AC 4412 (1) BEX 28 BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health and Report on the School Health Service For the Year 1963 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health BOROUGH OF BEXLEY Annual Report of the Medical Officer of Health For the Year 1963 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health Borough of Bexley. Mayor: Councillor F. W. Archer, J.P. Deputy Mayor: Alderman E. S. Newton, M.B.E. HEALTH COMMITTEE Chairman: Alderman Mrs. E. M. Sheppard. Vice-Chairman: Councillor W. P. Webster. Alderman M. J. Corr. Councillor S. H. Philpot. Alderman Mrs. H. F. Piggott. Councillor M. F. Townsend. Councillor R. B. Burke. Councillor A. Scutt. Councillor F. G. Donovan. 2 PUBLIC HEALTH STAFF 1963 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, Public Cleansing Officer and Shops Acts Inspector. *†G. Hind, M.A.P.H.I. Deputy Chief Public Health Inspector. *†J. T. Boocock. 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) E. F. Terry (Miss) (Shorthand Typist). Public Analyst H. E. Monk, B.Sc., F.R.I.C. (Retired 30.11.63). R. C. Spaldine, M.A., F.R.I.C. (Appointed 30.11.63). Smoke Control Assistant J. F. Castle (Appointed 1.1.63). Home Safety Organiser L. S. Brooke, S.R.N., R.M.N.. S.T.D. (London), M.R.I.P.H.H. (Appointed 1.4.63). Refuse Foreman G. E. Packman. Public Health General Assistants A. C. Ward. W. Early. *Certificate for Inspection of Meat and other Foods. †Certificate of Royal Sanitary Institute and Sanitary Inspectors Joint Board. 3 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH To the Mayor, Aldermen and Councillors of the Borough of Bexley. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report for the??? year 1963, my eighteenth and probably the last to be submitted to the Authority as at present constituted in view of the creation of the London Borough of Bexley under the London Government Act, 1963. Eighteen years is not a long time in the life of a local authority (although it does represent a substantial slice of the working life of an individual) but it is long enough to warrant a comparison of the health circumstances of the Borough at the beginning and end of this period. The year 1946 witnessed the beginning of the transitions from war to peace. The strain of bombardment of the civilian population was lifted and the re-integration of family lifes was assisted by the return of evacuated children and by and acceleration of the rate of demobilisation of the Armed??? Forces. Housing circumstances had been seriously affected by bombing and the suspension of new building, and represented the most serious of the problems facing the Borough at that time. Difficulties in the process of resettlement incivilian life inevitably occurred as a result of the enforced separation, over a number of years, of husbands and wivesi children and parents; food shortages remained and in many ways the discipline of the wartime years continued. 4 Strangely enough, in spite of these vicissitudes the general health of the community, as evidenced by the vital statistics of the area remained good. The infant mortality rate (i.e. the number of children dying in the first year of life per 1,000 live births), a very sensitive index of social conditions, was 29.5 per 1,000 live births in 1946, a very favourable rate compared with previous years. At the outbreak of the war the rate was 40.1 per 1,000. This rate has continued to fall and in 1963 was 17.89 per 1,000 and, even allowing for the inevitable fluctuations which are expected when dealing with small numbers, it may be said with some justification that there has been a downward trend since the end of the war which is statistically significant. This has, undoubtedly, been due to improved environmental conditions including housing, an advance in child health services including health education and the discovery of the chemotherapeutic drugs as well as penicillin and the other antibiotics which have greatly simplified the control of the childhood infections. The maternal mortality rate (the number of deaths of mothers in childbirth per 1,000 total births) had shown a similar decline. The rate in 1946 was 1.73 per 1,000 live and still births (3 maternal deaths). It is pleasant to report that there have been no maternal deaths due to childbirth, in the Borough, for the past eight years. This improvement can be related to improved obstetric services, better housing conditions and, again, better chemical and antibiotic control of the puerperal infections. The birth rate in 1946 was 19.75 per 1,000 of the population (18.81 and 21.06 in the previous two years) and fell steadily until about 1956 when an upward trend became noticeable. The rate for 1963 was 16.18 compared with 12.0 per 1,000 in 1952. The Department for Education and Sciences, "Statistics of Education", 1963 (H.M.S.O.) show that the post-war " bulge " now passing out of the secondary schools is but the forerunner of bigger bulges to come which are bound to have important social, industrial and educational implications for the future. The death rate, on the other hand, has remained almost unchanged over the past 18 years and more. The fall in the death rate in the country as a whole began around 1875 and was due to improvements in the adverse environmental conditions which the process of urbanisation had brought to bear on the community—not merely in regard to sanitation but housing, overcrowding, nutrition, hours of work and 5 factory conditions. The tuberculosis death rate also began to fall about the same time and the fall has continued unabated to the present day. Improved standards of living and medical discoveries have combined to bring this about and to raise the general expectation of life of the population. Why then has the death rate not continued to fall? The answer is twofold. Firstly with an ageing population more people may be expected to die for there is a limit to which life can be prolonged and, secondly, deaths from certain causes have increased over the past quarter of a century notably, cancer of the lung, cardio-vascular disease, including coronary disease and accidents both on the roads and in the home. The causes of these epidemics, for this is what they really are, are so complex and interwoven in the fobric of our Society that there can be no easy way to their prevention. The highly competitive nature of life today, the pursuit of ever-increasing standards of living, automatic, and the advances of science and technology, good in many respects, unfortunately bring with them new hazards to human health and happiness, e.g. radio active contamination atmospheric pollution, noise, sophistication of our food supplies, speed and a materialistic outlook which is not conducive to the mental health of the population. In 1950, the first year in which separate figures became available for cancer of the lung, the number of deaths from this cause was 21 compared with 53 in 1962 and 47 in 1963. The number of deaths ascribed to coronary disease similarly rose from 102 in 1950 to 205 in 1962 and 178 in 1963. During the period 28th October to 1st November, 1963, a Smoking and Health Campaign was held in conjunction with Erith and Crayford. The spearhead of this was a five day visit to the area of the Central Council for Health Education mobile unit which visited a number of secondary schools and a Youth organisation. Films were shown at those schools not actually visited by the Unit. Ten thousand copies of a personal letter addressed to parents by the Medical Officer of Health were distributed thoughout the schools and a large number of leaflets and posters were made available in the at The Campaign made a good impact on the public at the time but I fear that it will take much more than this to shake the public generally out of their apathy in regard to this problem. Section 32 of the Children and Young Persons Act, 1963 substantially increases the penalty for the sale of tobacco to persons under 16 years of age but it would appear that the problem of enforcement will remain. 6 The picture is much brighter in regard to the older epidemics. In 1946 eight cases of diphtheria were notified in the Borough with one death (21 cases with one death in 1945, 67 cases with 3 deaths in 1930). There has not been a single notified case of diphtheria in the Borough for the past 14 years. In the late summer of 1947, suddenly and Unaccoutably, poliomyelitis struck the country after many years of relative quiescence. Sixteen cases occurred in the Borough with three deaths. Immunisation against this disease began in 1956 and it is significant that, since that time, there has been a remarkable decline in poliomyelitis. The number of cases in Bexley in the five year period 1959 to 1963 was one compared with 36 in the previous five years. Few would deny that this decrease is closely related to the immunisation of children and young adults in the Borough first by the Salk vaccine and now by the oral vaccine which has almost replaced the former. Over the relatively short period under review there has been a marked improvement in food hygiene in the Borough as a re.sult of the implementation of the Food Hygiene Regulations and of internal developments of the Catering trades as a whole. Refrigeration of foodstuffs is, now, almost universal and the wrapping of foodstuffs have gone to considerable lengths. The opportunities for the occurrence of food poisoning are certainly fewer nowadays (there were no notified cases in 1963) but constant vigilance is still necessary as human sources of error can still defeat the most elaborate equipment. A further hazard arises from the growing tendency for people to take their holidays abroad and the importation of typhoid fever appears to be a growing risk. In regard to housing the Council have pursued a steady slum clearance programme both by clearance orders and by the demolition of individual unfit houses. Their greatest single achievement during this period has been the final clearance of the Lodge Hill and East Wickham hutments (erected in 1916 for the housing of munition workers employed at the Royal Arsenal) and their replacement by modern housing estates. The Borough now has no slums in the accepted sense of the word but there are still quite a number of individual houses which will need to be dealt with in the next five years. The obsolescence factor is, indeed, low and, with the increase in the number of owner-occupiers and the provision of new houses by the Council and private enterprise and the improvement of some of the older houses by improvement grant procedure this favourable position 7 could be maintataed. The housing needs of the elderly and of young families living in cramped conditions either in furnished accommodation or with "in-laws" present an urgent problem throughout the country and are recognised by the Council as a major obstacle to health and happiness which should be removed as soon as possible. Atmospheric pollution is nowadays the most important hazard to the health of the community. It is comparable in its magnitude to the pollution of public water supplies in the 19th century before the provision of water-carriage sewerage schemes and, the problems involved in its abolition are probably even more complex. The atmosphere is becoming, more and more, a new kind of public sewer into which every kind of gaseous filth is discharged—from the domestic fire, the factory chimney and of course the ever growing number of motor vehicles, both diesel and petrol, which threaten to bring chaos to our roads. The Clean Air Act of 1956 has enabled local authorities to take the first step to control black smoke emissions from the domestic hearth and factory and much has already been achieved in some of the worst " black areas " of the country. Despite its many shortcomings the Act remains one of the most important and far-reaching pieces of legislation on the Statute Book and the many frustrations arising from its operation should be seen as the teething troubles inherent in such a great task as the removal of one of the main causes of chronic respiratory disease, one of the great killing diseases, and of cancer of the lung, of which it is no doubt a contributory cause. The loss of the Child Welfare Services by Bexley to the: Kent County Council in 1948 under the National Health Service Act, 1946 was, to some extent, offset by the delegation to the Borough of the School Health Service by virtue of its Excepted1 District status under the Education Act, 1944. This has enabled us to keep in close touch with the personal health services generally and with the Welfare and Children's: departments of the Kent County Council. Now, the wheel has turned full circle and, as a result of the London Government Act, 1963 the new London Borough of Bexley will, oni 1st April, 1965 become responsible for the Health and Welfare and Children's services. It is difficult not to feel some; regret at the passing of the old order but one cannot but! welcome the great opportunities and challenge which face; the new Borough and which will, surely, in years to come,: bring about a fully integrated Health service, close to the; 8 people it is designed to serve and providing opportunities for the prevention of disease and the promotion of health greater than ever before particularly in the field of mental health and the welfare ot the elderly and the handicapped. 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 excellent work which has been done during the year. I am, Your obedient servant, JOHN LANDON, Medical Officer of Health. 9 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH Area. 4,869 acres. Population. New Dwellings Erected. Registrar General's Estimate midyear, 89,790 Houses 145 Relative figures for previous years. Population—Mid-Year. New Houses Erected. 1953 87,990 1953 265 1954 88,180 1954 503 1955 88,780 1955 529 1956 89,300 1956 423 1957 90,020 1957 384 1958 90,330 1958 313 1959 90,500 1959 287 1960 91,000 1960 367 1961 (Census) 89,670 1961 246 1962 89,910 1962 173 Number of inhabited houses at the end of 1963 (according to Rate Books) approximately 29,219 Rateable Value £3,657,971 Sum represented by a penny rate £15,060 Unemployment. Men Women Boys Girls Total December 31st, 1962 228 49 27 7 311 December 31st, 1963 234 68 17 9 328 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, housing shortages constitute a barrier to the health of a relatively large number of its citizens. The housing programme has been accelerated as much as possible and it can only be hoped that the housing position of the Borough will gradually reach the optimum standards for which the Council are striving. 10 The following public open spaces have been provided by the Corporation:— Brxley Woods, Parkhill Road, Bexley 27.00 acres Bigs Hill Wood, Watling Street, Bexleyheath 8.68 „ Brampton Park Recreation Ground, Avenue Road, Bexleyheath 1.66 „ 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 „ Shoulder of Mutton Green, Welling 4.00 „ 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 Grove, Bexleyheath .25 „ The Warren, Broomfield Road, Bexleyheath 12.47 „ Westwood Estate Children's Playground, .60 „ Welling Total 512.1025 „ Facilities for outdoor games are provided in many of these open spaces, including the large Swimming Pool in Danson Park, opened in July, 1936. 11 SUMMARY OF VITAL STATISTICS England and Wales. Borough of Bexley. Rates per 1,000 Home Population. Births- Live 18.2 16.18 Still 0.32 0.23 17.2(a) 14.2(a) Deaths- All Causes 12.2 9.6 Typhoid and Paratyphoid 0.00 — Whooping Cough 0.00 — Diphtheria 0 00 — Tuberculosis 0.06 0.07 Influenza 0.06 0.01 Smallpox — — Acute Poliomyelitis (including Polioencephalitis) 0.00 — Pneumonia 0.99 0.75 Notifications (corrected) Typhoid Fever 0.00 —. Paratyphoid Fever 0.00 — Meningococcal Infection 0.01 0.01 Scarlet Fever 0.37 0.77 Whooping Cough 0.74 0.37 Diphtheria 0.00 — . Erysipelas 0.04 0.08 Smallpox — — Measles 12.78 12.93 Pneumonia 0.30 0.03 Acute Poliomyelitis (Including Polioencephalitis) Paralytic 0.00 — Non-Paralytic 0.00 — Food Poisoning 0.12 — Puerperal Pyrexia 7.44(a) 8.14(a) Rates per 1,000 Live Births. Deaths All causes under one year of age 21.1 17.89 Enteritis and Diarrhoea under two years of age 0.53 0.69 Maternal Mortality England and Wales Borough o£ Bexley Rates per 1,000 total live and still births Maternal causes, excluding abortion 0.22 Nil Due to abortion 0.06 Nil Total maternal mortality 0.28 Nil EXTRACTS FROM VITAL STATISTICS FOR THE Year 1963 The Registrar General's Estimate of home population for the mid-year is 89,790 and this figure is assigned for the purpose of calculation of all rates. Births. Males Females Total Live Births—Total 716 737 1,453 Legitimate 687 712 1,399 Illegitimate 29 25 54 Birth Rate. Rate per 1,000 estimated home population 16.18 The following relates to the Birth Rate during the past ten years:— 1953 Birth Rate 12.70 per thousand 1954 „ „ 11.80 „ „ 1955 „ „ 12.60 „ „ 1956 „ „ 13.2 „ „ 1957 „ „ 13.6 „ „ 1958 „ „ 13.6 „ „ 1959 „ „ 14.4 „ „ 1960 „ „ 14.5 „ „ 1961 „ „ 14.7 „ „ 1962 .. .. 14.97 „ „ Rate per 1,000 for England and Wales 18,3 14 The Registrar-General has supplied a comparability factor for 1963. The standardised birth rate which allows for comparison with other parts of the country is 16.7. 54 illegitimate live births were registered against 51 in 1962 giving a percentage of 3.7 of total live births. Stillbirths. Males Females Total Total 12 9 21 Rate per 1,000 total (live and still) births 14.2 21 Stillbirths were registered during the year. This represents a rate of 0.23 per 1,000 population against 0.31 per 1,000 population in 1962. The following relates to the Stillbirth Rate during the past ten years:— Rate per Thousand Year Total Live and Still Births Population 1953 12.94 0.28 1954 13.26 0.16 1955 16.7 0.21 1956 20.8 0.28 1957 19.2 0.37 1958 19.9 0.28 1959 15.2 0.22 1960 14.9 0.22 1961 14.9 0.2 1962 20.4 0.31 Rate per 1,000 for England and Wales 1963 0.32 There were three Stillbirths registered as illegitimate. Males Females Total Total Live and Stillbirths 728 746 1,474 15 Infant Deaths. Males Females Total Deaths of Infants under one year of age 14 12 26 Legitimate 13 12 25 Illegitimate 1 — 1 Death rate of Infants under one year of age: Total per 1,000 live births 17.89 Legitimate per 1,000 legitimate live births 17.86 Illegitimate per 1,000 illegitimate live births 18.52 Neo-natal Deaths per 1,000 live births 13.76 Early Neo-natal Deaths 11.7 Perinatal Deaths 25.7 The following relates to the Infant Mortality Rate dur ing the past ten years:— 1953 14.36 per 1,000 live births. 1954 22.1 „ „ „ „ 1955 17.0 „ „ „ „ 1956 24.6 „ „ „ „ 1957 22.9 „ „ „ „ 1958 13.0 „ „ „ „ 1959 13.1 „ „ „ „ 1960 12.9 „ „ „ „ 1961 13.7 „ „ „ „ 1962 14.86 „ „ „ „ 16 17 INFANT MORTALITY, 1963 DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. These relate to deaths occurring in 1963 but not necessarily registered in that year. Causes of Death as Certified. Days Months 0- 1- 2- 3- 4- 5- 6- 7- 14- 21- 28- 2- 3- 4- 5 6- 7- 8- 9- 10 11- 12 Congenital Malformation 1 1 1 2 1 Prematurity 6 1 1 2 Atelectasis 1 Broncho Pneumonia 1 1 Cerebral oedema Convulsion 1 Hydrocephalus Meningomyelocele 1 Anencephaly 1 Cerebral haemorrhage Renal vein thrombosis 1 Trisomy 17-18 1 Hydrops foetalis 1 Meningitis 1 Totals 8 3 2 3 — 1 — 1 2 — — 2 — 1 1 — — 1 — — — 1 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:— 1953 2.63 per 1,000 live and stillbirths 1954 Nil „ „ „ „ ,, 1955 0.88 „ „ „ „ ,, 1956 Nil „ „ „ „ ,, 1957 Nil „ „ „ „ ,, 1958 Nil „ „ „ „ ,, 1959 Nil „ „ „ „ ,, 1960 Nil „ „ „ „ ,, 1961 Nil „ „ „ „ ,, 1962 Nil „ „ „ „ ,, Deaths All Causes. Males Females Total All causes 418 446 864 Death rate per 1,000 of estimated home population 9.6 Deaths from Measles (all ages) — — — Whooping Cough (all ages) — — — Enteritis (under 2 years of age 1 — 1 Cancer (all ages) 94 89 183 Death rate per 1,000 for England and Wales, 1963 12.2 18 19 Death Rate of Area during last ten years:— 1953 8.8 per thousand 1954 8.1 „ „ 1955 9.1 „ „ 1956 9.4 „ „ 1957 9.2 „ „ 1958 9.48 „ „ 1959 8.76 „ ,, 1960 8.7 „ „ 1961 9.6 „ „ 1962 9.5 „ „ The rate for Bexley compares favourably with that for England and Wales. The Registrar-General has supplied a comparability factor for 1963. The standardised death rate which allows for comparison with other parts of the country is 11.06. 20 CAUSES OF DEATH IN THE BOROUGH REGISTERED DURING THE YEAR 1963. Causes of Death. M. F. Total All Causes 418 446 864 1 Tuberculosis, respiratory 3 1 4 2 Tuberculosis, other 1 1 2 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 2 3 10 Malignant neoplasm, stomach 16 10 26 11 Malignant neoplasm, lung, bronchus 40 7 47 12 Malignant neoplasm, breast — 23 23 13 Malignant neoplasm, uterus — 6 6 14 Other malignant and lymphatic neoplasms 38 43 81 15 Leukaemia, aleukaemia 2 3 5 16 Diabetes 1 3 4 17 Vascular lesions of nervous system 43 63 106 18 Coronary disease, angina 112 66 178 19 Hypertension with heart disease 5 11 16 20 Other heart disease 24 60 84 21 Other circulatory disease 18 23 41 22 Influenza — 1 1 23 Pneumonia 20 47 67 24 Bronchitis 32 25 57 25 Other diseases of the respiratory system 2 1 3 26 Ulcer of stomach and duodenum 5 3 8 27 Gastritis, enteritis and diarrhoea 3 2 5 28 Nephritis and nephrosis 1 2 3 29 Hyperplasia of prostate 3 — 3 30 Pregnancy, childbirth, abortion — — — 31 Congenital malformations 4 6 10 32 Other defined and ill-defined diseases 25 29 54 33 Motor vehicle accidents 8 2 10 34 All other accidents 9 2 11 35 Suicide 2 3 5 36 Homicide and operations of war — — — DEATHS REGISTERED (IN AGE GROUPS) IN 1963 Total Under 1 year 1-4 years 5-14 years 15-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75 years and over 1 Tuberculosis, respiratory M F M F M F M F M F M F M F M F M F M F M F 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... ... ... 2. Tuberculosis, other 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 l ... ... ... ... ... 1 10. Malignant neoplasm, stomach 16 10 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 5 2 6 3 4 4 11. Malignant neoplasm, lung, bronchus 40 7 ... ... ... ... ... ... ... ... ... ... ... 1 4 ... 14 2 13 2 9 2 12. Malignant neoplasm, breast 23 ... ... ... ... ... ... ... ... ... ... ... 3 ... 4 ... 9 ... 4 ... 3 13. Malignant neoplasm, uterus 6 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 3 ... 1 14. Other malignant and lymphatic neoplasms 38 43 ... ... ... ... ... ... ... 1 ... 3 2 1 6 3 9 13 10 11 11 11 15. Leukaemia, aleukaemia 2 3 ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 1 ... 1 ... ... ... 16. Diabetes 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 2 17. Vascular lesions of nervous system 43 63 ... ... ... ... ... ... ... ... ... ... 1 ... 3 2 7 7 14 13 18 41 18. Coronary disease, angina 112 66 ... ... ... ... ... ... ... ... ... ... 3 2 10 2 31 7 44 23 24 32 19. Hypertension with heart disease 5 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 1 2 7 20. Other heart disease 24 60 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 6 4 5 9 12 44 21. Other circulatory disease 18 23 ... ... ... ... ... ... ... ... ... ... ... 1 2 1 4 3 4 5 8 13 22. Influenza 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 23. Pneumonia 20 47 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 7 4 5 15 32 24. Bronchitis 32 25 ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 8 ... 7 9 13 16 25. Other diseases of the respiratory system 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 26. Ulcer of stomach and duodenum 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 3 1 27. Gastritis, enteritis and diairhoea 3 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 28. Nephritis and nephrosis 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 29. Hyperplasia of prostate 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 30. Pregnancy, childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital malformations 4 6 2 4 ... 2 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 32. Other defined and ill defined diseases 25 29 12 5 1 ... ... 1 1 1 2 3 2 6 6 11 33. Motor vehicle accidents 8 2 1 1 ... 2 1 ... 1 ... ... 1 ... ... 2 1 34. All other accidents 9 2 ... ... 1 ... ......... ... ... ... 2 1 ... 1 ... ... ... 3 ... 1 2 35. Suicide 2 3 ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 2 36. Homicide and operations of war ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total .. 418 446 14 12 3 3 2 2 2 1 4 6 12 11 34 19 90 63 126 99 131 230 22 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH Isolation Hospital Accommodation. Patients suffering from infectious disease are admitted to hospitals controlled by the Woolwich and Dartford Hospital Management Committees (S.E. Metropolitan Regional Hospital Board). General Hospitals. Provision made by S.E. Metropolitan Regional Hospital Board. AMBULANCE FACILITIES. The provision of these facilities now rests with the Kent County Council as Local Health Authority. NATIONAL ASSISTANCE ACT, 1948. Action taken under Section 47. During the year a number of cases of elderly persons not receiving proper care and attention (reported to the department) were visited. It was not necessary for action to be taken under the Act for removal of any persons to hospital. Action taken under Section 50. It was not necessary to arrange for any 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. During the year 236 bodies were admitted and 234 postmortem examinations were made; 24 inquests were held. 23 DISINFECTION AND DISINFESTATION SERVICE The joint scheme with the Erith and Crayford Councils for the disinfection of bedding following cases of Infectious Diseases and Cancer, and for the disinfestation of bedding of verminous persons was discontinued during 1961 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. A joint application by Bexley, Erith and Crayford Councils was successfully made to the Woolwich Borough Council for the use of their facilities and these arrangements have continued. 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 2 No. of patients provided for:— Maternity _ Others 36 Total 36 No. of Homes first registered during year No. of patients provided for:— Maternity Others — Total — No. of Homes on the Register at end of year 2 No. of patients provided for:— Maternity Others 36 Total 36 24 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. 1896 Private Street Works Act, 1892 Jan. 1899 Public Health Acts Amendment Act, 1907, Parts 8 and 9 Apr. 1909 Part 2—the whole May 1909 „ 6—the whole Public Health Act, 1925, Part 2 Jan. 1926 Slaughter of Animals Act, 1933 Jan. 1934 Byelaws. Wireless Loudspeakers, Gramophones, etc. Mar. 1939 Baths, Wash-houses, Swimming Baths and Bathing Places Aug. 1938 Parks and Pleasure Grounds May and 1939 1959 Defacing of Pavements Nov. 1939 Deposit of Litter to the Detriment of Public amenities „ Deposit of Dangerous Substances „ Organs „ Loitering at Church Doors „ Indecent Language, etc „ Noisy Hawking „ Touting ä Noisy Animals „ Nursing Homes June 1940 Sale of Contraceptives in Slot Machines Dec. 1949 Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air May 1950 Improper Behaviour on School Premises May 1951 The Flying of Model Aircraft Nov. 1951 Public Libraries Jan. 1953 Building Apr. and 1954 1961 Parking Places for Vehicles May 1960 Fouling by Dogs of Footways Oct. 1960 Unruly Behaviour in Places of Entertainment July 1961 25 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. There have been no specific cases of contamination and the waters are not liable to have plumbo-solvent action. No new sources of piped water supply were instituted in the Borough of Bexley during 1963 but 1,000 yards of 18 in. main were laid from Bexley pumping station to Park Hill Road. Furthermore, new service mains were laid to the extent of 4,212 yards. During the year 10 samples of water from piped supplies were taken and submitted to the Public Health Laboratory for bacteriological examination and all were found to be satisfactory. (ii) Drainage and Sewerage. New drainage and sewerage works were carried out during the year as follows:— Surface Water Sewer, Victoria Cottage. 170 yds. 48 in. Surface Water Sewer, East Wickham House. 240 yds. 24 in. There has been, in addition, considerable amount of sewers laid in connection with private housing development. Number of cesspools emptied, 7. The total number of emptyings, 22. 2. Rivers and Streams. One serious case of pollution of the River Shuttle by sewage occurred during the year, due to a blocked 15 in. foul sewer in Upton Road, Bexleyheath. This was dealt with by treating the watercourse with chloride of lime at various points, followed by a thorough flushing with water from Danson Park Lake. 26 CHIEF PUBLIC HEALTH INSPECTOR'S REPORT Health Department, 8, Brampton Road, Bexleyheath. To the Mayor, Aldermen and Councillors of the Borough of Bexley. Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting my Annual Report as Chief Public Health Inspector and Public Cleansing Officer to your Council for the year 1963. The report consists mainly of a tabulated record of work carried out by the Public Health Inspectors. 27 TABLE No. 1. Details of Inspection Work Carried Out. Inspections Re-inspections Houses inspected (all particulars recorded) 18 134 Houses inspected (defects only recorded) 127 788 Houses inspected (certificates of disrepair) 37 36 Houses inspected (improvement grants) 46 — Houses inspected (Housing Act, 1936, Overcrowding) 18 12 Houses inspected re Infectious Disease (including scabies) 175 105 Factories with mechanical power 199 16 Factories without mechanical power 35 6 Outworkers' premises 104 29 Other premises under the Act 3 — Bakehouses 91 21 Water Samples 19 2 Food and Drugs Act Samples 225 3 Dairies and distributors 34 — Ice Cream premises 289 114 Restaurants, etc 268 85 Fish premises 158 89 Meat Shops 304 107 Public Houses 65 10 Shops re unsound food 359 104 Other premises where food is prepared 1,545 143 Offensive accumulations 189 190 Stables 24 9 Keeping of Animals 38 27 Rats 242 96 Drains inspected 881 551 Drains tested (water, smoke or colour) 96 2 Dustbins 4 1 Verminous premises 22 54 Smoke observations 11 2 Tents, Vans and Sheds 5 8 Refuse Tips 130 24 Refuse Removal and Salvage 442 4 Conveniences 145 17 Pet Animals Act, 1951 37 10 Council House applicants 231 37 Shops Act, 1950 1,195 26 Employment of Young Persons Act, 1938 19 2 National Assistance Act, 1948—Sec. 47 4 6 Miscellaneous inspections 595 154 Clean Air Act, 1956 777 1,007 28 TABLE No. 2. Improvements effected and defective sanitary conditions remedied. Houses— No. Provided with sufficient w.c. accommodation 18 Provided with sufficient ashplace accomdation 2 Provided with sufficient water supply 14 Houses Improved Internally— Walls and ceilings repaired 49 Dampness in rooms remedied 45 Defective floors repaired 18 Ventilation of Rooms improved 28 Windows repaired 36 Stoves, fireplaces, etc. provided or repaired 12 Houses Improved Externally— Roofs repaired 21 Eaves gutters and down spouts fixed or repaired 32 Yards paved or repaired 3 Chimney stacks repaired 4 Walls repointed or repaired 7 Miscellaneous repairs 18 Drainage— Drains cleansed or repaired 808 New drains constructed 1 New gullies provided 3 Ventilation of drainage system improved 6 Inspection chambers built or repaired 9 Waste pipes provided or repaired 7 New sinks provided 3 Offensive accumulations removed 9 Nuisances from animals abated — Other nuisances abated 3 TABLE No. 3. Infectious Diseases. Cases removed to Isolation Hospitals 18 Houses visited including revisits 280 Rooms disinfected — Notices delivered to Education Authorities, etc. 1711 29 TABLE No. 4. Food Inspection. The following is a summary of unsound food surrendered and destroyed: Corned Beef lbs. 328 Tinned Ham „ 763 Cooked Ham „ 529½ Beef „ 2,880½ Pork „ 350 Lamb „ 47½ Poultry „ 38 Offal „ 787½ Bacon „ 136½ Rabbit „ 131½ Fish „ 126 Cheese „ 64½ Macaroni „ 11 Vegetables „ 672 Fruit „ 5,180 Fruit and Fruit Juices tins 171 Vegetables „ 71 Meat „ 98 Fish „ 17 Milk „ 8 Soups „ 7 Preserves „ 1 Cream „ 2 Fruit trays 148 Frozen Foods pkts. 1,855 Miscellaneous items 48 30 TABLE No. 5. Factories Act, 1937 and 1948. 1. Inspections for Purposes of Provisions as to Health. Including Inspections made by Public Health Inspectors. Premises. 1 Number of: Inspections. 2 Written Notices. 3 Prosecutions 4 Factories without mechanical power 35 — — Factories with mechanical power 290 1 — *Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) *Electrical Stations should be reckoned as factories. 3 — Total 328 1 — 2. Defects Found. Particulars. 1 Number of Defects. Number of Prosecution*. 6 Found. 2 Remedied. 3 Referred to H.M. Inspector. 4 Want of cleanliness (S.l) 3 3 — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) — — — — Sanitary Conveniences (S.7)— Insufficient 1 1 — — Unsuitable or defective 1 1 — — 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.) — — — — Total 5 5 — — 31 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. During the year a weekly collection was well maintained, and the bonus scheme continued to give good results in ensuring a regular 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, involving an average haul of 1½ miles to the disposal point. Salvage. Details of salvage sales for the financial year ended 31st March, 1964 are set out below. Tons cwts. qrs. £ s. d. Waste Paper 385 3 1 2,940 4 6 Textiles 5 0 2 62 8 0 Ferrous Metals 3 15 0 7 10 0 Miscellaneous 3 12 0 393 19 2 3,010 14 6 32 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. A number of bins were either withdrawn or resited during the year as a result of complaints. At the September meeting, the Health Committee decided as a matter of policy to withdraw all waste food bins from the streets, and the contractor was given notice to terminate his agreement with the Council. All street bins were finally removed on the 31st March, 1964. Public Conveniences. Public Conveniences for men and women are situated at the following sites:— Market Place, Bexleyheath (closed December, 1963). Townley Road, Bexleyheath. Brampton Road, Bexleyheath. Danson Park, Welling. (4 men's, 4 women's). 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). 33 ATMOSPHERIC POLLUTION. The Council is represented on the Thameside Advisory Committee for the Abatement of Atmospheric Pollution. By arrangement with this Committee a deposit gauge is installed on the roof of the Education Office in Brampton Road, Bexleyheath, and the following table gives the results obtained during 1963. TONS PER SQUARE MILE. MONTH Rainfall inches Total water insoluble matter Soluble in C.S.2. Ash Other combustible matter Total water soluble matter Calcium Chlorine Sulphates Total solids January 0.45 7.56 0.07 5.72 1.77 10.27 1.68 1.78 4.26 17.83 February 0.41 12.30 1.19 9.35 2.75 9.90 2.14 0.87 3.59 22.20 March 2.23 9.30 0.20 7.11 1.99 6.71 1 30 1.07 2.85 16.01 April 1.84 4.48 0.11 3.29 1.09 0.20 1.43 0.87 2.74 13.68 May 1.82 6.15 0.07 4.46 1.63 5.50 0.77 0.67 1.74 11.65 June 1.92 5.02 0.08 3.75 1.19 5.30 0.81 0.47 1.88 10.32 July 1.27 3.06 0.04 2.36 0.66 2.55 0.41 0.30 1.04 5.61 August 2.38 5.36 0.09 3.52 1.75 7.65 1.23 0.81 2.79 13.01 September 1.91 6.17 0.08 3.98 2.11 7.70 1.73 0.60 3.39 13.96 October 1.47 4.15 0.10 2.86 1.19 4.70 0.90 0.60 1.91 8.85 November 3.35 4.03 0.09 3.12 0.81 7.78 1.08 1.88 2.54 11.81 December 0.51 7.90 0.15 5.62 2.14 7.99 1.54 0.94 3.33 15.89 A Lead Peroxide instrument for estimating atmospheric Sulphur-dioxide is situate near the deposit gauge and the results for the year are set out below.— MONTH Area Exposed Weight of Ba SO4 Wt. of SO3 Collected Mg. of SO2/day Collected by 100 sq cm of Batch A Pb O2 (Louvered Cover) In Sample In Control Due to Exposure Sq. Cm. Mg. Mg. Mg. MS /100 sq. Cm./day January 95 347.6 3.0 344.6 4.01 3.61 February 95 288.4 3.2 285.2 3.68 3.31 March 95 67.6 1.2 66 4 0.77 0.69 April 95 144.0 0.5 143.5 1.73 1.56 May 95 127.4 0.6 126.8 1.35 1.22 June 95 63.6 0.6 63.0 0.84 0.76 July 95 76.6 1.1 75.5 0.88 0.79 August 95 68.4 1.0 67.4 0.76 0.68 September 100 103.0 1.0 102.0 1.21 1.09 October 100 112.4 3.8 108.6 1.20 1.08 November 95 99.2 1.0 98.2 1.14 1.03 December 100 221.2 1.2 220.0 2.52 2.27 34 A volumetric apparatus for the measurement of sulphur dioxide and smoke is installed at the Health Department, Brampton Road, and a summary of the results obtain is set out below. Concentration of Smoke and Sulphur Dioxide. Smoke Cone, mg/100 m3 Sulphur Dioxide Cone. p.p 100m Average Value Highest Value Lowest Value Average Value Highest Value Lowest Value January 85 250 14 230 669 77 February 34 91 10 260 560 127 March 70 236 10 123 443 34 April 73 188 12 143 499 28 May 42 106 12 90 223 31 June 22 65 4 73 312 13 July 17 38 6 63 197 13 August 17 62 4 56 195 15 September 49 136 12 98 301 25 October 72 155 22 95 272 21 November 103 383 20 112 517 18 December 177 488 27 264 648 25 Clean Air Act, 1956—Smoke Control Areas. The Borough of Bexley (No. 1) Smoke Control Order, came into operation on the 1st October, 1963. A few contraventions of the Order were observed during the first few weeks, but a visit and talk with the occupiers concerned had the desired result. During the year a survey of the second area was commenced. PREVENTION OF DAMAGE BY PESTS ACT, 1949. One full time Rodent Operative is employed by 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. 35 Details of surface infestations dealt with during the yeav are set out below. Number of Properties Inspected 525 Number of Inspections 2,219 Number of Infestations found: Rats—Major — Minor 221 Mice 42 Number of Properties Treated Rats Mice Local Authority's premises 4 — Dwelling Houses 223 29 Business Premises 14 14 PET ANIMALS ACT, 1951. Licences to keep pet shops were issued to 9 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, 1,221 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. 36 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 year. Samples of water are taken by this department monthly, during the time the pools are open and the results of bacteriological examinations have been satisfactory on all occasions. Verminous Premises. During the year 1 house was found to be infested with bed bugs and this was treated with satisfactory results. Infestations at other premises were dealt with as follows:— Ants 3, Fleas 4, Woodworm 1. Wasps. The destruction of wasps nests is undertaken by the Department and during the year 44 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. 37 SECTION D—HOUSING The following particulars relate to the houses owned by the Council on the various Estates at 1st April, 1964:— Houses Flats Welling— 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 492 Glenmore Road No. 1 115 Glenmore Road No. 2 84 Bexleyheath- Highland Road Estate and Pickford Road Estate 302 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 51 Bristow Road — 60 Upton Close 13 28 Fairfield Road — 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 234 S.D.A Houses 7 Houses Purchased 13 3,071 318 38 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) 145 (b) Number of inspections made for the purpose (including re-inspection) 1,067 (2) Number of dwelling houses to be in a state so dangerous or injurious to health as to be unfit for human habitation 18 (3) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 127 2. Remedy of Defects during the year without service of Formal Notice. Number of defective dwelling houses rendered fit in consequence of informal action 88 3. Action under Statutory Powers during the year. A. Proceedings under the Housing Act, 1957 Number of dwelling houses which were rendered fit after service of formal notices: (a) By owners — (b) By local authority in default of owners 2 B. Proceedings under Public Health Acts— Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 1 (b) By local authority in default of owners — C. Proceedings under Sections 16 and 17 of Housing Act, 1957— (1) Number of dwelling houses in respect of which Demolition Orders were made 15 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 38 (3) Number of houses in respect of which Closing Orders were made 2 D. Proceedings under Section 18 of the Housing Act, 1957— parts of buildings closed 1 Improvement Grants. Discretionary Standard Number of applications for improvement grants 23 53 Total amount of grants made £1,925 0 10 £3,599 17 7 Rent Act, 1957. Number of applications for certificates of disrepair 6 Number of decisions not to issue certificates 2 Number of decisions to issue certificates 4 (a) in respect of some but not all defects 3 (b) in respect of all defects 1 Number of undertakings given by landlords 3 Number of undertakings refused by the Local Authority — Number of Certificates issued 1 Applications by landlords for cancellation of certificates — Obections by tenants to cancellation of certificates — Decisions by Local Authority to cancel in spite of tenants' objection — Certificates cancelled — 39 SECTION E.—INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply. The milk retailed for consumption in the area is all pasteurised and bottled. No. of Distributors with Dairy Premises 4 No. of Distributors with Shop Premises 29 No. of Distributors from outside area 7 Licences granted by the Council under the Milk (Special Designation) Regulations, 1960 Dealers' Licences:— Pasteurised Milk 32 Tuberculin Tested Milk 35 Sterilised Milk 37 24 sample's of milk were forwarded to the Public Health Laboratory for the Methylene Blue and Phosphatase Tests. All were satisfactory. (b) Slaughterhouses. There are no slaughterhouses in the area, and the majority of the butchers obtain their supplies through Smithfield Market. 40 (c) Adulteration of Food. Food and Drugs Act, 1955. The following table summarises the 173 samples taken during the year. Tinned Meat 15 Meat Pies and Puddings 2 Sausages 5 Patent Medicines 3 Condiments, Sauces, Pickles, Spices, etc 33 Butter and Fats, Cooking Oil, etc. 9 Soups 6 Minerals and Cordials, etc. 7 Bread, Flour, Biscuits 2 Glace Cherries 1 Sweets and Confectionery 13 Pure Coffee, Coffee Extracts, Coffee and Chicory 7 Preserves 9 Cream 4 Pastes, Spreads, Potted Meat and Fish 9 Vegetables 7 Flavouring and Essences 4 Fruit, Fruit Juice 10 Condensed and Evaporated Milks 2 Baking Powder 1 Cheese 3 Jellies, Custard Powders, etc 5 Hamburgers 1 Tea 3 Rice Puddings, etc 6 Tinned Fish 4 Ground Almonds 1 Malt Drink 1 41 Legal Proceedings. Metal Screw in Bread—Fined £25 plus £5 5s. Od. Advocate's fee. Glass in Bread—Fined £10 plus £5 5s. Od. 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 46 Cafes and Restaurants 28 Greengrocers 46 Sweet Shops 66 General Provisions 80 Bakers and Confectioners 26 Wet and Fried Fish Shops 23 Public Houses 40 355 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 4 Floors, walls, ceilings, etc., repaired 27 Infestations dealt with 1 Rooms cleansed 29 Water Closet accommodation improved 7 Accumulation of refuse removed 4 Accommodation for storage of refuse improved 3 Washing accommodation improved 3 Drainage repaired or improved 5 Food storage accommodation improved 11 Yard cleansed or repaired 3 Sinks renewed — Other contraventions 3 Unsatisfactory equipment cleansed or renewed 1 28 samples of Ice Cream were submitted for examination under the Ice Cream (Heat Treatment) Regulations, 1947. All were satisfactory. 43 Registration of Premises under Food and Drugs Act, 1955. No. of premises registered for:— Manufacture and Sale of Ice Cream ... 2 Sale of Ice Cream 167 Preparation of Sausages, etc 50 SECTION F.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES Scarlet Fever. During the year 69 cases were notified as compared with 23 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 1 During the past 15 years the character of this disease has changed from one of considerable severity to one of extreme mildness. The acute stage is, nowadays, in most cases, short and unaccompanied by high pyrexia and complications are in most cases mild or completely absent. Scarlet fever can now be disregarded as an important cause of acute endocarditis and acute nephritis which, in the past, were frequently encountered. Diphtheria. No cases were notified during the year. The following figures on Diphtheria and Whooping Cough Immunisation and Smallpox and Poliomyelitis Vaccination have been supplied by the County Medical Officer:— 44 IMMUNISATION The following table shows the diphtheria immunisation and whooping cough immunisation figure for 1963 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 1963 702 Nil 689 1962 626 16 624 1961 23 542 22 1960 5 191 4 1959 5 118 5 1954-1958 9 741 6 1949-1953 2 9 Nil Total 1,372 1,617 1,350 POLIOMYELITIS VACCINATION The following table shows the number of injections given in the various groups during the year ended 31st December, 1963. Year of Birth 2nd Injections (Salk) 3rd Dose (Salk and Oral) 4th Dose (Salk and Oral) 3 Orals (Complete Course) 1963 4 1 – 267 1962 11 50 – 911 1961 2 94 – 99 1957-1960 1 60 – 61 1943-1956 — 53 – 38 1933-1942 1 27 – 35 School Children under 12 years – 1,107 – Others — 70 – 42 Total 19 355 1,107 1,453 SMALLPOX VACCINATION The following table shows the smallpox vaccination figures for 1963 based on the return submitted to the Ministry of Health. Primary Vaccination 1 Year Re-Vaccination School Age but Under 8 Years 286 4 Typhoid Fever and Paratyphoid Fever. There were no cases notified during the year. Puerperal Pyrexia. 12 cases were notified during the year, all of which were treated in hospital. Ophthalmia Neonatorum. No cases were notified during the year. Measles. 1,161 cases were notified during the year. 3 cases were treated in hospital. Whooping Cough. 33 cases were notified during the year. No cases were treated in hospital. Acute Poliomyelitis. No cases were notified during the year. Scabies. No cases were notified during the year. Food Poisoning. No cases were notified during the year. Malaria. No cases were notified during the ye.ar. Dysentery. 14 cases were notified during the year. 2 cases were treated in hospital. 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 1963 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 Hospita) Total Deaths. Smallpox – – – – – – – – – – – – – Scarlet Fever 69 — 1 3 1 7 53 2 2 – – — — Diphtheria — — — — — — — — — — – — — Puerperal Pyrexia 12 — — — — — — — 7 6 — 12 — Ophthalmia Neonatorum — — — — — — — — — — – — — Acute Paralytic Poliomyelitis — — — — — — — — — — – — — Acute Non-Paralytic Poliomyelitis – — — — — — – — — – – — — Pneumonia 3 — — — — — — — — 3 — — — Erysipelas 7 — — — — — — — — 7 — — — Food Poisoning — — — — — — — — — — — — — Dysentery 14 — — 1 — — 3 2 1 7 — 2 — Typhoid Fever — — — — — — — — — — — — — Paratyphoid Fever — — — — — — — — — — — — — Meningococcal Infection 1 — — — — — — — — 1 — — — Measles 1161 34 112 114 146 165 561 16 8 5 — 3 — Whooping Cough 33 3 4 2 6 3 13 1 — 1 — — — Scabies — — — — — — — — — — — — — Encephalitis 2 — — — — 1 — — — 1 — 1 — Malaria — — — — — — — — — — — — — Totals 1302 37 117 120 163 176 630 21 18 30 — 18 — TUBERCULOSIS. During the year 23 new cases were notified. Particulars relating to the same, and also to the deaths which occurred during 1963 are contained in the following table:— Age Period New Cases Deaths Respiratory Non Respiratory Respiratory Non Respiratory M. F. M. F. M. F. M. F. Under 5 — — — — — — — — 5—14 1 — — — — — — — 15—24 3 — 1 — — — — — 25—34 1 1 — 1 — — — — 35—44 1 1 — — — — — — 45—54 2 3 — — — — — — 55—64 3 — — — — 1 — — 65—74 2 1 — — 3 — — — 75 and over 2 — — — — — 1 1 Totals 15 6 1 1 3 1 1 1 There was 1 death from an un-notified case. 48 BOROUGH OF BEXLEY COMMITTEE FOR EDUCATION Annual Report on the School Health Service For the Year 1963 JOHN LANDON, m.r.c.s., l.r.c.p., d.p.h.. Medical Officer of Health EXCEPTED DISTRICT OF BEXLEY WELFARE AND SCHOOL ATTENDANCE SUB-COMMITTEE Chairman: Alderman Mrs. E. Sheppard. Vice-Chairman: Miss M. Woodward, L.L.A., L.G.S.M.(Eloc.) Alderman John Cronin. Councillor F. Brearley. Councillor B. E. Francis. Councillor Mrs. M. P. Monk. Councillor S. H. Philpot. Councillor M. F Townsend. Councillor W. P. Webster. Co-opted Members: Revd. E. Maynard Wilson. Rev. Canon C. E. Youngman, M.A. Borough Education Officer W. E D. Stephens, M.A., Ph.D. Deputy Borough Education Officer R. R. Sutton. 50 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). (Resigned 10.7.63). Sybil R. Yeates, M.B., B.S., M.R.C.S., L.R.C.P. Dorothy F. Bate, M.B., Ch.B., D.C.H., D.(obs.) R.C.O.G. May B. Edge, M B., Ch.B., D.P.H Josephine C. Parker, M.B., Ch.B., M.R.C.S., L.R.C.P. (Appointed 9.9.63). Ophthalmic Surgeon Roland M. Chambers, M.B., B.S.. D.O.M.S. Dental Officers Mrs. A. B. Perkins, L.D.S., R.F.P.S. (Glas.). Mrs. E. A. Williams, B.D.S., L.D.S (Four sessions weekly). (Resigned 9.4.63). Mr. K. H. Friend, L.D.S. (Appointed 17.6.63). Dental Officers (continued): Dr. W. G. S. Neely, L.D.S. (Five sessions weekly). Mr. E. Seal, B.D.S., L.D.S., R.C.S. (Four sessions weekly). Miss C. Croome, Dental Ancillary. Health Visitors Miss B. Hart, S.R.N., S.C.M., and Health Visitor's Certificate (Parttime). 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). Physiotherapists Miss R. Cheeseman, M.C.S.P. (Resigned 31.12.63). Mrs. Tyler, M.C.S.P. (Appointed 31.12.63). Mrs. I. O. M. Poynder, C.S.P. Speech Therapists Mrs. E. Rollo, L.C.S.T. Mrs. R. Goodwins, L.C.S.T. Dental Attendants Miss K. Dunkley. Mrs. V. Sproul. Miss J. A. Smith — Hygienist. School Health Service Clerk Miss O. G. Turnbull. General Clerks Miss E. Turner. Mrs. D. Starling Miss P. M. Phillips. (Resigned 22.11.63). 51 REPORT ON THE SCHOOL HEALTH SERVICE DURING THE YEAR 1963 To the Chairman and Members of the Welfare and School Attendance Sub-Committee. Madam Chairman, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1963. The health of the schoolchildren has, generally speaking, been satisfactory and there were no serious epidemics during the year. Children of all ages are, nowadays, bigger than they were at the beginning of the century and are maturing physically and psychologically at a faster rate. Better nutrition is, probably, the main factor in this change as well as the greater opportunities for social development afforded by the " affluent society but there may also be more subtle genetic influences at work of which less is known. This earlier maturation and altered pattern of society bring with them their own problems of adjustment so that" perhaps more than ever, the period of adolescence is proving itself, for many, a time of special difficulty requiring sympathetic help and understanding. The School Health Service continued, during 1963, to provide a full range of services and reference to the statistical tables at the end of this report gives an indication of the work which has been carried out. Statistics can, however, be rather impersonal especially when concerned with the needs of human beings and one must read between the lines, as it were, to appreciate what the figures represent in terms of care and solicitude as applied to the school population by many agencies Especially is this true in the case of handicapped children. Everything possible is done to ensure that these children get the kind of education or training which will develop their actual or latent capabilities and which will, as far as possible, fit them for life among " normal " people. The whole trend in the health and welfare services, at the present time, is towards the acceptance by the community 52 of greater responsibility for the care of the handicapped and the School Health Service has a particularly important part to play in this process in that decisions taken during the early formative years profoundly influence the future lives of these children. Although day and residential special schools will always be necessary for some handicapped children the emphasis is changing in favour of special units integrated into ordinary schools. In this way children with handicaps will mix more with other children and their adaptation to. normal community life will be made much easier later on. Although it is natural to stress the work done for handicapped children the " bread and butter " jobs must not be taken too much for granted. Part I of the Tables provides interesting information in regard to the general health supervision of the 12,000 schoolchildren in the Borough. It will be noted that not less than 6,083 were examined by school medical officers during the year. In addition 1,910 reinspections were made of children previously seen. Part II gives an account of the defects found at these inspections and provides the justification for the considerable amount of time devoted to periodic medical inspections. Many of these defects would not have been discovered were it not for these examinations, particularly those relating to vision, hearing and orthopaedic defects, and could well have interfered materially with educational progress. Early psychological defects can be discussed with parents and teachers at a stage when simple adjustments of attitudes and environment is all that is necessary to restore stability. Although the School Health Service is very interested in manifest disease (and here it works in close collaboration with the family doctors) its aim has always been to watch for early deviations from health and by correcting them prevent the onset of more serious illness. It is this preventive outlook which gives it its special place among the health services. It is appropriate, at this stage, to recall that it is 17 years since the Borough of Bexley assumed responsibility for the local administration of the School Health Service in view of the fact that the Bexley Education (Divisional Administration) Scheme, 1945, under which the delegation from the Kent Education Committee was made, will come to an end on April 1st, 1965 when the new London Borough of Bexley will become an autonomous Education authority. From the point of view of the School Health Service this has proved 53 a pleasant and happy arrangement and I wish to place on record my appreciation of the help which we have received in such large measure from Dr. Elliott, the Principal School Medical Officer, and members of his Staff. The extension of the School Health Service to cover whole of the area of the London Borough of Bexley on a self-governing basis will be made all the easier by this long and valuable association. 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 Turnbull, the Senior Clerk, and from the Borough Education Officer and his Department. I am, Madam Chairman, Ladies and Gentlemen, Your obedient servant, JOHN LANDON, Medical Officer of Health. 54 KENT EDUCATION COMMITTEE EXCEPTED DISTRICT OF BEXLEY Schools. (Average number on Roll at 31st December, 1963) Bexley Grammar School 637 Bexley County Technical School for Girls 759 Bexley & Erith Technical School for Boys 552 Seven County Secondary Schools 3,402 Twenty-four County Primary Schools 6,874 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, 9.30-11 a.m. Friday, 1.30-3.30 p.m. Doctor m attendance—Friday. 55 Dental. Welling—Little Danson, Dansington Road. Daily—9.30-11 a.m., 2-4 p.m. Bexleyheath—315, Broadway. Monday and Thursday, 9.30-11 a.m. Daily—2-4 p.m. Bexley—Murchison Avenue. Tuesday and Thursday, 9.30-11 a.m., 2-4 p.m. Specialist's Clinics. Ophthalmic. Welling—Little Danson, Dansington Road. Monday 9.30-11.30 a.m. Thursday 1.30-3 p.m. Friday 9.30-11.30 a.m., 1.30-3.30 p.m. Orthopaedic (Physiotherapist Clinic). Welling—Station Approach. Tuesday morning 9.30-12.30 a.m. Friday afternoon 1.30-4.30 p.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. Clinics held daily. Appointments made through County Medical Officer by the Borough Medical Officer of Health. 56 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 67 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 Service Average number of pupils taking meals daily:— Primary Schools Secondary Schools Payment 2,915 3,605 Free 52 61 2,967 3,666 Milk. Average number of pupils taking milk daily:— Primary 6,068 Secondary 3,425 9,493 57 School Dental Service. The following reports have been received from the School Dental Surgeons:— Mrs. A. Perkins, L.D.S., Danson Clinic, Welling. During 1963 the clinic ran smoothly. We now have in addition to a full time Dental Officer, a Dental Ancillary for one day per week, a Dental Hygienist for one day a week and an Orthodontist once per month. All the schools were inspected during the year and those children requiring treatment offered same. The number inspected in schools was 5,004 and those requiring treatment numbered 3,337, i.e., 66%. Much useful work in dental health education has been carried out during the year. Orthopaedic Clinics. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report:— The Orthopaedic Clinics have continued throughout the year, but the fall in numbers that has been noticed now for several years has continued. It has, therefore, now been decided to continue the physiotherapy at the Welling Clinic, but to transfer the Surgeon's sessions to the Out Patient Department at West Hill Hospital, Dartford, where there are all the necessary facilities for x-ray and other investigations. During the past year Miss Cheeseman left us after fourteen years' service as physiotherapist and Mrs. Tyler has taken her place. I would like to take this opportunity of thanking Miss Cheeseman for all the care she has taken of the many children who have passed through her hands in these years. And to Mr. B. Lawson, F.R.C.S., for the following:— There has been no great change in the general pattern of patients seen at the Murchison Avenue Clinic during 1963. Generally about 150 children of school age were seen and about an equal proportion of children below this age were referred from the Health Clinic or by the home doctors; a rather larger number were referred by the home doctors than previously. Of the school age children there were 32 new cases; 17 were referred for x-rays, 20 had minor shoe adjustments, 9 were operated on and 25 were discharged during the year. The smooth running of the Clinic is largely due to the co-operation of the Physiotherapist, Mrs. Poynder and the other associated workers. 58 Ophthalmic Clinic I am indebted to Mr. R. M. Chambers, M.B., B.S., D.O.M.S., for the following report:— Cases seen at Little Danson Clinic other than refractive errors during 1963. Congenital. Ptosis 2 Nystagmus 3 Lens opacities 4 Albinism 1 Acquired. Constitutional Migraine 20 Retinitis Pigmentosa 1 Retinal Detachment 1 Infective Blepharitis 8 Conjunctivitis 10 Sty 7 Others. Optic Atrophy 1 Sinusitis 6 Cases referred to hospital 30 Number of appointments kept 2,171 Prescriptions for Spectacles 760 New Cases 389 Child Guidance Clinic Number of children referred during 1963. 1962 1963 Boys Girls Total Boys Girls Total Under 5 — 1 1 1 — 1 5—7 7 3 10 3 — 3 8—10 7 4 11 5 — 5 11 and over 4 11 15 5 2 7 18 19 37 14 2 16 59 Speech Therapy. I am indebted to Miss Joan Pollitt, Senior Speech Therapist to the Kent Education Committee for the following report: Sixty-six children attending Bexley Schools have beeq, dealt with within the County Speech Therapy Clinics during the year. The cases of thirty-four of these children have been closed during the year, and thirty-two will continue to attend into 1964. Of the thirty-four closed cases, twenty-one have been dealt with at the Murchison Avenue Clinic, twelve at the Woodside Road Clinic, and one at the Sidcup Clinic. Reasons for Closure: Satisfactory progress 20 Treatment incomplete—family left district or treatment incomplete for other reasons 7 Found to be improved when first seen 5 Reported improved 1 Appointments offered but never kept 1 34 Twenty of the thirty-two children attending Bexley Schools who will continue to attend in 1964 are being seen at the Murchison Avenue Clinic, ten are being seen at the Woodside Road Clinic, and two are being seen at the Sidcup Clinic. Fifty-nine children attending Bexley Schools were on the waiting lists at the end of 1963, forty-one await appointments at Woodside Road, and eight await appointments at the Murchison Avenue Clinic. Mrs. Rollo has continued to work at the Murchison Avenue and Woodside Road Clinics; Miss Formby sees children at the Woodside Road Clinic and Mrs. Goodwins at the Murchison Avenue and Sidcup Clinics. Children who do NOT attend Bexley Schools are in contact with the Murchison Avenue and Woodside Road clinics as follows:— Clinic Closed during 1963 Continuing to attend into 1964 On waiting lists Woodside Road 39 38 127 Murchison Avenue 1 10 11 60 Sweep Frequency Pure Tone Audiometry. During 1963, 1,096 children were tested during their last year in the Infants' School, i.e., during their seventh year. Of this number 977 passed and 119 failed. The latter children were referred to the School Medical Officers for investigation and any minor conditions causing temporary deafness were treated. Others were referred to Hospital. In addition 116 children of all age groups were tested as special cases referred from various sources including teachers, and of this number 62 passed and 54 failed. The 116 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 173 failed children were referred back to the School Medical Officers for further examination and treatment. Lastly, 222 children attended for a final audiometric test and this number included children seen in 1962 who had been referred by the School Medical Officers for a final test in 6 to 12 months time. Of these 222 children, 87 passed and 135 failed. Further treatment was instituted for the latter children either at the School Clinics or at the Ear, Nose and Throat Department of the West Hill Hospital, Dartford, or other Hospitals in the metropolis. Cleanliness Inspections. (See Table D). A feature of the health of schoolchildren in the Borough for many years has been the exceptionally low rate of infestation of schoolchildren with vermin. This is now being recognised by a substantial reduction in the number of school inspections by Health Visitors for this purpose. Cleanliness inspections are now carried out in secondary schools only when they are requested by head teachers. In primary schools regular cleanliness inspections have been discontinued where, at three consecutive inspections, no cases of uncleanliness have been found but further inspections are made if requested by the head teacher or it appears that special circumstances warrant an intensification of this work. 61 PHYSICAL EDUCATION I am indebted to the Physical Education Advisers, Mr. J. Hopkins and Miss E. A. Osgathorp for the following report:— The selection tests, G.C.E., College of Preceptors and R.S.A. examinations have, in recent years, been given so much publicity that some school timetables in the County have become overweighted with examination subjects. Fortunately most of the Headteachers in the Borough of Bexley believe that to educate a child in the widest sense, time must be found for artistic, creative, and physical activities. In spite of having very limited time at their disposal, the teachers concerned have worked to develop skill in gymnastics, dance, games, athletics and swimming. At infant, junior and secondary school levels a good standard has been maintained, and Upton Primary School was one of six schools who contributed to a film on Junior Gymnastics in Kent schools. Most of the infant, primary and secondary girls' schools realise the importance of creative physical activity and modern educational dance forms an imporant part of the physical education programme. Some interesting work takes place in the Borough and many schools are helped by the services of a gifted accompanist. Many schools are attempting to offer the older secondary children a bridge from school to adult clubs by introducing recreative club activities into the curriculum. The choice ranges widely from sailing and canoeing, to fencing, archery, badminton and table tennis. This policy is commendable. It involves a great deal of extra work on behalf of the staff particularly out of school hours. The willingness of some of the Borough's teachers to undertake this voluntary work is appreciated. In particular Westwood Secondary School and Bexley Technical High School for Girls should be congratulated on the liberal programme they offer to their pupils. All these activities require apparatus and equipment and the Borough has been very generous in its provision. Suitable dress for the children taking part is essential— clothing in which the body can breathe freely and move without restriction, and most parents are co-operative and 62 sensible in what they provide. Where conditions are suitable many schools encourage the children to work in bare feet. The freedom of movement develops strong muscles and may help in some measure to enable the feet of the young to resist the misshapening effects of fashionable shoes. The physical education advisers have continued to visit the schools to give help to teachers. Within easy reach of the Borough, courses have been run in swimming, junior gymnastics, trampolining, keep fit, infant dance, netball and junior netball. Notices of courses run by the C.C.P.R. and other organisations have been circulated. In conclusion the constant encouragement and help received by the advisers from the Borough Education Officer and his staff is much appreciated and valued. 63 SCHOOL HEALTH SERVICES. Statistical Tables. Part 1 — Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. Table A. Periodic Medical Inspections. B. Pupils found to require treatment. C. Other Inspections. D. Infestation with Vermin. Part II — Return of Defects found by Medical Inspection. Table A. Periodic Inspections. „ B. Special Inspections. Part III — Treatment Tables. Table A. Eye Diseases, Defective Vision and Squint. B. Diseases and Defects of Ear, Nose and Throat. C. Orthopaedic and Postural Defects. „ D. Diseases of the Skin. „ E. Other Treatment given. Part IV — Dental Inspection and Treatment including Orthodontics. Part V — Handicapped Children. 64 PART I. Medical Inspection of Pupils Attending Maintained and Assisted Primary and Secondary Schools. A.—Periodic Medical Inspections. Age Groups Inspected (By years of birth) Number of Pupils Inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory No. % of Col. (2) No. % of Col. (2) (1) (2) (3) (4) (5) (6) 1959 4 later 16 15 93.75 1 6.25 1958 372 372 100 — — 1957 583 583 100 — — 1956 325 325 100 — 1955 463 461 99.568 2 .432 1954 277 276 99.639 1 .361 1953 118 118 100 — — 1952 545 545 100 — — 1951 382 382 100 — — 1950 117 115 98.29 2 1.71 1949 180 180 100 — — 1948 & earlier 1216 1216 100 — — Total 4594 4588 99.87 6 .13 65 B.—Pupils Found to Require Treatment at Periodic Medical Inspections. Age Groups Inspected (by year of birth) (1) For defective vision (excluding squint) (2) For any of the other conditions recorded in Part II (3) Total individual pupils (4) 1959 & later 1 1 1 1958 22 43 53 1957 39 76 103 1956 25 40 58 1955 59 68 109 1954 43 43 69 1953 15 16 27 1952 86 70 133 1951 71 79 126 1950 17 23 32 1949 55 28 71 1948 & earlier 236 227 386 Total 669 714 1168 C.—Other Inspections. Number of Special Inspections 1,489 Number of re-Inspections 1,910 Total 3,399 D.—Infestation with Vermin. (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 6,638 (b) Total number of individual pupils found to be infested 39 (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) — 66 L9 PART II.—Return of Defects Found by Medical Inspection in the Year Defect Code No. Defect or Disease A. PERIODIC INSPECTIONS B. SPECIAL INSPECTIONS Entrants Leavers Others TOTAL Requiring Treatment Requiring Observatlon Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation Requiring Treatment Requiring Observation 4. Skin 20 48 105 103 84 118 209 269 45 12 5. Eyes— a. Vision 59 97 228 49 329 150 616 296 33 21 b. Squint 15 15 5 8 32 26 52 49 1 2 c. Other 3 11 8 13 42 19 53 43 6 4 6. Ears— a. Hearing 9 77 8 25 20 108 37 210 23 87 b. Ottis media 4 40 4 30 7 56 15 126 3 2 c. Other 12 13 21 10 32 32 65 55 9 2 7. Nose and Throat 18 227 17 123 24 337 59 687 48 52 8. Speech 4 30 — 14 4 53 8 97 13 11 9. Lymphatic Glands 4 159 — 30 2 214 6 403 — — 10. Heart 1 24 1 21 1 55 3 100 2 25 11. Lungs 4 97 7 65 14 128 25 290 8 36 12. Developmental— a. Hernia 5 17 — — 3 28 8 45 3 1 b. Other 1 35 1 11 to 56 12 102 5 15 13. Orthopaedic— a. Posture 1 30 11 73 29 133 41 236 — 4 b. Feet 11 60 2 46 30 169 43 275 3 6 c. Other 7 80 28 172 29 207 64 459 6 22 14. Nervous System— a. Epilepsy — 6 1 3 3 16 4 25 1 9 b. Other — 2 3 3 1 20 4 25 3 5 15. Psychological— a. Development — 10 — 14 1 90 1 114 21 87 b. Stability 1 70 — 49 8 233 9 352 30 95 16. Abdomen — 11 5 14 5 57 10 82 5 13 17. Other 3 24 8 75 28 101 39 200 45 118 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 250 Errors of refraction (including squint) 1,921 Total 2,171 Number of pupils for whom spectacles were prescribed 760 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 3 (b) for adenoids and chronic tonsilitis 123 (c) for other nose and throat conditions 6 Received other forms of treatment 153 Total 285 Total number of pupils in schools who are known to have been provided with hearing aids (a) in 1963 6 (b) in previous years 22 C—Orthopaedic and Postural Defects. ts. Number of cases known to have been treated (a) Pupils treated at clinics or out-patients departments 221 (b) Pupils treated at school for postural defects — Total 221 68 D.—Diseases of the Skin. Number of cases known to have been treated Ringworm— Scalp — Body — Scabies — Impetigo — Other skin diseases 48 Total 48 E.—Other Treatment Given. Number of cases known to have been dealt with (a) Pupils with minor ailments 642 (b) Pupils who received convalescent treatment under School Health Service arrangements (c) Pupils who received B.C.G. vaccination 820 (d) Other than (a), (b) and (c) above — Total (a)—(d) 1,462 69 PART IV—Dental Inspection and Treatment (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic inspections 9,003 (b) Specials 498 Total (1) 9,501 (2) Number found to require treatment 5,174 (3) Number offered treatment 4,848 (4) Number actually treated 1,824 (5) Attendances made by pupils for treatment, including those recorded at heading 11(h) below 6,319 (6) Half days devoted to: Inspection 52 Treatment 1,101 Total (6) 1,753 (7) Fillings: Permanent Teeth 3,388 Temporary Teeth 1,000 Total (7) 4,388 (8) Number of teeth filled: Permanent Teeth 2,977 Temporary Teeth 932 Total (8) 3,909 (9) Extractions: Permanent Teeth 179 Temporary Teeth 792 Total (9) 971 (10) Administration of general anaesthetics for extraction 390 (11) Orthodontics: (a) Cases commenced during the year 33 (b) Cases carried forward from previous year 74 (c) Cases completed during the year 22 (d) Cases discontinued during the year 34 (e) Pupils treated with appliances 40 (f) Removable appliances fitted 46 (g) Fixed appliances fitted 1 (h) Total attendances 435 (12) Number of pupils supplied with artificial dentures 13 70 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 puplis were newly assessed as needing special educational treatment at special schools or in boarding homes — 2 2 — 3 5 7 10 — — 29 B. (i) of the children at A. how many were newly placed in special schools (other than hospital special schools) or boarding homes — 1 2 — 1 5 2 7 — — 18 (ii) of the children assessed prior to 1-1-1963, how many were newly placed in special schools (other than hospital special schools) or boarding homes — — 1 — — 3 4 — — — 8 Total (B) — I 3 — 1 8 6 7 — — 26 On or about 20-1-1964, how many handicapped puplis from Authority's area: C. (i) were requiring places in special schools:- TOTAL (a) day — — — — — — — 2 — — 2 (b) boarding — — — — — — 5 — — — 5 (ii) included at (i) had not reached the age of 5 and were awaiting: (a) day places — — — — — — — — — — — (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 schools, were awaiting: (a) day places — — — — — — — — — — — (b) boarding places — — — — — — — — — — — 71  (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) D. (i) were on the registers of: (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 1. maintained special schools as: "(I (a) day pupils — 7 2 1 5 I — 34 — — 50 (b) boarding pupils — — 1 — 5 8 — 6 — — 20 2. non-maintained special schools as: (a) day pupils — — — — — — — — — — — (b) boarding pupils 2 — — 3 1 3 2 — — — 11 (ii) were on the registers of independent schools under arrangements made by the Authority — — 1 1 — 2 19 1 — — 24 (iii) were boarded in homes and not already included under (i) or (ii) — — — — — — — — — — — Total (D) 2 7 4 5 11 14 21 41 — — 105 E. On or about 20-1-1964, 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) — — — — — — — — — — — (iii) At home — — — — — — — — — — 5 During the calendar year ended 31-12-63: (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 72 INDEX. ITEM PAGE Health Committee 2 Public Health Staff 3 Foreword 4-9 STATISTICS AND SOCIAL CONDITIONS. Acreage 10 Population 10 New Houses Erected 10 Unemployment 10 Social Conditions and Amenities 10—11 Population Graph 12 Summary of Vital Statistics 13—14 Extracts from Vital Statistics— Births and Birth Rates 14—15 Stillbirths and Stillbirth Rates 15 Total Live and Still Births 15 Infant Deaths and Death Rates 16—17 Maternal Deaths 18 Death All causes 18—20 Causes of Death in Age Groups 21 GENERAL PROVISIONS OF HEALTH SERVICES. Isolation Hospital Accommodation 22 General Hospitals 22 Ambulance Facilities 22 National Assistance Act, 1948 22 Public Mortuary 22 Disinfection and Disinfestation Service 23 Laboratory Facilities 23 Registration of Nursing Homes 23 SANITARY CIRCUMSTANCES OF THE BOROUGH. Adoptive Acts and Byelaws 24 Water Supply 25 Drainage and Sewerage 25 Rivers and Streams 25 Chief Public Health Inspector's Report— Tables of Inspections and Improvements, etc. 27—28 Food Inspection 29 Tables—Factories Act, 1937 and 1948 30 Public Cleansing Service 31 Refuse Collection and Disposal 31 Salvage 31 Kitchen Waste 32 Public Conveniences 32 Atmospheric Pollution 33—34 Clean Air Act, 1956 Smoke Control Area 34 Prevention of Damage by Pests Act, 1949 34—35 Pet Animals Act, 1951 35 Shops Act. 1950 35 Swimming Pool 36 Verminous Premises 36 Wasp Destruction 36 Schools 36 73 ITEM PAGE HOUSING. Council Estates 37 Inspection of Dwelling Houses 38 Remedy of Defects without formal notice 38 Action under Statutory Powers 38 Improvement Grants 39 Rent Act, 1957 39 INSPECTION AND SUPERVISION OF FOOD. Milk Supply 40 Slaughterhouses 40 Adulteration of Food—Food & Drugs Act, 1955 41—42 Food Shops and Food Manufacturing Premises 42 Food Hygiene Regulations, 1960 43 Registration of Premises 43 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASE. Scarlet Fever 44 Diphtheria 44 Diphtheria and Whooping Cough Immunisation, 45—46 Smallpox and Poliomyelitis Vaccination Typhoid Fever and Para Typhoid Fever 46 Puerperal Pyrexia 46 Ophthalmia Neonatorum 46 Measles 46 Whooping Cough 46 Acute Poliomyelitis 46 Scabies 46 Food Poisoning 46 Malaria 46 Dysentery 46 Tables of Infectious Diseases Notified 47 Tuberculosis 48 SCHOOL HEALTH SERVICES REPORT, 1961. Welfare and School Attendance Sub-Committee 50 Staff 50—51 Foreword 52—54 Schools 55 Clinics 55—56 Co-ordination— Periodic Medical Inspections 57 School Meals Service 57 School Dental Service 58 Orthopaedic Clinic 58 Ophthalmic Clinic 59 Child Guidance Clinic 59 Speech Therapy 60 Sweep Frequency Pure Tone Audiometry 61 Cleanliness Inspections 61 Physical Education 62—63 Statistical Tables 64—72 74