BECS LIBRARY BOROUGH OF BECKENHAM REPORT ON THE HEALTH of the DISTRICT during 1937 INCLUDING THE Report on the Medical Inspection of Children in the Elementary Schools BY T. PHILIPS COLE, M.B., D.P.H. Medical Officer of Health. School Medical Officer. REPORT ON THE HEALTH of the DISTRICT during 1937 INCLUDING THE Report on the Medical Inspection of Children in the Elementary Schools BY T. PHILIPS COLE, M.B., D.P.H. Medical Officer of Health, School Medical Officer, 1 TABLE OF CONTENTS. Members of the Public Health Committee Members of the Education Committee Public Health Staff Introductory Letter Vital Statistics Social Conditions General Provision of Health Services in Area. Nursing Arrangements Maternity & Child Welfare Ante-Natal Home Visiting Welfare Centres Special Treatment Maternity Home Sanitary Circumstances of Area Infectious Diseases— Diphtheria Immunisation Tuberculosis Bacteriological Work Sanitary Inspection of the District— Summary of Visits made Premises controlled by Bye-Laws Shops Act Housing Statistics Housing Inspection and Supervision of Food— Milk Supply Meat Inspection Samples taken Table of Causes of Death Medical Inspection of Schools— Introductory Note School Nurses' Work Routine Inspections Findings of Medical Inspections Milk Supply to Schools Minor Ailment Clinics Eye Clinic Dental Report Ear Clinic Orthopaedic Clinic Report Ultra-Violet Ray Infectious Disease Employment of Children Special School Tables Showing Results of Medical Inspections BOROUGH OF BECKENHAM HEALTH, MATERNITY AND CHILD WELFARE AND HOUSING COMMITTEES Membership up to 9th November, 1937. Chairman: Councillor W. G. HORTON Deputy Chairman: Councillor Mrs. E. M. G. BARLAS Alderman Dr. J. H. Bennett, j.p. Councillor A. L. Carpenter Alderman J. A. Collister Councillor J. Collett Councillor Mrs. C. H. Bellringer Councillor E. C. Dixon Councillor Mrs. E. Campbell Councillor Dr. R. P. S. Edden, Councillor J. H. Atkins o.b.e. Councillor The Rev. R. Burges Councillor C. A. Hannam-Harris Councillor C. G. Brook Councillor G. J. Walker Councillor G. L. Wood Ex-officio Members: The Mayor (Alderman R. T. Parker, j.p.) The Deputy Mayor (Alderman F. Healey, j.p.) Membership from 9th November, 1937. HEALTH AND WELFARE COMMITTEE Chairman: Councillor R. S. JACKSON Deputy Chairman: Councillor Mrs. E. M. G. BARLAS Alderman Mrs. E. Campbell Councillor Mrs. C. H. Bellringer Alderman Dr. J. H. Bennett Councillor The Rev. R. Burges Alderman R. T. Parker, j.p. Councillor C. G. Brook Councillor W. G. Horton Ex-officio Members: The Mayor (Councillor Dr. R. P. S. Edden, o.b.e.) The Deputy Mayor (Alderman J. A. Collister) HOUSING COMMITTEE Chairman: Councillor Mrs. E. M. G. BARLAS Deputy Chairman: Councillor G. L. WOOD Alderman J. Crease, j.p. Councillor J. Collett, c.c. Councillor J. H. Atkins Councillor C. A. Hannam-Harris Councillor The Rev. R. Burges, c.c. Councillor W. G. Horton Councillor T. B. Boyd Councillor G. J. Walker Ex-officio Members: The Mayor (Councillor Dr. R. P. S. Edden, o.b.e., j.p.) The Deputy Mayor (Alderman J. A. Collister) l EDUCATION COMMITTEE List of Members from 9th November, 1936. Chairman: Alderman Mrs. E. Campbell Vice-Chairman: Councillor C. A. Hannam-Harris Other Council Members: The Mayor: Alderman R. T. Parker, j.p. Alderman F. Healey, j.p. Councillor E. C. Dixon Alderman R. W. Jeff Councillor W. G. Horton Councillor J. H. Atkins Councillor T. W. Mallett Councillor The Rev. R. Burges Councillor W. J. Sampson Councillor C. G. Brook Councillor G. J. Walker Councillor J. Collett Co-opted Members: Mrs. E. Brazil, b.a. E. H. Holford Mrs. M. Chamberlain G. W. Neal, b.sc. Mrs. Clayton Taylor Rev. J. W. Niven, d.d" Representative of the London University: Bayford Stone, m.a. Representatives of the Kent County Council: J. A. Bennett C. A. Elgood, j.p., c.a. List of Members from 9th November, 1937. Chairman: Alderman Mrs. E. Campbell Vice-Chairman: Councillor W. J. Sampson Other Council Members: The Mayor: Councillor Dr. Reginald P. S. Edden, o.b.e., j.p. Alderman F. Healey, j.p. Councillor J. Collett, c.c. Councillor J. H. Atkins Councillor E. C. Dixon Councillor C. G. Brook Councillor C. A. Hannam-Harris Councillor T. B. Boyd Councillor W. G. Horton Councillor The Rev. R. Burges, Councillor H. F. Lee c.c. Councillor E. G. Taylor Co-opted Members: Mrs. M. Chamberlain G. W. Neal, b.sc. Mrs. Clayton Taylor Rev. J. W. Niven, d.d. Mr. Ernest H. Holford Mr. Wm. Smerdon Representative of the London University: Bayford Stone, m.a. Members of the Kent County Council: J. A. Bennett, c.c. C. A. Elgood, j.p., c.a. J. R. Hambridge, Education Officer. 2 STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health and School Medical Officer T. Philips Cole, M.B., D.P.H. School Dental Officer R. A. Waters, L.D.S., R.C.S. Asst. to the Medical Officer Miss Greta Malmberg, M.B., D.P.H. (Resigned 30/11 /37) Miss Sheila Thomson, M.B., D.P.H. (Appointed 31/3/38). Chief Sanitary Inspector E. G. Moore, Cert.R.S.I., M.S.I.A. Sanitary Inspectors H. G. Richards, A.R.S.I., M.S.I.A., Cert. Food Inspector H. Handscomb, Cert.R.S.I., Cert. Food Inspector A. C. R. Neale, Cert.R.S.I., Cert. Food Inspector (Appointed 1 /6 /37) S. C. Smith, Cert.R.S.I., Cert. Food Inspector (Appointed November, 1936; Resigned 31 /3/37) Health Visitor Miss M. A. Cusack, Cert.R.S.I., S.C.M. School Nurse Miss B. D. Sizer, S.R.N., S.C.M. Health Visitors and School Miss E. F. Smith, S.R.N., S.C.M. Nurses H.V's.Cert. Miss C. R. Wheeler, S.R.N, S.C.M, H.V's.Cert. Mrs. M. V. Harwin, S.R.N., S.C.M., H.V's Cert. (Appointed 1 /9 /37. Resigned 30/11 /37). Miss R. Noble, S.R.N., S.C.M., H.V's Cert. (Appointed 1/2/38). Part-time Health Visitor Mrs. A. White, S.C.M. Dental Nurse Miss I. M. Monck, S.R.N., C.N. Matron of Maternity Home Miss D. Beard, S.R.N., S.C.M. Assistant Matron Miss H. Lomax, S.R.N., S.C.M. Chief Clerk S. W. Collett, Cert.R.S.I., Cert. Food Inspector. Assistants A. S. Evans R. C. Rogers, Cert.R.S.I. S. P. Lewis S. B. Hawley (Appointed 5 /4/37). The list of Specialist Officers in connection with School Medical work appears at the beginning of the School Report. 3 Public Health Department, Town Hall, Beckenham, Kent. To:— THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF BECKENHAM. Introduction to the Present Report as Set Out in the Form Prescribed by the Ministry of Health. The only matters calling for special comment are set out below :— 1. General Provision of Health Services. There are no great changes to report. An additional Health Visitor who gives half time to School work, took up her duties in September The demands on the services have kept up throughout the year, and the provision of the new Clinic Building in West Wickham is urgently needed to cope with the needs of that area. 2. Infectious Disease. The Diphtheria Immunisation work menced in 1928, continues to progress steadily and the proportion of children in the Elementary Schools who are protected by this method is now becoming a satisfactorily high one. It might be emphasised that this treatment is not restricted to Elementary School children, but is available to any child in the area. The local outbreak of Polio-Myelitis (Infantile Paralysis) during the year, is dealt with in full in the body of the report. 3. Health Publicity. The publication of the Beckenham "Health Notes" was discontinued during the year, the national publication "Better Health" taking their place. Advantage was taken of the national health publicity campaign during the autumn months and special literature and posters were used in the district. I should like to express my appreciation of the interest and support given to the work of the Department by the Members of the Council, and I am very gratified by the continued service given by all members of the staff of the Department. In this connection I would like to record my thanks to Dr. Malmberg ; she had been connected with the Department for a number of years and on her leaving to take up an appointment with the Middlesex County Council we experienced a very real sense of loss. May 23rd, 1938. T. PHILIPS COLE. 4 SUMMARY OF STATISTICS, 1937 Area of District in Acres 5,935 Population: 1931 Census 43,832 Estimated by Registrar General, June, 1937 69,580 Rateable value, 31st March, 1937 £804,005 Sum represented by a penny rate, 31st March, 1937 £3,250 Density of Population (Census, 1931) 11.28 Number of Occupied Houses (Census, 1931) 10,308 Houses erected in 1937 646 Number of live Births (Registrar General's figures):— Males Females Legitimate 474 445 Illegitimate 14 11 Total 930 Live Birth Rate 13.365 Still Births Registered:— Males Females Still Birth Rate (a) per 1,000 population 0.402 (b) per 1,000 Births—live and still 30.271 Number of Deaths (Registrar General's figures) :— Males—315; Females—306 621 Death Rate per 1.000 living 8.924 Infantile Mortality (33 deaths of infants under 1 year of age, per 1,000 births) 35.483 Legitimate: Male, 16; Female, 14 Illegitimate: „ 1 „ 2 Zymotic Death Rate (11 deaths) 0.071 Tuberculosis Death Rate (all forms, 43 deaths) 0.488 ,, (Pulmonary Tuberculosis, 34 deaths) 0.129 (Non- „ „ 9 „ ) 0.014 Disease of Respiratory Organs other than Tuberculosis, 61 deaths 0.876 Cancer Death Rate, 91 deaths 1.307 5 VITAL STATISTICS BIRTH RATE. After allowing for inward and outward transfers during the year, the Registrar General gives a figure of 930 live births and 28 stillbirths in 1937, and this gives a live birth rate of 13.365 compared with 13.766 in 1936. The provisional rate for England and Wales for 1937 was 14.9. DEATH RATE. There were 621 deaths during the year amongst residents, and this gives a death rate of 8.924 per 1,000, as compared with 9.177 in 1936. The figure, although uncorrected for age and sex distribution, compares favourably with the rate of 12.4 for England and Wales in 1937, and when corrected by the application of the "Comparability Factor" supplied by the Registrar General, the figure is reduced to 8.745, which is a very low figure. The causes of death and the ages at death are shown in Table 'A,' and a table showing how the Beckenham figures compare with those for England and Wales appears on page 7. CANCER DEATH RATE. The number of deaths from Cancer is 91, and the rate for 1937 of 1.307 compares with a rate of 1.568 for 1936. HEART DISEASE. The causes of deaths classed under the heading Heart Disease are numerous. The total of 155 deaths includes arterio sclerosis, rheumatic fever, and many deaths due to degenerative changes involving the heart muscle, and due to old age and not to disease. TUBERCULOSIS DEATH RATE. The number of deaths from all forms of Tuberculosis was 43, and the death rate of 0.488 compares with 0.381 in 1936. 34 deaths were due to pulmonary tuberculosis, and 9 to other forms. A table showing the ages at death and the ward distribution appears on page 41. ZYMOTIC DEATH RATE. The deaths from Zymotic diseases totalled 5:2 from Infantile Diarrhoea; 2 from Scarlet Fever; 1 from Whooping Cough. The rate of 0.071 compares with 0.161 in 1936 when there were 11 deaths. 6 BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY DURING 1937. Provisional Figurks. Rate per 1,000 total population Annual Death Rate per 1,000 population. Rate per 1,000 live births. All causes Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea (under 2 years). Total deaths under 1 year. Live Births Still Births England and Wales 14.9 0.60 12.4 0.00 - 0.02 0.01 0.04 0.07 0.45 0.54 5.8 58 122 County Boroughs and Great towns including London 14.9 0.67 12.5 0.01 - 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 143 Smaller Towns (with population between 20,000 and 50,000) 15.3 0.64 11.9 0.00 - 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London 13.3 0.54 12.3 0.00 - 0.01 0.01 0.06 0.05 0.51 0.51 12.0 60 BECKENHAM 1336 0 40 8.94 0 00 - 0 00 002 0 01 000 024 0.21 21 35 7 STILLBIRTHS The total number of Stillbirths was 28, which gives a rate of 0.402 per 1,000 of the population, compared with 0.425 in 1936, and a rate of 29.277 per 1,000 births. Enquiries have been made in 22 cases. 9 cases were attended by doctors and 13 by midwives. Obstetric History: Primagravida 11 Second Pregnancy 6 (In four cases there had been one normal pregnancy : in one case the previous pregnancy had terminated by miscarriage; and in the other the previous pregnancy was an ectopic gestation). Third Pregnancy 3 (In two cases the previous pregnancies were normal; in the other case there had been two miscarriages). Fourth Pregnancy 1 (Previous history showed one normal pregnancy, one stillbirth and one miscarriage). Eleventh Pregnancy 1 (There had been nine normal pregnancies, and one miscarriage). Duration of Pregnancy: Full Term 15 Primagravida 9 Multipara 6 Premature 7 Primagravida 2 Multipara 5 Time of Death: Before Labour 9 Primagravida 3 (All at Full Term) Multipara (2) 4 (One at Full Term; one at 30th week; one at 34th week; one at 36th week) Multipara (3) 1 (At 32nd week) Multipara (4) 1 (At 36th week) 8 During labour 13 Primagravida 8 (Six at Full Term; one at 27th week; one at 37th week) Multipara (2) 2 (Both at Full Term) Multipara (3) 2 (Both at Full Term) Multipara (11) 1 (At Full Term) Cause of Death: Before Labour 9 Full Term 4 (a) Pr. Accidental haemorrhage (b) Pr. (c) Pr. Cause unknown (d) M2. Premature 5 (a) M2. Accidental injury (b) M2. Toxaemia of pregnancy: Ante-partum haemorrhage (c) M2. Cause unknown (d) M3. Hydrocephaly (e) M4. Cause unknown During Labour 13 Full Term 11 (a) Pr. Uterine inertia: prolonged labour (b) Pr. Anencephaly (c) Pr. Uterine inertia: prolonged labour (d) Pr. Extended Breech (e) Pr. Minor contraction : prolonged labour (/) Pr. Cause unknown (g) M2. Extended Breech (h) M2. Cause unknown (i) M3. Toxaemia of pregnancy • (j) M3. Cause unknown (k) Mil. Ante-partum haemorrhage Premature 2 (a) Pr. Toxaemia of Pregnancy (b) Pr. Prolonged labour 9 INFANTILE MORTALITY. The number of deaths among infants under the age of 12 months was 33 as compared with 28 in 1936 and 28 in 1935. The Infantile Mortality Rate for the year was 35.483 per 1,000 births. Disease Weeks Months 0 to 1 1 to 2 2 to 3 3 to 4 Total under 1 mth. 1 to 3 4 to 6 7 to 9 10 to 12 Total under 1 year A. Congenital Deformities— 1. Congenital Heart Disease 1 - - - 1 - - 1 - 2 2. Pyloric Stenosis - - - - - 1 - - - 1 3. Congenital Stricture of Ureters 1 - - - 1 - -- -- - 1 B. Due to Ante-Natal or IntraNatal Conditions— 1. Prematurity 9 - - 1 10 - - - - 10 2. Asphyxia Neonatorum 3 - - - 3 - - - - 3 3. Marasmus - - - - --- 1 - - - 1 4. Congenital Debility 1 - - - 1 -- - - - 1 5. Birth Injury 1 - - - 1 - - - - 1 C. Due to Infections— 1. Broncho-Pneumonia - - - 1 1 2 - - 1 4 2. Whooping Cough: - - - - - - - - - - Broncho Pneumonia - - - - - - 1 - - 1 3. Pyelitis - - - - - 1 - - - 1 4. Meningococcal Meningitis - - - - - - - - 1 1 5. Tubercular Meningitis - - - - - - - - 1 1 6. Gastritis - - - - - 2 - 1 - 3 D. Other Causes— 1. Volvulus—Acute testinal obstruction - 1 - - 1 - - - - 1 2. Cerebral Haemorrhage: Little's Disease - - - - - - 1 - - 1 16 1 - 2 19 7 2 2 3 33 The neo-natal death rate (deaths within the first week) is 17.741 per 1,000 births, compared with 12.77 in 1936 and 11.50 in 1935. 10 INFANTILE MORTALITY 1930 - 1937 inclusive. In the different Wards of the Borough. 1 2 3 4 5 6 Area Births Infant Deaths i.m.r. NeoNatal One week to one year Beckenham M.B. 5,840 196 33.56 15.22 18.32 Manor House Ward ... 1,027 43 41.86 14.60 27.26 Shortlands Ward a 448 18 40.22 15.67 24.55 Copers Cope Ward a 327 12 36.70 27.50 9.10 Lawrie Park Ward ... 683 25 36.60 14.64 21.96 Kent House Ward ... 655 23 35.11 10.68 24.40 Langley Park Ward a 494 16 32.38 16.19 16.19 West Wickham Ward* a 771 24 33.72 18.15 12.97 Eden Park Ward A 1,435 35 24.40 13.20 11.10 *1934-37 only. The above table shows the Infantile Mortality rates in the various wards during the last eight years. There was some revision of boundaries in the year 1935, but this revision did not materially alter the residential character of any of the wards. It will be seen at once (1) that the rates in the various wards differ quite markedly; (2) that although the wards with the greatest density of population did not show the highest rates, the rates for such wards are all higher than the rate for the Borough as a whole. The wards with the greatest density of population are those chiefly occupied by members of the working classes, and are those in which the general standard of housing accommodation is the least satisfactory. The wards where the standard of housing accommodation is best are indicated in the table by the letter "A"; and it is noteworthy that in two of these wards the rates are definitely high. To appreciate the position more exactly, it is necessary to study columns 5 and 6 in the table. In these columns the Total Rate is divided into the neo-natal death rate, and the death rate among infants who have survived the first week of life. The neo-natal death rate is chiefly caused by factors on which environmental conditions have very little influence, and over which we have, with 11 the present state of knowledge, very little effective control. Whilst environmental conditions have a profound influence on deaths from the various infections which are responsible for the majority of deaths occurring in infants over the age of one week and under that of one year, and which in the main are, at any rate theoretically, preventable. It will be noticed: (1) That so far as Neo-natal deaths are concerned, the highest rates occur in the wards where the residential conditions are best. (2) That the highest rates for infections—the more definitely pieventable class of deaths—occurs in the wards where the residential conditions are least satisfactory. Although an average Infantile Mortality Rate of 33 per 1,000 for the whole Borough over a period of eight years represents a very low figure, it can not be considered either satisfactory or irreducible so long as the loss of infant life in children over the age of one week remains as high as it is at present in the more densely populated parts of the Borough. To anyone who has an intimate knowledge of the social and environmental conditions in the different parts of the Borough, this Table will indicate the importance of and the need for a really adequate standard of housing accommodation and amenities. MATERNAL MORTALITY. It is well known that whilst many other fatality rates have declined during recent years, the maternal mortality rate for England and Wales has shown but little alteration, remaining in the neighbourhood of 4.0 per 1,000 births. Two maternal deaths occurred in 1937, the causes being:— A. I. (a) Myocardial degeneration. (b) Rheumatic Fever. II. Caesarean Section. B.Toxaemia of Paralyticileus following Csesarean Section. 12 NATURAL AND SOCIAL CONDITIONS Details of the area and character of the district have been given in previous reports. The estimate of the population at June, 1937, based on information possessed by the Department, is 70,000, and and the Registrar General's estimate is 69,580. UNEMPLOYMENT AND PUBLIC ASSISTANCE. The unemployment in the district is shown by the figures supplied by the Ministry of Labour ; the number of Beckenham residents registered as unemployed on the 31st December, 1937, was 266, as compared with 221 the previous year. The figures for West Wickham were 89. The Kent County Council Public Assistance Department state that the total amount of out-relief given in Beckenham and West Wickham during the year was £8,802, and that 422 cases were admitted for treatment to the Farnborough Hospital. METEOROLOGY. The following observations, taken at the Recreation Ground, Croydon Road, have been kindly supplied by the Borough Surveyor. 1937 METEOROLOGY Month Self-registering Mean Reading of Barometer at 9 a.m. thermometer Rainfall total, per month (inches) Max. in Air Min. in Air January 29.71 54 28 4.31 February 29.47 57 31 4.14 March 29.50 60 25 3.62 April 29.73 65 31 2.31 May 29.94 83 40 2.40 June 30.03 87 46 2.15 July 29.97 86 50 .41 August 30.03 88 50 1.25 September 29.87 81 40 1.96 October 29.89 71 35 2.83 November 29.89 59 26 1.53 December 29.72 56 25 3.91 Mean for year 29.81 70.6 35.6 (Total) 30.82 Borough Engineer and Surveyor's Department, Town Hall, Beckenham. 14th February, 1938. 13 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA The Hospital Ambulance and Nursing facilities in the area are as set out in last year's report. LOCAL CLINIC SERVICES. Ante-Natal The time-table printed is that in force for 1938 and not 1937, and includes amendments made to meet requirements. Mondays, 2 to 4.30; Thursdays, 10 to 12.30 Clinic Block, Town Hall Child Welfare Held afternoons from 2 to 4 Tuesdays (a) Mission Hall, Churchfields Road (alternate weeks) ,,(b) Church House, Lennard Road. Wednesdays Church Hall, Langley Rd., Elmers End. Thursdays Town Hall Fridays (a) Church Hall, Langley Rd., Elmers End. (b) Gospel Hall, W. Wickham (alternate weeks) (c) School Hall, Coney Hall School Inspection Tuesdays, 10 to 12.30 Clinic Block, Town Hall Wednesdays, 10 to 12 ,, ,, Fridays, 10 to 12.30 ,, ,, Minor Ailments Tuesdays and Fridays, 9 to 10 a.m. Churchfields Schools Tuesdays, 9 to 10 a.m., Thursdays, 2 to 3 p.m. Alexandra Schools Tuesdays and Thursdays, 9 to 10 a.m. Marian Vian School Tuesdays and Thursdays, 9 to 10 a.m. Hawes Down School Tuesdays, 9 to 10 a.m. Town Hall Tuesdays and Thursdays, 9 to 10 a.m. Wickham Common School Dental Daily: Cases seen by appointment Clinic Block, Town Hall Tuesdays, 10 to 12 noon Hawes Down School Thursdays, 2 to 4.30 p.m. ,, ,, Orthopaedic and U.V.-ray Mondays, all day Clinic Block, Town Hall Wednesdays, all day ,, ,,, Thursdays, all day ,, ,, Friday mornings ,, ,, Ophthalmic Wednesday afternoons. Clinic Block, Town Hall Aural Tuesday afternoons, monthly Clinic Block, Town Hall Tuberculosis Dispensary Wednesdays, 5 to 6 p.m. Fridays, 1.30 to 3.30 p.m. 1, Westbury Road, Penge 14 The Tuberculosis work is carried out by the Kent County Council, and the staff and the premises are maintained by them. PUBLIC MORTUARY. There were 39 cases of sudden death in the district during 1937. The following statement shows details of these cases:— No. brought to Mortuary No. of postMortems No. of Inquests Causes of Death Natural Suicide Motor Accidents Other Accidents 39 22 16 22 5 5 7 VENEREAL DISEASES. There is no treatment Centre in the area for these diseases. The following is a list of the nearest available Clinics and Hospitals:— NURSING HOMES REGISTRATION ACT, 1927. At the end of the year there were 15 Homes on the Register; one new application was accepted during 1937, and one Home has closed down. The Medical Officer of Health and Assistant M.O.H. paid 60 visits of inspection to the premises and found the records and equipment satisfactory. 15 King's College Hospital, Men Mondays and Thursdays, 5 p.m. Denmark Hill Tuesdays and Fridays, 5.30 p.m. Women Mondays, 7 p.m. Tuesdays, 5 p.m. Wednesdays, 6 p.m. Fridays, 2 p.m. 37, West Hill, Dartford Men Mondays, 4.30 p.m. Wednesdays, 5 p.m. Women Tuesdays, 4 p.m. Guy's Hospital, London ... Daily, 9 a.m. to 8 p.m. St. George's Hospital, Hyde Mondays to Fridays, 9 to 2, and Park Corner 6 to 9 Saturdays, 9 to 3 Croydon General Hospital Men Tuesdays, 7 p.m. Saturdays, 2.30 p.m. Women Wednesdays, 4.30 p.m. THE CHILDREN ACT, 1908. At the beginning of the year there were 18 registered foster mothers having charge of 18 children. 20 children left during the year, and 27 new cases were received. At the end of 1937 ' there were 25 children under the care of 23 foster mothers; 10 foster parents gave up keeping children or left the area, and 11 new names were registered; 4 registered foster parents recommenced keeping children. The Health Visitors made 79 inspections of the premises on the register, and most of the children were seen at the Welfare Centres. ACTS AND BYE-LAWS. No local Acts or Byelaws were put into operation during the year. MIDWIVES ACTS. The Kent County Council are responsible for the supervision of midwives in the district. The new Scheme for County Midwives came into operation on 1/9/37. 16 MATERNITY AND CHILD WELFARE This service deals with the ante-natal care of expectant mothers and the supervision of nursing mothers, and of the children up to the age of five years. NOTIFICATION OF BIRTHS. The 1,087 entries in the Birth Register during the calendar year included 207 inward transfers, and 139 outward transfers, leaving a total of 948 entries, less 28 stillbirths; or 920 infants belonging to Beckenham. The Registrar General gives a figure of 930, calculated over a slightly different period. ANTE-NATAL WORK. In 297 of the 741 births in and belonging to the area, the services of a private medical practitioner were engaged, and the remaining 444 were attended by Midwives. It is for these latter cases that examination and supervision at the Ante-Natal Clinics is intended, and 231 of these were examined at the Ante-Natal Clinics. All assessments for the Maternity Home and district cases are made through the Office, and a visiting card is made out so that advice can be given by the Health Visitors ; this work necessitated 381 visits to 274 cases during 1937. ANTE-NATAL PANEL. The Scheme approved by the Council whereby the ante-natal examination of expectant mothers would be conducted by medical practitioners practising in the district, continued in operation during the year, and the total attendances were 506 compared with 493 in 1936. The panel contains the names of 30 Doctors practising in the district. During the year the following work was done under the scheme:— Sessions held 96 Number of expectant mothers attending for examination240 Number of attendances made 506 Number of doctors attending 30 17 The arrangements worked smoothly and the appointments were well kept by both doctors and patients. In 2 cases X-Ray examinations were carried out at a local hospital to assist in diagnoses. The Assistant Medical Officer saw 20 new cases and made 10 re-examinations of expectant mothers. POST-NATAL CLINIC. Doctors on the panel saw 183 cases, and Dr. Malmberg saw 10 cases. OBSTETRIC CONSULTANT. A consultant was requested by Doctors in 12 cases, four as a result of examinations made at the Ante-Natal Clinic, and 3 in cases of suspected puerperal fever. HOME HELPS. A list is kept of approved "Home Helps," that is, women who undertake domestic work and look after the family during the mother's confinement. In certain cases the Council pay all or part of the fee for such assistance. Arrangements were made to help one case, but the mother finally went into Hospital. GRANT TO MIDWIVES. In necessitous cases the Council are prepared to give a grant of £\ towards the fee of a Midwife attending a confinement with a Doctor. Two applications for this grant were made, and the K.C.C. Scheme now covers this provision. HOME VISITING This work is carried out by the Health Visitors. During 1937 the Health Visitors made a home visit to 578 out of 920 new cases belonging to the district. 18 Home Visits, New Under One 1 to 5 Special Illness Expect. Mothers Boarded Oat No reply to call Total Welfare Visits T.B. Visits Miss Cusack 200 900 1,573 335 173 35 407 3,623 229 Miss Smith 174 440 678 98 99 20 306 1,815 131 Miss Wheeler 139 460 978 79 79 21 333 2,089 156 Mrs. White 22 112 326 - - - - 460 - Temporary Nurse 43 235 600 16 30 3 115 1,042 32 Total 578 2,247 4,155 528 381 79 1,161 8,981 548 The total number of visits, 8981 compares with 8,823 in 1936. INFANT WELFARE ATTENDANCES Town Hall C'tre Alexandra C'tre Elmers End Ct're Wickham C'tre Coney Hall C'tre Ch'chfields C'tre Total 1937 Total 1936 Individual Children 486 309 677 215 192 106 1,985 1,970 Total Attendances 4,486 3,745 6,654 1,720 1,833 842 19,280 18,222 New Cases 207 153 199 102 95 32 788 819 Average Sessional Attendance 86.2 78.0 65.8 63.7 67.8 33.7 68.8 61.97 Sessions 52 48 101 27 27 25 280 294 Cases seen by Medical Officer 919 618 1,586 441 536 354 4,454 4,492 Average No. per The total attendances show an increase. Six sessions per week have been held during the year. It is undesirable for the attendance at any one session to exceed 50, as with a number greater than this it is impossible for the Health Visitors to devote the necessary time to individual cases and to get to know the mothers present, or to give those informal talks which are such a valuable means to health education. 19 The following figures show the main reasons for medical examinations:— Referred Average Number Total seen Feeding and to Special Special General seen by Doctor by Doctor. Digestion. Clinics. Cases. Progress. per Session. 4,454 1,160 183 91 3,020 15.9 FOLLOWING-UP OF 2 TO 5 YEARS OLD CHILDREN. There are approximately 2,000 children of these ages on the register, and, wherever possible, they are visited twice a year by the Health Visitors. The attendances of "Toddlers" at the Centres reached the satisfactorily high figure of 2,964. The following figures show the attendances of children in age groups:— Year born Total who Attended Attendances made Average number of Attendances per Child 1932 157 456 2.9 1933 207 926 4.3 1934 259 1,582 6.1 1935 361 2,627 7.2 1936 521 8,390 16.1 1937 480 5,299 11.0 Total 1,985 19,280 9.9 PROVISION OF MILK, MILK FOODS, ETC. A stock of dried milks and other foods is kept at the Centres and sold to the mothers at cost price. During the year foods to the value of approximately £1,200 were sold. FREE MILK TO NECESSITOUS CASES. A sum of £180 was spent upon providing milk for children under five years of age. A form of application is submitted in every case showing the family income, and a scale of income has been adopted by the Council for guidance in granting free issues. 20 VOLUNTARY HELPERS. We are much indebted to the following ladies who continue to give most valuable assistance at the Welfare Centres: Miss Bradford, Mrs. Buckley, Mrs. A. P. Cole, Mrs. T. P. Cole, Miss Exley, Miss G. Firmin, Mrs. Jeffries, Mrs. Harris, Mrs. Matthews, Miss Morland, Mrs. Moirison, Mrs. Porter, Mrs. R. Prebble and Mrs. Tovey. The following ladies have continued to give assistance at the West Wickham Centre : Mrs. Bunce, Mrs. Chester, Mrs. Drayton. Mrs. Lebbon, Mrs. Martin and Mrs. Poole. The following ladies assist at the Coney Hall Centre: Mrs. Barber, Mrs. Bone, Mrs. Jeffreys, Mrs. Lee, Mrs. Reardon and Mrs. Shambrook. SPECIAL TREATMENT. Arrangements have been made for children from 1—5 years of age to participate in the special services available for school children, and the use made is shown by the following figures:— Cases in attendance— Dental. Tonsils and Adenoids. Eye Clinic. U.V.Ray Clinic. Orthopaedic Clinic. Aural Clinic. 1935] 178 Infints 7 49 19 103 23 93 Mothers 1936 187 Infants 23 46 27 110 22 120 Mothers 1937 166 Infants 11 49 21 95 28 128 Mothers MATERNITY AND CHILD WELFARE DENTAL REPORT, 1937. The sessions are held on Friday afternoons and at such other times as circumstances demand. The estimated number of sessions is 72 and the attendances totalled 696 compared with 766 in 1936. The comparatively large increase in Mothers attending reported in 1936 has been maintained, 128 this year compared with 120 in 1936 and 93 in 1935. An increasing need for treatment of expectant and nursing mothers must be anticipated in the near future. 21 There is not much variation in the numbers of children attending for treatment, 166 this year, 187 in 1936 and 178 in 1935, but there is a difference in the amount of treatment required :— 1936 1937 Extractions 273 186 Fillings 212 166 The fact that the more severe dental troubles are less prevalent in the toddler class, is due, I think, to the advice given by the Health Visitors at the centres and during the home visits, on the importance of mouth cleanliness and the attention to diet. The following is the summary of the year's work:— Mothers Children Attendances 395 301 Number treated 128 166 Extractions 463 186 Fillings 82 166 Dressings 87 83 Silver Nitrate — 140 Local Injections 38 16 Nitrous Oxide 86 53 Ethyl Chloride — 10 Impressions, etc.. 103 — Scalings 19 — Dentures 39 - Repairs 5 — Robert A. Waters, L.D.S., R.C.S.Eng 2 2 BECKENHAM AND PENGE JOINT MATERNITY HOME This Home was opened on the 1st August, 1920, with accommodation for 10 beds, which has since been increased to 14 beds. The figures give the number of mothers admitted during 1937, with comparative figures. Year Total cases admitted Beckenham cases Penge cases Out-district cases 1931 343 217 123 3 1932 333 236 93 4 1933 324 227 97 - 1934 347 254 93 - 1935 323 226 97 - 1936 339 245 94 - 1937 319 288 81 - STAFF. The Nursing Staff consists of a Matron, Assistant Matron, and two trained Midwives as Staff Nurses and two Probationers. There are also pupils receiving training. The accommodation consists of:— Two general wards, each containing 4 beds. One ward containing 4 cubicles. Two private rooms. A Theatre or Labour Ward, nursery, sterilising room. An Isolation Block, containing 2 wards, kitchen, accommodation for the nursing staff engaged in the block. FEES PAYABLE. The scale of fees drawn up by the Committee in 1930 was revised during the year, to provide for a more gradual increase in fees and an increase in the higher income grades. TRAINING OF MIDWIVES. The Home is recognised by the Ministry of Health and the Central Midwives' Board as a Training Centre for Midwives, and is allowed to have 5 pupils in training. Since its inception as a Training Centre in 1923, 72 pupils have been trained and passed the examination of the Central Midwives' Board ; 4 passing in 1937. 23 DISTRICT CASES. Cases who do not wish to enter the Maternity Home for their confinement and cannot afford the services of a private doctor, can have the attendance of a Midwife, who, in these cases, works in conjunction with the Welfare Centres and the Maternity Home. The District Midwives attended 90 cases of this kind referred to them through the Welfare Centres (Beckenham, 42 ; Penge, 48) up to 1 /9 /37, when the County Scheme came into operation. ANTE-NATAL WORK. Ante-natal Clinics are held at the Home on Tuesdays, Wednesdays and Thursdays. Every mother entering the Home under the care of the Midwives, or engaging the services of the District Midwives working in conjunction with the Home, attends these Clinics for Ante-natal supervision by the Home Midwives. Both Beckenham and Penge cases are dealt with, and further Ante-natal care is given to Beckenham cases on Thursdays mornings at the Town Hall Clinic. During 1937, 346 expectant mothers (Beckenham, 252 ; Penge, 94) attended the Maternity Home Clinic. The number of sessions held was 156, and the attendances totalled 1,969, a weekly average of 37. ADMINISTRATION AND COST. The comparative return of the cost of maintaining Municipal Maternity Homes in England shows that the cost per patient week in the Beckenham and Penge Home compares favourably with similar Homes throughout the country. MATERNAL MORTALITY. Since the Home was opened in August, 1920, there have been 4,969 births in the Home and 1,250 on the District, giving a total of 6,219 births. There have been, in all, 9 maternal deaths, giving a maternal mortality rate of 1.44 per 1,000 births, compared with the rate over the same period of approximately 4.0 per 1,000 births for England and Wales as a whole. 24 ANNUAL STATISTICS FOR 1937 Relating to the Beckenham and Penge Joint Maternity Home Information Required Particulars 1. Name and Address of Institution Beckenham and Penge Joint Maternity Home, 80, Croydon Road, Beckenham 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds) 14 2a Number of such beds used for Ante-Natal cases 3 3. Number of maternity cases admitted during the year 319 4. Average duration of stay 14.569 days 5. Number of cases delivered by (a) Midwives 258 (b) Doctors 61 6. Number of cases in which medical assistance was sought by a midwife in emergency 84 7. Number of cases notified as : (a) Puerperal Fever 1 (b) Puerperal Pyrexia* 6 8. Number of cases of Pemphigus Neonatorum Nil 9. Number of infants not entirely breast-fed while in the Institution 13 Supplementary feeds 1 Completely artificially fed. *i.e. rise of temperature to 100.4° F. for 24 hours, or its recurrence within that period. 25 Information Required Particulars 10. (a) Number of cases notified as ophthalmia neonatorum Nil (b) Result of treatment in each case — 11. (a) Number of Maternal deaths Nil (b) Cause of death in each case 12. (a) Number of foetal deaths : (i) Stillborn 10 (ii) Within 10 days of birth 6 (b) Cause of death in each case, and results of post - mortem examination (if obtainable) See below : 1. Stillbirths : 1. Uterine inertia (Prolonged labour) 2. Anencephaly. 3. Ante-partum haemorrhage. 4. Toxaemia. 5. Accidental haemorrhage. 6. Extended breech. 7. Cause unknown. 8. Prolonged labour. instrumental delivery. 9. Cause unknown. 10. Cause unknown. 2. Infant Deaths : 1. Lived 25 minutes, maturity. 2. Lived 1 day, Convulsions prematurity. 3. Lived 1 hour, Asphyxia neonatorum. 4. Lived 11 hours, pneumonia, congenital debility. 5. Lived 11 hours, prematurity —32 weeks. 6. Lived 8 hours, prematurity —24 weeks. 26 SANITARY CIRCUMSTANCES OF THE AREA Full details of the Water Supply, Sewerage and Drainage, and Scavenging arrangements have been given in previous reports. The few premises in the added areas not provided with main I drainage are connected as the development of the area proceeds. INFECTIOUS DISEASE The following table gives the number of cases which were notified during the year, the number removed to Hospital for treatment, and the number of deaths. Diseases Notified Removed to Hospital Total Deaths Bk. W.W. Total Total Diphtheria 8 3 11 11 - Scarlet Fever 56 59 115 86 2 Enteric Fever - 5 5 2 - Puerperal Fever and Pyrexia 9 8 17 - - Pneumonia 44 7 51 — 38 Tuberculosis (all forms) - - 60 - 43 Erysipelas 4 3 7 - - Poliomyelitis 2 10 12 - — Polio-Encephalitis 2 - 2 - 1 Ophthalmia Neonatorum - - - - - Dysentery 13 5 18 - - Food Poisoning 3 - 3 - - DIPHTHERIA. The incidence of Diphtheria was again very low in 1937. Only 11 cases were notified. Eight cases occurred in Original Beckenham 27 and 3 in West Wickham. There were only 5 cases among children attending the elementary schools in the Borough. No case occurred in a person who had been rendered immune by protective inoculation. The age incidence of the cases was:— 0—5 5—15 Over 15 Total Original Beckenham1 4 3 8 West Wickham 0 2 1 3 DIPHTHERIA IMMUNISATION. During 1937, consents were received in respect of 637 children, and of these 102 were under school age. Whilst a reasonable number of school children continue to be protected, the percentage of children under school age who are brought for protection is extremely lowIt must be remembered that we do not yet know the percentage of protection necessary to prevent extensive outbreaks of the disease. It is true that the incidence of Diphtheria has been low in the Borough for the last nine years, but we are not yet in a position to assert that this continued low incidence has been brought about by the protective work which has been done. Should the disease appear again in a more widespread outbreak, the comparatively small degree of protection at present existing among the pre-school children would be reason for considerable anxiety. I indicated in my Annual Report for 1936 that the then existing degree of protection in the West Wickham area would be quite ineffective in limiting any outbreak which might occur, and which recent epidemiological experience suggested might be expected. During 1937, there has been a good response to the offer of protective treatment, and the percentage of protected children in the West Wickham schools at the end of the year was much more satisfactory. So far as the Infants' Departments were concerned, the percentage protected had risen from 30 to 50. 28 The following table shows the position in the Infants' Departments at 31st December, 1937, with comparative figures for four preceding year:— School Year of Birth Percentage Protected 1930 1931 1932 1933 Total 1937 1936 1935 1934 1933 Alexandra— On Roll 95 85 63 - 243 Immune 52 37 3 - 92 42.3 50.8 39.5 37.2 23.7 3 Doses 3 4 4 — 11 Balgowan— On Roll 61 83 73 — 217 Immune 35 32 14 — 81 45.0 47.9 50.2 54.1 35.4 3 Doses 1 2 16 — 19 Bromley Rd.— On Roll 37 34 34 1 106 Immune 13 12 5 — 30 39.6 44.9 52.8 72.0 41.6 3 Doses 1 4 7 — 12 Churchfields- On Roll 100 104 101 1 306 Immune 48 55 15 - 118 55.8 49.5 48.2 50.6 47.4 3 Doses 4 7 42 — 53 Hawes Down- On Roll 121 96 81 - 298 Immune 29 19 3 - 51 52.6 29.9 35.9 25.7 - 3 Doses 37 35 33 — 105 Marian Vian— On Roll 118 145 106 - 369 Immune 68 80 9 - 155 50.1 56.0 51.2 50.6 40.5 3 Doses - 9 21 — 30 Wickham Common— On Roll 60 74 66 - 190 Immune 26 17 1 - 44 50.5 30.4 - - - 3 Doses 7 20 25 — 52 The percentage of Immunity for all Infants' Departments combined, in the last five years, has been :— 1933 1934 1935 1936 1937 37.6 49.4 48.0 44.7 49.0 29 30 DIPHTHERIA IMMUNISATION, 1937 Number of Children in Elementary Schools completely Protected at 31/12/1937. School. born 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 B G B G B G B G B G B G B G B G B G B G B G B G Alexandra: or 33 30 41 44 45 50 39 42 50 65 46 53 52 - 61 - 67 - 31 - - - - - imm 1 1 1 — 4 4 2 2 1 8 1 — 2 — 8 — 12 — 12 — — — — — 3 d — 1 17 19 23 21 13 12 8 18 15 16 19 — 12 — 7 — 11 — — — — — Balgowan or 38 35 41 42 25 36 47 41 38 26 51 4 33 39 15 27 6 5 imm 1 1 1 1 — — 4 2 4 6 4 1 7 16 5 4 2 1 3 D 3 9 13 17 11 24 10 12 6 9 6 — 2 1 2 3 1 — Bromley Rd: or 14 20 19 15 11 26 27 35 29 45 26 33 21 22 26 45 19 23 4 16 - - - - imm - 1 - - - 2 1 — 3 4 1 1 2 4 3 7 4 4 — 4 — — — — 3 d 2 2 6 6 4 7 14 17 10 14 12 15 3 7 6 18 3 4 — 2 — — — — Churchf'ds : or 45 56 48 56 50 50 51 60 35 45 42 64 — 71 — 76 — 47 - 25 - - - - imm - 2 1 — — 2 2 3 1 1 4 4 — 6 — 16 — 10 — 7 — — — — 3d 8 5 27 27 19 26 25 32 14 16 17 22 — 20 — 14 — 9 — 1 — — — — Hawes D'n : or 39 42 54 51 70 65 74 56 78 65 68 51 42 57 44 40 39 54 10 17 - - — - imm - 1 - 1 2 — 1 2 1 — 2 1 3 1 6 — 1 1 — 1 — — — — 3 D 1 1 17 10 16 24 24 15 17 21 14 15 2 8 2 5 4 2 — 2 — — — — MarianVian: or 58 48 71 74 66 52 77 63 80 78 67 83 47 42 50 53 40 58 18 20 - - - - imm - 1 - - — — 6 — 4 4 2 5 6 5 11 8 4 7 4 5 — — — — 3 D 5 3 48 32 31 35 39 36 36 32 28 35 10 10 10 12 6 6 — 2 — — — — Wickham C.: or 35 31 30 44 24 36 39 30 29 26 31 30 imm - - — — — — — — — 3 2 3 3 D 1 - 5 12 9 17 13 10 2 7 5 - 31 DIPHTHERIA IMMUNISATION. Table Shewing New Cases Commencing Treatment during 1937. Born Schick Test Doses First Retest Negati ve + Failed to complete or left area Had 3 doses Left area Not due Negative Positive *Had 4th dose and proved Negative. 1936 - - - 11 - 7 4 - „ „ „ „ 1935 - 2 2 18 - 9 9 - New Cases 48 1934 - 2 1 26 2 12 12 - from 43 1933 1 15 3 40 3 25 12 - Table 546 1932 8 221 21 203 3 168 32 - - 1931 7 105 7 100 1 80 18 1* 637 1930 8 71 3 68 1 57 9 1* 1929 5 29 - 30 1 24 3 2* 1928 8 22 2 20 - 18 2 - New Cases from Summary 675 1927 3 17 1 16 1 12 3 - Less 35 1926 4 11 3 9 1 6 2 - - 1925 4 3 - 3 - 3 - - 640 1924 — 1 — 2 — 2 — — - 48 499 43 546 13 423 106 4 SCARLET FEVER. The number of cases notified during the year was 115 compared with 122 in 1936. Original Beckenham. Fifty-seven cases were notified compared with 71 in 1936. This continued downward trend was in accordance with expectations. The periodical incidence curve is near its lowest point, and incidence should remain low during the next year or two. The cases were spread over the whole district, the only noteworthy feature being the unusually large number of early secondary cases occurring in families where the original case was removed to Hospital for isolation and treatment. West Wickham. Fifty-eight cases were notified compared with 51 in 1936. The increased prevalence noted in West Wickham during the latter months of 1936 persisted through the earlier months of 1937 ; but after the month of April the incidence rapidly declined. The peak of the outbreak was in December, 1936. Thirty-two cases being notified in the last three months of 1936, and 31 in the first four months of 1937. The total number of cases occurring during the two years 1936 and 1937 among children attending the elementary schools was 63, representing an incidence of 5.6 per cent of the average number of children in attendance during the period. This percentage is rather lower than that frequently met with under similar circumstances. As indicated in my Annual Report for 1936, outbreaks only terminate when the mass immunity has reached a sufficiently high level, and the only practicable method of developing this mass immunity is to allow individuals to acquire personal immunity by mingling with their fellows. If mass immunisation against Scarlet Fever by protective inoculations were a practicable procedure, Nature's method with its inevitable increase in the number of actual cases could be obviated. School closure might reduce the number of cases during the actual period of closure, but it would interfere with this natural production of immunity, and its ultimate effect would be to prolong the period of the outbreak, and lead to the production of a greater total number of cases. The age incidence of the cases was:— 0—5 5—15 Over 15 Total Original Beckenham 15 33 9 57 West Wickham 8 43 7 58 32 Observation during the last two years lends support to the view that late secondary cases are commoner in houses where the original case was removed to Hospital than in houses in which the first case was treated at home. It is possible that in the latter instance the other occupants of the house, though not in actual personal contact with the patient, acquire a reasonable degree of immunity against the disease. POLIO-MYELITIS AND POLIO-ENCEPHALITIS. These titles probably refer to a single disease, the description varying with the part of the central nervous system principally affected in each case. The more generally known name of this disease is Infantile Paralysis. The epidemiology of the disease is not fully understood. It principally affects young children and adolescents. It is more prone to occur in the late summer and autumn. It is noticed that it tends to break out at the same time in many different areas all over the country ; or even all over the continent ; this tendency appears to be commoner with diseases caused by a virus, than in diseases caused by demonstrable bacteria. The infection is believed to gain access to the human body through the upper respiratory passages, and present opinion regards the terminal filaments of the olfactory nerves in the roof of the nasal passages as the point of entry. The infection appears to involve the central nervous system by direct extension along the nerves themselves ; it is not, primarily at any rate, a blood borne infection. This may explain why the use of antitoxins have proved to be of no practical assistance in preventing infection or combating the disease. On the other hand, the relatively low incidence among adults suggests that most people are able, in the course of time, to acquire an adequate degree of natural active immunity. The disease is thought to be due to a virus, and is spread by " droplet " infection in much the same way as the ordinary common cold spreads. No information of practical value can be obtained from swabs taken from the throats or noses of patients or contacts, and this in itself adds considerably to the difficulties of controlling an outbreak. If one adds to this the fact that in every outbreak, mild and abortive (but still infectious) cases are extremely common, the difficulties of control are apparent. Recent opinion suggests that very little reliance can be placed on ordinary douching or spraying of the nasal passages as a measure of prophylaxis ; though work is proceeding in America on the possible value of spraying the roof of the nose with certain substances. Initial reports on this process are encouraging, but it requires a much more extended period of trial; it is, however, already quite clear that the work requires the employment of a special technique by surgeons experienced in throat and nose work. 33 34 IMMUNISATION TREATMENT Cases Commencing Treatment prior to 1937. TABLE II. Result of Treatment given during 1937. Born Completed 3 Failed 1 st Retest 1st Retest 4th Dose 2nd Retest 5th Dose Remarks Retest Negative Positive Failed Had Negative Positive 1936 — — — — - - - 1935 — — 8 — — — - - — — 1934 1 1 12 — — — - - — — 1933 1 — 18 — — 1 - - — — 1932 1 1 21 — — — - - — — 1931 34 16 188 7 1 6 6 - — — 1930 8 5 73 1 — 3 3 - — — 1929 6 4 23 — — — - - 1 Neg. 1928 — — 3 1 — 1 1 - — - 1927 3 2 4 1 — 1 1 - — - 1926 2 1 4 — — 1 — 1 — - 1925 — 1 3 — — — — — 1 6 doses Neg. 56 31 357 10 1 13 12 1 2 The disease is infectious right from the onset of the illness, some days before any actual signs of paralysis are present, and in many cases the initial symptoms resemble very closely those of other acute and sometimes quite mild illnesses. When warned of the presence of the disease in the community, it is possible by careful examination to arrive at a provisional diagnosis. There were two limited outbreaks of the disease in the Borough during the year; an outbreak in the Elmers End and Eden Park areas during the end of July and the beginning of August; and a subsequent outbreak in the Coney Hall district of West Wickham in October and early November. An interval of several months occurred between the two outbreaks, and it is not possible to establish any definite connection. The first outbreak occurred towards the end of July, and the first notification was received at the beginning of August. In this outbreak four cases were notified, three being classed as Polioencephalitis and one as Polio-myelitis. In one case of Polioencephalitis the diagnosis was a provisional one and it was subsequently withdrawn. Associated with this outbreak there were three cases which occurred among Beckenham residents whilst away on holiday. The total of known cases in this outbreak, therefore, was six, of which four were severe and two slight; two cases terminated fatally. The onset of the disease in the severe cases was very rapid, evidence of paralysis affecting the brain-centres being present at the end of forty-eight hours. At this time the schools were closed for the holidays and the children dispersed ; and although this may have had some effect in limiting the number of cases, it deprived the Health Department of one of the most valuable factors in controlling the outbreak. Medical practitioners were immediately notified of the circumstances, and received a memorandum indicating the clinical characters of the cases and the best means of arriving at an early diagnosis in any suspected cases. Arrangements were made with the London County Council for the reception and treatment of cases during the acute infectious stage at one of their special hospitals, there being no accommodation available for the treatment of this condition at the Hospital of the West Kent Joint Hospital Board. The weekly Death Returns were carefully scrutinised and arrangements were made with the Registrar of Births and Deaths to forward immediately to the Health Department particulars of deaths occurring among children. The last notified case occurred cn August 9th. The second outbreak occurred in October in the Coney Hall area. In this outbreak the cases were all classed as Polio-myelitis, no case showing any evidence of paralysis of the brain centres. Cases were notified on the 16th and 21st October. The practitioners were again advised, and their assistance in detecting mild cases was very valuable. Every school child who was at that time absent from school 35 36 DIPHTHERIA IMMUNISATION Table Shewing Position at 31/12/1937 of All Cases Commencing Treatment before 31/12/1936. TABLE III. Born Schick Doses Doses S.T. 1st Retest Doses 2nd Retest 5th Dose 3rd Retest Neg. + F 3 F 3 F Neg. + F 4th F Neg. + F Had F Neg. + Add Doses Retest Neg. 1935 - - - - - 9 1 8 - - - - - - - - - - - - - 1934 - 1 - 1 — 18 2 17 - - - - - - - - - - - - - 1933 - 6 1 5 — 37 1 40 1 — 1 — 1 — - - - - - - - 1932 - 21 1 20 1 37 4 53 - - - - - - - - - - - - - 1931 5 265 4 261 3 64 31 282 12 2 10 — 10 - - - - - - - - 1930 17 285 10 275 5 63 19 310 9 1 8 — 7 1 - 1 - - 1 1 1 1929 22 284 11 273 6 57 16 295 19 1 18 — 17 1 - 1 - 1 - - - 1928 31 226 11 215 3 103 18 279 21 3 18 1 14 3 - 3 - 3 - - - 1927 29 180 6 174 — 171 16 299 30 2 28 — 28 - - - - - - - - 1926 21 98 7 91 7 235 26 243 57 2 55 4 48 3 - 3 - 2 1 1 1 1925 21 78 1 77 — 210 18 212 57 7 50 — 47 3 - 3 1 2 - - - 1924 26 94 4 90 1 193 14 218 51 13 38 — 34 4 1 3 - 3 - - - 1923 62 97 3 94 1 183 24 201 52 8 44 — 41 3 1 2 - 2 - - - 1922 59 113 4 109 — 107 18 152 46 8 38 — 36 2 - 2 - 2 - - - 1921 82 141 5 136 — 109 23 185 37 4 33 — 28 5 2 3 - 3 - - - 1920 248 454 37 417 1 36 46 333 74 23 51 — 47 4 2 2 - 2 - - - and earlier cases 623 2343 105 2238 28 1632 277 3127 466 74 392 5 358 29 6 23 1 20 2 2 2 Total Protected at 31/12/1937 : Naturally Immune 623 3 Doses Negative 3,127 4 Doses Negative 358 5 Doses Negative 20 6 Doses Negative 2 4,130 was excluded until visited by a member of the Public Health Staff, and every child who had been absent for two consecutive days or longer was also examined. The school was not closed, but every child who was absent during the ensuing months was seen by the Public Health Staff or by a private doctor before being permitted to return. As a result of these measures, seven very mild cases were discovered ; in several instances the children were quite well but showed very slight degrees of muscular weakness and gave a history of feverish attacks with headache and weakness during the previous fortnight. An isolated case occurred in an infant in another part of the district on November 18th, and this proved to be the last case. The mild cases were isolated at home for a month from the date of onset and were thereafter examined by the Orthopaedic Surgeon, who confirmed the existence of slight muscular weakness in every case and prescribed the appropriate treatment where necessary. The total number of cases notified during the outbreak was ten, and of these three were severe and seven mild. The severe cases were removed to hospital. It is only by the careful examination of all cases of illness occurring among children when the presence of the disease has declared itself, and by the close supervision of contacts of all known cases that any effective control can be established ; and in this connection the whole-hearted co-operation of the medical practitioners in the district—such as was given to the Public Health Department in the outbreaks recorded—is of the greatest possible value. The following table shows the cases with the dates of onset and the dates of notification :— Case Number Sex Age Date of onset Date of notification 1 Male 5¼ 19/ 7/37 12/ 8/37 2 ,„ 7 28/ 8/37 8/ 9/37 3 „ 10 7/8/37 10/ 8/37 (Subsequently withdrawn). 4 „ 4 9/ 8/37 13/ 8/37 5 Female 7 8/10/37 16/10/37 6 „ 7 20/10/37 21 /10/37 7 Male 13 13/10/37 21 /10/37 8 Female 6 10/10/37 25/10/37 9 Male 8 16/10/37 25/10/37 10 „ 6 12/10/37 25/10/37 11 „ 3 13/10/37 25/10/37 12 „ 6 18/10/37 12/11/37 13 „ 30 . 11/11/37 15/11/37 14 „ 1½ 18/11/37 20/11/37 37 The preponderance of males is noteworthy. Past experience shows that males are affected more frequently than females. TYPHOID FEVER. Three cases of Typhoid Fever and two cases of Paratyphoid Fever were notified during the year. All the cases occurred in the West Wickham Ward. Typhoid Fever. Onset Notified Case (1) Femaleagedll 21/10/37 2/11/37 Case (2) Male aged 17 21/10/37 5/11/37 Case (3) Male aged 16 27/11/37 3/12/37 Cases 1 and 3 occurred in the same house, and there is no doubt that case 3 was secondary to case 1. Cases 1 and 2 occurred at a time when the disease was prevalent in an adjoining Borough ; enquiry showed that it was probable that case 1 contracted the disease in that Borough, but no direct relation of a similar nature could be established with regard to case 2. The cases were all severe, but none proved fatal. Paratyphoid Fever. Onset Notified Case (1) Male aged 4 21/3/37 7/4/37 Case(2) Female aged 13 2/5/37 13/5/37 In neither case was the source of infection discovered. PUERPERAL PYREXIA AND PUERPERAL FEVER. Fifteen cases of Pyrexia and 2 of Puerperal Fever were notified The term Puerperal Fever was discontinued after 1 /10/37. Six of the Pyrexia cases occurred in the Beckenham and Penge Joint Maternity Home. The table on page 39 gives details of the cases. 38 63 DETAILS OF CASES OF PUERPERAL PYREXIA AND FEVER [Case No. Date of Confinement Onset Notified Cause Treatment and Result Cases in Municipal Maternity Home : 8 31/12/36 10/ 1/37 11/ 1/37 Influenza Treated by own Doctor. Complete recovery. 41 8/ 2/37 11/ 2/37 17/ 2/37 Urinary Infection Isolated in Block. Complete recovery. 107a 22/ 5/37 23/ 5/37 27/ 5/37 Urticarial Rash Rapid Recovery. 137 31/ 7/37 3/ 8/37 6/8 /37 Adherent Placenta Isolated in Block Good recovery. 182 18/10/37 20/10/37 1/11/37 Uterine Infection : Had Septic Thumb Isolated in Block. Recovered after 12 days. 209 16/11/37 23/11/37 1/12/37 Cause unknown Isolated in Block. Cases in other Institutions : 13 14/ 1/37 17/ 1/37 18/ 1/37 Uterine Infection. Influenza To Hospital 18/1/37. 31 29/ 1/37 1/ 2/37 6/ 2/37 Urinary Infection Strep : faecalis To Hospital 6/2/37. Discharged 20/2/37. 53 21/ 2/37 22/ 2/37 25/ 2/37 Post partum haemorrhage No final report. 65 15/ 3/37 18/ 3/37 23/ 3/37 Streptococcal Infection To Hospital 19/3/37. Discharged 30/3/37. Good recovery. 66 3/ 3/37 4/ 3/37 23/ 3/37 B.coli and B.Hae.Strep. Infection To Hospital. 102 7/ 5/37 25/ 5/37 27/ 5/37 Thrombosis of Veins, both legs Good recovery. 122 2/ 7/37 8/ 7/37 9/ 7/37 Pelvic Cellulitis Good recovery. 150 24/ 8/37 27/ 8/37 31/ 8/37 Bronchial Infection and Peritonitis To Hospital 30/8/37. Died 31/8/37. Cases in Own Homes: 133 27/ 7/37 30/ 7/37 3/ 8/37 Retained Placenta; Streptococcal To Hospital 4/8/37. Disch. 18/9/37. Well fection except for foot drop. Treated through Orthopaedic Clinic. 152 25/ 8/37 25/ 8/37 8/ 9/37 Urinary Infection : Anaemia To Hospital 8/9/37. Disch. 17/9/37. Good recovery. 210 18/11/37 30/11/37 1/12/37 Local Infection To Hospital 1/12/37. Disch. 21/12/37. Good recovery. OPHTHALMIA NEONATORUM. No cases were notified. TUBERCULOSIS. The table on page 41 gives details of the number of new cases, the deaths, the age and sex of the patients, and the wards to which they belong. The total of 60 cases compares with 72, 67, 69, 36 and 55 in the preceding five years. There were 43 deaths. In addition to the 60 new cases there were 24 definite cases transferred from other areas, 1 case restored to the register, and at the end of the year the number of notified cases in the area was 116 Pulmonary Males, 111 Pulmonary Females, 31 nonPulmonary Males, and 28 non-Pulmonary Females ; a total of 286 cases, which compares with 278 last year. 86 cases were placed off the register for the following reasons : died, 42 ; cured, 11 ; withdrawn (not T.B.), 2 ; left area, 31. Notification.—In 8 cases notification was not made until after death, 5 being cases of pulmonary tuberculosis; in 2 of these the diagnosis was made after a post mortem. The non-pulmonary cases were 2 of meningitis in children aged 2 years and 10 years respectively, and one of peritonitis in a female aged 66. Home Visits.—The Health Visitors call upon new or transferred cases which are likely to require treatment through the Dispensary, and advise them how to obtain treatment and upon precautions to take against the spread of infection. The Nurses made 543 visits to cases on the register, and 80 out of the notified and transferred cases were visited. 40 41 TUBERCULOSIS—TABLE OF PRIMARY NOTIFICATIONS AND DEATHS, 1937 Ages. Wards. Notifications. Totals. 0 to 4 4 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and over Copers Cope Eden Park Langley | Park Shortlands Manor House Kent House Lawrie Park Wickham Total Pulmonary M 27 1 — 7 6 7 5 — 1 3 5 2 2 5 1 3 6 27 F 23 1 - 1 8 5 4 3 — 1 3 5 5 3 3 1 — 3 23 Non-Pulmonary M 6 1 — 3 1 1 — — — — 1 1 2 — — — 2 — 6 F 4 — — 2 1 1 — — — — — 1 1 — 1 1 — — 4 Totals 60 3 — 6 17 13 11 8 — 2 7 12 10 5 9 3 5 9 60 Deaths—Pulmonary M 21 — — — 2 3 9 4 3 — 1 3 1 2 3 4 4 3 21 F 13 1 — 1 — 4 5 1 — 1 2 4 1 — 2 3 1 13 Non-Pulmonary M 3 1 - - - 1 - - 1 - - - - - - - 1 1 3 F 6 1 — 1 1 1 1 - — 1 — 2 — — 1 — 1 2 6 Institutional Treatment.—The Kent County Council provided in-patient treatment in Sanatoria for 45 cases during the year, and 9 patients were admitted to Farnborough Hospital for short periods. Dispensary Treatment.—The following figures provided by Dr. Gordon Edelston, the Tuberculosis Officer, indicate some of the work done at the Dispensary during 1937 :— New cases attending for the first time :— Adults Children Male Female Male Female Pulmonary 23 20 1 3 Non-Pulmonary 1 3 2 — Negative 18 31 2 2 Total 42 54 5 5 30 " contacts " were examined and 29 found to be negative. 45 patients completed a course of residential treatment during 1937. Care Committee.—During the year a Voluntary Tuberculosis Care Committee was formed in the area, and it is anticipated that this organisation will be able to give considerable assistance to patients in ways which are outside the scope of the official schemes. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No occasion has arisen during the year to exercise the powers conferred by these Regulations of prohibiting any person engaged in the milk trade from continuing his employment. PUBLIC HEALTH ACT, 1936 (SECTION 169). It has not been necessary to apply for an Order under this Section for the removal of a patient to hospital. WHOOPING COUGH. 210 cases were notified during the year, 25 having a private doctor in attendance, and 34 cases were under five years of age. 42 MEASLES. Measles is not a notifiable disease in the district, but medical practitioners are paid a fee for notifying cases among children attending the elementary schools. Only 4 cases were notified to the Health Department during the year, 1 under five years of age. CHICKENPOX. 131 cases were notified, 14 being by doctors ; 7 cases were under the age of five years. MUMPS. 108 cases of Mumps were brought to the notice of the Department during the year, 25 being notified by doctors ; 1 was under the age of five years. EPIDEMIC DIARRHCEA. This disease becomes notifiable annually during the period 15th July to 15th October. No cases were notified. SMALLPOX. No cases were notified during the year. The Public Vaccinator dealt with 705 cases during the year, and 668 of these were infants under one year of age. BACTERIOLOGICAL WORK The number and results of the examinations made at the Public Health Department Laboratory during 1937 was:— Disease suspected Total 1937 Results Positive Negative Comparative Total for 1936 Diphtheria 321 12 309 310 Tuberculosis 145 17 128 170 Other Diseases 50 6 44 66 Total 516 35 481 546 43 Various special examinations can be made at the County Laboratory, Maidstone, free of charge, and the following were carried out in 1937:— Swabs for Diptheria 7 Typhoid Fever Blood Tests 4 Miscellaneous Tests 29 Sputum Tests 134 Dysentery Tests 5 The Public Analyst for the Kent County Council carries out any examinations required under the Sale of Food and Drugs Acts, or for other purposes. The results of samples taken during the year appear on page 59. 44 SANITARY INSPECTION OF THE DISTRICT, 1937 Nature of Nuisances or Defects Remedied. No. of defects remedied. Choked drains 52 Drains defective or altered 110 Defective gullies 9 Defective W.C. pans 11 Choked W.C. pans 2 Flushing apparatus to W.C. defective 12 Dirty W.C. pans 9 W.C. apartments, dirty or defective 63 Waste pipes, defective or untrapped 33 Defective channels to waste gullies 5 House sinks, defective 12 Soil pipes, defective 4 Ventilating shafts, choked or defective 10 Fresh air inlets, defective 15 Manhole covers, defective or unsealed 14 Water supply cisterns, uncovered, dirty or defective 7 Galvanised iron dustbins, defective or absent 32 Defective pointing 23 Dampness 147 Rain-water pipes, defective 18 Defective gutters 44 Defective roofs 74 Defective floors 41 Defective walls 48 Defective ceilings 31 Dirty walls 101 Dirty ceilings 114 Yard paving defective or absent 18 Defective stoves 30 Defective coppers 13 Defective airbricks 7 Defective windows and fittings 54 Defective doors 7 Keeping of animals contrary to Bye-Laws 3 Accumulation of offensive material 29 Absence of manure pit, or pit uncovered or defective 1 Insufficient ventilation to room 4 Verminous rooms 30 Absence of, or defective food cupboards 11 Cesspools overflowing 2 Carried forward 1,350 45  No. of defects remedied. Brought forward 1,350 Defective cement rendering 4 Defective stairs and handrails 16 Absence of water supply 1 Smoke 1 Rats, premises freed of 71 Miscellaneous Shop Acts, Defects 40 Miscellaneous 52 Total 1,435 Summary of Inspections and Visits Visits and Inspections. Census for Overcrowding 476 Housing 865 Nuisances 1,757 Cowsheds 48 Milkshops 206 Bakehouses 117 Butchers' shops 259 Other meat shops 16 Slaughterhouses 908 Places where food is prepared 89 Shops where food is stored 143 Workshops, etc 222 Outworkers 15 Rats and Mice Act 533 Houses let in lodgings 29 Stables 75 Fried fish shops 35 Ice cream vendors 122 Verminous premises 102 A.R.P. Courses 57 Drainage 1,117 Infectious disease 241 Smoke observations 14 Samples taken under Sale of Food and Drugs Acts 20 Samples of Milk taken for Bacteriological Examination 117 Shops Acts 538 Miscellaneous 609 Interviews 1,461 Totals 10,191 46 The usual practice of notifying the Metropolitan Water Board, when waste of water was detected, was continued. SMOKE ABATEMENT. There are seven factory chimneys within the district, and one on the boundary. Fourteen observations were kept, and one nuisance was found at time of visit. PREMISES CONTROLLED BY BYELAWS, ETC. The following Table supplies particulars of the premises and the occupations in the district which are controlled by Byelaws or Regulations:— Character of Premises No. Statutory or other provisions Action taken and result Cowsheds 7 Milk and Dairies Order, 1926 254 inspections have been made of these premises Milkshops 53 Bakehouses 25 Factory and Workshops Act, 1901 117 inspections and visits have been made of these premises. Eight defects were remedied upon notices being served. Fried Fish Shops 6 Byelaws made 1935 under Section 113, Public Health Act, 1875. 35 inspections have been made of these premises. Meat Shops (Butchers) 50 Public Health (Meat) Regulations, 1924 259 inspections and visits were paid to these premises. Five notices had to be served. The defects were remedied. Other Meat Shops Public Health (Meat) Regulations, 1924 16 visits were made and the meat, chiefly bacon, was found to be kept under good conditions. Places where food is prepared Public Health Act, 1925, Section 72 89 inspections were made. In three cases nuisances were found. These were remedied upon notices being served. Shops where food is stored 35 Public Health Act, 1925, Section 72 143 inspections have been made of these premises. 47 Character of Premises No. Statutory or other provisions Action taken and result Slaughterhouses 4 Public Health (Meat) Regulations, 1924, and Byelaws under Sec. 169 of the Public Health Act, 1875. Slaughter of Animals Act, 1933. These premises were visited on 908 occasions when slaughtering was in progress. During the year 13,574 carcases were inspected. Ice-Cream Shops 96 Section 88, Beckenham Urban District Council Act, 1903, Section 61, B.U.D.C. Act, 1935. 122 inspections have been made of these premises. Two premises were not registered ; one notice was served and complied with. All premises Byelaws dated 1935, respecting the keeping of animals. Contravention of these Byelaws occurred on 1 premises during the year. The usual notice was served upon the occupier and complied with. Stables (Manure Pits) 29 Byelaws made 1935 regulating Nuisances. 75 inspections were made of these premises. One notice was served upon the occupier. Houses Let in Lodgings 11 Byelaws made 1926, under Section 6 of the Housing Act, 1925. 29 inspections were made. Notices had to be served upon 2 premises. These were complied with. OUTWORKERS. Notices are received, chiefly from London Boroughs, of persons employed as outworkers in this area ; 15 inspections were made as a result of these notices, and all the premises used were found to be in a satisfactory condition. LEGAL PROCEEDINGS. Proceedings were taken in four cases during the year in respect of five premises : two were under the Shops Acts:— (1) In one case the Occupier was ordered to do the necessary work in seven days. As the Order was not complied with, a further seven days was allowed with an order to pay 10/6 costs—second order complied with. 48 (2) This Owner was prosecuted on two summonses regarding two separate premises. He was Ordered to complete the work in seven days and the Corporation was allowed £1 1s. Od. costs on each summons. (3) Shops Acts. (Four Summonses) Proceedings were taken against the Firm and Managers for selling after hours. The Firm was fined 40/- and £1 1s. Od. costs were awarded and the Managers were fined 5/-. (4) Shops Acts This Occupier was summoned for selling after hours. The defendant was fined 20/- : no costs allowed. DISINFECTION The routine disinfection of rooms and bedding after Scarlet Fever and Diphtheria has been discontinued since 1932. Bedding is steam disinfected after Tuberculosis, without charge, and at Hospitals and Nursing Homes to prevent the spread of infection. Other work is done on request and charged for. Bedding and clothing was removed for Steam Disinfection in 141 cases, and Rooms Disinfected at 45 Houses, an amount of £22 being received for this work. THE SHOPS ACTS. During the year, 538 visits were made under the above Acts. In 49 cases " defects " were found. The " defects " discovered were : Defective or dirty W.C. apartment 7 Absence of or defective washing accommodation 3 Hours of work by assistant under 18 too long 1 Absence of forms 27 Selling after hours 11 The Occupier was " warned " in every case of selling after hours, and proceedings were taken against two shopkeepers when a second offence was detected. After the Occupier had been communicated with in the other†7 cases the "defect" was remedied. 49 SWIMMING BATHS. The only Public Swimming Baths in the area are those provided by the Local Authority. Here a continuous filtration and chlorination plant is in use, and two-hourly chemical tests are made throughout the time the baths are in use. A monthly summary of these results is submitted to the Medical Officer of Health by the Baths Superintendent. The results obtained have been uniformly good even during the busiest periods. SANITARY CONDITION OF ELEMENTARY SCHOOLS. The schools in the district all have good and adequate sanitary accommodation and water supply. FACTORIES AND WORKSHOPS. A few factories were established during the year, but the district is mainly residential. The majority of the places on the Register, Rowever, are small and are associated with the requirements of the inhabitants of the district. During the year 122 visits were made to premises on the Register, the following 4 nuisances being found, which were remedied after service of informal notices:— Dirty walls and ceilings 3 Accumulation of rubbish 1 HOUSING STATISTICS 1.—INSPECTION OF DWELLING-HOUSES DURING THE YEAR :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 760 (b) Number of inspections made for the purpose 764 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 209 50 (b) Number of inspections made for the purpose 213 (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-head) found not to be in all respects reasonably fit for human habitation 650 2.—REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 448 3.—-ACTION UNDER STATUTORY POWERS DURING THE YEAR (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930. Notices served Nil (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served, requiring defects to be remedied 31 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 31 (b) By local authority in default of owners Nil (c) Proceedings under Sections 19 and 21 of the Housing Act, 1930 Nil (d) Proceedings under Section 20 of the Housing Act, 1930 Nil 51 REPORT ON HOUSING NEEDS IN THE DISTRICT, 1937. To the fifty-nine cases of overcrowding which were discovered at the Survey made in 1935/36, twenty further cases were added by the 30th April, 1938 ; eleven of these were " Border-line Cases," where the increasing age of the children had created overcrowding ; seven being resident on the Corporation Housing Estate. Up to the same date, sixty-two cases have been removed from the list as the overcrowding has been abated, this result having been secured by the following means :— (1) Eleven cases have been accommodated in Corporation Houses. (2) Seven cases where lodgers occupied rooms, the lodgers have been got rid of and the family have taken over the extra accommodation. (3) Three cases where the family have arranged for the children to sleep out with relatives. (4) Twenty-two cases where the size of the family has been reduced by the adult children leaving home. (5) Ten families have left the area. (6) Two families have secured adequate accommodation in other parts of the area. (7) Seven cases have obtained additional accommodation in their present house. Of the fourteen remaining cases of overcrowding no less than five occupy Corporation Houses and these are families who require six or seven bedrooms. The Corporation are proposing to build houses of sufficient size to accommodate these families. In three cases the overcrowding was abated once but recurred. During 1937, the Survey was made of the ninety-two applicants for Corporation Houses and from the information compiled it appears that forty-four cases were in urgent need of the accommodation by reason of insufficient rooms, unhealthy conditions, lack of amenities and insufficiency of fresh air. I should reiterate that these figures take nc account of the many families whose cases have never been accepted for investigation because of the closure of the waiting list, or of the three hundred families which at the time of the Census were compelled to use every room they had in order to conform to the requirements of the Housing Act of 1935. 52 I reported to the Committee in September, 1937, that I considered that the number of Corporation Houses should be increased by one hundred and fifty, and this report was accepted and it is upon this basis that the present housing plans are being drawn up. INSPECTION AND SUPERVISION OF FOODS MILK. Milk was again subjected to bacteriological supervision. The results were very good although the counts were not quite so satisfactory as in the previous year. Over 90 per cent of the samples of ordinary milk purchased in the winter months complied with the standard for Pasteurised milk, and 63 per cent of the summer samples reached this standard. Bacillus coli was found to be present in many of the specimens examined. In the summer months it was present in 68 per cent of the samples of milk purchased, but in the winter months it was present in only 20 per cent of the samples. Two specimens of Pasteurised Milk had a very high count; the firms responsible were warned and the later samples complied with the standard. One sample of Accredited Milk did not comply with the requirements. The following table shows the results that were obtained during the year:— No. of Bacteria per Cubic Centimetre Percentage of samples in which Bacillus Coli present in 1/100th of a c.c. or less Percentage of Samples with Less than 30,000 30,000 to 100,000 100,000 to 200,000 200,000 to 500,000 Over 500,000 Ordinary Milk May to Sept. 45.4 18.2 27.2 4.6 4.6 68.1 Rem'd'r of year 53.3 36.7 6.7 3.3 — 20.0 Pasteurised Milk May to Sept. 62.5 25.0 6.2 — 6.2 31.2 Rem'd'r of year 72.2 27.8 - — — Nil 53 MILK SPECIAL DESIGNATIONS ORDER, 1936. Under this Order the following licences have been granted by the Council to distributors of milk:— Supplementary to Retailers retailers from in area outside area Licence to sell Tuberculin Tested Milk 7 4 Licence to sell " Pasteurised " Milk 15 3 One licence was issued to a firm for Pasteurising at premises in the area, and one licence for bottling and sale of Tuberculin Tested Milk. MEAT. There are four slaughterhouses in Beckenham, 2 Registered, 2 Licensed, but most of the meat sold in the district is " dressed " elsewhere. Nearly all of the meat retailing shops in the district now have glass fronts, automatic refrigerators and fans. MEAT INSPECTION IN 1937 The number of carcases dressed in the Borough in 1937 amounts to 13,574. This figure exceeds that of the previous year by 2,654. During the year, 1,686 carcases were found to have diseased conditions and necessitated the destruction of 6 tons 2cwt. 1qr. 18½ lbs. In 1936 the totals were 966 carcases and 3 tons 16 cwt. 2qrs. 8½ lbs. In addition to the above mentioned meat, 390½ lbs. of tinned foods and poultry were condemned, making a record total of 6 tons 5 cwt. 3 qrs. 17 lbs. The slaughtering of animals in the West Wickham area steadily increased during the year and has now reached the stage when animals have to be inspected in the afternoon and evening on each of the seven days of the week. As usual, pigs contributed most of the diseased meat, Tuberculosis being the chief complaint which caused the unfit condition. Bovines were responsible for a large quantity of the destroyed meat, the amount under this heading being about double that of last year. A table of the number of animals inspected and the amount of meat destroyed is appended. 54 ANIMALS DRESSED IN 1937 Bovines Calves Sheep Pigs Goats Total Beckenham 2 8 70 58 138 West Wickham 52 1,052 1,671 10,651 10 13,436 Totals 54 1,060 1,741 10,709 10 13,574 SUMMARY OF CONDEMNED MEAT Animal Condition No. affected Weight lbs. Bovines Tuberculosis 14 2,861 Non-Tuberculosis 9 973½ Calves Tuberculosis 1 8 Non-Tuberculosis 6 195 Sheep Non-Tuberculosis 60 645 Pigs Tuberculosis 864 5,989 Non-Tuberculosis 732 3,039 Total 1,686 13.710½ Other foods 390½ Total weight destroyed : 6 tons 5 cwt. 3 qrs. 17 lbs. MEAT INSPECTION. The number of carcases dressed in the Borough in 1937 amounted to 13,574. This figure exceeded that of the previous year by 2,654. During the year, 1,686 carcases were found with diseased conditions and this necessitated the destruction of 6 tons 2 cwts.1 qr. 18½ lbs. In 1936 the totals were 966 carcases and 3 tons 16 cwts. 2 qrs. 8½ lbs. A quantity of tinned foods and fowls were also condemned, which brought the total of food destroyed to 6 tons 5 cwt. 3 qrs. 17 lbs. Bovines. About 26% of the Bovines inspected were found to be affected, to some extent, with Tuberculosis. Three whole carcases 55 were destroyed on account of this disease. Two of these carcases were cows that had given milk. In each case the appropriate authority was acquainted with the facts. Calves. These animals were exceptionally healthy. Only one case of Tuberculosis was detected and only 0.6% of them had diseased conditions. Sheep. Only 3.4% of the carcases dressed were affected with disease, which is about 1 % better than last year. Pigs. There was a decided increase in the number of pigs found to be affected with disease and also in the amount destroyed on this account. Diseased conditions were found in 14.9% 0 the carcases—an increase 0 2.4% over the previous year. Tuberculosis was again the chief cause which necessitated the surrender of the meat, 8.1% of the animals dressed being affected with this disease. The amount destroyed for disease other than Tuberculosis showed a very marked increase, the total being approximately twice that for 1936. A detailed account of the animals inspected and of the meat destroyed is given in the following tables. Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed, if known *54 1,060 1,741 10,709 Number Inspected 54 1,060 1,741 10,709 All Diseases except T.B. : (a) Whole Carcases condemned 1 3 13 12 (b) Carcase of which some part or organ was condemned 8 3 47 720 (e) Percentage of the number inspected affected with disease other than T.B. 16.6 0.56 3.4 6.8 Tuberculosis Only : (a) Whole Carcases condemned 3 Nil Nil 7 (6) Carcases of which some part or organ was condemned 11 1 Nil 857 (c) Percentage of the number inspected affected with T.B 25.9 0.09 Nil 8.1 *No separate figures kept for 1937, but it is known that two of the T.B. carcases were cows. 56 SUMMARY OF CONDEMNED MEAT Animals Condition Part Condemned Number affected Weight in lbs. Bovines Tuberculosis Carcase 3 2,644 „ Head and Tongue 2 56 Head and Lungs 2 38 „ Head, Tongue and Liver 1 40 „ Lungs 1 16 „ Lungs and Heart 4 64 „ Mesentery 1 3 —14 —2,861 Non-Tuberculous : Uraemia and Traumatic Pericarditis Carcase 1 715 Dropsy Carcase 1 208 Pleurisy Lungs 3 15 "Flukes" Liver 3 194 Abscesses Liver 1 16 —9 —973½ Calves Tuberculosis Pluck 1 8 Non-Tuberculous : —1 —8 Immaturity Carcase 1 12 Oedema Carcase 1 135 Fevered Flesh Carcase 1 40 Fatty Infiltration Liver 1 3 Fatty Degeneration Liver 1 2 Abscesses Liver 1 3 —6 —195 Sheep Dropsy Carcase 1 40 Emaciation Carcase 10 412 Pneumonia Carcase 1 55 Dropsy and Immaturity Carcase 1 12 Cirrhosis (including "Flukes") Liver 27 68½ Cysts, multiple Liver 10 24 Congestion Liver 1 3 Necrosis Liver 3 10 Strongylosis Lungs 2 7 Abscesses Lungs 1 1 Pleurisy Lungs 1 1½ Strongylosis Pluck 1 5 Strongylosis and " Flukes " Pluck 1 6 —60 —645 Pigs Tuberculosis Carcase 7 685 „ Head 299 3,702 „ Head and Mesentery 9 125 „ Head and Pluck 1 16 „ Head, Pluck and Mesentery 9 132 „ Head and Lungs 2 32 „ Head, Mesentery and Spleen 1 13 57 Animals Condition Part Condemned Number affected Weight in lbs. Pigs Tuberculosis Lungs 4 5 (contd.) II Lungs and Mesentery 4 20 li Lungs and Heart 1 1 II Liver 13 45 II Pluck 60 422 II Pluck and Mesentery 2 15 II Pluck, Mesentery and Spleen 2 16 II Mesentery 448 562 II Collar 1 8 II Forequarter 1 190 —864 —5,989 Non-Tuberculous : Emaciation Carcase 5 100 Suffocation Carcase 2 256 Erysipelas Carcase 4 294 Septic Metritis Carcase 1 200 Abscesses Head 3 27 Hepatized Lungs 2 2 Pleurisy Lungs 38 39 Pneumonia Lungs 88 97 Congestion Lungs 26 26 Pleurisy and Pericarditis Pneumonia and Lungs and Heart 121 181½ Pericarditis Cirrhosis (including Lungs and Heart 2 4 milkspots) Liver 167 688 Peritonitis Liver 9 38½ Cysts, Multiple Liver 89 322 Fatty Degeneration Liver 8 31 Fatty Infiltration Liver 3 12 Venous Congestion Liver 3 12 Hepatitis. Liver 1 4 Pleurisy, Pericarditis and Cirrhosis Pluck 39 259 Pleurisy, Pericarditis and Peritonitis Pluck 38 257 Pericarditis Heart 62 67 Cysts, Multiple Kidney 2 ½ Cysts, Multiple Omentum 7 1 Cysts, Multiple Mesentery 1 1 Indurated Udder 2 62 Sepsis Ear 1 1½ Erysipelas Bruising and Strippings, etc. 1 24 Laceration Various 7 32 —732 —3,039 Totals 1,686 6 tons, 2 cwt., 1 qr., 18½ lbs. Other Foods Putrid Tinned Ham 3 52½ Putrid Tinned Beef 1 6 Putrid Fowls 121 332 —125 -390½ Total weight destroyed : 6 tons, 5 cwt., 3 qrs., 17 lbs. 58 Once again the proprietors of the slaughterhouses and their assistants helpfully co-operated with the Inspectors. FOOD AND DRUGS (ADULTERATION) ACT, 1928 53 samples were purchased by the Sanitary Inspector during the year under this Act, and submitted to analysis : 6 of these were milk. All the samples were genuine. 160 samples were taken in the Borough by the Kent County Inspector, and all of these were "genuine," except 1 sample of New Milk, which was reported to be "inferior" and one Gin sample reported to be "inferior." No legal proceedings were instituted by the Kent County Council. 59 60 TABLE SHOWING CAUSES OF DEATHS AT DIFFERENT AGE PERIODS DURING THE YEAR, 1937 Causes of Death Registrar General. 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 Shortlands Langley Park Eden Park Manor House Kent House Lawrie Park West Wickham |  Male Female Total Typhoid Fever, etc. - - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 2 2 — 2 - - 1 1 - - — — — — - - - - - 1 1 - - - 2 Whooping Cough 1 — 1 1 1 - — — - - — — — — — - — — - - 1 - - - 1 Diphtheria — — - — - - — — - - — — — — — - — — - - - - - - - Influenza 17 *9 7 16 - - - - - - - 2 4 4 2 4 2 2 - - 3 3 4 2 16 Encephalitis Lethargica — — — — - - — — - - — — — — — — — - - - - - - - - Cerebro-Spinal Fever 1 — 1 1 1 - — — - - - — - — - - - - - - - - 1 - 1 Pulmonary Tuberculosis 34 21 13 34 - - 1 1 3 5 16 5 2 1 - - 3 2 2 8 2 5 7 5 34 Non-Pulmon'y Tuberculosis 9 3 6 9 1 1 — 1 1 2 1 - 1 1 - - - - - 2 2 1 2 2 9 Syphilis 1 — 1 1 - - — — — — - 1 - - - — - - - 1 - - - - 1 Cancer 91 43 48 91 - - — — 1 1 5 14 19 27 24 — 8 15 4 13 14 11 17 9 91 Diabetes 8 *4 3 7 - - - - - 1 2 — 2 — 2 — 1 — 1 2 - I - 2 7 Cerebral Haemorrhage 31 18 13 31 - - - - - - 1 5 10 9 4 2 2 3 2 3 6 5 7 3 31 Heart Diseases 155 83 72 155 - - - - - 2 8 11 28 45 43 18 19 15 11 19 23 16 29 23 155 Other Circulatory Diseases 43 21 22 43 - - 1 — 1 4 4 2 6 15 7 3 3 5 1 9 5 5 5 10 43 Bronchitis 13 7 6 13 1 - 1 — — — — — 3 3 3 2 1 2 1 3 1 1 4 - 13 Pneumonia 38 16 22 38 4 1 1 1 3 3 — 3 3 13 5 1 1 5 3 8 10 4 2 5 38 Other Respiratory Diseases 10 5 5 10 - - - - - 1 — 1 2 5 1 — 2 2 1 2 1 1 1 10 Peptic Ulcer 6 5 1 6 - - - - - - 2 1 2 1 — — — - 2 3 - - - 1 6 Appendicitis 4 2 2 4 - - - - - 1 1 1 1 — — — 1 — — 1 1 - - 1 4 Diarrhoea 2 — 2 2 2 - - - - - - - - - - - - - - - - - 1 1 2 Other Liver Diseases 5 1 4 5 - - - - - - - 1 1 2 1 - 1 2 - - - 1 1 - 5 Other Digestive Diseases 14 6 **6 12 2 - — — - — 1 2 3 2 2 - 1 1 - 2 4 - 2 2 12 Nephritis 19 8 11 19 — - — — 1 1 3 1 3 4 6 - 1 1 1 5 1 4 3 3 19 Congenital Debility— Prematurity 18 8 10 18 18 - - - - - - - - - - - - 2 2 4 3 2 5 18 Senility 15 2 13 15 — - — — — — — — — — 9 6 — 2 2 2 5 1 3 15 Suicide 4 2 *1 3 — - — — — — 1 1 1 - - - 2 1 - - - - - 3 Other Violence 15 *4 10 14 — 2 — 1 4 — 2 - 1 1 3 - 1 1 2 3 1 2 1 3 14 Other Defined Causes 65 *39 **23 62 3 3 2 8 1 3 5 9 7 10 9 2 2 6 4 16 9 9 8 8 62 111 Defined Causes — — — — — — — — — — — — — — — — — — — — — 621 309 303 612 33 7 7 13 15 24 52 60 98 144 121 38 49 68 38 105 88 77 98 89 612 The Registrar General has allocated a total number of deaths to this area of 621. Of this number we are unable to trace 9. Those headings where we have been unable to agree the figures are marked with an asterisk. BOROUGH OF BECKENHAM REPORT ON THE MEDICAL INSPECTION OF CHILDREN IN THE ELEMENTARY SCHOOLS DURING 1937 STATISTICS RELATING TO EDUCATION. Census population of Beckenham (1931) 43,834 Estimated population (June, 1937) 69,580 Number of Elementary Schools 7 Number of Departments 19 Accommodation (31/12/37) 6,154 Number on Roll (31/12/37) 5,174 Special Day School for the Mentally Defective 1 Other Schools:— County Secondary School (Girls) 1 Trade School 1 Private Schools 26 STAFF ENGAGED IN MEDICAL INSPECTION. School Medical Officer (approximately 1 /3rd time) : T. Philips Cole, M.B., D.P.H. Assistant to S.M.O.: Miss G. Malmberg, M.B., D.P.H. (Resigned 30/11 /37) Miss S. Thomson, M.B., D.P.H. (Appointed 1 /3/38) School Dental Surgeon (5 /6ths time to School work) : R. A. Waters, L.D.S., R.C.S. (Eng.) Assistant D.S. (part time) : A. E. Carr, L.D.S., R.C.S. Anaesthetist to Dental Clinic (part time) : Alan R. Marsh, M.R.C.S., L.R.C.P. Ophthalmic Surgeon (part time) : A. E. A. Looseley, F.R.C.S. (Eng.) Orthopaedic Surgeon (part time) : H. J. Seddon, F.R.C.S. (Eng.) Aural Specialist (part time) : G. H. Howells, F.R.C.S. (Eng.) School Nurses: Miss B. D. Sizer, S.R.N., S.C.M. Miss E. F. Smith, S.R.N., S.C.M., H.V.'s Cert. Miss C. R. Wheeler, S.R.N., S.C.M., H.V.'s Cert. Miss R. Noble, S.R.N., S.C.M., H.V.'s Cert. (Appointed 1 /2 /38) Dental Nurse (5 /6ths of time to School work) : Miss I. M. Monck, S.R.N., C.N. Part-time Dental Nurse: Miss A. E. Dobson, S.R.N., C.M.B. (Resigned 31 /3/38) Orthopaedic Nurse (part time) : Miss E. N. Sutton, C.S.M.M.G. Throat Operations: Dr. F. C. Trapnell. Dr. J. K. Moore. Dr. W. G. A. Shuttleworth. 62 INTRODUCTION TO REPORT ON THE SCHOOL MEDICAL SERVICE CLINIC BUILDING, WEST WICKHAM. The plans for this building have been passed and it is hoped that it will be ready for use towards the end of 1938. SCHOOL DENTAL SERVICE. As will be seen from the report by the School Dental Surgeon, the appointment of a part-time Dental Surgeon has made it possible to return to the annual programme of inspection and treatment. NUTRITION. For the third year a special table appears in the report showing the classification of children separated into four headings. Not one child out of the 1,938 inspected was classed as definitely badly under nourished. It may generally be stated that the nutrition of the children in the district is good, and that there is no evidence of any wide-spread under-nourishment due to poverty or to incorrect feeding. "The Milk in Schools Scheme" continues to function but the number of children taking advantage of it has been somewhat reduced. HEALTH PUBLICITY. During the Autumn, advantage was taken of the National Health Publicity Campaign, and posters and leaflets were issued to all schools. CO-ORDINATION WITH OTHER SERVICES The arrangements which exist for complete co-ordination with the Infant Welfare Services have been given in detail in previous reports. SCHOOL HYGIENE AND HEALTH EDUCATION The new schools in the district provide a very high standard of accommodation, and the older buildings are all in good repair, and the best use is made of the accommodation available. The following major improvements have been carried out during 1937:— Balgowan.—Playgrounds have been relaid. Marian Vian Infants.—Glass covered roofing to lavatories. 63 Hawes Down Infants—The open verandah has been enclosed. Generally.—In many cases modern furniture has been provided and sanitary drinking fountains have now been installed in place of the old bowl and cup type, and many minor works of modification have been carried out. The monthly Magazine, "Better Health," was distributed throughout the year to all Schools, and use made of special Literature supplied by the Central Council for Health Education. CLOTHING AND FOOTGEAR The records of the children inspected this year show there were very few children whose condition was unsatisfactory. WORK OF THE SCHOOL NURSES The home visits to cases of infectious disease, absentees from school, cases who fail clinic appointments, etc., are made by the School Nurses, in addition to attendance at the Minor Ailment, Inspection and Special Clinics; the following figures give some indication of the amount of work done by them during the year :— Home Visits : Total 1937 Total 1936 To cases of Infectious Disease 379 646 Other cases 1502 1733 Follow-up cases No reply 153 143 Total Home Visits 2034 2522 Visits to Schools : re Personal Hygiene 83 86 Children Examined 11744 14226 Found Unclean 62 103 Children seen 2751 2400 Clinic Sessions Attended : Minor Ailment Clinics 420 410 Inspection Clinics 108 113 Eye Clinics 41 40 Immunisation Clinics 96 85 Aural Clinics 11 11 Dental Clinic 80 66 64 MEDICAL INSPECTION (a) Routine Inspections. Routine inspections are those made on the school premises of the groups of children prescribed for examination by the Board of Education. The number of children examined at these inspections during the year was:— 1936 1937 Entrants 809 749 Intermediate 615 699 Leavers 554 477 Other Routine Inspections 30 42 2008 1967 These groups have been explained in previous reports. (b) Other Inspections. In addition to the above groups, 982 " Special " Inspections were made of children referred to the Medical Inspector either at the School or the Clinic, or to Specialist Clinics for examination. 3,130 re-inspections were made of the above routine or special cases, compared with 2,808 in 1936. (c) Following up. In connection with children found defective at Routine or Special Examinations, steps are taken to see that they are followed up until treatment is obtained. The following figures show the extent of this work:— Children referred for treatment— (a) From School Inspections 527 (b) From other Inspections 440 Total 967 Written appointments are given for all the Specialist Clinics. FINDINGS OF MEDICAL INSPECTION The results of Medical Inspection and Treatment are summarised at the end of the Report in Tables I—IV. Comments on the principal defects found are set out in the following pages 65 PARENTS PRESENT AT ROUTINE INSPECTIONS. All parents receive written notice of the date of Routine Medical Inspections at Schools and are invited to be present. 1,660 parents were present, representing 84.4 per cent. Only 2 objections were made to children being examined. MALNUTRITION AND DEBILITY. The statistical tables at the end of this report include one giving the classification into four groups of all children who were examined at routine medical inspections during the year. The groups are :— A= Excellent. B=Normal. C=Slightly subnormal. D=Bad. In classifying the cases the general well-being of the child and not the height and weight only were taken into consideration. The table shows that only 4.8 per cent. of the children examined were found to be subnormal, and no child was considered as coming within the fourth group as " Bad Nutrition." In my previous reports I have given details of records which have been kept of the heights and weights of children inspected, and these records were again kept in 1937. These show that on height and weight alone 8.4 per cent. of the children were regarded as definitely underweight. PROVISION OF MILK AT SCHOOL. A sum of £50 was allowed in the estimates to provide milk at school for children selected by the School Medical Officer ; and 274 children have received this daily issue during the months, January to March, and September to December. In September, 1934, the Milk Marketing Board's scheme to supply milk to school children at one half-penny per bottle holding one-third of a pint, was taken up in this district, and has continued in force. The whole work of distribution and collection of cash and checking is done by the teaching staff, and represents a considerable amount of labour. It would not be possible to carry out this scheme without the willing co-operation of the teaching staff, and there is no doubt that this daily addition of milk to the dietary is of value. The supply is from selected sources, all the milk being pasteurised. 66 Half-yearly Statement submitted to the Board of Education 1st October, 1937. Provision of Milk at School. —Numbers Receiving Daily Issues at ½d. per Day. Infants. Juniors. Seniors. Total. School. On Roll Milk On Roll Milk On Roll Milk On Roll Milk Alexandra 253 175 295 177 206 49 754 401 Balgowan 216 172 — — 384 110 600 282 Bromley Road — — 296 163 143 33 439 196 Churchfields 294 215 295 160 259 119 848 494 Special — — 17 16 — — 17 16 Marian Vian 364 251 446 207 329 90 1139 548 Hawes Down 314 251 392 234 305 111 1011 596 Wickham Common — — 390 260 — — 390 260 Totals 1441 1064 2131 1217 1626 512 5198 2793 Percentage of total on roll receiving milk 54 per cent. Percentage in Infants Schools 74 „ „ Junior Schools 57 „ „ Senior Schools 31 „ SKIN DISEASES. The number of cases of skin disease remains low. One case of Ringworm was discovered during the year, and 9 children with other skin diseases had to be excluded from school. These small numbers are a tribute to the effectiveness of the work done by the School Nurses and to the increased care which parents take of their children. EAR, NOSE AND THROAT CONDITIONS. A number of cases of Otorrhoea are found among children, and this is a serious condition which may have far-reaching effects. All the 19 cases were referred to the Ear Clinic. 173 children were found with enlarged Tonsils and /or Adenoids and operations were carried out in 84 cases. 22 children with defective hearing were referred to the Aural Clinic. 67 HEART DISEASE. There are twelve children in the district with severe heart disease and one of these had a long period of institutional treatment during the year. Altogether 27 children needed to be kept under observation during the year for conditions of heart and circulation. TUBERCULOSIS. The classification of the notified cases on the roll of Elementary Schools in the district is :— Pulmonary— Three cases :1 active and at home; 2 arrested and at school. Other Forms— Nineteen cases :15 at school; 1 not at school; 3 at special schools Beckenham children attend the County Tuberculosis Dispensary for diagnosis and treatment. CRIPPLING DEFECTS. There were few serious crippling defects discovered, the majority of the 132 cases noted, being knock-knees, flat feet, round shoulders and slight spinal curvature. All these cases are referred to the Orthopaedic Clinic, and the report of the work done appears on page 75. WORK OF THE SPECIAL CLINICS TREATMENT OF MINOR AILMENTS. Five Clinics were in operation throughout the year. The attendances total 4,882, compared with 4,681 in 1936. The number of sessions has been reduced at Alexandra School, owing to the necessity for allowing the Nurses more time for other work. Days Held For Children from Marian Vian School Churchfields School Alexandra School Hawes Down School Wickham Com. School Tuesdays & Thursdays Mondays, Wednesdays and Fridays Mondays & Fridays Ditto Wednesdays Marian Vian School Churchfields School Alexandra Infants and J unior Mixed and Senior School Hawes Down School Wickham Com. School The attendances during the year are shown below, with comparative figures for 1936 :— Sessions held Attendances Average per Session 1937 1936 1937 1936 1937 1936 Marian Vian 96 82 1447 1073 15.0 13.0 Churchfields 106 124 1085 1436 10.2 11.5 Alexandra 73 98 663 826 9.3 8.4 West Wickham 55 33 593 231 10.7 7.0 Hawes Down 90 83 1094 1115 12.1 13.4 Totals 420 410 4882 4681 11.6 11.4 INSPECTION CLINIC. An Inspection Clinic was held on Tuesdays, Wednesdays and Fridays throughout the year. The total attendances were 1,830 as compared with 1,756 in 193639 Tuesday sessions were held; 32 Wednesday sessions, and 37 Friday sessions. 69 The average attendance per session was 17.7. The children who attended are divided into the following groups:— 921 Specials—that is, cases brought by parents or sent by teachers or nurses. 193 referred from Routine Medical Inspection—that is, reinspections of cases seen at School and found to need further observation. 716 Re-inspections—that is heart, rheumatic cases brought up for frequent observation and those of the above cases needing to make further attendances. EYE CLINIC 41 sessions were held, and on all of these the Surgeon put in an extra half-session, making three instead of two hours. The average attendance over the sessions was 26.8, which compares with 25.7 last year, and shows that the extra sessions are necessary. The work done during the year is summarised below:— I.W.C. S.M.S. County Attendances by new cases 24 198 32 Attendances by other cases 88 1145 155 Total attendances 112 1343 187 Treatment given Glasses prescribed 9 145 22 Lenses altered 7 130 21 Repairs to frames 2 10 2 No glasses required 2 28 5 No change in lenses 43 404 75 Refused treatment — 6 — Referred for further observation 13 19 32 DENTAL REPORT, 1937 Ladies and Gentlemen, I have the honour to present the Dental Report for the year 1937, of the inspection and treatment of the scholars in the elementary schools. 70 Each school in the Borough has been visited for the routine annual inspection and it is the first time since 1933 that this has been possible. The results of the annual inspections were as follows:— No. of inspections 40 No. of children inspected 4947 No. referred for treatment 3609 No. refused treatment 862 In addition 106 children were inspected and were awaiting treatment at the end of the year, but have not been included in the present report. The number of children for whom no treatment was needed was 1,338, a percentage of 27. The comparable figures for 1936, were 973, a percentage of 24.6. I commented, in the 1936 report, on the importance of maintaining a fairly constant figure of sound dentitions at the annual inspections and it is gratifying to note that with the return to an inspection of not more than a twelve monthly period, this percentage has increased from 24.6 to 27. The comparable figures for five years are as follows:— 1933 1934 1935 1936 1937 29.5 27.5 34.4 24.6 27.0 An average of 28.6 over the period. The percentage of refusals is 23.8 compared with 19.8 in the previous year. The number of children in each year being 862, compared with 591. The increase is accounted for by the fact that all schools have been included in this report. The refusal percentage in the West Wickham Schools is higher than in the older part of the Borough, but one would not expect to obtain quite the same results in the first complete year, as are obtained where a clinic has been established for many years. I am confident, however, that as time goes on, full advantage will be taken by the parents of the facilities provided. In an interim report in 1936, indicating the necessity for a dental clinic in West Wickham, I estimated that in a full year, attendances would be approximately 800. During this year the attendances at that clinic were 892. Mr. Carr, the Dental Officer and Miss Dobson, the Dental Nurse, are to be congratulated on an excellent year's work. 71 The comparative figures of attendances and treatment were as follows:— Attendances Children treated Fillings Extractions 1936 1937 3993 4290 2383 2747 3280 3990 3765 3696 The extractions of permanent teeth numbered 506 and of these 60 were sound teeth removed for regulation purposes and three supernumerary teeth, a total of 63, reducing the loss due to caries to 443. The loss of permanent teeth in 1936 was 464. As one of the primary objects of a school dental service is to preserve the permanent dentition, it is worthy of note that with an increase in the number of individual children treated, there is a decrease in the number of permanent teeth lost. The number of cases of irregularity treated by mechanical means was 11 and those by extraction 39. The number of scholars treated from the Secondary Schools was 59 and they made 12l attendances. Summary of Monthly Reports Children inspected 4947 Number of attendances:— New cases 2747 Old cases 1328 Specials 215 Total Attendances 4290 Number of fillings:— Permanent teeth 3133 Temporary 835 Root fillings 19 Crowns 3 Total Fillings 3990 72 Number of extractions:— Permanent teeth 506 Temporary 3190 Total Extractions 3696 Dressings 612 Siver Nitrate 843 Scalings 56 Regulation Plates 11 Nitrous Oxide Administrations 935 Local injections 705 My thanks are due to Dr. Marsh and Dr. Friedlander for the administration of Nitrous Oxide, to Miss Monck for her valuable assistance and to the School Nurses who assist at anaesthetic sessions. I am indebted to the Head Teachers for their help and cooperation during the year and wish to accord to them my thanks. The dental service of the Borough owes much of its success to the interest they take in the dental health of the scholars entrusted to their care. Robert A. Waters, L.D.S., R.C.S. (Eng.) 73 REPORT ON WORK OF AURAL CLINIC IN 1937 By G. H. Howells, F.R.C.S. Sessions Total New Cases. Re-examinations. held. attendances. Infants. School. Infants. School. 1935 11 321 13 55 23 230 1936 11 330 13 54 30 233 1937 11 318 5 60 33 220 This Clinic has continued to do useful work during the year, the majority of cases clearing up with conservative treatment; and many are now under observation only, without needing any active treatment. In 31 cases the removal of tonsils and adenoids was recommended. As will be seen from the attendance figures a number of infants are referred from the Welfare Centres, and the value of early treatment is very great. A considerable proportion of the cases have required removal of adenoids or of tonsils and adenoids, and have not needed further special treatment. Summary of work done:— School Children. Infants. Number cured by operation 14 2 Number cured by other treatment 17 2 Failed to complete treatment 20 2 Left area 5 2 Failed to keep first appointment — — 57 8 The condition of those cases cured during the year was:— School Children. Infants. Tonsils and Adenoids 5 1 Otorrhoea 4 1 Nasal Catarrh 6 - Earache 2 - Defective hearing 2 1 Mastoid 2 - Miscellaneous 0 1 31 4 74 The following summary shows the work of this Clinic during 1937, and the comparative figures are given for the preceding year: Year. Half-day Sessions held. Surgeons Examinations. Total attendances. New cases. Re-examinations. School. Infants. School. Infant s. School. Infants. 1935 304 2,461 713 160 61 466 188 1936 354 3,133 798 110 46 608 214 1937 340 2,263 912 102 43 557 240 Year. Treatment by Nurse. Electrical and other Treatments. Fees paid. Massage. Exercises. School. Infants. School. Infants. School. Infants. £ s. d. 1935 324 367 1,419 4 13 11 28 9 9 193 42 1936 305 412 1,921 3 230 131 31 3 3 1937 231 372 1,127 75 376 233 30 5 2 145 children attended as new cases and the diagnoses are tabulated below. In six cases the diagnosis appears under two headings:- Classification No. Condition No. of Cases 1. Congenital Deformities 15 2. Birth Injuries 2 3. Rickety Deformities 14 4. Knock Knees (non rickety) 20 5. Postural Defects 22 6. Structural Curvature 1 7. Flat Foot, Pes Cavus, Hallux Ridigus and Foot Strain 27 8. Infantile Paralysis 7 9. Sequelae of other Acute Fevers 1 10. Fractures and other injuries 4 11. Other Bone Disease (non-tuberculous) 3 12. Osteomyelitis 1 13. Other conditions including intoeing (see details below) 7 14. Non-Orthopaedic 10 15. Diagnosis Uncertain 3 16. Diagnosis not Recorded 13 Total 150* *Six cases appear under two headings:— 7 and 4: 1 case. 4 and 5: 1 case. 5 and 7: 1 case. 5 and 14: 1 case. 3 and 5: l.case. 13 and 7: case. 75 The seven cases placed under heading 13 were as follows:— Case 1, Born 1935. Delayed walking. Case 2, Born 1925. Ganglion over Medial malleolus. Case 3, Born 1926. Plantar warts. Pes valgus. Case 4, Born 1907. Lumbo-sacral plexus injury following childbirth. Case 5, Born 1931. Plantar warts left heel. Case 6, Born 1937. Postural Torticollis. Case 7, Born 1923. Ganglion left wrist. Case No. 4 above was dealt with specially at the Orthopaedic Clinic, as the patient had been dealt with through the Council's Ante-Natal Clinic. She was fitted with a special support and prescribed a course of electrical treatment, and has made good progress. Fifteen children were admitted to Hospital for correction of various deformities. Progress has been satisfactory in every case. ULTRA VIOLET RAY CLINIC Three sessions of one hour each are held weekly. The sessions totalled 134 and the attendances 1,116; of these, 324 were infants. A fee of 6d. per attendance is charged in all but necessitous cases, and a total amount of £14 19s. 0d. was received during the year. 76 OTHER WORK OF THE SCHOOL MEDICAL SERVICE DIPHTHERIA IMMUNISATION. This work has been carried out amongst children since 1928, and the total number of children of school age who have been artificially immunised is 3,984 ; not all of these are still on the roll. A full report of the work done during the year appears on page 28 in the Infectious Disease section of this volume. INFECTIOUS DISEASE. No change has been made in the existing methods of notification. The following table shows details of the cases excluded from School during the year:— Condition for which excluded Names of Schools Alexandra Balgowan Bromley Road Churchfields Marian Vian Hawes Down Wickham Com. Others Totals, 1937 Totals, 1936 Chicken Pox 69 8 4 7 48 10 2 18 166 147 Diphtheria — — — — 1 2 — — 3 4 „ Contacts — — — 4 2 3 2 6 17 1 Measles - - - - - - - 2 2 426 „ Contacts - - - - - - - - - 21 „ German — — — 2 2 2 — — 6 7 Mumps 5 5 5 15 68 26 2 13 139 56 Contacts — — — — — — — — — 2 Scarlet Fever 16 5 3 10 2 36 15 18 105 71 „ Contacts 52 11 3 24 2 18 2 21 133 56 Whooping Cough 13 26 15 34 85 20 26 52 271 45 „ Contacts 4 6 4 10 14 1 7 — 46 13 Impetigo — — 5 3 4 — 2 — 14 8 Ringworm 1 — — 3 4 2 — — 10 3 Skin Diseases 8 1 3 17 8 3 — — 40 18 Verminous Heads 7 — 6 6 — 1 — — 20 3 Bronchitis 1 2 2 6 8 1 — — 20 16 Lungs—Non T.B. — — - — — — — — — — Tuberculosis — — - — — — — — — — Debility - 2 6 5 2 2 — 1 18 65 9 Ear Conditions. - — 1 1 3 — — — 5 Enlarged Glands 2 — — 4 — 2 — — 8 6 Eye Conditions - — — 3 — — — — 3 10 Heart Disease - — — — 1 2 — — 3 6 Nose and Throat 8 10 7 27 9 21 8 5 95 80 Miscellaneous 23 17 16 56 46 23 44 8 233 208 Totals 209 93 80 237 309 175 110 144 1357 1331 77 CO-OPERATION WITH VOLUNTARY BODIES. The School Medical Service receives a good deal of assistance from the National Society for the Prevention of Cruelty to Children in obstinate cases of uncleanliness, and from the Invalid Children's Aid Association and the local charitable organisations in providing convalescent treatment for children of school age. SCHOOL BATHS AND SWIMMING. The arrangement whereby children from the Elementary Schools attend the Public Swimming Baths for instruction continued in force during the year, and the report of the Superintendent (Mr. A. V. Palmer) shows that the percentage of those who learn to swim and those who can swim is on the increase; as is also the number of voluntary attendances outside school hours. The time available is now used to capacity, and the new teaching Bath now in course of erection will be very useful. Of 2,465 children under instruction, 1,742 could swim. PHYSICAL TRAINING. The organisers of Physical Training in the Schools took up their duties on 1st September, 1936; their report at the end of August, 1937, reveals that good progress has been made in the organisation of the scheme. SPECIAL SCHOOL FOR MENTALLY DEFECTIVE CHILDREN. The Special School, under the direction of Miss L. Ross, has continued during the year, 4 children being admitted during the year (4 from Beckenham). The number on roll at 31st December, 1937, was 17 (Beckenham, 4 boys and 10 girls; Penge, 2 boys; Bromley, 1 boy). Six children left during the year, in the following circumstances:— Beckenham— 1 Boy, aged 14 Secured work as Errand Boy. 2 Boys, aged 14 Secured work in Factory. 1 Girl, aged 7 Left area. Penge— 1 Boy, aged 14 Notified to K.C.C. 1 Girl, aged 12 Left area. Provision of Meals.—A mid-day meal is provided at the School, and the number of meals served was 3,519, the total cost being £58 13s. 0d., towards which the parents contributed £31 4s. 4d. 78 BOOT CLUB. At Churchfields School, a club is run whereby children can pay small amounts weekly, so that when boots are required they can be obtained at reduced prices. In several cases it has been possible to provide boots free of cost for necessitous cases. Mr. Hambridge is responsible for the management of the Club, and the Teachers collect the weekly payments. SCHOOL LEAVING REPORTS. Each term reports are provided for the information of the Juvenile Welfare Bureau and special attention is drawn to the existence of any defects which render certain types of occupation unsuitable in special cases. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Under the Committee's Byelaws, the following 103 certificates were issued during the year:— Delivering Newspapers 43 Delivering Milk 10 Miscellaneous 50 The number of certificates issued compares with 104 in 1936, and this is evidence that the Byelaws are being rigidly enforced. Licences to take part in Stage Plays were issued in 8 cases during the year. CO-OPERATION OF PARENTS. Parents are notified of the date and time of Routine Medical Inspections, and both parents are invited to attend. Usually the mother only attends. The nature of any defects found is explained to the mother, and advice is given as to treatment and how it should be obtained. CO-OPERATION OF TEACHERS. The Head Teacher is present at the Routine Inspections, and a summary of the defects found is provided for the information of the Head Teachers. 79 The School Medical Service derives a great deal of valuable help from the teachers, and particularly from the Head Teacher, who takes a practical interest in the physical welfare of the children, and is under a great obligation to the teachers in this respect, for their co-operation has resulted in very large numbers of defects being found and remedied which otherwise might not have been detected, or which might have persisted for long periods without treatment. CO-OPERATION OF SCHOOL ENQUIRY OFFICERS. The School Enquiry Officers supply the School Medical Officer with valuable information about children whose absence from school is due to illness, and this leads to the homes being visited by the Nurse, and appropriate advice being given by the Medical Officer as to the length of time the child should be absent from school. SECONDARY SCHOOL CHILDREN. The Committee's Specialist Clinics are available for children attending the Secondary Schools. The attendances made during 1937 were:— Dental Clinic 59 cases made 121 attendances. Orthopaedic Clinic 10 „ 29 „ Eye Clinic 89 „ 187 „ FEES PAYABLE. The scale for all forms of treatment is set out on page 153 vol. 29 of the Education Minutes. PARKSTONE CONVALESCENT HOME. During the year 22 boys and 24 girls were sent for periods of six weeks' stay; 2 boys remained for an extra period. All gained in weight and improved in general condition. PROVISION OF MEALS. With the exception of the Special School (see page 78; there is no arrangement for giving "Free" Meals at the Elementary Schools; but at the Hawes Down School and the Marian Vian School there are School Canteens which provide meals upon payment and serve a very real need. The number of meals supplied during the financial year ended 31st March, 1938, was:— Marian Vian School 11,965 Hawes Down 28,860 80 MEDICAL INSPECTION RETURNS, 1937 TABLE I. RETURN OF MEDICAL INSPECTIONS A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 749 Intermediates 699 Leavers 477 Total 1,925 Number of other Routine Inspections 42 B.—Other Inspections. Number of Special Inspections 982 Number of Re-inspections 3,130 Total 4,112 TABLE I. B.—Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups. Age Groups No. of children inspected 'A' Excellent 'B' Normal 'c' Slightly subnormal 'D' Bad No. % No. % No. % No. % Entrants 749 200 26.7 508 67.83 41 5.47 0 0 00 Intermediate 694 189 27.23 474 68.30 31 4.47 0 0.00 Leavers 477 152 31.87 306 64.15 19 3.98 0 0.00 Other Routine Inspections 18 4 22.22 12 66.67 2 11.11 0 0.00 Total 1938 545 28.12 1300 67.08 93 4.80 0 0.00 The Total inspected as shewn on Table 1 as 1,967. Records as to height and weight were not available in 29 cases. 81 TABLE I. C.—Children Found to Require Treatment Number of individual children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. Code Groups:— Entrants 749 54 7.2 Intermediates 699 58 8.3 Leavers 477 38 7.9 Total of Code Groups 1,925 150 7.7 Other Routine Inspections 42 8 19.04 Total of Code Groups 1936, for comparison 1,978 171 8.6 TABLE I. D.—Children found to Require Treatment. Number of individual children found at Routine Medical Inspection to require treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases). Group. (1) For defective vision (excluding squint). (2) For all other conditions recorded in Table IIA. (3) Total. (4) Entrants 4 50 54 Second Age Group 33 27 58 Third Age Group 13 27 38 Total (Prescribed Groups) 50 104 150 Other Routine Inspections 1 7 8 Grand Total 51 111 158 82 TABLE II. A .—Return of Defects found by Medical Inspection in the Year ended 31st December, 1937. Excluding Defects of Nutrition, Uncleanliness and Dental Disease. DEFECT OR DISEASE Routine Inspections Special Inspections Requiring Treatment Requiring to be kept under observation, but not for Treatment Requiring Treatment Requiring to be kept under observation, but not for Treatment Skin— Ringworm — — 1 — Scabies 3 — 11 — Impetigo 1 — 9 — Other diseases (non-Tuberculous) ... 4 1 25 3 Eye— Blepharitis 3 — 5 — Conjunctivitis 1 — 9 — Defective Vision (excluding Squint) 51 13 43 — Squint 15 — I — Other conditions — - 4 — Ear— Defective Hearing 3 1 18 — Otitis Media 2 — 14 3 Other conditions 3 1 15 Nose and Throat— Enlarged Tonsils only 9 46 16 17 Adenoids only 15 6 6 4 Enlarged Tonsils and Adenoids 23 4 26 1 Other conditions 13 20 31 20 Enlarged Cervical Glands (non- Tuberculous) 1 3 4 2 Heart and Circulation— Organic Heart Disease 4 2 1 — Functional Heart Disease 5 3 6 2 Anaemia 3 — 1 — Lungs— Bronchitis 2 — 7 3 Other non-Tuberculous Diseases ... 3 6 13 20 Tuberculosis— Suspected Pulmonary — 2 3 — Non-Pulmonary — — 1 — Nervous System— Epilepsy — — 1 — Other conditions 1 6 6 4 Deformities— Spinal Curvature 19 3 5 1 Other Forms 40 16 45 3 Other Defects and Diseases 29 33 142 73 Totals, 1937 253 166 469 156 Comparative Totals,1936 255 226 504 169 83 TABLE III. Return of all Exceptional Children in the Area, 1937. (a) Children suffering from combination of defects— Heart and Feebleminded 1 (b) Totally blind children— At Certified Schools for the Blind 2 (c) Partially blind children— At Certified Schools for the Partially Blind 1 (d) Deaf children— At Certified Schools for the Deaf 5 (e) Partially deaf children Nil (f) Mentally defective children— At Certified Schools for the Mentally Defective 14 At no school or institution 3 At other Institutions 1 At Public Elementary Schools 1 (g) Children with severe epilepsy Nil (h) Tuberculous children— i. Pulmonary tuberculosis— At public elementary schools 2 At no school or institution 1 ii. Non-pulmonary tuberculosis— At public elementary schools 15 At other institutions 3 (i) Delicate children— At public elementary schools 7 At certified special schools 6 (j) Crippled children— At certified special schools 4 At public elementary schools 8 At no school or institution 1 (k) Children with Heart Disease— At certified special schools 1 At public elementary schools 8 At no school or institution 2 At other institutions 1 84 TABLE IV. Treatment Tables.—Group I Minor Ailments. Didease or Defect Number of Defects trented, or under treatment,during 1937 Under the local Authority's Scheme Skin: Ringworm (Scalp) (Nil) X-ray Treatment - Other - Ringworm (Body) 3 Scabies 3 Impetigo 58 Other Skin Diseases 588 Minor Eye Defects: External and other 128 Minor Ear Defects 80 Miscelleneous: Minor Injuries, Sores. etc. 1207 Total 2084 TABLE IV. Group II. Defective Vision. No. of Defects death with. Under the Authority's Scheme Otherwise. Total Errors of Refraction (including Squint) 597 - 597 Other defect or disease of the eyes - - - No. of Children for whom Spectacles were (a) Provided 167 - 167 (b) Obtained 162 - 162 85 Group III.—Treatment of Defects of Nose and Throat. Received Operative Treatment Number of Defects. Received other forms of treatment Total Tonsils only Adenoids only Tonsils and Adenoids Other defects Under the Authority's Scheme 12 10 62 — 163 247 Group IV.—Orthopædic and Postural Defects. Under the Authority's Scheme. Total 379 Residential treatment with education 9 Residential treatment without education - Non-residential treatment at an Orthopaedic Clinic 379 Group V.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist:— Routine Age Groups Aged: 5 529 6 600 7 574 8 614 9 543 10 538 11 414 12 429 13 469 14 237 Total 4947 Specials 215 Grand Total 5162 (b) Found to require treatment 3609 (c) Actually treated 2747 (2) Half-days devoted to:— Inspection 40 Treatment 432 472 (3) Attendances made by children for treatment 4290 (4) Fillings:— Permanent Teeth 3155 Temporary Teeth 835 3990 (5) Extractions:— Permanent teeth 506 Temporary teeth 3190 3696 (6) Administrations of general anaesthetics for extractions 935 (7) Other operations:— Permanent teeth 629 Temporary teeth 1598 2227 86 Group VI.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 12 (ii) Total number of examinations of children in the schools by School Nurses 11,744 (iii) Number of individual children found unclean 62 (iv) Number of children cleansed under arrangements made by the Local Education Authority Nil (v) Number of cases in which legal proceedings were taken: (a) Under the Education Act, 1921 Nil (b) Under School Attendance Bye-Laws Nil 87 Sainsbury (Printers) Ltd., Anerley, S.E. 20