Richardson, S.R.N., S.C.M., Health Visitor's Certificate. (Part-time). Mrs. V. E. Gurnett, S.R.N. (Retired 15.12.61). Physiotherapists Miss R. Cheeseman, M.C.S.P. Mrs. I. O. M. Poynder, C.S.P. Speech Therapists Mrs. E. Rollo, L.C.S.T. (Appointed April 1961). Mrs. T. Grove, L.C.S.T. (Resigned September 1961). Mrs. R. Goodwins, L.C.S.T. (Appointed October 1961). Dental Attendants Miss K. Dunkley. Mrs. V. Sproul. Miss J. A. Smith — Hygienist. School Health Service Clerk Miss M. C. A. Smith. (Retired 30.9.61). Miss O. G. Turnbull. (Appointed 1.10.61). Miss O. G. Turnbull. (Until 1.10.61). General Clerks Miss E. Turner. Mrs. D. Starling 51 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1961 To the Chairman ami Members of the Welfare and School Attendance Sub-Committee. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1961. 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. No serious problems arose out of infectious diseases but an outbreak of Sonne dysentery occurred at an Infants School of which a brief account is set out on page 45. In the early days of the School Health Service,over half a century ago, the main problem was the detection and treatment of gross physical disease due mainly to poverty, malnutrition and overcrowding. The infectious diseases took their toll of thousands of lives every year and, what is more left behind them a legacy of ill-health in the form to heart, lung and kidney disease, deafness, blindness and a general lack of stamina and well-being. The School Health Service was, in fact, one of the measures designed to counteract the ravages of an adverse physical environment. The milieu of the schoolchild has, of course,improved beyond all recognition but it would be wrong to assume that environmental factors no longer play a decisive part in his health and development. What has changed, chiefly, is the nature of the environmental hazards to which he is nowadays subjected. In the field of nutrition, for example, problems of scarcity have been replaced by those of over -abundance and the heavy, over-weight child is now more of a problem than the thin, undernourished child. Dental disease is still very prevalent but for different reasons and the Welfare and School Attendance SubCommittee have, for some time, been very concerned at the high proportion of children found at dental inspections to require treatment. Apart from the provision of dental services, two factors are mainly involved; firstly the nutrition of the expectant mother and, later, of the child (and this includes not only an adequate mineral diet but a sufficiency of vitamins 52 and mineral salts which are essential to the proper development of the teeth) and, secondly, a sound standard of dental hygiene by which the onset of dental caries may be prevented. Medical and dental authorities are convinced that the real cause of the increase in dental decay among children since the end of the war is the increased consumption of sweets, " lollies," fruit drinks, ice cream and biscuits indiscriminately throughout the day. Debris collects between the teeth and the fermentation which results produces harmful substances which attack and break down the tooth enamel and create cavities which may render extraction inevitable. It is not suggested that children should be denied these things—they enjoy sweets which are a source of energy. What is important is that they should get them at a time when it is possible for them to clean their teeth afterwards, either by toothbrush or by eating an apple or similar fruit. Children should, of course, clean their teeth after breakfast and last thing at night (nothing more being eaten after that). Much lip service has been paid to this matter but few authorities appear to have considered any practical steps to implement this requirement. I have discussed with the Borough Education Officer whether routine brushing of teeth and subsequent rinsing could not be made a regular practice in schools and it appears that the problems raised by this suggestion are not insuperable. Certainly it is both desirable and possible that children having dinners in school should be required to clean their teeth before resuming lessons. A start might be made, experimentally, in the primary schools and it is suggested that a circular letter be sent to parents asking, among other things, that each child be provided with a toothbrush in a plastic container for use in school. It would be an enormous step forward if the practice of dental hygiene could become a regular feature of school life. The number of school dentists during the year was maintained at two whole-time and one part-time officer (two days per week) and it is anticipated that, in the near future, a ' dental ancillary' will for the first time be appointed to work in the School Dental Service. This new class of dental officer came into being as a result of the Dentist Act, 1956, his function being to carry out extractions and fillings etc. under the close supervision of the dental surgeon. The training of these officers entails a two years whole-time course in an approved hospital. 53 Finally, the long awaited report on the fluoridation of water supplies in relation to dental disease has now been published by H.M. Stationery Office. Striking confirmation is contained therein that the addition of fluoride to the public water supply to the extent of one part per million would bring about a substantial improvement in the teeth of young children. More will be heard of this matter in the future and, notwithstanding the controversial nature of the Proposal,it is to be hoped that the report will result in practical measures being taken to implement its recommendations. The report is of particular importance to this area where the water supply is practically devoid of natural fluorine. The recently published report of the Royal College of Physicians on Smoking and Health has drawn attention to the smoking habits of schoolchildren as ascertained in numerous surveys. It is stated that, in general, 11% to 15% of boys are already smoking small numbers of cigarettes by the age of 10 years. Girls smoke less often but, by the age of 15 years, about 15% smoke regularly. There is no reason to believe from such information as is available, locally,that these figures would not apply to this area. The Committee for Education are giving much attention to methods of counteracting this disturbing trend but the issue is a very complex one, involving both short-term and long-term plan ning and much more is to be gained from example than from mere exhortation and the display of posters,important as these may be. A special responsibility rests not only on parents but on teachers, doctors and youth leaders generally to demonstrate, clearly, that they take the subject seriously by refraining, as far as possible, from cigarette smoking in the presence of young people. A degree of personal hardship may, therefore, be inevitable if there is to be any chance of success of impressing upon children that we really mean business. Dr. S. M. Ring has now left the School Health Service after ten years' work in the Borough and I would like to place on record my appreciation of the outstanding services which she has rendered during this period. As in previous years, I wish to acknowledge the excellent co-operation that exists between head teachers,parents,school medical officers and health visitors and to refer to the work 54 of the education welfare officers whose reports on families and individual children are instrumental in bringing to our notice many departures from health as early as possible. I wish to record the excellent team work of all members of the staff on which the success of the School Health Service so largely depends and, also, to express my appreciation of the help which I have received during the year from the Chairman and Members of the Committee, from Miss Smith, the Senior Clerk, from the County Medical Officer and his staff and from the Borough Education Officer and his Department. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, JOHN LANDON, Medical Officer of Health. 55 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY Schools. Bexley Grammar School. Average number on Roll at 31st December, 1961 627 Bexley County Technical School for Girls. Average number on Roll 781 Bexley & Erith Technical School for Boys. (Opened September, 1961). Average number on Roll 538 Eight County Secondary Schools. Average number on Roll 3,640 Twenty-four County Primary Schools. Average number on Roll 6,711 Clinics. Minor Ailments. Welling—Little Danson, Dansington Road. Tuesday and Wednesday, 1.30-3.30 p.m. Doctor in attendance—Wednesday. Welling—Wrotham Road. Tuesday, 9.30-11 a.m. Thursday, 1.30-3.30 p.m. Doctor in attendance—Thursday. Bexleyheath—315, Broadway. Tuesday, 1.30-3.30 p.m. Monday and Friday 9-10 a.m. Wednesday, 9-11 a.m. Doctor in attendance—Tuesday. Bexley—Murchison Avenue. Tuesday and Friday, 9.30-11 a.m. Doctor in attendance—Friday. 56 Dental. Welling—Little Danson, Dansington Road. Daily—9.30-11 a.m., 2-4 p.m. Bexleyheath—315, Broadway. Wednesday, Thursday, Friday, 9.30-11 a.m. 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. Orthopedic. 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. Woodside Road, Crayford. Monday, Tuesday, Wednesday, 2-4 p.m. Murchison Avenue, Bexley. Friday, 9.30-11.30 a.m., 2-4 p.m. Child Guidance. 18, Crook Log, Bexleyheath. (Nov. 1961). Clinics held daily. Appointments made through County Medical Officer by the Borough Medical Officer of Health. 57 CO-ORDINATION. In spite of the transfer of the Maternity and Child Welfare Services from the local Council to the Kent County Council, a satisfactory degree of co-ordination of effort between the School Health Service and the Infant Welfare Services has been maintained as a result of the co-operative attitude of all members of the Staff concerned. Periodic Medical Inspections. See Table A. The successful carrying out of routine medical inspections was made possible by the excellent co-operation of Head Teachers and their staffs and it is true to say that this is now regarded as an integral part of the school curriculum. It is at these inspections that the greatest number of defects is discovered and where a great deal of information is obtained in regard to the school children by discussions with the parents. Generally speaking, it was found that entrants, 8-yearolds and 11-year-olds showed a uniformly high standard of personal hygiene. Clothing was good and clean and the incidence of skin diseases very low. The attendance of parents at routine medical inspection was good, being practically 100 per cent, in the case of entrants, but as might be expected there was a falling off in the case of senior children. Reference to the Statistical Table on Page 69 emphasizes the number of defects discovered. Bearing in mind that these defects are nearly always diagnosed in the early stages and observation or treatment instituted at once, periodic inspections will be seen to represent the truly preventive aspect of School Health Work. School Meals, 1961. Average number of pupils in attendance:— Primary School 6,711 Secondary Schools 5,586 Average number of dinners served to children daily: — Paid Free Total Primary 2,825 38 2,863 Secondary 3,570 51 3,621 Milk. Average number of pupils taking milk daily:— Primary 5,777 Secondary 3,314 58 School Dental Service. In 1961 there were 3,214 children inspected in schools allotted to Danson Clinic and of these, 69% required treatment. It is encouraging to note that since 1958, the percentage ot those requiring treatment is decreasing, as can be seen from the following:— 1958 86% required treatment 1959 81% 1960 70% 1961 69% At the end of the year a high speed air turbine engine was installed in the Surgery. The figures for 1961 are as follows:— Number inspected at school 3,214 inspected as specials 215 „ requiring treatment 2,248 treated 812 of fillings (a) Permanent teeth 1,527 (b) Temporary teeth 271 of extractions (a) Permanent teeth 169 (b) Temporary teeth 609 of attendances 2,756 Orthodontics. Number of cases commenced 20 of attendances 364 „ of cases completed 12 of appliances 41 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 as in previous years. The problems of adolescents are now making themselves felt in this department in the shape of painful feet being crammed into badly fitting shoes, and postural 59 ties, very often the result of a "don't care" attitude towards life. As in both these conditions the active and willing co-operation of the patient is frequently lacking, these cases are presenting a real and increasing problem as to how they should be handled. In the first instance it is very largely a matter of discipline both at home and at school. The importance of effective physical education in all secondary schools is still a matter that needs careful attention, and anything that can be done along these lines will help us in the Orthopaedic Department. I wish to thank Miss Cheeseman and all the staff in the Clinic for their continued help during the year." and to Mr. B. Lawson, F.R.C.S., for the following:— "There has been no marked change in the type of cases referred to the Children's Clinic at Bexley during the past year. The general health of the children has been good. Orthopaedically one of the main problems that has concerned the Orthopaedic surgeon is the many variations from normal and the difficulty in deciding which are large enough variations to be considered deformities. Minoj disturbances from normal are p000000ossible with perfectly normal function but some deformities, if left alone, will cause arthritic changes in later life. Some of these could be prevented by operative treatment but the operative treatment itself carries with it a certain morbidity. These many and variable factors make decision as to operative treatment a difficult problem." Opthalmic Clinic. I am indebted to Mr. R. M. Chambers, M.B., B.S., D.O.M.S. for the following report:— "The attendance during the year has been satisfactory and only a very few patients have defaulted repeatedly. If a second appointment is not kept, unless the patient is of school leaving age, a visit is usually made by one of the staff to try to overcome difficulties of ignorance, apathy or transport. I much appreciate these efforts. A number of patients attending for the first time lose their way, for Little Danson Clinic is not easy to find. I am sure it would be a great help if a small map of the vicinity could be enclosed with the appointment form of all first attenders. 60 The use of mydrilate as a cycloplegic has been found more satisfactory in many cases of the 10-16 year age group, than oscine or homatropine and cocaine. The depth of cycloplegia being good and the duration short, results in minimal interference with school work. A close watch is being kept on results of treatment in the United States of convergent squint in highly-strung children by the use of Chlordiazepoxide (Librium), a method of treatment that might be of great benefit in a school eye clinic." Cases seen at Little Danson Clinic other than refractive errors during 1961. Congenital. Ptosis 2 Nystagmus 5 Lens opacities 4 Colour Defectives: Unsafe 12 Safe 10 Acquired. Constitutional Migraine 26 Retinitis Pigmentosa 1 Myopic Degeneration 1 Infective Blepharitis 8 Conjunctivitis 11 Choroiditis 1 Others. Dermato-Lipoma 1 Pseudoglioma Retinae 1 Eclipse Scotoma 1 Melanosis Conjunctivae 1 Optic Atrophy 3 Sinusitis 5 Tarsal Cysts 1 Corneal Scars 3 Cases referred to hospital—22 Number of appointments kept 2,204 Prescriptions for Spectacles 743 New Cases 344 61 Child Guidance Clinic. Number of children referred during 1961. 1960 1961 Boys Girls Total Boys Girls Total Under 5 — — — 2 — 2 5—7 5 3 8 9 4 13 8—10 7 5 12 11 — 11 11 and over 4 6 10 3 5 8 16 14 30 25 9 34 Speech Therapy. I am indebted to Miss Joan Pollitt, Senior Speech Therapist to the Kent Education Committee for the following report:— "Seventy-seven children, who are under the care of the Bexley Education Authority, have been dealt with within the County Speech Therapy Services during the year. The cases of thirty-seven of these children have been closed and forty will continue to attend into 1962. Of the thirty-seven closed cases, twenty-two have attended at the Murchison Avenue Clinic, thirteen at the Woodside Road Clinic, and two have attended at Sidcup. The cases of the thirty-seven children have been closed for the following reasons:— Satisfactory results following appointments at the clinic 28 Treatment incomplete — considerable progress made — appointments then rejected 3 Treatment continued elsewhere 3 Appointments offered but never kept 3 37 Seventeen of the forty children who will continue to attend into 1962, are on the Murchison Avenue 'open' list, twenty are being seen at the Woodside Road Clinic and three at the Sidcup Speech Therapy Clinic. One hundred and eighteen Bexley children were awaiting appointments at the end of the year. Fifteen are on the waiting list at the Murchison Avenue Clinic, and one hundred and two at the Woodside Road Clinic, and one at Sidcup. 62 Mrs. Grove continued to visit the Murchison Avenue Speech Therapy Clinic until September 1961, when she resigned her appointment. Mrs. Goodwins took over Mrs. Grove's work in October 1961. Mrs. Rollo, who was appointed to the County Services in April 1961, was able to join Mrs. Goodwins at the Murchison Avenue Clinic on taking up her appointment. Bexley children who attend schools which are nearer to Woodside Road than to Murchison Avenue have received and will continue to receive appointments at the former clinic." Sweep Frequency Pure Tone Audiometry. During 1961, 1,057 children were tested during their last year in the Infants School, i.e., during their seventh year. Of this number, 947 passed and 110 failed. The latter children were referred to the School Medical Officers for investigation and any minor conditions causing temporary deafness were treated. In addition, 160 children of all age groups were tested as special cases referred from various sources including teachers, and of this number 87 passed and 73 failed. The 160 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 73 failed children were referred back to the School Medical Officers for further examination and treatment. Lastly, 140 children attended for a final audiometric test and this number included children seen in 1960 who had been referred by the School Medical Officers for a final test in 6 to 12 months time. Of these 140 children, 72 passed and 68 failed. Further treatment was instituted for the latter children either at the School Clinics or at the Ear, Nose & Throat Department at 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 63 they are requested by head teachers. In primary schools regular cleanliness inspections have been discontinued where, at three consecutive inspections, no cases of uncleanliness have been found but further inspections are made if requested by the head teacher or it appears that special circumstances warrant an intensification of this work. PHYSICAL EDUCATION 1 am indebted to the Physical Education Advisers, Mr. J. Hopkins and Miss E. A. Osgathorp for the following report:— "The shortage of trained teachers is an acute national problem and Physical Education is particularly affected as it is neither desirable nor safe to allow untrained members of staff to be responsible for this subject, particularly at the secondary stage where much gymnastic apparatus and athletic equipment is available. It is pleasing to note that the effect of this national problem is less noticeable in the Borough of Bexley than in some other parts of the County, and on the whole a good standard of physical education has been maintained. The schools are well equipped for physical education and a large range of apparatus is provided to stimulate the children's interest, and help them to adjust to, and manage their rapid physical development. The primary schools in particular are making excellent use of this apparatus. It is presented as a challenge to the children, to help develop: their initiative, courage and self-reliance as well as physical agility and strength. The majority of the primary children transfer to secondary schools full of enthusiasm, and with a willingness to work hard and to tackle anything presented to them, to the best of their ability. All too often with the onset of adolescence this interest in active pursuits fades, particularly with the girls, and some children who were once so alive and eager become lethargic and disinterested. Some secondary schools are overcoming this problem, to some degree, by encouraging new activities such as fencing and badminton, and developing the courage, initiative and self-reliance fostered in the primary school, by introducing the children to some of the challenges offered by their surroundings—the air, rivers, the sea, countryside and hills, etc. These activities can only be introduced during school life, but they may be pusued later to become worthwhile hobbies. The Youth Service is doing 64 much to encourage young people to use their leisure more actively, to combat the passive past-times of car riding and television. The popularity of first ‘rock-and roll’ and then the ‘twist’ is perhaps a significant sign that youth needs an outlet for its physical energy. Parents as well as teachers can all help by ensuring that unoccupied leisure time is not due to ignorance of what else is available. These more recreational activities take a great deal of time as they are best presented to small groups in out of school hours. Much valuable help on this side is given by teachers who are not physical education specialists, and this is greatly appreciated. Ten primary and five secondary schools received swimming instruction during the summer term, and four primary schools were able to swim throughout the year. The number of fatalities each year through drowning is tragic, and it is reassuring to note so many of the schools protect their children by teaching them to swim, but the need for a covered swimming bath in this area is still an urgent one. Without the ability to swim all the fascinating water sports will be denied to them in later life. The constant help and co-operation of the Borough Education Officer and his staff is much appreciated by the Physical Education advisers, and also the work of those teachers who, despite difficulties, strive to maintain high standards of work, behaviour, dress and attitude, without which everything is worthless." Swimming—1961. The closed-in Baths at Eltham, Plumstead and Woolwich and the open-air Baths at Eltham Park, Danson Park and Martens Grove were used during the Summer Term, 1961. The attendances were:— Schools Attendances No. of children 10 Primary 16 classes of 30-35 children each week 504 (approx.) each week 5 Secondary 14 classes of 25-30 children each week 350 (approx.) each week A total of 340 swimming certificates for distances between 25 yards and one mile were issued during the year 1961. 4 Primary Schools continued winter swimming during the Spring and Autumn Terms, 1961. 65 SCHOOL HEALTH SERVICES. Statistical Tables. Part 1 — Medical Inspection of Pupils attending main tained Primary and Secondary Schools. Table A. Periodic Medical Inspections. B. Pupils found to require treatment. „ C. Other Inspections. „ D. Infestation with Vermin. Part II — Return of Defects found by Medical Inspection. Table A. Periodic Inspections. „ B. Special Inspections. Part III — Treatment Tables. Table A. Eye Diseases, Defective Vision and Squint. „ B. Diseases and Defects of Ear, Nose and Throat. „ C. Orthopaedic and Postural Defects. „ D. Diseases of the Skin. „ E. Other Treatment given. Part IV — Dental Inspection and Treatment including Orthodontics. Part V — Handicapped Children. 66 PART 1. 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) (1) (2) (3) (4) (5) (6) 1957 & later 22 22 100 — — 1956 373 371 99.5 2 .5 1955 432 432 100 — — 1954 266 264 99.2 2 .8 1953 529 528 99.8 1 .2 1952 449 449 100 — — 1951 176 176 100 — — 1950 28 28 100 — — 1949 239 238 99.6 1 .4 1948 132 132 100 — — 1947 55 54 98.2 1 1.8 1946 & earlier 1300 1294 99.5 6 .5 Total 4001 3988 99.6 13 .4 67 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) 1957 & later - 1956 20 55 49 1955 32 64 78 1954 26 42 59 1953 74 79 122 1952 60 65 92 1951 37 12 43 1950 11 6 14 1949 26 29 44 1948 12 11 20 1947 12 9 16 194(5 & earlier 279 198 426 Total 589 570 963 C.—Other Inspections. Number of Special Inspections 1496 Number of re-Inspections 1871 Total 3367 D.—Infestation with Vermin. (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 3,264 (b) Total number of individual pupils found to be infested 2 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act. 1944) - (d) Number of individual pupils in respect of whom cleasing orders were issued (Section 54(3), Education Act, 1944) - 68 PART II.—Return of Defects Found By Medical Inspection in the Year Defect Code No. Defect or Disease A. PERIODIC INSPECTIONS B. SPECIAL INSPECTIONS Entrants Leavers Others TOTAL Requiring Treatment Kequiring Observation Kequiring Treatment Kequiring Observation Requiring Treatment Kequiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation 4. Skin — 14 13 72 60 38 56 124 129 42 10 5. Eyes— a. Vision 45 78 254 59 220 125 519 262 52 28 b. Squint 12 14 15 10 35 14 62 38 8 1 c. Other 7 13 25 23 38 38 70 74 19 12 6. Ears— a. Hearing 9 41 10 36 8 115 27 192 41 79 b. Ottis media 4 19 3 10 2 20 9 49 6 5 c. Other 1 8 9 3 14 10 24 21 3 2 7. Nose and Throat 25 198 23 67 35 206 83 471 41 53 8. Speech 7 27 — 11 9 14 16 52 21 17 9. Lymphatic Glands 6 83 1 25 2 83 9 191 5 10. Heart 1 18 2 20 1 46 4 84 8 40 11. Lungs 9 58 3 49 11 105 23 207 25 49 12. Developmental— a. Hernia 2 3 — 2 4 5 6 10 2 1 b. Other 3 7 2 11 8 26 13 44 6 6 13. Orthopaedic— a. Posture 5 12 8 38 28 44 41 94 7 1 b. Feet 8 47 10 40 21 140 39 227 11 6 c. Other 5 47 13 118 18 113 36 278 16 27 14. Nervous System— a. Epilepsy — 7 — — — 6 — 13 2 4 b. Other — 6 3 2 2 18 5 26 4 12 15. Psychological— a. Development 1 8 4 1 60 2 72 32 85 b. Stability 3 69 2 33 6 166 11 268 66 93 16. Abdomen 2 15 5 10 2 47 9 72 20 20 17. Other 2 11 17 44 8 68 27 123 67 121 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 289 Errors of refraction (including squint) 589 Total 1,878 Number of pupils for whom spectacles were prescribed 743 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 4 (b) for adenoids and chronic tonsilitis 129 (c) for other nose and throat conditions Received other forms of treatment 118 Total 251 Total number of pupils in schools who are known to have been vided with hearing aids (a) in 1961 — (b) in previous years 24 C—Orthopaedic and Postural Defects. Number of cases known to have been treated (a) Pupils treated at clinics or out-patients departments 260 (b) Pupils treated at school for postural defects — Total 260 70 D.—Diseases of the Skin. Number of cases known to have been treated Ringworm— Scalp — Body — Scabies — Impetigo 1 Other skin diseases 37 Total 38 E.—Other Treatment Given. Number of cases known to have been dealt with (a) Pupils with minor ailments 613 (b) Pupils who received convalescent treatment under School Health Service arrangements — (c) Pupils who received B.C.G. vaccination 922 (d) Other than (a), (b) and (c) above — Total (a)—(d) 1,535 71 PART IV—Dental Inspection and Treatment (1) Number of pupils inspected by the Authority’s Dental Officers— (a) Periodic inspections 7,714 (b) Specials 590 Total (1) 8,304 (2) Number found to require treatment 4,629 (3) Number offered treatment 4,301 (4) Number actually treated 1,517 (5) Attendances made by pupils for treatment, including those recorded at heading 11(h) below 6,273 (6) Half days devoted to: Inspection 52 Treatment 879 Total (6) 931 (7) Fillings: Permanent Teeth 2,610 Temporary Teeth 997 Total (7) 3,607 (8) Number of teeth filled: Permanent Teeth 2,291 Temporary Teeth 968 Total (8) 3,259 (9) Extractions: Permanent Teeth 200 Temporary Teeth 743 Total (9) 943 (10) Administration of general anaesthetics for extraction 369 (ID Orthodontics: 3l (a) Cases commenced during the year 115 (b) Cases carried forward from previous year 35 (c) Cases completed during the year 25 (d) Cases discontinued during the year 64 (e) Pupils treated with appliances 103 (f) Removable appliances fitted 12 (g) Fixed appliances fitted 1,291 (h) Total attendances (12) Number of pupils supplied with artificial dentures 11 (13) Other operations: Permanent Teeth 664 Temporary Teeth 1,469 Total (13) 2,133 72 PART V Handicapped Pupils requiring Education at special Schools or boarding in Boarding Homes. (1) Blind (2) Partially sighted (3) Deaf (4) Partially Deaf (5) Physically Handicapped (6) Delicate (7) Maladjusted (8) E S.N. (9) Epileptic (10) Speech Defects Total | (1) to (10) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) A. How many handicapped pupils were newly assessed as needing special educational treatment at special schools or in boarding homes — 2 — 16 5 7 — — 30 B. (i) of the children included at A. how many were newly placed in special schools(other than hospital special schools) or boarding homes — — — — — — — — 6 — — 6 (ii) of the children assessed prior to 1-1-1961, how many were newly placed in special schools (other than hospital special schools) or boarding homes — — — — — — — 5 — — 5 Total (B) — 11 — — 11 On or about 20-1-1962 how many handicapped pupils from Authority’s area: C. (i) were requiring places in special schools:— total (a) day 2 — — — — — 1 — — 3 (b) boarding — — — — — 6 — — — 6 (ii) included at (i) had not reached the age of 5 and were awaiting: — (a) day places — — 1 — — — — — — — 1 (b) boarding places — — — — — — — — — — — (iii) included at (i) who had reached the age of 5 but whose parents had refused consent to their admission to a special school, were awaiting: (a)day places — __ — (b) boarding places — — — — — — — — — — — 73 (1) Blind (2) Partially sighted (3) Deaf (4) Partially Deaf (5) Physically Handicapped (6) Delicate (7) Mai- adjusted {8) E.S.N. (9) Epileptic (10) Speech Defects (11) ??? (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) D. (i) were on the registers of: 1. maintained special schools as: (a) day pupils — 5 3 2 a 1 1 37 — — ??? (b) boarding pupils — — — — — — — — — — 2. non-maintained special schools as: (a) day pupils — — — — — — — — — — — (b) boarding pupils 3 — 3 2 2 7 6 — — — ??? (ii) were on the registers of independent schools under arrangements made by the Authority 15 — — — — — — - — ??? (iii) wore boarded in homes and not already included under (i) or (ii) — — — — — — — — — — Total (D) 18 5 6 4 8 8 7 37 — — ??? E. On or about 20-1 -1962, how many handicapped pupils (irrespective of the areas to which they belong) were being educated under arrangements made by the Authority in accordance with Section 56 of the Education Act, 1944: (i) In hospitals — — — — — — — — — — — (ii) In other groups (e.g. units for spastics, convalescent homes) 1 — — — — — — — - — 1 (iii) At home — — — — 4 2 — — — — 6 During the calendar year ended .31-12-61 : (i) how many children were the subject of new decisions recorded under Section 57 (4) of the Education Act, 1944 ??? (ii) how many decisions were cancelled under Section 57A (2) of the Education Act, 1944 ??? 74 INDEX. ITEM PAGE Health Committee 2 Public Health Staff 3 Foreword 4-7 STATISTICS AND SOCIAL CONDITIONS. Acreage 1 Population 1 New Houses Erected 8 Unemployment 8 Social Conditions and Amenities 8—9 Population Graph 10 Summary of Vital Statistics0 1—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 Accommodation 20 General Hospital 20 Ambulance Facilities 20 National Assistance Act, 1948 20 Public Mortuary 20 Disinfection and Disinfestation Service 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 Revers 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 75 PAGE ITEM HOUSING. Council Estates 35 Inspection of Dwelling Houses 36 Remedy of Defects without formal noticc36 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, 1960 41 Registration of Premises 41 PREVALENCE AND CONTROL OVER infectious AND OTHER DISEASE. Scarlet Fever• 42 Diphtheria 42 Diphtheria and Whooping Cough Immunisation, Smallpox and Poliomyelitis Vaccination 43-44 Typhoid Fever and Para Typhoid Fever .44 Puerperal Pyrexia 44 Ophthalmia Neonatorum 44 Measles 44 Whooping Cough 44 Acute Poliomyelitis 44 Scabies 44 Food Poisoning 45 Malaria 45 Dysentery 45-46 Tables of Infectious Diseases Notified 47 Tuberculosis 48 SCHOOL HEALTH SERVICES REPORT, 1961- Welfare and School Attendance Sub-Committee .50 Staff .50-51 Foreword52-55 Schools 56 Clinics 56-57 Co-ordination— Periodic Medical Inspections 58 School Meals and Milk 58 School Dental Service . 59 Orthopaedic Clinic 59- 60 Ophthalmic Clinic 60-61 Child Guidance Clinic 62 Speech Therapy 60- 63 Sweep Frequency Pure Tone Audiometry 63 Cleanliness Inspections 63-64 Physical Education 64-65 Swimming 65 Statistical Tables 66-74 76