BEC 3 Urban District of Beckenham. REPORT on the HEALTH of the DISTRICT DURING 1922, including the Report of the Medical Inspection of Children in the Elementary Schools by J. M. CLEMENTS, M.D., D.P.H., Medical Officer of Health. School Medical Officer. Urban District of Beckenham. 1922. GENERAL PURPOSES COMMITTEE. Chairman A. J. WINCH. Vice-Chairman Dr. G. ELAM. s. Baylis. H. W. Beavis. John A. Bennett. Dr. J. H. Bennett c. Blake, J.p. C. A. Campbell. F. J. Clark. c. J. L. Clarke. J. A. collister. T. C. Cole. J. Crease. A. H. Dykes, J. P. C. A. Elgood A. R. Layman. J. O. Murgatroyd. J. P. Smith Mrs. A. Webb. F. W. Gedney, Clerk of the Council. EDUCATION COMMITTEE. Chairman Sir R. MURRAY HYSLOP, J.P. Vice-Chairman Miss VIAN. S. Baylis J. A. Bennett. C'has. Blake, J.P. Mrs. Brazil, B.A. C. A. Campbell. C. J. L. Clarke. T. C. Cole J. A. Collister. J. Crease C. A. Elgood. Mrs. M. E. De R. Epps. The Rev. R. S. Fleming, M.A. R. Henderson, C.B. T. Lyle, M.A. F. W. Payne, J.P. R. M. H. Randell, M.D. Sir Geo. Sutton, Bart. Mrs. A. Webb A. J. Winch. J. R. Hambridge, Secretary. OFFICIALS OF THE HEALTH DEPARTMENT. Medical Officer of Health J. M. Clements, M.D., D.P.H. Sanitary Inspector E. G. Moore, M.S.I.A., A.R.S.I. Assistant „ R. V. Jacob, A.R.S.I., M.I.S.E. Health Visitors Miss M. A. Cusack, A.R.S.I., C.M.B. Miss M. E. Chapple, A.R.S.I., C.M.B. School Dentist R. Waters, L.D.S., R.C.S. Dental Nurse Mrs. A. E. Page Clerks Miss G. Slattery S. W. Collett. A. S. Evans. 5 To the Chairman and Members of the General Purposes Committee. Mrs. Webb and Gentlemen, I beg to submit my Annual Report for the Year 1922. The Report this year differs in its arrangement and is much shorter than previous Reports. This change is in accordance with the instructions issued by the Ministry of Health in Circular 359. The Ministry, in the above-mentioned Circular require that annual reports on public health matters shall consist of what are called "ordinary reports for four years, and every fifth year of a "survey" report. Ordinary reports will be "of a more simple character." The Quinquennial Reports will be more full and detailed, and will review the progress of the preceding five years. In this way unnecessary repetition from year to year will be avoided and at the same time all essential matters affecting the Public Health will be given due consideration. I have the honour to be, Your obedient Servant, J. M. CLEMENTS. 6 GENERAL STATISTICS. Area (acres) 3883 Population (as estimated by Registrar-General in June, 1922) 33160 Number of inhabited houses 7432 Rateable Value £267,350 Sum represented by a Penny Rate £1,075 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births. Total. Males. Female. Birth Rate. Illegitimate 20 12 8 16.0 Legitimate 512 261 251 Deaths.—355. Death Rate, 10.7. Number of women dying in or in consequence of child birth:—from Sepsis, Nil; from other causes, Nil. Deaths of infants under one year of age per 1,000 births: Legitimate, 54.6; Illegitimate, 50; total, 54.5. Deaths from Measles (all ages) 3 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) Nil BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1922. Birth Rate per 1000 Total Population. Annual Death Rate per 1000 Civilian Population. Rate per 1000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping-cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. Deaths in Public Institutions. Certified Cause of Death. Inquest Cases. Uncertified Causes of Death. England and Wales 20.6 12.9 0.01 0.00 0.15 0.04 0.11 0.54 0.54 0.44 6.2 77 25.6 92.7 6.2 1.1 County Boroughs and 105 Great Towns, including London 21.4 13.0 0.01 0.00 0.22 0.05 0.19 0.13 0.56 0.41 7.6 82 32.9 92.6 6.7 0.7 155 Smaller Towns (1921 adjusted Populations 20,000 to 50,000) 20.5 11.7 0.01 0.00 0.10 0.03 0.15 0.09 0.58 0.35 5.6 75 16.9 93.6 5.1 1.3 London 21.0 13.4 0.01 ... 0.35 0.07 0.25 0.25 0.57 0.45 7.1 74 48.7 92.1 7.8 0.1 BECKENHAM 16.0 10.7 0.00 0.00 0.09 0.00 0.06 0.09 0.84 0.24 00.0 54 16.0 96.6 3.1 0.3 8 HEALTH VISITOR'S REPORT FOR 1922. Births notified 612 Not notified 23 635 No. of Still Births (6 out-ward transfers) 16 Doctors' Cases 415 Midwives 197 Not notified 23 First visits to children under 1 year 450 Total visits to children under 1 year 1541 Total visits to children over 1 year 1250 First visits to expectant mothers 141 Total visits to expectant mothers 165 Individual children who attended Centre 446 Total attendances of children at Centre 2976 Individual expectant mothers who attended Centre 136 Total attendances of expectant mothers at Centre 208 New cases admitted to Centre Roll 280 Attendances at Office, apart from Baby Clinic 1261 Average attendances of children at Centre 60 Infant Deaths.—Of the 29 Infant deaths registered in Beckenham during the year only three were on the Centre Roll, three were "in-ward transfer " deaths, and 13 belonged to better class homes , which are not visited by the Health Visitor. Ten deaths occurred within one week of birth. Free Milk.—During the financial year £123 was expended in supplying cow's milk or dried milk foods to mothers and babies attending the Infant Welfare Centre. Sale of Dried Milk Foods.—£200 worth of Dried Milks were sold during the year to mothers and babies on the Centre Roll. 9 ANNUAL STATISTICS RELATING TO MATERNITY HOSPITALS AND HOMES FOR THE YEAR 1922. Name of Institution: Joint Maternity Home. Address: 80, Croydon Road, Beckenham. Information Required. Particulars. 1. Total number of cases admitted 183 (Births 181, Miscarriage 1, (non-viable). One baby born in 1923. Mother admitted in 1922. 2. Average duration of stay days. 3. Number of cases delivered by (a) Midwives; (b) Doctors) (a) 128; (b) 54. 4. Number of cases in which medical assistance was sought by the midwife, with reasons for requiring assistance. (a) Ante-natal (b) During Labour. (c) After Labour. (d) For Infant. Total 22. (a) 5:— 2 Small pelves. 1 Hydramnios. 1 Albuminuria and oedema. 1 Endocarditis. (b) 11:— 7 Forceps. 2 Extended breech. 2 Transverse presentation. (c) 4:- 2 Lacerated perineum. 1 Post part-hæmorrhage. 1 Pyrexia. (d) 2:- 1 Congenital heart. 1 Prematurity-cyanosis. 5. Number of cases notified as puerperal sepsis, with result of treatment in each case 1 (a case of slight saprsemia). 6. Number of cases in which temperature rose above 100.4 for 24 hours, with rise of pulse rate 5 — 1. Abscess of breast. 1 Suffering from tonsilitis on admission. 1 Saprsemia. 1 Antenatal endocarditis. 1 Cause unknown. 10 Information Required. Particulars. 7. Number of cases notified as ophthalmia neonatorum, with result of treatment in each case Nil. 8. Number of cases of "inflammation of the eyes," however slight Nil. 9. Number of infants not entirely breast-fed while in the Institution, with reasons why they were not breast-fed. Total 17, as follows:— Wholly Bottle Fed:— 1 Mother Pulm. Tuberculosis. 1 ,, Heart Disease. 1 ,, Albuminuria & CEdema. 1 „ Abscess breast. 1 Premature baby (2½ lbs.) 1 By request of doctor in attendance. Partly Bottle 6 3 pairs twins. Insufficient supply. 4 Insufficient supply of mother's milk. 10. Number of maternal deaths with causes. Nil. 11. Number of foetal deaths (stillborn or within 10 days). Total 10 (5 still-births):— 2 Transverse presentation. 1 Extended breech. 1 Macerated foetus. 1 Malformed foetus. Within 10 days (5):— 1 Congenital heart disease. 4 Prematurity. NURSING ARRANGEMENTS, HOSPITALS, AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home. (a) General. (1) The Beckenham District Nursing Association supplies two trained nurses for general district work. These nurses are available for all who require their services in their homes. A small fee is paid depending on the circumstances of the patient. 11 2. In addition to the above several of the Churches provide a District Nurse. The work is limited to the parishioners of the respective Churches. (b) Infectious Diseases.—The Health Visitors of the District Council visit cases of the minor Infectious Diseases at their homes and give appropriate advice as to management and treatment. Midwives.—There are two Certified Midwives practising Midwifery in the district, and a number of unqualified persons who go out as monthly nurses under the supervision of the doctor in charge of the case. With regard to the latter there is need, in the interests of the mother and infants, of the Midwives' Acts being amended so as to limit as far as possible unqualified persons doing this work, except in emergencies, and to define more precisely the degree of supervision that shall be given by the doctor in charge of the case. The Beckenham and Penge Maternity Home employs a number of qualified Midwives on the Staff, some of whom attend extern cases in the patients' homes. An arrangement has also been made by the Home whereby certain extern cases are attended by the two Midwives who are in practice in the district, and it has also been arranged that probationer nurses obtaining their training at the Home will receive experience in district work under the supervision of these latter. The supervision and control of Midwives under the Midwives' Acts is in the hands of the County Council and not the District Council. This is an unsatisfactory arrangement as the District Council is responsible for initiating and administering all the other Statutes and Regulations which provide for the care of Expectant Mothers and Infants, and the work of Midwives is indissolubly connected and bound up with the whole scheme of welfare on behalf of infants and expectant mothers. The District Council, through its Maternity Home, through the Welfare Centres, and the Home Visiting of its Health Visitors is in a position to exercise a very intimate amount of supervision and control over the Midwives as compared with an Authority whose 12 inspecting officials live more than 25 miles away, and who can only pay flying visits at considerable intervals for this purpose. There are other reasons why the same medical and nursing staff which administers the Maternity and Child Welfare work should also take charge of the supervision of Midwives. Such an arrangement would bring the Midwives into closer co-operation with the work of the Centres and induce them to send expectant mothers to the Centre. The notification of artificial feeding by the Midwife to the Supervising Authority is at present of little practical use unless the Authority acts also under the Maternity and Child Welfare Act. When one considers the large number of infant deaths which occur during the first week or ten days of life and before the midwife has ceased to attend, it emphasises the need for closer co-operation between the Health Visitor and the Midwife in their preventive work, both ante natal and post-natal, if the high mortality at this early age is to be reduced. Such co-operation can be more easily arranged if these officials are under one Supervising Authority. It would also lead to economy and prevent overlapping of duties if the Midwifery and Welfare Home Visiting were done by one person. NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total cases notified. Cases admitted to Hospital. Total Deaths. Diphtheria 23 12 3 Scarlet Fever 80 58 ... Enteric Fever (including Paratyphoid) ... 4 1 ... Puerperal Fever ... ... ... Pneumonia 23 ... 19 Encephalitis Lethargica ... ... ... Cerebro-Spinal Fever 1 ... 1 Erysipelas 9 ... 1 Malaria 1 ... ... Trench Fever ... ... ... Opthalmia Neonatorum ... ... ... Chickenpox 28 ... ... 13 Tuberculosis. Notifications. Deaths. a. Pulmonary (Males) 15 12 (Females) 20 10 Totals 35 22 b. Non Pulmonary (Males) 4 2 (Females) 6 2 Totals 10 4 Notification of Tuberculosis.—Two cases were not notified until after death. One was a case of Tubercular Meningitis in an infant of seven months, the other was a woman of 43 years with Pulmonary disease of long duration, who had recently moved into the district, and the doctor in attendance knew that the case had been previously notified in other areas, and did not think it was necessary to notify again. CLINICS AND TREATMENT CENTRES. Clinic or Centre. Address. Nature of accommodation. By whom provided. Maternity and Child Welfare Centre 73-75, High St. Waiting Room, Weighing Room, Consultation Room, Beckenham District Council School Clinics Inspection 73-75, High St. Waiting Room Treatment and Opthalmic Consultation Room Dental Balgowan Road School 3 Rooms Tuberculosis Dispensary Bromley Road Waiting and Consultation Rooms Kent County Council 14 HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY OR BY THE COUNTY COUNCIL. 1. Fever Hospitals.—The Bromley and Beckenham Joint Hospital Board provides Fever Hospital accommodation for Beckenham and a number of other districts. The Board have erected two hospitals, one for the isolation of Small Pox and the other for the common Infectious Diseases. In previous Reports I have given details of the position, accommodation, staff, and cost to the District Council of these Hospitals. 2. Maternity Home.—The Urban Districts of Beckenham and Penge have provided a Joint Maternity Home at 80, Croydon Road, Beckenham. The Ministry of Health have approved of the accommodation for 14 beds. 3. The Beckenham Cottage Hospital.—This Hospital is situated in Croydon Road, and is the General Hospital for the district. It is supported by voluntary contributions and certain charges made to patients. The operative treatment for Tonsils and Adenoids in Elementary ochool Children is carried out at the Hospital by arrangement with the District Council. AMBULANCE FACILITIES. (a) For Infectious Diseases.—The Bromley and Beckenham Joint Hospital Board provide a Motor Ambulance for the removal of fever cases to hospital. (b) For Non-Infectious and Accident Cases.—The District Council maintain a Motor Ambulance for the removal of non-infectious and accident cases. The ambulance was recently presented to the District Council by the local Voluntary Aid Detachment, and the Council make a charge for its use to cover running expenses. 15 LABORATORY WORK. There is a Laboratory in the Health Department and the following Table sets out the work done in it during the year:— Diseases suspected. Total Number of Examinations. Result. Positive. Negative. Diphtheria 500 52 448 Tuberculosis 173 28 145 Typhoid Fever 2 2 Other Diseases 47 34 13 Totals 722 114 608 A supply of Diphtheria Anti-toxin is kept at the Health Department and is given free of charge to doctors for use in Diphtheria. During the year 54,000 units of Anti-toxin were used, 42,000 for curative and 12,000 for prophylactic purposes. Anti-streptococcic serum and Influenza vaccine are also kept in stock at the Health Department and are available free of charge to doctors. LIST OF THE ADOPTIVE ACTS, BYE-LAWS AND LOCAL REGULATIONS RELATING TO PUBLIC HEALTH. Local Acts. The Beckenham Urban District Council Act, 1903. Part V. Infectious Disease. Part VI. Tuberculosis. Part VII. Streets, Buildings, and Sewers. Part IX. Sanitary Provisions. 16 General Adoptive Acts. Infectious Diseases Prevention Act, 1890. Public Health Acts, Amendment Act, 1890. Part III. Public Health Acts, Amendment Act, 1907. Part n. Sections 21, 22, 23, 26, 28, 33. Part III. Sections 34, 35, 45, 49, 50, 51. Part IV. Sections 52, 53, 59, 61, 62, 63, 65, 68. Part VI. Sections 76, 77, 85, 86, 90. Bye-Laws. Slaughter Houses, 1883. Houses let in Lodgings, 1883. New Streets and Buildings, 1892, 1910, and 1914. Removal of Offensive or Noxious Matters, 1893. Employment of Children Act (1903), 1904. Occupation of New Buildings, 1905. Fire Escapes in Factories and Workshops, 1907. Cleansing of Cisterns, 1909. Nuisances, 1911. Offensive Trade of Fish Frier, 1913. Regulations. Dairies, Cowsheds, and Milk Shops, 1899 Construction of New Streets and Sewers. Theatres and Buildings Licensed for Stage Plays, &c., 1911. 17 SANITARY INSPECTION OF THE DISTRICT. Nature of Defects or Nuisances Discovered. Drainage and Sanitary Arrangements:— No. of premises at which defects were found. Choked Drains 23 Defective Drains 19 Waste Pipes, defective or untrapped 12 Waste Pipes, directly connected to the drains — Rain Water Pipes, defective 10 House Sinks, defective 2 Water Closets or Flushing Apparatus, defective . 38 W.C. Apartments, defective or dirty 46 Soil Pipes, defective 4 Drain Ventilating Pipes, choked or defective 23 Man-Hole Covers, defective or unsealed 9 Public Urinals, dirty 4 Water Supply Cisterns, uncovered 21 Water Supply Cisterns, defective or dirty 4 Galvanised Iron Dustbins, absent or defective 30 Defective Fresh Air Inlets 27 Insufficient Ventilation to Houses 3 Defective Sanitary Fittings 13 Dwelling Houses:— Rooms requiring fumigation 222 Walls, Floors, and Ceilings, defective 77 Houses damp 95 Roofs and Gutters, defective 103 Houses or parts, dirty 169 Yard Paving, absent or defective 31 Defective Stoves 33 Miscellaneous 72 Miscellaneous Nuisances:— Smoke Nuisances Nil Keeping of Animals contrary to Bye-Laws 11 Accumulation of offensive manure 10 Absence of manure pit Nil Contamination of streams 1 Dirty Yard 1 18 The following Table supplies particulars of the premises and occupations in the district which are controlled by Bye-Laws or Regulations:— Character of Premises. No. Bye-Laws or Regulations affecting same. Action Taken and Result. Dairies 14 Regulations under Contagious Diseases (Animals) Acts, 1878 & 1886, and Dairies, Cowsheds and Milkshops Orders, 1885 & 1886 One hundred and forty-five inspections have been made of these premises and three notices were served to remedy defects, and these have been complied with. Cowsheds 6 Milkshops 4 Bakehouses 14 Factory & Work shops Act, 1901 Fifty-eight inspections have been made of these premises and four notices were necessary to abate nuisances, etc. Slaughterhouses 2 Bye-Laws made under Sec. 169, Public Health Act, 1875 Two notices were served on the occupiers of these premises calling upon them to abate contraventions of the ByeLaws and these notices have bean complied with. Fried Fish Shops 6 Bye-Laws under Sections 112-115, Public Health Act, 1875, and Sec. 51 Public Health Acts, Amend Act, 1907 Thirty - two visits have been paid to these premises during the year. 19 Character of Premises. No. Bye-Laws or Regulations affecting same. Action Taken and Result. Ice-cream Shops 30 Scction 88, Beckenham Urban District Council Act, 1903 Ninety-nine inspections have been made of these premises and in one instance it was necessary to serve a notice upon the owner to abate a nuisance, which notice has been complied with. All premises Bye-Laws respecting Keeping of Animals, dated November, 1911 Contravention of these Bye-Laws were found on 11 premises during the year and notices were served calling upon the occupiers to cease to keep the animals or remove them to a distance greater than 10 feet from the premises and these notices wer? all complied with. All premises Bye-Laws respecting Cleansing and Covering of Domestic Water Supply Cisterns made undsr Section 139 of the Beckenham U.D.C. Act, 1903 Contravention of theee Bye-Laws were found on 25 premises and notices were served for cleansing or covering as the case required and these notices have been complied with in all cases. 20 FUMIGATION OF ROOMS. Showing the number of rooms Fumigated each month. Month. ROOMS FUMIGATED. Scarlet Fever. Typhoid Fever. Diphtheria Cancer. Phthisis. Pneumonia. Measles. Miscellaneous. Total. January 25 ... 1 ... 7 ... ... 4 37 February 10 ... ... ... 2 ... 1 1 14 March 8 ... 2 1 1 2 2 5 21 April 5 ... 1 9 2 ... ... 3 20 May 11 ... 2 ... 2 2 1 2 20 June 11 2 2 2 1 ... 1 19 July 5 ... 4 1 9 1 ... 2 15 August 6 ... 3 ... 3 ... ... 4 15 September 7 ... ... 1 2 ... ... 1 11 October 9 1 1 2 5 ... ... 18 November 4 ... 2 ... 8 ... ... 1 15 December 7 ... 1 1 4 ... ... 4 17 Total 107 3 19 17 38 6 4 28 222 Table showing Materials Fumigated each month. Materials Fumigated. January February March April May June July August Septemb'r October November December Carpets 8 ... ... ... 1 ... 1 3 ... 7 ... ... Rugs and Mats 19 12 5 2 3 4 1 4 ... 9 7 1 Mattresses 38 20 30 13 25 32 22 23 11 25 18 14 Palliasses ... ... 2 ... 2 2 ... ... ... ... 2 ... Beds 15 4 12 7 7 2 7 8 7 4 5 6 Pillows 65 36 67 34 57 66 57 46 27 57 32 28 Bolsters 28 13 16 12 14 15 19 15 9 13 10 12 Sheets 51 25 27 16 20 10 25 16 12 26 13 14 Blankets 85 46 77 48 38 50 58 33 20 59 37 28 Quilts 19 10 13 8 11 4 12 9 6 9 11 8 Curtains 35 27 14 14 13 ... 13 12 12 35 12 12 Clothing 101 38 46 47 18 26 67 42 17 38 20 25 Eiderdowns 13 14 9 7 9 16 12 7 3 7 6 7 Cushions 9 5 12 4 5 7 2 10 1 11 5 5 Miscellaneous (Blinds, Covers, &c.) 14 2 11 3 5 8 12 4 5 6 1 6 Totals 500 252 341 215 228 242 308 232 130 306 179 166 21 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. These Regulations are designed to prevent or control the addition of preservatives and other foreign substances to Milk and Cream, which additions have from time to time been demonstrated to be dangerous and injurious to health. During the year one sample of cream was taken for analysis, which was satisfactory. UNSOUND FOOD. During the year 18 pounds of meat and 112 pounds of fish were condemned as unfit for consumption and were destroyed. SALE OF FOOD AND DRUGS ACTS. Sixty-nine samples were purchased during the year under these Acts and submitted to analysis. The results are as follows:— NUMBER OF SAMPLES TAKEN DURING 1922. Nature of Sample. Number Taken. Analyst's Report thereon. New Milk 26 One sample of milk was adulterated as it was deficient in milk fat to the extent of at least 7 per cent. of milk fat. The vendor was fined 12s. 6d. including costs. The remaining 25 samples were genuine. Butter 13 Genuine Sago 2 ,, Ground Rice 2 ,, White Pepper 6 ,, Demerara Sugar 2 ,, Tapioca 1 ,, Self Raising Flour 1 ,, Cream 1 ,, Wood Vinegar 1 ,, Malt Vinegar 3 ,, Mustard 2 ,, Cocoa 1 ,, Lard 5 ,, Ground Ginger 3 ,, Total 69 22 PUBLIC HEALTH STAFF. Medical Officer of Health: J. M. Clements, M.D., D.P.H. This Officer devotes all his time to Public Health work. He is School Medical Officer, Medical Superintendent of the Beckenham and Penge Maternity Home, and Tuberculosis Officer for the District under the County Council. Contribution is made to his salary under the Public Health Acts, and by Exchequer Grants. School Dentist: R. Waters, L.D.S., R.C.S. The Dentist gives all his time to the Service of the Council, and in addition to his duties as School Dentist he acts as Dentist to the Maternity and Child Welfare Centre. A portion of his salary is paid by Exchequer Grants. Chief Sanitary Inspector: E. G. Moore, A.R.S.I. A whole-time Officer, who is also Inspector under the Food and Drugs Acts. A contribution is made towards his salary under the Public Health Acts. Sanitary Inspector: H. G. Richards, A.R.S.I. A whole-time Officer, who possesses the Certificate of the Royal Sanitary Institute for Meat and other Foods. A contribution is made towards his salary under the Public Health Acts. Health Visitors and School Nurses (Three) : — Miss M. A. Cusack, A.R.S.I., C.M.B. Miss M. E. Chapple, A.R. S.I., C.M.B. Mrs. A. E. Page. All the above are trained nurses, and a contribution towards their salaries is made by Exchequer Grants. Miss Cusack is also Tuberculosis Nurse under the County Council for this District, and Mrs. Page devotes most of her time to the work at the Dental Clinic. 23 HOUSING. Number of New Houses erected during the year : — (a) Total 92 (b) As part of a Municipal Housing Scheme 72 1.—Unfit Dwelling Houses. 1.—Inspection. (1) Total number of Dwelling Houses inspected (under the Public Health or Housing Acts) 654 (2) Number of Dwelling Houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 247 (3) Number of Dwelling Houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of Dwelling Houses (exclusive of those referred to under the preceding sub-heading) found to be not in all respects reasonably fit for human habitation 514 2.—Remedy of Defects without Service of Formal Notice. (a) Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919: — (1) Number of Dwelling Houses in respect of which notices were served requiring repairs Nil (2) Number of Dwelling Houses which were rendered fit: — (a) By Owners Nil (b) By Local Authority in default of Owner Nil (3) Number of Dwelling Houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close Nil (b) Proceedings under Public Health Acts : — (1) Number of Dwelling Houses in respect of which notices were served requiring defects to be remedied 35 24 (2) Number of Dwelling Houses in which defects were remedied: — (a) By Owners 35 (b) By Local Authority in default of Owners Nil (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909: — (1) Number of representations made with a view to the making of a Closing Order Nil (2) Number of Dwelling Houses in respect of which Closing Orders were made Nil (3) Number of Dwelling Houses in respect of which Closing Orders were determined, the Dwelling Houses having been rendered fit Nil (4) Number of Dwelling Houses in respect of which Demolition Orders were made Nil (5) Number of Dwelling Houses demolished in pursuance of Demolition Orders Nil 25 DISTRICT OF BECKENHAM. Infant Mortality. 1922. NETT DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER 1 YEAR OF AGE. CAUSE OF DEATH. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 mouths & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under One Year. All Causes Certified 10 2 1 2 15 3 4 3 4 29 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Cheken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... Meningitis (Not Tuberations') ... 1 ... ... 1 1 ... ... ... 2 Convulsions 2 ... ... ... 2 ... ... ... ... 2 Organic Heart Disease ... ... 1 ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 1 ... ... 1 Pneumonia (all forms) ... ... ... ... ... ... 2 ... ... 3 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... 1 2 ... ... ... ... 2 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... 2 ... ... ... 2 ... ... 2 ... 4 Premature Birth 4 1 ... 1 6 ... ... ... ... 6 Atrophy, Debility & Marasmus 1 ... ... ... 1 2 1 ... ... 4 Other causes ... ... ... ... ... ... ... ... 1 1 Dentition ... ... ... ... ... ... ... ... ... ... Totals 10 2 1 2 15 3 4 3 4 29 Nett Births in the year legitimate 512, illegitimate 20. Nett Deaths in the year of legitimate infants 28, illegitimate 1. 1922 METEOROLOGY. Meteorological observations taken at the Recreation Ground, Croydon Road (supplied by J. A. Angell, Esq., A.M.I.C.E.): — Month. Mean reading of Barometer at 9 a.m. Self-registering thermometers. Rainfall total per month. Max. in air. Min. in air. F° F° inches. January 29.70 56 24 2.85 February 29.79 60 22 2.27 March 29.74 54 24 1.89 April 29.65 70 18 3.60 May 30.08 88 36 2.26 June 29.99 84 42 1.73 July 29.88 78 44 2.79 August 29.93 76 40 2.64 September 29.92 70 35 2.28 October 29.98 65 24 1.40 November 30.11 54 24 1.82 December 29.75 52 26 4.51 Mean for the year 29.88 67.25 29.91 (Total) 30.04 URBAN DISTRICT OF BECKENHAM. TABLE SHEWING CAUSES OF DEATHS AT DIFFERENT AGE PERIODS OF RESIDENTS DURING THE YEAR 1922. Causes of Death. All Ages. 0 to 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and over Copers Cope Ward Eden Park Ward Langley Park Ward Shortlands Ward Manor House Ward Kent House Ward Lawrie Park Ward Male Female Total 1. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Measles 1 2 3 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... 2 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 6. Diphtheria 3 ... 3 ... 1 1 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 7. Influenza 11 17 28 1 1 ... ... 1 3 2 3 6 9 2 ... 1 2 ... 2 2 8 13 8. Encephalitii Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Meningococcal Meningitis 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 10. Tuberculosis of Respiratory System 12 10 22 ... ... ... ... 8 5 4 2 1 2 ... ... 1 2 ... 1 7 3 8 11. Other Tuberculous Diseases 2 2 4 1 1 ... ... ... ... ... 2 ... ... ... ... 2 ... ... ... l 1 ... 12. Cancer, Malignant Disease 17 34 51 ... ... ... ... 1 ... 3 5 18 17 6 1 5 7 3 1 16 4 15 13. Rheumatic Fever 1 1 2 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... 14. Diabetes 2 1 3 ... ... ... ... ... ... ... 2 ... ... ... 1 ... 1 ... ... ... 1 1 15. Cerebral Hæmorrhage, etc. 14 18 32 ... ... ... ... ... ... 1 1 9 10 10 1 ... 2 2 ... 10 4 14 l6. Heart Disease 20 18 38 ... ... ... ... ... 1 ... 9 3 13 11 1 4 5 1 4 7 10 7 17. Arterio-Sclerosis 8 4 12 ... ... ... ... ... ... ... ... 2 3 7 ... ... ... 1 1 4 2 4 18. Bronchitis 19 15 34 1 3 ... ... ... ... 1 1 5 8 11 4 4 5 1 ... 7 10 7 19. Pneumonia 9 10 19 2 1 ... 1 ... ... 2 3 5 1 4 ... ... 1 2 ... 3 7 6 20. Other Respiratory Diseases 2 2 4 1 ... ... ... ... ... ... ... 2 ... ... 1 ... ... ... 1 ... 1 2 21. Ulcer of Stomach or Duodenum 3 1 4 ... ... ... ... ... ... ... ... 1 2 1 2 ... ... ... ... 1 1 22. Diarrhœa, &c. (under 2 yrs). ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23. Appendicitis & Typhlitis... 1 2 3 ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... 1 ... 1 1 24. Cirrhosis of Liver l ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 25. Acute & Chronic Nephritis 9 4 13 ... ... ... ... 1 1 ... ... 5 4 2 ... ... l 3 ... 2 6 1 26. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27. Other accidents and diseases of pregnancy and parturition ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28. Congenital debility and malformation 9 5 14 14 ... ... ... ... ... ... ... ... ... ... ... ... 3 2 2 3 ... 4 29. Suicide 1 2 3 ... ... ... ... 1 ... 2 ... ... ... ... ... 1 ... ... ... 2 ... ... 30. Other deaths from violence 3 2 5 2 ... ... 1 ... ... 1 1 ... ... ... ... 1 l ... ... 2 1 ... 31. Other defined diseases 22 31 53 6 1 1 2 1 3 4 2 4 5 16 8 7 6 4 4 12 6 14 32. Cause Ill-defined or unknown 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... Totals 172 183 355 29 9 5 6 13 14 22 32 62 74 72 17 30 37 19 18 82 68 101 Urban District of Beckenham. Report on the Medical Inspection of School Children, 1922. 28 STATISTICS IN RELATION TO EDUCATION. Estimated Population of Beckenham 33160 Number of Public Elementary Schools 5 Number of Departments 14 Accommodation 3891 Number on Roll 3363 Special Day School for the Mentally Defective 1 Other Schools: — County Secondary School (Boys) 1 County Secondary School (Girls) 1 Private Schools 20 One Penny Rate produces for Elementary Education £1110 STAFF ENGAGED IN MEDICAL INSPECTION. School Medical Officer 1 School Dentist 1 Ophthalmic Surgeon 1 School Nurses 3 Clerks 2 New Appointment.—A part-time Ophthalmic Surgeon has been appointed, and it is estimated that he will give 25 Sessions of 3 hours duration to the work of the Eye Clinic during the year. Offices and Equipment.—No material alterations or additions have been made during the year. The Dental Clinic continues to be held at the Balgowan Road School, in rooms which have been placed temporarily at our disposal for this purpose. As soon as the present period of financial stress is over it is hoped that the Committee will again consider the proposals for building an extension to the present School Clinic at 75, High Street. This extension would bring the Dental Clinic under the same roof as the School Clinic and the Infant Welfare Centre, would afford additional 29 accommodation for the latter, which is urgently needed, and would at the same time be a great convenience when children have to be referred from one Clinic to another. It would also simplify the work of administration and supervision. Co-ordination of the Work of the School Medical Service with that of other Health Services. (a) Infant and Child Welfare.—The Maternity and Child Welfare Centre is held in the same building as the School Clinic, and is under the supervision of the School Medical Officer. The School Nurse also gives some assistance in the Infant Welfare Centre, so that the work of the two Clinics is intimately associated. (b) Tuberculosis.—The School Medical Officer acts as Tuberculosis Officer for the area supervised by the Beckenham Tuberculosis Dispensary, and there is therefore a direct connecting link between the School Service and the provisions made by the County Council for dealing with Tuberculosis. ROUTINE INSPECTIONS, 1922. Routine Inspections refer to those made on the School premises of the Groups of Children prescribed for examination by the Board of Education. The number examined at these inspections during 1922 was as follows : — Entrants 439 Leavers 190 Intermediate Group 471 In addition to the above Groups, 471 "Special" children were referred to the Medical Inspector, either at the School or the School Clinic, for examination. These "Special" cases were selected by the Teachers, School Nurses, School Attendance Officers, or Parents, on account of some obvious or suspected physical defect. Tables I. and II. (see pages 54 and 55) set out in summary form the numbers inspected and the defects found. 30 Analysis of Defects together with the results of "following up" and Treatment. Malnutrition.—54 children were classified as suffering from defective nutrition, of whom 17 were referred for treatment and 37 for observation. Of the 17 requiring treatment, 10 received it at the School Clinic, 5 were treated at home, 1 was sent to hospital, and 1 left the district. The condition of these at the end of the year is as follows:—3 have regained normal weight and condition, 9 have definitely improved, and 4 are still undergoing treatment. Of the 37 observation cases, 29 are reported as much improved, 7 still attend the Clinic at regular intervals, and 1 has left the district. Uncleanliness.—The standard adopted for cleanliness is now a very high one, and any child found with even a few nits on the hair or whose body or clothing is flea marked, or shows signs of being " flea-bitten," is included under this heading. 106 cases are reported as having unclean heads, and 31 were returned as having their body or clothing unclean. Further particulars relating to the methods adopted for securing and enforcing cleanliness will be found on page 42. Skin Disease: Ringworm.—There were 7 cases of Ringworm of the Scalp, and 3 cases of Ringworm of the Body, found at the Inspection Clinic during the year. Two doubtful cases of Scalp Ringworm referred to the Clinic turned out to be Alopecia and not Ringworm. Five of the 7 cases of Scalp Ringworm were traced to infection contracted outside the district; in the remaining two, the source was not discovered. The history as regards treatment of these 7 cases is as follows:—3 were cured by X-ray treatment supplied through the Education Committee. In two the disease died out or was cured while the patient was undergoing treatment by iodine or ointment at the School Clinic. In one chronic case the disease is 31 still active, and X-ray treatment is refused. The remaining case left school while the disease was still active and has been lost sight of. Scabies, which became common during the War, is now on the decline. Only 4 cases were found this year, as compared with 15 cases in 1921, and 58 cases in 1920. The parents are instructed how to carry out the bath treatment followed by inunction of sulphur ointment and all infected bedding and clothing are steam disinfected. 19 cases of Impetigo and 18 cases of other forms of skin disease received treatment at the School Clinic. Diseases of the Eye: (1) Defective Vision—(a) Routine Inspections.—134 cases of defective vision, including 18 cases of squint, were found at the Routine inspections. Of this number 49 were wearing suitable glasses, and were referred for re-inspection at intervals. 10 cases were referred for re-examination later in the year, and the result of the second examination was as follows: — In 7, the eyesight was found to be normal, in one case it was defective, and the child was referred for treatment, and in two cases the children had left the district. The remaining 75 routine cases with defective vision were passed on to the Ophthalmic Surgeon at the Eye Clinic, and the report upon them at the end of the year is as follows:—39 have been provided with spectacles, 4 do not require spectacles, 8 have failed to keep appointments for testing, and 24 are undergoing treatment or waiting for spectacles to be provided. (b) Special Cases.—Under this heading 51 cases of defective vision were discovered, either at the School or at the Inspection Clinic. 49 were referred for treatment by the Ophthalmic Surgeon, and 2 were referred for observation and examination at a later date. The further history of the 49 sent for treatment is as follows:—33 have been provided with spectacles, 12 cases do not require spectacles, and 4 are waiting for appointments to attend the Eye Clinic. 32 (2) Other Eve Diseases.—51 cases suffering from the following conditions were found:- Blepharitis, 22; Conjunctivitis, 21; Keratitis, 1; Corneal opacity, 1; other conditions, 4. The cases of Blepharitis and Conjunctivitis attended the treatment Clinic, and 34 are now cured, the remainder are under observation or treatment. Disease of the Ear.—Twelve cases of Otitis Media were discovered at the Routine Inspection, and in five of these the hearing was definitely impaired. Nine were referred for treatment, and at the end of the year the disease was reported as quiescent or cured ; in five cases, four are still under treatment—two at a London Hospital, one by the family doctor, and one is attending the treatment Clinic. Fourteen cases of Otitis Media were found at the Inspection Clinic, and in seven of these the hearing was impaired. Thirteen were referred for treatment, and their condition at the end of the year was as follows:—In eight cases the disease was quiescent or cured, four were still receiving treatment at their own homes, and one was attending the treatment Clinic. Affections of the Nose and Throat.—51 children, 28 Routine Inspection cases, and 23 special cases were referred for treatment on account of Adenoids and Enlarged Tonsils, or one of these conditions. The condition of these at the end of the year was as follows:—27 were cured by operation—25 under the Education Authority's Scheme, and 2 by the family doctor. Sixteen are reported cured, following a course of breathing exercises, 4 are waiting for operative treatment, 2 have left the district, and in two cases the parents refuse to submit the child to operative treatment. Under the heading "Other Conditions," 29 cases are included. These were chiefly cases of Tonsilitis and Rhinorrhoea, and appropriate action was taken in each case. Heart and Circulation.—Twenty-one children were classified as suffering from Valvular Disease of the Heart, and twenty-four presented conditions which were regarded as functional. All the cases 33 of Valvular Heart Disease are inspected at intervals of six months and the condition noted on the following-up card. In three cases, one boy and two girls, the disease is so advanced as to prevent their attending school. The condition of the four cases of Anaemia at the end of the year is as follows:—One is cured, two are still under observation and attending the Clinic, and one is under treatment in a local hospital. Tuberculosis.—All children suffering from Tuberculosis or suspected Tuberculosis are referred for treatment and observation to the Tuberculosis Dispensary. During the year 32 children attended the Dispensary; of this number, 2 were definite cases of Pulmonary Tuberculosis, and 12 were suspected cases of this form of the disease and were referred for observation. The remaining 18 children were suffering from Tubercle of bones or glands. At the end of the year 12 out of the 32 cases were discharged from " observation " and ceased to attend the Dispensary, the remaining 20 are still under supervision or treatment at the Dispensary. Nervous System.—Three cases of Epilepsy have been under observation during the year. The latest report relating to them is as follows:—One has been free from fits for a considerable time and is regarded as cured; one is still under treatment by the family doctor, and in the third case, now over school age, the attacks persist. Nine cases of Chorea were discovered, one at the Routine Inspection, and 8 at the Inspection Clinic. Their condition at the end of the year is as follows:—3 are cured; 1 girl died of heart disease due to Chorea ; 1 is under treatment in hospital; and 4 are still under treatment and supervision through the Clinic. Deformities.—Fifty-four children were found to have some physical deformity, including 4 cases due to Rickets, and 2 of curvature of the spine. In 8 cases the defect was congenital and did not require treatment, Of the 22 cases referred for treatment, 6 are cured, 2 are attending a London Hospital, 1 is still attending the treatment Clinic, and in 10 of the others there are varying degrees of improvement as a result of physical drill and special exercises. 34 TREATMENT CLINIC. The Treatment Clinic is open on week days from 9 to 12 in the morning, except during the School holidays, and children suffering from minor ailments attend for treatment. The School Nurse is in charge of the Clinic, and she is assisted by " V.A.D." Nurses from the Beckenham Voluntary Aid Detachment, No. 86. The valuable and entirely voluntary services of these latter are much appreciated. The following is a statement of the attendances at the Treatment Clinic and the conditions for which treatment was given. The corresponding figures for the previous year are given for comparison : — 1922. 1921. Total number of attendances 3262 3332 Diseases of the Skin— Ringworm (Scalp) 7 13 Scabies 6 15 Impetigo 183 148 Minor Injuries 103 65 Other Skin Diseases 98 149 Diseases of the Ear 101 71 Diseases of the Eye 86 97 Verminous Heads 215 586 Miscellaneous 143 114 INSPECTION CLINIC. An Inspection Clinic was held every Tuesday afternoon during the year, at which 714 individual children attended, as compared with 665 in the previous year. The total number of attendances was 1918. Of these 714 children, 227 attended as a result of advice given to the parents at the Routine Inspections in the Schools ; they are classified under columns 2 and 3 of Table II., according to the defects found. The remaining 487 children were "special" cases sent to the Clinic for advice or treatment; they are included in columns 4 and 5 35 of Table II. The treatment provided and the results have been set out in dealing with the defects in Table II. EYE CLINIC. In my last Annual Report I referred to the decision of the Education Committee to terminate the arrangements whereby children requiring spectacles were sent to the Out-patient Department of one of the London Hospitals. An Eye Clinic has been opened at 75, High Street, and all School children suffering from defective vision are now referred for treatment to this Clinic. Mr. A. E. A. Loosely, F.R.C.S. (Eng.), has been appointed a Part-Time Ophthalmic Surgeon, and his appointment has been approved by the Board of Education. It is estimated that the Clinic will be open about 25 Sessions during the year, each Session lasting three hours. The first Session of the Clinic was held on the 10th April, 1922, and since that date to the end of the year the following is a record of the work done:— Number of Sessions from 10th April to 31st December, 1922 15 Number of Children examined 153 Total number of Attendances 315 Number of Spectacles prescribed 75 Spectacles are obtained on reasonable terms from two local opticians. The cost of the spectacles is borne by the Education Committee in the first instance, and recovered from the parents later, usually by weekly instalments. The local facilities for prescribing spectacles are much appreciated by the parents, and are a great improvement on the old arrangements. Much less difficulty has been experienced in securing the provision of spectacles in new cases, and in the re-examination of those already wearing glasses. 36 INFECTIOUS DISEASES. The methods by which information of sickness, infectious or non-infectious, among school children is brought to the School Medical Officer have been described in previous reports, and no important changes have taken place during the year. The School Nurse has paid 1,066 visits to the homes of children who were reported absent on account of sickness. School Closure.—The School Medical Officer, acting in accordance with Paragraph 53 (b) of the Code, closed the following Departments for the diseases indicated: — School. Dept. Disease. Period of Closure. Churchfields Road Infants Influenza 24.1.22 to 7.2.22 Churchfields Road Girls and Boys Influenza 25.1.22 to 7.2.22 Alexandra Infants Influenza & Measles 17.1.22 to 31.1.22 Alexandra Girts and Boys Influenza 19.1.22 to 31.1.22 Balgowan Infants Mumps. 25.5.£2 to 14.6.22 Exclusions.—The following Table gives the numbers of children excluded from school under Article 53 (b) of the Code, or other Statutory provisions during the year: — 37 Condition for which excluded. Totals excluded. Name of Schools. Bromley Road. Alexandra. Churchfields. St. James's Balgowan. Other Schools. Diphtheria patients 7 1 2 1 ... 2 1 „ contacts 20 3 5 5 ... 1 6 Scarlet Fever patients 53 8 4 11 11 8 11 „ contact 56 7 3 18 13 9 6 Measles 266 9 84 135 26 5 7 Whooping Cough 102 28 6 2 12 3 51 Chicken Pox 35 ... 2 8 20 1 4 Mumps 216 60 13 10 79 49 5 Eye Disease 13 2 .3 8 ... ... ... Ear 4 ... ... 4 ... ... ... Bronchitis and Pneumonia 16 3 3 7 1 2 Tuberculosis 8 2 1 3 1 ... 1 Tonsilitis, etc .4 1 3 ... ... ... Ringworm 7 3 1 3 ... ... ... Scabies 10 ... 3 3 3 1 ... Impetigo 20 7 3 4 3 3 ... Other Skin Diseases 35 4 11 12 5 1 2 Influenza 13 4 4 4 1 ... ... Verminous 205 3 66 96 38 1 1 Chorea 11 1 9 1 ... ... Glands 7 1 ... 4 1 1 ... Debility 5 2 ... 3 ... ... ... Miscellaneous 215 46 47 88 15 16 3 Totals 1328 194 262 441 230 103 98 SCALE OF CHARGES FOR TREATMENT. The Board of Education addressed a letter (31st October, 1922) to the Education Committee, pointing out that the Board could not regard as satisfactory the Authority's arrangements as set out in Section 1 (d) of Form 9.M, for parents' payments for Medical treatment of School Children. The letter further indicated the lines along which provisions should be made for the recovery of cost of treatment. 38 The following report on the extent of the treatment provided by the Authority was submitted to the Elementary Education SubCommittee, and as a result of their enquiries the Education Committee prepared a Scale of Charges, given below, which have been forwarded to the Board of Education for approval. To the Chairman of the Elementary Education Sub-Committee. Sir, I have to make the following report on the Board's letter of the 31st October, 1922, relating to the recovery from parents of the cost of treatment. It will be necessary to define briefly the forms of treatment that have been provided by the Education Committee, to state the annual cost of these, and to indicate any arrangements that are in force for the recovery of a portion, or all, of the cost from the parents. Treatment may be considered under the following five headings : — 1. Operations for the Removal of Tonsils and Adenoids. These are carried out at the Cottage Hospital, and the cost to the Education Committee is One and a Half Guineas per operation, which includes a fee of half a guinea to the operator, half a guinea to the ansethetist, and half a guinea to the hospital. The parents make no contribution towards the cost. In 1921 there were 27 operations, at a cost of £31 8s. 6d. In 1922 to date, there have been 25 operations, at a cost of £39 7s. 6d. 2. X-Ray Treatment of Ringworm of the Scalp. This treatment is done by the London Hospital at the rate of two and a half guineas per case. Expenditure, financial year 1921-22 ... £23 12s. 6d. (9 cases) „ „ 1922-23 Nil The parents make no contribution towards the cost of treatment. 39 3. Treatment of Minor Ailments. A Clinic is held at 9 a.m. every morning at 75, High Street, for this purpose. Children suffering from minor ailments such as running ears, skin diseases, &c., receive treatment by the School Nurse or voluntary workers. In connection with this Clinic a sum of about £50 is spent annually on bandages, dressings, ointments, medicines, and appliances. A portion of this is recovered from the parents in the form of payment for ointments and medicines. During the financial year 1921-22, £16 were recovered from parents, and from April, 1922, to date, the sum of £7 6s. has been recovered. The letter of the Board suggests that no charge for treatment should be made during the first week or two ; such an arrangement would permit the large majority of those who attend to obtain treatment free. 4. Eye Clinic. About twenty-five Sessions of two and a half hours each are held during the year. The expenditure may be considered under three headings: — (a) Salary of Mr. Loosely, at the rate of 3 guineas per Session. (b) Apparatus. (c) Cost of spectacles. The necessary appliances have been provided at a cost of about £15. Spectacles are provided by the Education Committee, and the cost is recovered from the parents, except in certain necessitous cases approved by the Education Committee. Expenditure to date on Spectacles £28 13 3 Amount recovered from Parents £14 14 6 Amount outstanding £13 18 9 Paragraph 3 of the Board's letter states that refraction work is not regarded as treatment, and if the Committee takes this view, no charge can be made for treatment at the Eye Clinic beyond recovering the cost of the Spectacles provided. 40 5. Dental Treatment. The provision of dental treatment is the largest item of expenditure under the heading of treatment, and only a small amount is recovered from the parents at present. (See Minute of Education Committee, loth June, 1920. Given below.) The figures given above of expenditure on treatment do not include the rent of premises or other establishment expenses. The premises are provided for the work of Medical Inspection and it is probable that in allocating the total cost of the School Medical Service the Board would not approve of any part of the expenditure on such items as rent, rates, taxes, heating, lighting, and cleaning, being included under the heading of "Treatment," such expenditure being necessarily incurred in carrying out the work of School Medical Inspection as distinct from treatment. The rules at present in force for the recovery of cost of treatment are based on the following Minutes of the Education Committee:— Extract from Minutes dated 21st May, 1913: — General Medical Treatment. "The Committee having received a report by the School Medical Officer hereon, recommend that no charge be made to parents for medical treatment." Extract from the Minutes of the Committee held on 15th June, 1920: — Dental Treatment. "The Committee approved the following scale of charges for treatment of children at the Dental Clinic: — (a) Fillings and Extractions—Free. (b) Regulation Plates and Crowns—At cost price. (c) Artificial Dentures—At cost price. In the case of (b) and (c) an increase of 10 to 20 per cent. on the cost price to be charged in certain cases, depending on the circumstances of the patient, in order to defray incidental expenses. 41 It was resolved that the School Dentist be authorised to collect money at the time of treatment and to issue a receipt for the same.'' Provision of Spectacles. The cost of the glasses will, in the first instance, be borne by the Education Committee, but the cost in full will be recovered from the parents except in very special cases of poverty or necessity." It is now nine or ten years since a Treatment Scheme was considered as a whole by this Committee, and I recommend that a Sub-Committee be appointed to draw up a new scheme and consolidate the present arrangements, and at the same time prepare a scale of charges for parents suitable to the various forms of treatment provided. J. M. CLEMENTS. School Medical Officer. Revised Scale of Charges for the Medical Treatment of School Children. 1. Where the total family income does not No charge. exceed 50/- per week, plus an allowance of 5/- each for the first two children and 2/6 each for any additional children above that number. 2. Where the total family income exceeds the amount set out under (1) but does not exceed £5 per week : — (a) Operations for removal of adenoids 15/- per case, and tonsils. (b) X-Ray Treatment of Ringworm of No charge, the Scalp. (c) Treatment of minor Ailments and Actual cost of Injuries, Scabies, Impetigo, and dressings, &c., for other Skin Diseases. 2 weeks, and then 6d. per week per child. (d) Treatment of Visual Defects. Actual cost of spectacles. No charge for refraction work. (e) Treatment of Dental Defects : — Extractions without an anaesthetic 1/- per child per attendance. 42 Extractions with an anæsthetic 2/6 per child per attendance. Fillings 1/- for each filling Dressings No charge. Scalings No charge. Silver Nitrate No charge. Regulations Actual cost. Plates and Crowns Actual cost. Artificial Dentures Actual cost. 3. Where the total family income exceeds Each case to be £5 per week. brought before the Committee and considered on its merits. 4. The Committee decided to agree to the Board's suggestion that in order to reduce the cost of collection, the parent's payments should as far as possible, be taken at the Clinics when the children attend for treatment. 5. The Board's suggestion that a box should be placed in each Clinic in which parents who are able to do so can place voluntary contributions over and above the fixed scale of charges, having been tried and found unsatisfactory, the Committee do not recommend its adoption. 6. The Committee are of opinion that the above Scale of Charges should apply for a period of six months from this date and be reconsidered if necessary at the expiration of that period. CLEANSING SCHEME. The methods adopted for discovering and dealing with verminous children have been fully set out in previous Reports, and no change in the procedure has taken place during the year. All the children are inspected at least once every term by the School Nurse, and the following is a tabular statement of the work done: — Total number of visits made to the Schools 205 Average number of visits to each School 41 Total number of examinations made by the School Nurse 14364 Number of individual children found unclean 330 43 Legal proceedings were taken against the parents in 12 cases and fines were imposed in 10 cases, varying from 2/6 to 10/-. In two of the cases the proceedings were adjourned for 14 days and finally withdrawn. EVENING PLAY CENTRES. The Play Centre at the Alexandra Schools, referred to in my last year's report, has been open during the winter months and games and recreation under the supervision of voluntary workers have been provided. The following information is extracted from the annual report of the Honorary Secretary:— Number of Children in Attendance.—The average attendance before Christmas was 125 out of 130 children. After Christmas there was a slight falling off in the attendance owing to children leaving school in mid-winter, and to a certain amount of sickness. The average attendance for the whole period was 112. Routine.—Active games for the boys and girls have played a large part in the Curriculum, also handwork, i.e., painting and raffia work. Chip carving has been started and has proved very popular. At the end of both sessions an entertainment has been given to the children. Workers.—There are 18 workers at the Centre, some of whom attend once a fortnight only. On the Committee are two representatives of the Education Committee, viz., Mrs. Brazil, B.A., and Mr. J. A. Bennett. PHYSICAL TRAINING. No Special Organiser of Physical Training has been appointed for the Elementary Schools. The Teachers give instruction in physical drill and carry out the exercises prescribed in the official syllabus of special instruction issued by the Board of Education. 44 I have referred in previous reports to the excellent facilities provided for teaching school children to swim at the Beckenham Public Baths. The following is a short extract from Mr. Austin's Annual Report, which will indicate the extent to which these facilities are made use of: — " The numbers attending for instruction show a considerable increase, but as a large number of the children made but few attendances, the number to pass the swimming test was less than in the fine summer of the previous year. Results of swimming instruction in the open air must inevitably depend to a certain extent upon the weather, and under the circum stances those of 1922 must be regarded as good as compared with 1921. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. During the year the Education Committee made Bye-Laws under the Employment of Children Act, 1903, and the Education Act, 1918, regulating the hours of employment of school children over 12 years of age. Under these bye-laws children employed in delivering newspapers or milk, or in domestic work away from their home, must obtain a certificate from the School Medical Officer to the effect that such employment will not be prejudicial to their health or physical development or render them unfit to obtain proper benefit from their education. Since the month of June, when the bye-laws came into force, 104 certificates have been issued. The figures are as follows:— 1921. 1922. Boys. Girls. Total. Boys. Girls. Total. No. attended 570 580 1150 681 612 1293 No. learned to Swim 138 126 264 110 102 212 Total No. of Swimmers 236 295 531 262 321 583 Percentage of Swimmers to those attending 41.4 50.8 46.17 38.4 52.4 45.0 45 DENTAL REPORT FOR YEAR 1922. I have the honour to submit the Dental Report for the year 1922. I have examined all the children in the Elementary Schools, but Balgowan Girls have not been treated, so I have not included the statistics for that Department in the present report. I propose to commence the treatment of the girls immediately. Thirty visits were made by the Dental Nurse and myself at the Schools, and 3056 children were inspected, giving an average of 101.8 children inspected per visit. Of the ch?fdren examined, 758 had sound dentures (those children rendered artificially sound by treatment are included). This figure gives a percentage of 24, an increase of 6 per cent, on the previous report, and' means that the treatment given is providing the children with a good healthy mouth and an efficient masticating organ. The number of children referred for treatment was 2,298, and of this number, 1,788 were actually treated, the difference between the two, viz., 510 represents the " refusals " during the year. The percentage of " refusals " is 22, an increase of 1 per cent, over the previous report, but that report did not include Alexandra School, where the " refusals " in the Infants Department were large. These " refusals " are further sub-divided as follows: — (a) 18 per cent-, refused. (b) 2 per cent, treated privately. (c) 2 per cent, did not keep appointments. With regard to Group (a), the Dental Nurse has visited the homes whenever possible, but the results are not very satisfactory, only very few parents have altered their previous decisions not to accept treatment". In those cases that have reconsidered the matter, the children on attending are found not amenable to treatment. In the older children (13-14), the children themselves refuse to attend, 46 and I have come across quite a number of parents who attend with the younger members of the family, and are anxious that the older ones should be treated, but cannot get them to attend. In Group (b), on re-inspection, it is found that very few have been treated privately, and if they have had any treatment, it has usually consisted of an extraction and no attempt has been made to remedy any fillings that should have been done. In Group (c) these cases originally accept treatment, but owing to various causes, such as illness of the child, or illness in the family, they do not keep appointments. Each child in this group is given two opportunities of attending. Several cases of fracture of the upper incisors come under notice. In those cases where the pulp (nerve) is not involved in the fracture, treatment consists of reducing the inflammation of the surrounding tissues and later of trimming up the rough edges of the fractured teeth. In one case, a boy aged 11, the blow had been so severe that the only treatment was the extraction of three upper incisors. This boy will be fitted with a plate in due course. In seven cases treatment consisted of crowning. In these cases the pulps (nerves) were exposed and had to be removed preparatory to fixing the crowns. In 13 cases plates were made for the regulation of one or more teeth, and the parents have expressed their gratitude for the results obtained. Irregularities that can be corrected by the extraction of one or more permanent teeth are undertaken in the routine work. The arrangements I made last year of treating "casual" cases at 11.30 a.m. daily, are greatly appreciated by the parents. 310 children attended as " casuals " during the year 47 One bundled and forty-one attended for extractions under nitrous oxide (gas), and in only three cases did the parents refuse gas extractions. I am indebted to Dr. Curtis for his valuable assistance in administering the nitrous oxide. I have made a strong point of impressing on the children, both at school and at the Clinic, the importance of cleanliness of the mouth, and where opportunity offers I have a short talk with the parents also. I have included in the report the statistics required by the Board of Education, and also a summary of the monthly reports already furnished to the Committee. From the latter the following average work per Session can be obtained: — 7.9 children attended per Session. 6.3 Fillings completed per Session. 5.3 Extractions per Session. 1.8 Dressings per Session. These figures will compare very favourably with that of any other single-handed Dental Officer. I wish to express my gratitude to Dr. J. M. Clements for his help and advice during the first year, and to the Heads of Departments in the Schools for the assistance they give and the interest they take in the dental work. ROBERT A. WATERS, L.D.S , R.C.S.(Eng.) December 31st, 1922. Summary of Dental Reports. Number Inspected 3056 New Cases 1788 Old Cases 859 " Casuals " 310 Total attendances 2957 48 Fillings (Permanent) 1864 „ (Temporary) 445 (Root) 35 Total Fillings 2344 Extractions (Permanent) 314 ,, (Temporary) 1651 Total Extractions 1965 Dressings 432 Scalings 87 Silver Nitrate Treatment 134 Regulations (Plates) 13 Crowns 7 Denture 1 Nitrous Oxide Administrations 141 The Maternity and Child Welfare Dental Scheme. I append below a summary of the work done during the year. The patients attend on Saturday mornings only under the Welfare Scheme. The work is gradually increasing, and is of great benefit to the mothers concerned. Number of Sessions 47 Number of Attendances 261 Extractions (Permanent) 336 ,, (Temporary) 6 Total Extractions 342 Fillings (Permanent) 23 „ (Temporary) 3 Total Fillings 26 Impressions and Bites 101 Dressings 35 Scalings 9 Nitrous Oxide Administrations 10 Dentures Supplied 38 Repairs to Dentures 3 ROBERT A. WATERS, L.D.S., R.C.S. (Eng.). 49 SCHOOL FOR MENTALLY DEFECTIVE CHILDREN. This School was opened on 9th October, 1906, and has accommodation for 20 children. Further details relating to it will be found in previous Annual Reports. At the beginning of the year there were 14 children on the roll, and during the year 10 were admitted and 7 withdrawn or discharged. Of the new admissions, 6 belong to Penge, and 4 to Beckenham. Of the latter, one is a re-admission. The seven children who left the School during the year did so in the following circumstances: — One boy was transferred to the Elementary School as normal; one was removed to an institution for the feeble-minded; two children left the district to reside elsewhere; two left School on attaining the age of 16 years, and one boy was too low grade to benefit by the instruction provided and was discharged. INSPECTIONS. I have visited the School for the purpose of inspection on 8 occasions during the year. A Routine Inspection for the purpose of discovering physical defects is held once a year, and every child suffering from remedial defects is followed up until appropriate treatment is provided. In addition to this physical examination, a detailed enquiry is made at intervals into the mental condition of the children, their attainments in mental and manual Work, and suggestions are given as to the lines along which instruction can be profitably directed. Various mental tests, such as the Stanford Revision of the BinetSimon Intelligence Scale, are used as an aid to estimating the mental ability of the children, and as a guide to classifying them. Defects of the Special Senses are extremely common amongst these children, and the carrying out of efficient treatment is not so 50 easy as in the case of normal children. In this connection I gratefully acknowledge the assistance and help I have received from Miss McBretney, the Head Teacher, upon whom the success of the School largely depends. Defective eyesight, carious teeth, impediment in speech, and mouth breathing are the more common physical defects, and special attention is given to remedy these as they seriously interfere with the mental development of the child. Those who are intimately associated with the mentally defective realise the large amount of time and attention that has to be given to them, not only in respect of their teaching and training, but also with regard to their medical care and supervision. The general public do not always realise how much more time and money has to be expended upon them than on normal children. They are the " sick " members of the community, and one must approach them with a sympathetic understanding of their infirmities to be able to help or assist them. An increasing amount of attention is given to instruction in manual work, and the progress that some of the children have made in handwork is very satisfactory. PROVISION OF MEALS. The practice of providing a mid-day meal has now been in force since February, 1920, and has proved a great convenience quite apart from the definite benefit which I am satisfied it confers on those children who are Enable to go Jiome in the middle of the day A Cook attends the School daily, and the opportunity is taken to train and instruct the older girls in household duties. The meal consists of two courses and is served on the School premises. The Head Mistress superintends the giving o.f the meals, and attention is given to the conduct of the children and to the service of the food in a proper way. 51 The cost of the meal works out at 4d. per head. The following statement of expenditure refers to the period from 1st November, 1921, to 1st December, 1922. Total number of Meals 2506 £ s. d. Total cost of Meals 41 15 4 Paid by Parents of Children 34 15 0 Allowance by Education Committee 7 0 4 ANNUAL RETURN OF THE AFTER-CAREERS OF CHILDREN FORMERLY ATTENDING SPECIAL SCHOOLS. LOCAL EDUCATION AUTHORITY, BECKENHAM. Name of School. Beckenham Special School. (1) No. of children who have left the School since 1906 or since the date of certification, if later (2) No, who: — (a) have since died (b) are known to be incapable by reason of mental or physical defect of undertaking employment (c) are in attendance at an Institution for further education (d) are in any other Institution 61—43 boys and 18 girls. 7—4 boys and 3 girls. 5 boys and 3 girls. These are not in Institutions. 8—2 boys, Darenth; 1 boy, Leavesden; 1 boy, Starcross; 1 boy, Sevenoaks' Poor Law Institution ; 1 boy, Eastern Counties Institution ; 1 boy returned to normal school; 1 girl, Whittington Hall. 5—1 boy (epileptic), Earlswood ; 1 boy, Kent County Asylum; 1 boy, Caterham Mental Hospital ; I girl, Kent County Asylum ; 1 girl, Bromley Poor Law Institution. 52 (3) No. who are employed in (a) Industrial or manual occupations (b) Agricultural or rural occupations (c) Domestic occupations, including those who are helping in the Domestic work at home (d) Commercial, professional, or clerical work (e) Blind alley or other precarious occupations (4) No. who have left the hood, or whose after-careers have not been traced Wages Table : — (1) Under £l per week (2) £l to £2 per week (3) £2 to £3 per week (4) Over £3 per week 4 men. 3 men. 2—1 boy i girl. 1 man. 11—9 men and youths, 2 girls 19—12 boys and 7 girls. (6 boys reported to other Associations; 1 emigrated; 2 lost sight of; 3 corresponding with ; 2 girls emigrated ; 3 corresponding with ; 2 girls reported to other Associations.) 10 youths, 2 girls. 2 youths. 5 youths. 1 youth. I am much indebted to Mrs Brazil, B.A., the honorary secretary of the After-Care Association, for the information contained in the above Table. REPORT OF AFTER-CARE COMMITTEE. Supplied by Mrs. Brazil, B.A. During the year 1922 five pupils left the Special School; one shortly before his sixteenth birthday, who should become at least partly self-supporting ; another boy who left on attaining the age limit, has been reported to the local authority under Section 2 (b), he is too defective to obtain employment, and no vacancy has yet been found for him ; the parents of a boy excluded under Section 53 2 (a) at present refuse to allow him to go into an Institution ; a fourth boy moved away from the district; the girl who left moved back to Bromley, and re-entered the Special School there. There has been one fresh entry to an Institution—a girl who was sent for health reasons to the Bromley Infirmary. She remains in the Institution, but, we understand, is to be transferred by the Local Authority. Our wage earners number twenty. Those who were previously in good employment have kept their work with one exception, a case that may require increased care. One ex-pupil seems to be making good as an expert carver and joiner, and earns up to £4 per week. The men whose work is of the casual or blind alley kind, have experienced increasing struggle and privation; they have been out of work altogether for long periods in some cases; the entries under the heading " under £l a week " in the wages table include several in such circumstances. In the above Table, Institution Cases are not included under heading 2 (b), nor under heading 4. What duplication there is occurs in heading 3, where occupations of ex-pupils who have left the district are entered, if known. Of the nineteen cases who have left the neighbourhood, all except one have been reported to other Associations, where such exist, or touch is maintained by correspondence. One parent has for twelve years past sent us information about her son. The Committee have, as usual, shown interest in the School by assisting in different ways towards the well-being of the pupils ; they have entertained the wage-earning " old boys '' in the district, and done what they could to show friendly sympathy towards the ex pupils and their relatives. ETHEL BRAZIL, Hon. Secretary. 54 TABLE I.—Number of Children Inspected 1st January, 1922, to 31st December, 1922. A.—ROUTINE MEDICAL INSPECTION. Age Entrants. 3 4 5 6 Other Ages. Total. Boys ... ... 92 28 89 209 Girls ... ... 106 38 96 230 Totals ... ... 198 66 185 439 Age Intermediate Groups. Leavers. Other Ages. Total. Grand Total. 8 12 13 14 Boys 88 90 1 1 145 325 534 Girls 90 88 6 4 148 336 566 Totals .. 178 178 7 5 293 661 1100 B.—SPECIAL INSPECTIONS. Special Cases. Re-examinations (i.e.'), No. of children re-examined. Boys 204 123 Girls 267 144 Totals 471 267 C.—TOTAL NUMBER OF INDIVIDUAL CHILDREN INSPECTED BY THE MEDICAL OFFICER, WHETHEB AS ROUTINE OR SPECIAL CASES (no Child being counted more than once in one Tear). 1571. 55 TABLE II.—Return of Defects found in the course of Medical Inspection, 1922. Defect or Disease. Routine Inspections. Specials. No. referred for treatment. No. requiring to be kept under observation, but not refer rel for treatment. No. referred for treatment. No. requiring to be kept under observation, but not referred for treatment. 1 2 3 4 5 Malnutrition 10 26 7 11 Uncleanliness— Head 106 ... ... ... Body 31 ... ... ... Skin— Ringworm (Head) ... ... 7 2 (Body) ... ... 3 ... Scabies ... ... 4 ... Impetigo 10 ... 9 ... Other Diseases (Non-Tubercular) 3 "2 15 12 Eye- Blepharitis 15 ... 7 ... Conjunctivitis 7 ... 14 ... Keratitis 1 ... ... ... Corneal Ulcer ... ... 2 ... Corneal Opacities ... 1 ... ... Defective Vision 68 48 39 2 Squint 7 11 10 ... Other Conditions 1 ... 2 1 Ear— Defective Hearing 3 2 6 1 Otitis Media 9 3 14 ... Other Ear Diseases ... ... ... ... Nose and Throat— Enlarged Tonsils 18 30 13 3 Adenoids 3 2 4 2 Enlarged Tonsils and Adenoids 7 6 1 Othr Conditions 3 ... 24 2 Enlgd. Cervical Glands (Non-Tubercular) 1 5 2 5 Defective Speech 2 8 ... ... Teeth—Dental Diseases (sec above) ... ... ... ... Heart and Circulation— Heart Disease (Organic) ... 12 9 (Functional) ... 18 1 5 Anæmia 3 1 ... Lungs— Bronchitis 8 8 11 1 Other Non-Tubercular Diseases ... 2 26 3 Tuberculosis— Pulmonary (Definite) 1 ... I ... (Suspected) 1 1 4 6 Non-Pulmonary (Glands) 2 ... 4 3 (Spine) ... ... 1 ... (Hip) ... ... 1 ... Other Bones and Joints ... ... 2 ... Skin ... ... ... ... Other Forms 2 ... 3 ... Nervous System— Epilepsy ... ... ... 3 Chorea 1 ... 6 2 Other Conditions ... 3 ... 4 Deformities— Rickets ... 4 ... ... Spinal Curvature 1 ... ... Other Forms 14 12 7 8 Other Defects and Diseases 7 32 64 40 No. of Individual Children having detects which required treatment or to be kept under observation 908 56 MEDICAL INSPECTION RETURNS. TABLE III. NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1922. Boys. Girls. Total. Blind (including partially blind) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools ... ... ... Attending Certified Schools for the Blind ... 2 2 Not at School ... ... ... Deaf and Dumb (including partially deaf) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools Attending Certified Schools for the Deaf 1 2 3 Not at School Mentally Deficient Feeble minded Attending Public Elementary Schools Attending Certified Schools for Mentally Defective Children 7 3 10 Notified to the Local Control Authority by Local Education Authority during the year 1 0 1 Not at School ... ... ... Imbeciles At School ... ... ... Not at School ... ... ... Idiots ... ... ... Epileptics Attending Public Elementary Schools ... 1 1 Attending Certified Schools for Epileptics 1 ... 1 In Institutions other than Certified Schools ... ... ... Not at School ... 1 ... Physically Defective Pulmonary Tuberculosis Attending Public Elementary Schools ... l 1 Attending Certified Schools for Physically Defective Children ... ... ... In Institutions other than Certified Schools ... ... ... Not at School ... 1 1 Crippling due to Tuberculosis Attending Public Elementary Schools 1 l 2 Attending Certified Schools for Physically Defective Children ... ... ... In Institutions other than Certified Schools Not at School ... Crippling due to causes other than Tuberculosis, i.e. Paralysis, Pickets, Traumatism. Attending Public Elementary Schools ... ... ... Attending Certified Schools for Physically Defective Children ... ... ... In Institutions other than Certified Schools ... ... ... Not at School (now awaiting admission 1 0 1 Other Physical Defectives, delicate & other children suitable for admission to Open-air Schools children suffering from severe Heart Disease. Attending Public Elementary Schools ... l 1 Attending Open-air Schools ... ... ... Attending Certified Schools tor Physically Defective Children other than Open-air Schools ... ... ... Not at School 1 2 3 *Dull or Backward. Retarded 2 years 25 76 101 Retarded 3 years 13 22 35 * Judged according to age and standard. No case retarded more than 3 years to be included in this category unless it has been decided after examination by the Medical Officer that the child is not Mentally Defective. 57 TABLE IV.—Treatment of Defects of Children during 1922. A.—TREATMENT OF MINOR AILMENTS. Disease or Defect. NUMBER OF CHILDREN. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Skin— Ringworm—Head 4 3 1 4 Ringworm—Body 3 3 ... 3 Scabies 4 4 ... 4 Impetigo 183 183 ... 183 Minor Injuries 103 103 ... 103 Other skin disease 98 98 ... 98 Ear Disease 101 101 ... 101 Eye Disease (external & other) 86 86 ... 86 Miscellaneous 143 143 ... 143 B.—TREATMENT OF VISUAL DEFECT. NUMBER OF CHILDREN. Referred for Refraction. Submitted to Refraction. For whom Glasses were Prescribed. For whom Glasses were Provided. Recommended for Treatment other than by Glasses. Received other Forms. of Treatment. For whom no Treatment was considered necessary. Under Local Education Authority's Scheme—Clinic or Hospital. By Private Practitioner or Hospital. Otherwise. Total. 124 106 3 ... 109 81 72 2 2 16 58 D.—TREATMENT OF DENTAL DEFECTS. 1.—No. of Children Dealt With. Age Groups. Specials Total. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by the Dentist 252 302 328 351 391 364 349 334 290 93 2 3056 (b) Referred for Treatment ... 2298 (c) Actually treated ... 1788 (d) Re-treated (result of periodical examination ... 185 C.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Referred for Treatment. NUMBER OF CHILDREN. Received Operative Treatment. Received other Forms of Treatment. Under Local Education Authority's Scheme —Clinic or -Hospital. By Private Practitioner or Hospital. Total. 79 25 2 27 38 59 2.—Particulars of Time Given and of Operations Undertaken. No. of half days devoted to Inspection. No. of half days devoted to Treatment. Total No. of attendances made by the children at the Clinic. No. of Permanent Teeth. No of Temporary Teeth. Total No. of Fillings. No. of administrations of General Anaesthetic included in (4) and (6) No. of other operations. Permanent Teeth. Temporary Teeth. Extracted. Filled. Extracted. Filled. 1 2 3 4 5 6 7 8 9 10 11 30 370 2957 314 1899 1651 445 2344 141 569 105 60 TABLE V. SUMMARY OF TREATMENT OF DEFECTS AS SHOWN IN TABLE IV. (A, B. C, D and F, but excluding E). Disease or Defect. NUMBER OF CHILDREN. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Minor Ailments 725 724 1 725 Visual Defects 124 106 3 109 Defects of Nose and Throat 79 63 2 65 Dental Defects 2298 1788 10 1798 Other Defects 215 186 29 215 Total 3441 2867 45 2912 61 TABLE VI. SUMMARY RELATING TO CHILDREN MEDICALLY INSPECTED AT THE ROUTINE INSPECTIONS DURING THE YEAR 1922. (1) The total number of children medically inspected at the Routinu Inspections 1100 (2) The No. of children in (1) suffering from— Malnutrition 36 Skin Disease 15 Defective Vision (including Squint) 134 Eye Disease 25 Defective Hearing 5 Ear Disease 12 Nose and Throat Disease 63 Enlarged Cervical Glands (Non-Tubercular) 6 Defective Speech 10 Dental Disease 1788 Heart Disease— Organic 12 Functional 18 Anaemia 4 Lung Disease (Non-Tubercular) 18 Tuberculosis— Pulmonary (definite) 1 (suspected) 2 Non-Pulmonary 4 Disease of the Nervous System 4 Deformities 31 Other defects and diseases 39 (3) The No. of children in (1) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for Treatment) 231 (4) The No. of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 210 (5) The No. of children in (4) who received treatment for one or more defects (excluding uncleanlinees, defective clothing, etc.) 187 INDEX. PAGE Analysis of Mortality Table 7 Ambulance Facilities 14 Bacteriological Examinations 15 Bakehouses 18 Births: — Notified 8 Rate 7 Cerebro-Spinal Fever 12 Chickenpox 12 Death: — Table of Causes of 7 Rates 7 Diphtheria 12 Erysipelas 12 Fried Fish Shops—Inspection of 18 Food 21 Fumigation of Materials—Table of 20 Fumigation of Rooms—Table of 20 Health Visitor's Report 8 Housing 23-24 Ice-Cream Shops—Inspection of 19 Infantile Mortality 25 Infectious Diseases 12 Isolation Hospitals 14 Maternity and Child Welfare Dental Scheme 48 Maternity Home—Statistics re 9-10 Measles 6 Medical Inspection of Children: — After-Care Committee—Report 52-53 ,, „ Table 51 Cleansing Scheme 42-43 PAGE Clinics: — Eye 32-33 Dental 33 Inspection (Tuesday Afternoon) 34-35 Treatment 34 Co-ordination of School Medical Service with other Health Services 29 Dental Report 45-48 Deformities 33 Diseases of : — Ear 31-32 Eye 31-32 Heart and Circulation 32-33 Malnutrition 30 Nervous System 35 Nose and Throat 32 Skin 30-31 Employment of Children 44 Evening Play Centres 43 Exclusion from School 37 Infectious Disease 36 Mentally Defectives: — School for 49-51 Provision of Meals for 50 New Appointments 28 Physical Training 43-44 Routine Inspections, 1922 29-33 Staff 28 Tables showing: — Defects found at Routine Inspection 55 Number of Children Inspected 54 Number of Exceptional Children 56 Summary of Routine Inspections 54 Summary of Treatment of Defects 60 Treatment of Defects of Nose and Throat 58 Treatment of Dental Defects 58-59 Treatment of Minor Ailments 57 Treatment of Visual Defects 57 PAGE Treatment Scheme 37-42 Tuberculosis 33 Uncleanliness 30 Meteorology, Table of 26 Milk and Cream Regulations, 1912 21 Nursing Arrangements 10-12 Notifiable Diseases 12-13 Population 6 Public Health Staff 22 Sale of Food and Drugs Act 21 Samples taken during the Year 21 Sanitary Inspection of District 17-19 Slaughter Houses 18 Statistics:—Extracts from 6 General 6 Tuberculosis—Notification of 13 Unsound Food—Destruction of 21 Welfare Centre—Report of 8 Whooping Cough 6