BEC 6 BOROUGH OF BECKENHAM REPORT ON THE HEALTH of the DISTRICT during 1938 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. BOROUGH OF BECKENHAM REPORT ON THE HEALTH of the DISTRICT during 1938 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. 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 AND WELFARE COMMITTEE. Membership up to 9th November, 1938. Chairman: Councillor R. S. JACKSON. Deputy Chairman: Councillor Mrs. E. M. G. BARLAS. Alderman Mrs. E. Campbell. Councillor The Rev. R. Burges, Alderman Dr. J. H. Bennett. c.c. Alderman R. T. Parker, J.P. Councillor C. G. Brook. Councillor Mrs. C. H. Bellringer. Councillor W. G. Horton. Ex-officio Members : The Mayor (Councillor Dr. R. P. S. Edden, o.b.e., j.p.). The Deputy Mayor (Alderman J. A. Collister). HEALTH AND WELFARE COMMITTEE. Membership from 9th November, 1938. Chairman: Councillor R. S. JACKSON. Deputy Chairman: Alderman Dr. J. H. BENNETT. Alderman Mrs. E. Campbell. Councillor C. G. Brook. Alderman R. T. Parker. Councillor J. Collett, c.c. Councillor Mrs. E. M. G. Barlas. Councillor Dr. R. P. S. Edden, Councillor Mrs. C. H. Bellringer. o.b.e., j.p. Councillor The Rev. R. Burges, Councillor G. J. Walker. c.c. Ex-officio Members : The Mayor (Alderman F. Healey, j.p.). The Deputy Mayor (Alderman R. W. Jeff). HOUSING COMMITTEE. Membership up to 9th November, 1938. 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). 1 HOUSING COMMITTEE Membership from 9th November, 1938. Chairman : Councillor Mrs. E. M. G. BARLAS. Deputy Chairman: Councillor G. L. WOOD. Alderman J. A. Collister. Alderman J. Crease, j.p. Councillor T. B. Boyd. Councillor J. Collett, c.c. Councillor C. A. Hannam-Harris. Councillor W. G. Horton. Councillor K. R. Maynard. Councillor G. J. Walker. Ex-officio Members: The Mayor (Alderman F. Healey, j.p.). The Deputy Mayor (Alderman R. W. Jeff). EDUCATION COMMITTEE List of Members from 9th November, 1938. Chairman : Alderman Mrs. E. Campbell. Vice-Chairman : Alderman J. A. Collister. Other Council Members : The Mayor: Alderman F. Healey, j.p. Alderman R. W. Jeff. Councillor J. H. Atkins. Councillor Mrs. Bellringer. Councillor C. G. Brook. Councillor The Rev. R. Burges, c.c. Councillor J. Collett, c.c. Councillor E. C. Dixon. Councillor C. A. Hannam-Harris. Councillor H. F. Lee, m.a. Councillor W. J. Sampson. Councillor E. G. Taylor. Co-opted M embers: Mrs. M. Chamberlain. G. W. Neal, b.sc. Mrs. Clayton Taylor. Rev. J. W. Niven, d.d. Ernest H. Holford. Wm. Smerdon. Representative of the London University : Bayford Stone, j.p., m.a. Members of the Kent County Council: J. A. Bennett, c.c. C. A. Elgood, j.p., c.a. R. C. Dungay, Acting 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. Wateks, 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 Thompson, 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 (Appointed 1 /6/36; Resigned 28 /3 /38). A. C. R. Neale, Cert. R. S. I., Cert. Food Inspector (Appointed 1 /6/37; Resigned 4 /6 /39). E. U. Williams, Cert. R.S.I., Cert. Food Inspector (Appointed May, 1938). 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 Nurses 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). Part-time Health Visitor Mrs. A. White, S.C.M. (Resigned 31 /3/39). Dental Nurse Miss 1. 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. (Resigned 31/3/38). R. C. Rogers, Cert. R.S.I. S. P. Lewis. J. Dungay (Appointed 1/4/38). S. B. Hawley. Miss H. E. Thomas (Appointed 1 /4/38). 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. There are no special matters calling for attention. The New Clinic Building at West Wickham was opened in January, 1939 and was not available during 1938. A great deal of the time of the staff of the Department has been absorbed by A.R.P. work and I should like to express my appreciation of the additional work put in by the staff to meet these added demands. The Chairman and Members of the Health Committee have, as ever, given every support to the efforts of the Department to maintain the standard of the Health Services in the Borough. T. PHILIPS COLE. June 16th, 1939. 4 SUMMARY OF STATISTICS, 1938 Area of District in Acres 5,935 Population: 1931 Census 43,832 Estimated by Registrar-General, June, 1938 70,590 Rateable value, 1st October, 1938 £833,406 Sum represented by a penny rate, 31st March, 1938 £3,333 Density of Population (Census, 1931) 11.28 Number of Occupied Houses (Census, 1931) 10,308 Houses erected in 1938 630 Number of live Births :— Males Females Legitimate 451 417 Illegitimate 13 10 Total 891 Live Birth Rate 12.622 Still Births Registered :— Legitimate: Males, 19; Females, 21 40 Still Birth Rate (a) per 1,000 population 0.566 (b) per 1,000 births—live and still 42.964 Number of Deaths (Registrar-General's figures) :— Males, 290; Females, 300 590 Death Rate per 1,000 living 8.358 Infantile Mortality (31 deaths of infants under 1 year of age, per 1,000 births) 34.792 Males Females Legitimate 15 10 Illegitimate 2 4 Zymotic Death Rate (3 deaths) 0.042 Tuberculosis Death Rate (all forms, 25 deaths) 0.354 ,, (Pulmonary Tuberculosis, 22 deaths) 0.312 Disease of Respiratory Organs other than Tuberculosis, 84 deaths 1.189 Cancer Death Rate, 96 deaths 1.359 5 VITAL STATISTICS BIRTH RATE. After allowing for inward and outward transfers during the year, the Registrar General gave a figure of 891 live births and 40 stillbirths in 1938, and this gives a live birth rate of 12.622 compared with 13.365 in 1937. The provisional rate for England and Wales for 1938 was 15.1 DEATH RATE. There were 590 deaths during the year amongst residents, and this gives a death rate of 8.358 per 1,000, as compared with 8.924 in 1937. This figure, although uncorrected for age and sex distribution, compares favourably with the rate of 11.6 for England and Wales in 1938, and when corrected by the application of the " Comparability Factor "supplied by the Registrar General, the figure is reduced to 8.190, 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 96, and the rate for 1938 of 1.359 compares with a rate of 1.307 for 1937. HEART DISEASE. The causes of deaths classed under the heading Heart Disease are numerous. The total of 159 deaths includes arterio sclerosis, rheumalic 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 25, and the death rate of 0.354 compares with 0.488 in 1937. 22 deaths were due to pulmonary tuberculosis, and 3 to other forms. A table showing the ages at death and the ward distribution appears on page 35. ZYMOTIC DEATH RATE. The deaths from Zymotice diseases totalled 3 : 1 from Infantile Diarrhœa; 2 from Diphtheria. The rate of 0.042 compares with 0.071 in 1937, when there were 5 deaths. 6 7 BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY DURING 1938. Provisional Figures. 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. Diarrhoea (under 2 years). Total deaths under 1 year. Live Births Still Births England and Wales 15.1 0.60 11.6 0.00 0.00 0.04 0.01 0.03 0.07 1 0.11 5.5 53 126 County Boroughs and Great towns including London 15.0 0.65 11.7 0.00 0.00 0.05 0.01 0.03 0.07 0.10 7.8 57 148 Smaller Towns (with population between 20,000 and 50,000) 15.4 0.60 11.0 0.00 0.00 0.06 0.01 0.03 0.05 0.06 13.1 57 London 13.4 0.48 11.4 0.00 0.00 0.06 0.01 0.03 0.05 0.06 13.1 57 BECKENHAM 1262 056 8.35 0 00 000 0.00 000 0 00 002 013 1.1 34 STILLBIRTHS. The total number of stillbirths was 40, which gives a rate of 0.566 per 1,000 of the population (compared with 0.402 in 1937) and a rate of 42.964 per 1,000 births. Enquiries have been completed in 24 cases and details are set out below. Obstetric History: Primagravida 12 Second Pregnancy 4 (In two cases there had been one normal pregnancy ; in the other two the previous pregnancies had miscarried) Third Pregnancy 3 (In one case there had been two normal pregnancies; one case had had one normal pregnancy and one stillbirth; and the third case had had one normal pregnancy and one miscarriage). Fourth Pregnancy 3 (In one case there had been three normal pregnancies; one case had had one normal pregnancy and two stillbirths, and the third case had had one normal pregnancy, one stillbirth and one miscarriage). Fifth Pregnancy 1 (Previous history showed two normal pregnancies, one stillbirth and one miscarriage). Seventh Pregnancy 1 (Previous pregnancies were normal). Duration of Pregnancy : Full Term 12 Primagravida 7 Multipara 5 Premature 12 Primagravida 5 Multipara 7 Time of Death : Before Labour 13 Primagravida 6 (One at Full Term ; one at 32nd week ; one at 35th week ; two at 36th week ; and one at 37th week). Multipara (2) 1 (At 31st week). Multipara (3) 2 (One at 35th week, and one at 38th week). 8 Multipara (4) 2 (One at 32nd week, and one at 38th week). Multipara (5) 1 (At Full Term). Multipara (7) 1 (At Full Term). During Labour 11 Primagravida 6 (All at Full Term). Multipara (2) 3 (Two at Full Term; one at 36th week). Multipara (3) 1 (At 36th week). Multipara (4) 1 (At Full Term). Cause of Death: Before Labour 13 Full Term 3 (a) Pr. Toxaemia of Pregnancy. (b) M5. Congenital Deformities of the Foetus. (c) M7. Ante-partum haemorrhage. Premature 10 (a) Pr. Congenital Deformities of the Foetus. (b) Pr. Acute Nephritis. (c) Pr. Toxaemia of Pregnancy (d) Pr. (e) Pr. Cause unknown. (f) M2. (g) M3. Toxaemia of Pregnancy. (h) M3 Toxaemia of Pregnancy. (i) M4 Twin Pregnancy. (f) M4 Acute Accidental Haemorrhage. During Labour 11 Full Term 9 (a) Pr. Disproportion—Prolonged Labour. (b) Pr. Prolonged Labour (c) Pr. Persistent Occipito-Posterior—Prolonged Labour. (d) Pr. Breech Presentation. (e) Pr. Hydrocephalus. (f) Pr. Cause unknown. (g) M2. Hydrocephalus. (!) M4. Cause unknown. Premature 2 (a) M2. Hydramnios—Uterine Inertia. (b) M3. Uterine Inertia—Prolapse of Cord. 9 INFANTILE MORTALITY. The number of deaths among infants under the age of 12 months was 31 as compared with 28 in 1936 and 33 in 1937. The Infantile Mortality Rate for the year was 34.792 per 1,000 births. Disease Weeks Total under 1 mth. Months Total under 1 year 0 to 1 1 to 2 2 to 3 3 to 4 1 to 3 4 to 6 7 to 9 10 to 12 A. Congenital Deformities— 1. Congenital Heart Disease 2 2 - - 4 - - - - 4 2. Pyloric Stenosis - - - - - 2 - - - 2 3. Congenital Atresion of Rectum 1 - - - 1 - - - - 1 4. Spina Bifida - - - - - 1 - - - 1 B. Due to Ante-Natal or IntraNatal Conditions— 1. Prematurity 9 - - - 9 - - - - 9 2. Want of Attention at at Birth 2 - - - 2 - - - - 2 3. Inter-cranial haemorrhage 1 - - - 1 - - - - 1 4. Congenital Debility 1 - - - 1 - - - - 1 5. Difficult Labour 1 - - - 1 - - - - 1 C. Due to Infections— 1. Broncho-Pneumonia - - - - - 2 - 1 - 3 2. Streptococcal Septicaemia - 1 - - 1 - - - - 1 3. Gastro-Enteritis - - - - - 1 - - - 1 D. Other Causes— 1. Accidental Suffocation - - - - - - 2 - - 2 2. Haemorrhagic Disease of the Newly-born 1 - - - 1 - - - - 1 18 3 - - 21 6 2 1 - 30 Local records only cover 30 cases. The neo-natal death rate (deaths within the first week) is 20.20 per 1,000 births, compared with 17.74 in 1937 and 12.77 in 1936. Of the 30 Infant deaths recorded in the Table above, 4 were not due to disease, being caused by accidents and neglect, and could have been prevented. Of the nine deaths due to Prematurity, three occurred in Twin Pregnancies and three more were due to Toxaemias of Pregnancies; in addition to these, there were two deaths due to abnormalities in labour. Study of these particulars suggests that in the future Infantile Mortality Rates of 20 per 1,000 or under are well within the bounds of possibility. 10 INFANTILE MORTALITY 1938 The Infantile Mortality Rates for the different Wards in the Borough is as follows :— Area Births Infant Deaths I.M.R. NeoNatal One week to one year Kent House Ward 107 5 46.7 28.0 18.7 Langley Park Ward 88 4 45.4 45.4 - Lawrie Park Ward 77 3 39.0 13.0 26.0 Manor House Ward 94 3 31.9 21.2 10.7 West Wickham Ward 251 7 27.8 11.9 15.9 Eden Park Ward 182 5 27.5 16.4 11.1 Shortlands Ward 82 2 24.4 24.4 - Copers Cope Ward 49 1 20.4 - 20.4 The wide differences in the rates shown is largely due to the small numbers contained in the table. Even so, a noteworthy point is the general reduction in the infant death-rate after the first week of life. 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 1938, the cause being :— (a) Puerperal Sepsis : Peritonitis. (b) Other Puerperal Disease : Paralytic Ileus. 11 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, 1938, based on information possessed by the Department, is 71,500, and the Registrar General's estimate is 70,590. 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, 1938, was 105, as compared with 266 the previous year. The figures for West Wickham accounted for approximately half the total. The Kent County Council Public Assistance Department state that out-relief was given in Beckenham and West Wickham during the year to 50 cases, and that 439 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 Engineer. 1938 METEOROLOGY Month Mean Reading of Barometer at 9 a.m. Self-registering thermometer Rainfall total, per mouth (inches) Max. in Air Min. in Air January 29.76 57 32 2.51 February 30.18 56 27 .66 March 30.19 66 30 .62 April 30.21 63 26 .21 May 29.89 76 27 1.42 June 30.00 79 44 .49 July 29.92 84 44 1.88 August 29.97 85 43 2.92 September 29.96 79 39 2.62 October 29.81 64 28 2.34 November 29.75 67 31 3.13 December 29.72 26 21 2.77 Mean for year 29.94 66.8 32.7 Total 21.57 12 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. The time-table printed is that in force for 1939. Ante-Natal Tuesdays—Alternate, 2 to 4.30 Clinic Block, Hawes Down Thursdays, 10 to 12.30 ,, Town Hall Fridays—Alternate, 11 to 12.30 ,, Hawes Down Ditto, 2 to 4 p.m. „ Town Hall Obstetric Consultant Mondays, 2 to 4 p.m. (three per month) Clinic Block, Town Hall Child Welfare Held afternoons from 2 to 4 Tuesdays (a) Mission Hall, Church fields Road. ,, (b) Church House, Lennard Road. Wednesdays Church Hall, Langley Rd., Elmers End. Thursdays(a) Town Hall (b) Hawes Down Clinic, West Wickham Fridays (a) Church Hall, Langley Rd., Elmers End. ,, (b) School Hall, Coney Hall School Inspection Tuesdays, 10 to 12.30 Clinic Block, Town Hall Wednesdays, 10 to 12 ,, ,, Fridays, 10 to 12.30 „ Hawes Down 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 Thursdays, 2 to 4.30 p.m. ,, ,, Orthopaedic and U. V.-ray Mondays, all day Clinic Block, Town Hall Wednesdays, all day ,, ,, Thursdays, afternoons ,, ,, Friday mornings ,, ,, Tuesday mornings ,, Hawes Down Thursday mornings ,, ,, Ophthalmic Wednesday afternoons. Clinic Block, Town Hall Aural Tuesday afternoons, monthly Clinic Block, Town Hall Tuberculosis Dispensary Wednesdays, 5 to 6 p.m. 1, Westbury Road, Penge Fridays, 1.30 to 3.30 p.m. 13 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 49 cases of sudden death in the district during 1938, where the public mortuary was used. 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 :— King's College Hospital, Denmark Hill Men Mondays and Thursdays, 5 p.m. 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 Park Corner Mondays to Fridays, 9 to 2, and 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. NURSING HOMES REGISTRATION ACT, 1927. At the end of the year there were 12 Homes on the Register ; no new applications were received during 1938, and three Homes closed down. The Medical Officer of Health and Assistant M.O.H. paid 54 visits of inspection to the premises and found the records and equipment satisfactory. BOARDED OUT CHILDREN. At the beginning of the year there were 23 registered foster mothers having charge of 25 children. 14 children left during the year, and 8 new cases were received. At the end of 1938 there were 18 children under the care of 17 foster mothers; 7 foster parents gave up keeping children or left the area, and 5 new names were registered ; 4 foster mothers had no cases in their charge at 31 /12 /38. The Health Visitors made 436 inspections of the premises on the register, and most of the children were seen at the Welfare Centres. 14 ACTS AND BYELAWS. The following Byelaws were put into operation during the year (1) Regulation of Nursing Homes. (2) Pleasure Fairs. MID WIVES ACTS. The Kent County Council are responsible for the supervision of midwives in the district. The new Scheme for County Midwives has been in operation since 1 /9/37. 15 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 1,089 entries in the Birth Register during the calendar year included 222 inward transfers and 157 outward transfers, leaving a total of 932 entries, less 35 stillbirths; or 897 infants belonging to Beckenham. The Registrar General gives a figure of 891 calculated over a slightly different period. ANTE-NATAL WORK. In 332 of the 710 births in and belonging to the area, the services of a private medical practitioner were engaged, and the remaining 378 were attended by Midwives. It is for these latter cases that examination and supervision at the Ante-Natal Clinics is intended, and 243 of these were examined at the Clinics. All assessments for the Maternity Home 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 269 visits during 1938. 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 528 compared with 506 in 1937. The panel contains the names of 32 Doctors practising in the District. During the year the following work was done under the scheme :— Sessions held 75 Number of expectant mothers attending for examination 243 Number of attendances made 528 Number of Doctors attending 32 The arrangements worked smoothly and the appointments were well kept by both doctors and patients. In 8 cases X-Ray examinations were carried out at a local hospital to assist in diagnoses. 16 The Assistant Medical Officer saw 34 new cases and made 18 re-examinations of expectant mothers. POST-NATAL CLINIC. Doctors on the panel saw 176 cases, and Dr. Thomson saw 10 cases. 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. GRANT TO MIDWIVES. In necessitous cases the Council are prepared to give a grant of £1 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. 17 OBSTETRIC CONSULTANT'S CLINIC As from 20th April, 1938, a Consultants Clinic of Ante-Natal and Post-Natal cases was held, and in the course of the first eight months of this service there were 187 attendances. Thirty-two of these were cases referred by practitioners in the area for the opinion on some question of Ante-Natal difficulty, while the remaining 155 were Post-Natal cases. While this Post-Natal service is too young and the numbers too small to reach any definite conclusion, it can already be stated that the number of injuries sustained by mothers is negligible and that practically all the conditions dealt with were of a simple nature and readily remedied. Towards the end of the year it was obvious that the number attending these Clinics was rapidly increasing. D. M. Lindsay, M.D., Ch.B., F.S.O.G. Obstetric Consultant. During the year fifteen Medical Practitioners called upon the services of the Obstetric Consultant. The consultations from this source numbered twenty-one, and they were distributed as shown in the table that follows:— Ante-Natal Conditions :— Haemorrhage. Threatened Miscarriage 1 Toxaemias. Hyperemesis Gravidarum 1 Albuminuria and Pre-Eclampsia 4 Inter-Natal Conditions :— Dystocia. Vertex Cases 6 Frank Breech 1 Haemorrhage. Post-Partum Haemorrhage 1 Trauma. Extensive perineo-vaginal laceration 1 Post-Natal Conditions: Infections. Puerperal Pyrexia 6 21 18 HOME VISITING This work is carried out by the Health Visitors. During 1938 the Health Visitors made a home visit to 581 out of 710 new cases belonging to the district. The work done by the Health Visitors is summarised below:— Home Visits, New Under One 1 to 5 Special Illness Expect. Mothers Boarded Out No reply to call Total Welfare Visits T.B. Visits Miss Cusack 208 894 1450 306 132 27 498 3515 252 Miss Smith 108 492 730 62 101 14 349 1856 119 Miss Wheeler 121 493 843 48 48 22 317 1892 147 Mrs. White 38 81 262 6 - - - 387 - Miss Noble 106 395 901 20 72 12 388 1894 124 Total 581 2355 4186 442 353 75 1552 9544 642 The total number of visits, 9,544 compares with 8,981 in 1937. 19 20 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 1938 Total 1937 Individual Children 464 309 662 239 243 139 2056 1985 Total Attendances 5072 3975 6332 1885 2993 1023 21280 19280 New Cases 191 119 203 98 95 44 750 788 Average Sessional Attendance 99.4 81.1 62.7 72.5 66.5 38.7 71.1 68.8 Sessions 51 49 101 26 45 27 299 280 Cases seen by Medical Officer 948 737 1731 388 725 430 4959 4454 Average No.per Session seen by M.O. 18.6 15.0 17.1 14.9 16.1 15.9 16.4 15.9 The total attendances show a further 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 ; despite the increased facilities, attendances continue to outstrip the accommodation provided. The following figures show the main reasons for medical examinations :— Total seen by Doctor. Feeding and Digestion. Referred to Special Clinics. Special Cases. General Progress. 4,959 1,322 274 31 2,816 Average Number seen by Doctor per Session. Immunisation. 516 16.4 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 3,947. 21 The following figures show the attendances of children in age groups :— Year born Total who Attended Attendances made Average number of Attendances per Child 1933 132 545 4.1 1934 252 1,432 5.6 1935 281 1,970 7.0 1936 395 3,488 8.8 1937 495 8,016 16.2 1938 501 5,829 11.6 Total 2,056 21,280 10.3 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 £300 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. VOLUNTARY HELPERS. We are much indebted to the following ladies who continue to give most valuable assistance at the Beckenham Welfare Centres: Miss Bradford, Mrs. Buckley, Mrs. T. P. Cole, Miss G. Firmin, Mrs. Forrester, Mrs. Jeffries, Mrs. Harris, Mrs. Mac Williams, Mrs. Matthews, Miss Morland, Mrs. Morrison, Mrs. Porter, Mrs. R. Prebble. The following ladies have continued to give assistance at the West Wickham Centre : Mrs. Chester, Mrs. Drayton, Mr. Lampugh, Miss Latter, Mrs. Lebbon and Mrs. Poole. The following ladies assist at the Coney Hall Centre: Mrs. Budd, Mrs. Barber, Mrs. Jeffreys, Mrs. Lee, Mrs. Shambrook and Mrs. Smith. 22 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. 1936 187 Infants 120 Mothers 23 46 27 110 22 1937 166 Infants 128 Mothers 11 49 21 95 28 1938 207 Infants 116 Mothers 22 52 41 140 26 MATERNITY AND CHILD WELFARE DENTAL REPORT, 1938 The sessions were held on Friday afternoons and at such other times as circumstances demanded. The estimated number of sessions was 72 and the attendances totalled 740, compared with 696 in 1937. The individual number of mothers attending for treatment was approximately the same as in the previous year. Thirty-one patients were supplied with dentures and 11 were awaiting dentures at the end of the year. For the latter the extractions had been completed. The number of children who attended shows an increase, 207 this year, compared with 166 in 1937. The following is the summary of treatment:- Mothers Children Attendances 382 358 Number treated 116 207 Extractions 471 224 Fillings 59 226 Dressings 109 93 Silver Nitrate — 94 Local Injections 20 13 Nitrous Oxide 87 63 Ethyl Chloride — 11 Impressions, etc. 91 — Scalings 9 — Dentures 47 — Repairs 9 — Local Injections 20 13 Robert A. Waters, L.D.S. Eng. 23 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 1938, 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 319 238 81 — 1938 333 242 91 — STAFF. The Nursing Staff consists of a Matron, Assistant Matron, and three 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 last 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, 79 pupils have been trained and passed the examination of the Central Midwives' Board; 7 passing in 1938. 24 DISTRICT CASES. Cases who do not wish to enter the Maternity Home for confinement and cannot afford the services of a private doctor, can have the attendance of a County Midwife who may refer her patient to the Clinic under the Ante-Natal Scheme. Forty-seven patients were referred to the Clinic by Midwives during 1938. 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 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 Thursday mornings at the Town Hall Clinic and on alternate Tuesday afternoons at the Hawes Down Clinic. In addition, Dr. Thomson holds Clinics on alternate Fridays at the Town Hall Clinic and Hawes Down Clinic. During 1938, 326 expectant mothers (Beckenham 235, Penge 91) attended the Maternity Home Clinic. The number of Sessions held was 156, and the attendances numbered 1,830, a weekly average of 33. 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 5,302 births in the Home and 1,250 on the District, giving a total of 6,552 births. There have been in all, 10 maternal deaths, giving a maternal mortality rate of 1.52 per 1,000 births, compared with the rate over the same period of approximately 4.00 per 1,000 births for England and Wales as a whole. 25 ANNUAL STATISTICS FOR 1938 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 333 4. Average duration of stay 14.69 days 5. Number of cases delivered by : (a) Midwives 249 (b) Doctors 78 (c) Post natal cases 3 6. Number of cases in which medical assistance was sought by a midwife in emergency 122 7. Number of cases notified as: (a) Puerperal Fever Nil (b) Puerperal Pyrexia* 8 8. Number of cases of Pemphigus Neonatorum Nil 9. Number of infants not entirely breast-fed while in the Institution 8 Supplementary feeds *i.e. rise of temperature to 100.4° F. for 24 hours, or its recurrence within that period. 26 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 1 (b) Cause of death in each case Sepsis-Peritonitis. 12. [a) Number of foetal deaths : (i) Stillborn 12 (ii) Within 10 days of birth 6 (b) Cause of death in each case, and results of post - mortem examination (if obtainable) See below : Stillbirths : 1. Two months premature. Macerated. 2. Full term. Premature rupture of membrances, uterine interia, prolonged labour and forceps delivery. 3. Full term. Overmoulding and ossification. Meningeal haemorrhage. 4. Full term. Hydrocephalic. 5. Full term. Two previous stillbirths— Wasserman test negative. Unknown. 6. Full term. Breech presentation, premature rupture of membranes. 7. Two weeks premature. Twin pregnancy. Unknown. 8. Four weeks premature. Toxæmia of pregnancy. 9 and 10. Five weeks premature. Twin pregnancy. Unknown. 11. Full term. Macerated. 12. Full term. Uterine inertia. Unknown. Infant Deaths: 1. Aged 4 days. Hæmophylia. 2. Aged 14 hours. Prematurity. Toxaemia of pregnancy. 3. Aged 4 days. Congenital heart disease. 4. Aged 7 days. Congenital heart lesion. Bronchitis. 5. Aged 2 days. Prematurity. 6. Aged 2 days. Prematurity. 27 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 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 19 3 22 17 2 Scarlet Fever 117 57 174 131 — Enteric Fever 1 — 1 1 — Puerperal Pyrexia 9 4 13 2 1 Pneumonia 27 6 33 — 28 Tuberculosis (all forms) 54 17 71 — 25 Erysipelas 12 4 16 — — Poliomyelitis — — — — — Polio-Encephalitis — — — — — Ophthalmia Neonatorum 1 — 1 1 — Dysentery 1 2 3 — — Food Poisoning — — — — — Malaria 1 — 1 — — DIPHTHERIA. Twenty-two cases of Diphtheria were notified in 1938, compared with 11 cases in 1937. Eighteen cases occurred in original Beckenham and 4 in West Wickham. The age incidence of the cases was :— 0—4 5—14 15 + Beckenham 3 9 6 West Wickham 2 1 1 The seasonal incidence was Jan.-Mar. Apr.-June. July-Sept. Oct.-Dec. 10 1 3 2 Although there were 10 cases in the 5—14 years age group, it is noteworthy that only 3 of these cases occurred among children attending the Elementary Schools, in which Diphtheria Immunisation is carried out. No case of Diphtheria in a person who had received protective innoculation was notified during the year. DIPHTHERIA IMMUNISATION. During 1938, consents were received in respect of 792 children and of these 221 were under school age; of the remainder, 407 were attending the Elementary Schools in the Borough and 26 were scholars at the County Schools. 28 The large increase in the number of pre-school children dealt with can be attributed almost entirely to the practice, adopted for the first time in 1938, of carrying out Diphtheria immunisation at the Infant Welfare Centres as well as at the regular Immunisation Clinic at the Town Hall. It is hoped that in this way it may be possible to protect a satisfactory proportion of pre-school children. The following table shows the position in the Infants' Department of the Elementary Schools at 31st December, 1938, with comparative figures for recent years. School Year of Birth Percentage Protected 1931 1932 1933 1934 Total 1938 1937 1936 1935 1934 Alexandra— On Roll 89 82 83 8 262 Immune 48 25 10 — 83 41.2 42.3 50.8 39.5 37.2 3 Doses 3 5 24 3 35 Balgowan— On Roll 89 74 74 237 Immune 41 43 22 — 106 47.6 45.0 47.9 50.2 54.1 3 Doses — 4 3 — 7 Bromley Rd.— On Roll 36 42 30 3 101 Immune 17 18 6 — 41 45.5 39.6 44.9 52.8 72.0 3 Doses — 2 3 — 5 Churchfields- On Roll 96 111 72 5 284 Immune 56 66 17 — 139 58.8 55.8 49.5 48.2 50.6 3 Doses 3 8 16 1 28 Hawes Down- On Roll 109 129 117 — 355 Immune 53 44 4 — 101 40.8 52.6 29.9 35.9 25.7 3 Doses 1 14 23 3 41 Marian Vian— On Roll 133 133 120 3 389 Immune 89 60 24 2 175 60.1 50.1 56.0 51.2 50.6 3 Doses 2 15 41 1 59 wickham Common— On Roll 80 78 69 1 228 Immune 37 27 4 — 68 45.8 50.5 30.4 — — 3 Doses 2 5 29 1 37 The percentage of Immunity for all Infants' Departments combined in the last five years, has been :— 1934 1935 1936 1937 1938 49.4 48.0 44.7 49.0 49.9 29 DIPHTHERIA IMMUNISATION Number of Children in Elementary Schools completely Protected at 31/12/1938. School. born 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. * or 5 3 42 41 44 38 48 41 39 54 43 46 47 55 61 — 57 — 52 — 7 — — — — — Alexandra: † imm — — — — 3 2 4 1 5 2 1 2 — 7 5 — 2 — 6 — — — — — — — ‡ 3dn — — 6 4 5 15 22 21 21 22 11 12 8 17 16 — 18 — 11 — — — — — — — * or — — 36 38 39 35 42 47 — — — — — — 38 45 46 40 36 35 51 50 13 25 1 Balgowan: † imm — — — — 1 1 1 1 — — — — — — 2 1 5 2 5 6 3 11 3 9 — — ‡ 3dn — — 10 12 19 22 18 21 — — — — — — 9 20 9 13 6 12 6 3 — 1 — — * OR 2 1 17 13 15 27 19 17 27 37 28 37 29 39 19 21 26 24 19 26 5 — — — — — Bromley Rd: † IMM — — — — — 1 — — — 1 3 — 5 2 2 — 1 4 2 3 1 — — — — — ‡ 3dn — — 2 4 6 11 9 8 9 20 12 15 11 16 4 8 3 9 4 10 1 — — — — — *or 2 3 37 35 50 61 41 55 48 55 51 65 40 46 — 89 — 76 — 78 — 2 — — — — Churchf'ds: † IMM — — — — — 1 1 — 1 3 2 3 2 1 — 4 — 6 — 15 — — — — — — ‡ 3dn — — 7 10 28 37 27 28 21 30 23 32 15 14 — 20 — 19 — 12 — 1 — — — — * OR — — 66 51 62 67 54 55 74 64 80 61 81 62 46 50 41 56 46 40 5 10 — — — — Hawes D'n : † IMM — — — — — 1 — 1 1 1 5 2 9 1 4 5 5 1 10 — — 1 — — — — ‡ 3dn — — 3 1 19 24 26 26 29 39 25 21 17 23 7 4 3 9 2 6 — 1 — — — — * or 1 2 69 51 73 60 69 64 70 64 73 72 79 78 39 49 49 49 50 48 9 33 — — — — MarianVian: † imm — — 1 — — 2 — — — — 4 — 2 6 1 3 6 7 11 11 1 — — — — — ‡ 3dn — 2 14 9 30 28 52 37 35 42 36 35 32 30 16 19 10 9 9 8 1 2 — — — — Wickham C. : * or 1 32 37 41 37 28 52 27 35 37 31 31 28 — — — — — — — — — — — — † imm — — — — — — — 1 — 1 1 — — 4 — — — — — — — — — — — — ‡ 3dn — — 2 2 15 12 11 25 12 15 13 11 10 6 — — — — — — — — — — — — *On Roll. † Naturally Immune. ‡Immunised. 30 DIPHTHERIA IMMUNISATION. TABLE NO. 1 1938. Treatment Given to New Cases in 1938. Born Shick Test Doses after Test Doses Sans Test 1st Retest Further Doses 2nd Retest Neg. Pos. Failed Had 3 Failed Had 3 Failed Not Due. Neg. Pos. Failed Had Neg. Pos. Not Due. 1938 — — — — — 2 — 2 — — — — — — — 1937 — — — — — 5 — 4 — 1 — 1 1 — — 1936 — — — — 1 76 1 58 15 2 — 2 1 — 1 1935 — — — — 5 78 4 41 31 2 — 2 2 — — 1934 — 2 — 2 2 73 5 46 24 — — — — — — 1933 2 34 3 31 5 205 5 187 43 1 — 1 — — 1 1932 5 68 5 63 5 56 5 83 30 1 — 1 1 — — 1931 4 17 2 15 1 12 1 21 5 — — — — — — 1930 3 17 1 16 — 2 — 13 5 — — — — — — 1929 6 11 — 11 — 2 — 11 2 — — — — — — 1928 10 13 — 13 — 2 — 12 3 — — — — — — 1927 9 4 — 4 1 1 — 4 1 — — — — — — 1926 7 11 — 11 — — — 10 1 — — — — — — 1925 7 15 — 15 — 1 1 13 2 — — — — — — 1924 1 4 — 4 — 1 — 5 — — — — — — — 1923 1 — — — — — — — — — — — — — — 1922 1 — — — — 1 — 1 — — — — — — — and earlier Totals 56 196 11 185 20 517 22 511 162 7 — 7 5 — 2 31 DIPHTHERIA IMMUNISATION Table Shewing Position at 31/12/1938 of All Cases Commenced Treatment before 31/12/1937. TABLE III. Shick Test Doses after Test Doses Sans Test Retest Doses 2nd Retest Doses Retest Born Neg. + failed had 3 failed had 3 failed Neg. + n.d. failed 4th failed Neg. + n.d. failed 5th failed Neg. i ii iii iv v vi vii viii ix x xi xii xiii xiv xv xvi xvii xviii xix xx 1936 — — — — — 11 3 7 1 — — 1 1 — — — — — — — 1935 — 2 2 — — 27 11 15 1 — — 1 — 1 — — — — — — 1934 — 3 1 2 — 42 2 41 1 — — 1 — 1 — — — — — — 1933 1 21 3 18 — 65 4 78 1 — — 1 — 1 — — — — — — 1932 9 242 7 235 1 40 4 250 17 4 — 17 — 16 1 — — 1 — 1 1931 12 370 7 263 3 67 40 368 22 — 2 20 — 20 — — — — — — 1930 25 356 10 346 5 63 20 374 15 — 1 14 1 12 1 — — 1 — 1 1929 27 313 11 302 6 58 18 319 23 — 1 22 — 21 1 — — 1 — 1 1928 39 248 13 235 3 103 18 297 23 — 3 20 1 16 3 — — 3 — 3 1927 32 197 6 191 — 171 20 311 31 — 2 29 — 29 — — — — — — 1926 25 109 10 99 7 236 27 249 59 — 2 57 5 49 3 — — 3 — 3 1925 25 81 1 80 — 210 18 215 57 — 7 50 — 47 3 — — 3 — 3 1924 26 95 4 91 1 194 14 219 52 — 13 39 — 35 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 330 595 42 553 1 145 69 518 111 — 27 84 — 75 9 — 4 5 — 5 Total 672 2842 124 2718 28 1722 310 3614 512 4 74 438 8 400 30 — 6 24 — 24 32 SCARLET FEVER. The number of cases notified during the year was 174, compared with 115 in 1937. Of these cases 113 occurred in Original Beckenham and 61 in West Wickham. The incidence throughout the year was :— Original Beckenham : Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. 6 12 13 9 8 7 6 7 11 11 14 9 West Wickham : Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. 10 7892 6 1 1 5435 The age incidence of the cases was :— 0—4 5—14 15 + Original Beckenham 24 68 21 West Wickham 8 47 6 Forty-three cases occurred in the Elementary Schools in Original Beckenham and 33 in the Elementary Schools in West Wickham. There were 156 primary infections and 18 secondary cases (including 4 return cases). The incidence of secondary cases in houses where the primary case was removed to Hospital and in houses where the case was treated at home, showed no appreciable variation. Original Beckenham. The rise in incidence in the later months of the year was not quite in accordance with expectation. The interval since the last peak (in 1934), being considerably shorter than has been usual in the past. The rapid development of certain parts of the Borough in the last ten years was bound to have some eliect on the periodicity of outbreaks of infectious disease, and a good many years may elapse before a regular periodicity again becomes established. West Wickham. The high incidence of the previous year was maintained in the opening months of 1938; thereafter the incidence gradually declined. Throughout the Borough the disease appeared in a very mild form, and, as is commonly the case nowadays, in a large number of the cases, the symptoms were by no means typical. In some instances the symptoms in the initial case in a house were so slight that it passed unrecognised, and the true nature of the infection only became evident when secondary cases occurred. 33 The distribution of the disease in the different Wards was as follow:— Lawrie Park Ward 21 Eden Park Ward 29 Kent House Ward 22 Shortlands Ward 9 Copers Cope Ward 11 Langley Park Ward 19 Manor House Ward 16 West Wickham Ward 47 TYPHOID FEVER. One case of Typhoid Fever was notified during the year. PUERPERAL PYREXIA. Thirteen cases of Pyrexia were notified, 7 occurred in the Beckenham and Penge Joint Maternity Home. The table on page 34 gives details of the cases. OPHTHALMIA NEONATORUM. One case was notified. TUBERCULOSIS. The table on page 35 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 71 cases compares with 60, 72, 67, 69 and 36 in the preceding five years. There were 25 deaths. In addition to the 71 new cases there were 24 definite cases transferred from other areas, 2 cases restored to the register, and at the end of the year the number of notified cases in the area was :— 129 Pulmonary Males, 111 Pulmonary Females, 37 nonPulmonary Males, and 32 non-Pulmonary Females; a total of 309 cases, which compares with 286 last year. 80 cases were placed off the register for the following reasons: died, 29; cured, 10; withdrawn (not T.B.), 1 ; left area, 44. Notification.—In 7 cases notification was not made until after death, 5 being cases of pulmonary tuberculosis; in 1 of these the diagnosis was made after a post mortem. 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 642 visits to cases on the register, and 89 out of the notified and transferred cases were visited. 34 CASES OF PUERPERAL PYREXIA, 1938 No. Date of Confinement Onset Notified Where Cause Treatment and Result 13 2/ 1/38 13/1 /38 14/1 /38 Private Nursing Home Retained Placenta Consultant provided. 25 18/ 1/38 23/ 1/38 27/ 1/38 Municipal Home Unknown Consultant provided. 36 23/ 1/38 31/ 1/38 3/ 2/38 Municipal Home Cystitis: B. Coli Infection Consultant provided. Good recovery. 60 17/ 2/38 21/ 2/38 24/ 2/38 Own Home Thrombosis of Varicose Veins Good recovery. 78 9/ 3/38 11/ 3/38 19/ 3/38 Municipal Home Influenza Good recovery. 109 17/ 4/38 18/ 4/38 20/ 4/38 Municipal Home Sapræmia: Albuminuria: B.Coli Good recovery. 143 26/ 5/38 30/ 5/38 1/ 6/38 Private Nursing Home Albuminuria To hospital. Good recovery. 160 29/ 6/38 1/ 7/38 5/ 7/38 Municipal Home Subinvolution Good recovery. 164 7/ 7/38 8/ 7/38 12/ 7/38 Own Home. B. Coli Infection Good recovery. 165 9/ 7/38 10/ 7/38 13/ 7/38 Private Nursing Home Perineal Injuries: Uterine Infection Consultant provided. To Hospital. Good recovery. 178 8/ 8/38 16/ 8/38 19/ 8/38 Municipal Home B. Coli Infection Good recovery. 211 16/10/38 16/10/38 18/10/38 Own Home Good recovery. 227 30/10/38 31/10/38 4/11/38 Municipal Home Sapræmia Good recovery. 35 TUBERCULOSIS—TABLE OF PRIMARY NOTIFICATIONS AND DEATHS, 1938 Notifications. Totals. Ages. Wards. 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 31 1 1 2 4 5 10 5 1 2 — 4 1 6 4 7 2 7 31 F 25 — 2 2 6 10 4 1 — — 2 4 1 1 3 3 1 10 25 Non-Pulmonary M 10 — — 4 3 2 1 — — — — 4 1 1 1 3 — — 10 F 5 — — 2 — — 1 — 2 — — 1 1 — 1 1 1 — 5 Totals 71 1 3 10 13 17 16 6 3 2 2 13 4 8 9 14 4 17 71 Deaths—Pulmonary M 13 — — — 4 1 4 2 — 2 — 2 — 1 4 1 1 4 13 F 9 — — — 3 2 1 1 1 1 1 2 — 1 1 1 1 2 9 Non-Pulmonary M 2 — — — 1 — 1 — — — — 1 — — — — 1 — 2 F 1 — 1 — — — — — — — — — — — — — — 1 1 36 Institutional Treatment.— The Kent County Council provided in-patient treatment in Sanatoria for 62 cases during the year, and 7 patients were admitted to Farnborough Hospital for short periods. Dispensary Treatment.— The following figures provided by Dr. S. Roy C. Price, the Tuberculosis Officer, indicate some of the work done at the Dispensary during 1938 :— New cases attending for the first time :— Adults Children Male Female Male e Pulmonary 29 16 2 1 Non-Pulmonary 5 3 1 2 Negative 16 10 7 6 Total 50 29 10 9 31 "contacts" were examined and 29 found to be negative. 62 patients completed a course of residential treatment during 1938. 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. 54 cases were notified during the year, 32 having a private doctor in attendance, and 4 cases were under five years of age. 37 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. 659 cases were notified to the Health Department during the year, 29 under five years of age, 477 had a private doctor in attendance. CHICKENPOX. 287 cases were notified, 84 being by doctors; 8 cases were under the age of five years. MUMPS. 321 cases of Mumps were brought to the notice of the Department during the year, 88 being notified by doctors; 2 were under the age of five years. EPIDEMIC DIARRHOEA. 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 697 cases during the year, and 674 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 1938 was :— Disease suspected Total 1938 Results Comparative Total for 1937 Positive Negative Diphtheria 379 17 362 321 Tuberculosis 168 20 148 145 Other Diseases 70 15 55 50 Total 617 52 565 516 Various special examinations can be made at the County Laboratory, Maidstone, free of charge, and the following were carried out in 1938 :— Swabs for Diphtheria 20 Typhoid Fever Blood Tests 6 Miscellaneous Tests 81 Sputum Tests 109 Dysentery Tests 1 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 54. 38 SANITARY INSPECTION OF THE DISTRICT, 1938 Nature of Nuisances or Defects Remedied. No. of defects remedied. Choked drains 25 Cesspools overflowing 7 Drains defective or altered 73 Defective gullies 10 Defective W.C. pans 16 Choked W.C. pans 9 Flushing apparatus to W.C. defective 18 Dirty W.C. pans 10 W.C. apartments, dirty or defective 84 Absence of ventilated lobby to W.C. apartments 3 Waste pipes, defective or untrapped 53 Defective channels to waste gullies 4 House sinks, defective 32 Soil pipes, defective 6 Ventilating shafts, choked or defective 6 Fresh air inlets, defective 8 Manhole covers, defective or unsealed 14 Water supply cisterns, uncovered, dirty or defective 10 Galvanised iron dustbins, defective or absent 19 Defective pointing 31 Dampness 124 Rain-water pipes, defective 27 Defective gutters 29 Defective roofs 68 Defective floors 61 Defective walls 63 Defective ceilings 56 Dirty walls 84 Dirty ceilings 76 Yard paving defective or absent 39 Defective stoves 47 Defective coppers 21 Defective airbricks 11 Defective windows and fittings 75 Defective doors 15 Keeping of animals contrary to Bye-Laws 1 Accumulation of offensive material 14 Absence of manure pit, or pit uncovered or defective 4 Insufficient ventilation to room 9 Verminous rooms 1 Absence of, or defective food cupboards 50 Defective cement rendering 5 Carried forward 1,318 39 40 No. of defects remedied. Brought forward 1,318 Defective stairs and handrails 29 Defective matching 5 Absence of water supply 2 Smoke — Rats, premises freed of 67 Absence of Statutory Information in Rent Book 30 Miscellaneous Shop Acts, Defects 59 Miscellaneous 49 Total 1,559 Summary of Inspections and Visits Visits and Inspections. Census for Overcrowding 371 Housing1,138 Nuisances 1,487 Cowsheds 49 Milkshops 210 Bakehouses 117 Butchers' shops 242 Other meat shops 21 Slaughterhouses 805 Places where food is prepared Shops where food is stored 163 Factories 203 Workplaces (offices, etc.) 18 Outworkers 16 Rats and Mice Act 456 Houses let in lodgings 14 Stables 81 Fried fish shops 66 Ice cream vendors 84 Verminous premises 46 A.R.P. Courses and Inspections, etc 40 Drainage 965 Infectious disease 242 Smoke observations 1 Samples taken under Sale of Food and Drugs Acts 11 Samples of Milk taken for Bacteriological Examination 104 Samples of water 34 Shops Acts 1,131 Miscellaneous 697 Interviews 1,553 Total 10,419 41 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. One observation was kept, and no nuisance was found at time of inspection. 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 6 Milk and Dairies 259 inspections have been Milkshops 56 Order, 1926 made of these premises Bakehouses 25 Factory and Workshops Act, 1901 117 inspections and visits have been made of these premises. Six defects were remedied upon notices being served. Fried Fish Shops 8 Byelaws made 1935 under Section 113, Public Health Act, 1875. 66 inspections have been made of these premises. Meat Shops (Butchers) 49 Public Health (Meat) Regulations, 1924 242 inspections and visits were paid to these premises. Six notices had to be served. The defects were remedied. Other Meat Shops Public Health (Meat) Regulations, 1924 21 visits were made and the meat, chiefly bacon, was found to be kept under good conditions. Places where food is prepared 33 Public Health Act, 1925, Section 72 54 inspections were made. In two cases nuisances were found. These were remedied upon notices being served. Shops where food is stored 33 Public Health Act, 1925, Secton 72 163 inspections have been made of these premises. 42 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 805 occasions when slaughtering was in progress. During the year 20,047 carcases were inspected. Ice-Cream Shops 104 Section 88, Beckenham Urban District Council Act, 1903, Section 61, B.U.D.C. Act, 1935. 84 inspections have been made of these premises. Two notices were 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) 26 Byelaws made 1935 regulating Nuisances. 81 inspections were made of these premises. Five notices were served upon the occupiers. Houses Let in Lodgings 11 Byelaws made 1926, under Section 6 of the Housing Act, 1925. 14 inspections were made. No notices had to be served. OUTWORKERS. Notices are received, chiefly from London Boroughs, of persons employed as outworkers, in this area; 16 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 : one was under the Shops Acts:— (1) In one case two Companies controlled the property. The work was completed after a week's adjournment and each defendant was ordered to pay 10s. 6d. costs. (2) The Owner in this case refused to pay expenses incurred in repairing a sewer. He was ordered to pay this amount (7s. 7d.) and 7s. 6d. costs were allowed. 43 (3) A milk bottle, containing pasteurised milk, was in a very dirty condition. Case dismissed upon payment of £5 5s. Od. costs. (4) Shops Acts. The occupier was summoned for selling after hours. The defendant was fined 10s. (5) The Owner was summoned for not completing certain works. He was ordered to do the work in 14 days. The Bench awarded £3 3s. 0d. costs and Court costs against the defendant. 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 149 cases, and Rooms Disinfected at 74 Houses, an amount of £30 being received for this work. THE SHOPS ACTS. During the year 1,131 visits were made under the above Acts. The following defects were remedied during the year :— Dirty W.C. apartments 7 Dirty W.C. pans 10 Defective W.C. pans 3 Insufficient W.C. accommodation 2 Absence of ventilated lobby to W.C. 3 Defective hand basin 3 Absence of washing facilities 3 Absence of meals room 2 Dirty walls 6 Dirty ceiling 5 Dirty floor 3 Defective ceiling 1 Absence of seats for female assistants 1 Young persons working over 48 hours per week 1 Absence of forms 38 Selling after hours 8 Heating, insufficient 1 44 The Occupier was "warned" in each case of selling after hours, if it was his first offence. Proceedings were taken against three shopkeepers, who had had a previous warning, under this section. In all the other cases an informal notice was served upon the Occupier and all the notices were complied with. OFFICES. During the year eighteen Offices were inspected and in two cases "defects" were found. In one instance there was no sanitary accommodation for the female staff. In the other case the Office was in a dirty condition. CAMPING SITES. There are no camping sites in the area. SWIMMING BATHS. The only Public Swimming Baths in the area are those provided by the Local Authority. Here a continious 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. A few factories were established during the year, but the district is mainly residential. The majority of the places on the Register, however, are small and are associated with the requirements of the inhabitants of the district. During the year 203 visits were made to premises on the Register. In ten cases defects were found. The nuisances mentioned in the attached table were remedied after the service of informal notices:— Dirty W.C. apartments 3 Absence of light to W.C. apartment 1 Defective W.C. seat 1 Dirty walls 1 Dirty ceiling 1 Insufficient heating 2 Defective stairs 1 Accumulation of refuse 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) 727 (b) Number of inspections made for the purpose 730 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 121 (b) Number of inspections made for the purpose 124 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 706 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 692 3.—ACTION UNDER STATUTORY POWERS DURING THE YEAR (a) Proceedings under Sections 9,10 and 16 of the Housing Act, 1936:— 45 (1) Number of dwelling-housing in respect of which notices were served requiring repairs 49 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 49 (b) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served, requiring defects to be remedied 42 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 42 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursaunce of Demolition Orders 4 (d)Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4.—HOUSING ACT, 1936; PART IV.; OVERCROWDING:— (a) (i) Number of dwellings overcrowded at the end of the year 13 (ii) Number of families dwelling therein 13 (iii) Number of persons dwelling therein 110 46 (b) Number of new cases of overcrowding reported during the year 6 (c) (i) Number of cases of overcrowding relieved during the year 10 (ii) Number of persons concerned in such cases 65 (d) Particulars of any cases in which dwelling- 1 houses have again become overcrowded (daughter after the Local Authority have taken steps returned for the abatement of overcrowding home from Service) 47 REPORT ON HOUSING NEEDS IN THE DISTRICT, 1938 To the fifty-nine cases of overcrowding discovered at the Survey carried out in 1935/36, twenty-six more cases had been added by the 31st December, 1938. Fifteen of these are border-line cases where the increasing ages of the children had created overcrowding. Up to the same date, sixty-nine cases had been abated— fifteen by the provision of accommodation in Corporation houses. At the end of the year there were thirteen registered overcrowded cases—seven being resident on the Corporation Housing Estates and all needing houses with more than four bedrooms. Progress is being made in building more Corporation Houses and a careful investigation has been made of the living conditions of applicants already on the waiting list. I am still of the opinion that 150 houses are required to meet the needs of the cases in the district where the living accommodation is decidedly unsatisfactory. INSPECTION AND SUPERVISION OF FOODS MILK. Milk was again subjected to bacteriological supervision. The results were very satisfactory. Over 89 per cent, of the samples of ordinary milk purchased in the winter months complied with the standard for Pasteurised milk, and 69 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 more frequent, but in the winter months it was present in only about 7 per cent, of the samples. These results are a great improvement upon those of last year. 48 Six samples of Accredited Milk were taken and three of these did not comply with the requirements. The following table shows the results that were obtained during the year:— No. of Bacteria per Cubic Centimeter Percentages of sample 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. 53.8 15.4 15.4 7.7 7.7 15.4 Rem'd'r of year 72.4 17.2 10.4 - - 6.9 Pasteurised Milk May to Sept. 72.7 27.3 - - - 13.6 Rem'd'r of year 88.9 11.1 - - - 22.2 MILK SPECIAL DESIGNATIONS ORDER, 1936 AND 1938. 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 13 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. 49 FOOD INSPECTION IN 1938 MEAT INSPECTION. The number of carcases dressed in the Borough in 1938, amounted to 20,047. This total exceeded that of the previous year by 7,473. Diseased conditions were found in 2,900 carcases and caused 8 tons 1 cwt. 2 qrs. 27 lbs. to be destroyed. A quantity of potatoes and other food stuffs were also condemned as unfit for food and brought the total of food destroyed to 9 tons 2 cwts. 12½ lbs. Bovines. All the bovines were found to be affected with a disease to some extent. Only two of the cows, or 4.8% were affected with Tuberculosis, but 63% of the oxen were affected with the disease. The disease was, however, localised in each case and it was therefore not necessary for a whole carcase to be destroyed. In every case the appropriate authority was acquainted with the facts. Calves. These animals did not maintain the healthy standard of last year. Tuberculosis was found in 0.98% of the carcases and was responsible for the destruction of four carcases. Sheep. These animals were very healthy, only 2.9% of the carcases were affected with disease. Pigs. There was again an increase in prevalence of diseased conditions in pigs. Last year 14.9% of the carcases showed diseased conditions, this year 18% were affected. Tuberculosis, however, was not so frequent, only 7.5% suffered from this complaint, which is a reduction of 0.6%. A detailed account of the animals inspected and of the meat destroyed is given in the following tables : ANIMALS DRESSED IN 1938 Cows. Oxen. Calves. Sheep. Pigs. Goats. Total. 42 33 1,218 3,614 15,134 6 20,047 50 SUMMARY OF CONDEMNED MEAT Animal. Condition. No. affected. Weight. Cows Tuberculosis 2 24 lbs. Non-Tuberculosis 7 908 „ Oxen Tuberculosis 21 287 „ Non-Tuberculosis 12 250 „ Calves Tuberculosis 12 226 „ Non-Tuberculosis 9 129½ „ Sheep Non-Tuberculosis 108 1,561 „ Pigs Tuberculosis 1.139 8,740 ,, Non-Tuberculosis 1,590 5,989 „ Totals 2,900 18,115 „ Other Foods 1 ton 1 qr. 13¼ lbs. Total destroyed: 9 tons 2 cwt. 0 qr. 12½ lbs. Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed, if known 33 42 1,218 3,614 15,134 Number Inspected 33 42 1,218 3,614 15,134 All Diseases except T.B.: (a) Whole Carcases condemned Nil Nil 1 15 6 (6) Carcase of which some part or organ was condemned 12 7 8 93 1,584 (c) Percentage of the number inspected affected with disease other than T.B. 36 17 0.73 2.9 10.5 Tuberculosis Only: (a) Whole Carcases condemned Nil Nil 4 Nil 8 (b) Carcases of which some part or organ was condemned 21 2 8 Nil 1,131 (c) Percentage of the number inspected affected with T.B. 63 4.8 0.98 Nil 7.5 51 SUMMARY OF CONDEMNED MEAT Animal. Condition. Part condemned. No. affected. Weight in lbs. Bovine Tuberculosis Head and Tongue 5 128 „ Lungs 4 35 „ Lungs and Heart 6 62 „ Liver 4 44 „ Mesentery 2 18 „ Lungs and Mesentery 2 24 „ 23 311 Non-Tuberculous: Traumatic, Pericarditis and Dropsy Carcase 1 756 Abcess and Cirrhosis Lungs and Liver 1 26 Pleurisy and Abscess Lungs and Liver 1 26 "Flukes" Liver 3 27 Angeoma Liver 7 119 Indurated Udders 4 130 Bone taint - 1 10 Bruising Various 1 64 19 1,158 Calves Tuberculosis Carcase 4 178 „ Pluck 8 48 Non-Tuberculous: 12 226 Umbilical Pyaemia Carcase 1 56 Fevered flesh ,, 1 40 Cysts, multiple Liver 2 9 Fatty degeneration „ 3 51 Bruising Various 2 19 9 129½ Sheep Dropsy Carcase 15 639 Emaciation ,, 14 639 Strongylosis Lungs 4 8 Fatty degeneration Liver 8 23 Abscesses „ 1 2 Cirrhosis, including " Flukes " „ 36 108 Cysts, multiple ,, 24 91 Pneumonia and Cirrhosis Pluck 1 6 Bruising Various 5 45 108 1,561 Pigs Tuberculosis Carcase 8 752 ,, Head 458 6,224 „ Head and Mesentery 34 403 „ Head and Lungs 2 22 „ Head and Pluck 11 66 „ Head, Pluck and Mysentery 1 13 „ Lungs 22 23 „ Lungs and Heart 1 6 „ Liver 5 20 „ Pluck 59 476 „ Mesentery 534 633 „ Mesentery and Spleen 1 2 „ Forequarters (prs) 1 32 „ Hindquarters (prs) 2 68 „ 1,139 8,740 52 Animal. Condition. Part condemned. No. affected. Weight in lbs. Pigs (contd.) Non-Tuberculous: Erysipelas Carcase 1 60 Emaciation „ 4 136 Acute Fever * „ 1 108 Abscesses Head 1 11 Pleurisy Lungs 59 59 Pneumonia ,, 142 173 Congestion ,, 26 30 Strongylosis ,, 1 1 Percarditis Heart 165 144 Pleurisy and Pericarditis Lungs and Heart 108 184 Pneumonia and Pericarditis Lungs and Heart 5 214 Necrosis Liver 110 434 Hepatitis „ 3 12 Cirrhosis (including Milk spots) „ 409 1,707 Peritonitis „ 75 272 Cysts, Multiple ,, 155 616 Fatty Infiltration ,, 22 89 Fatty Degeneration ,, 6 71 Abscesses „ 1 4 Cloudy swelling ,, 4 16 Lymphogranulomatosis „ 110 437 Pleurisy and Peritonitis Lungs and Liver 1 5 Pleurisy, Pericarditis and Cirrhosis Pluck 27 200 Pleurisy, Pericarditis and Peritonitis „ 95 746 Pneumonia, Pericarditis and Cirrhosis „ 33 259 Nephritis Kidneys 3 1½ Cysts, Multiple ,, 6 1¼ Hæmorrhagic ,, 4 1 Abscesses Leg 1 10 Abscesses Hindquarter 1 38 "Splashed" Flare 1 8 Indurated Udder 1 30 Parasitic " Trimmings " 1 5 Bruising and Laceration Various 8 99 1,590 5,989½ Totals 2,900 18,115¼ Other Foods Putrid Tinned Beef 2 12 „ Figs — 11½ Rancid Dripping — 3½ Putrid Mackerel 1 box 14 Coccidiosis Rabbits livers 3 i "Blight" Potatoes — 2,240 Rancid Mustard Small quantity 2,281¼ Total weight destroyed : 9 tons 2 cwt. 12£ lbs. * A11 signs and symptoms in this instance pointed to the conclusion that this was a case of Swine Fever. The appropriate action where this disease is suspected was taken in this instance and proper authorities informed The carcase was inspected by them and specimens taken therefrom. 53 FOOD AND DRUGS (ADULTERATION) ACT, 1928 46 samples were purchased by the Sanitary Inspector during the year under this Act, and submitted to analysis. All the samples were genuine. 168 samples were taken in the Borough by the Kent County Inspector, and all of these were " genuine," except one sample of new milk which was reported to be " inferior." The deficiency was not sufficient to warrant the institution of legal proceedings. 54 55 TABLE SHOWING CAUSES OF DEATHS AT DIFFERENT AGE PERIODS DURING THE YEAR, 1938 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 Total Male Female Total Typhoid Fever, etc. - - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria 2 1 1 2 - - 1 1 - - - - - - - - - 1 - - - - 1 - 2 Influenza 8 4 4 8 - - - - - - 1 2 3 1 - 1 2 - - 1 2 1 1 1 8 Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - - - - - - - - - - - - - Pulmonary Tuberculosis 22 13 9 22 - - - - 7 3 5 3 1 3 - - 1 2 - 4 5 2 2 6 22 Non-Pulmon'y Tuberculosis 3 2 1 3 - - - - - - - - - - - - - - - - - - 1 1 3 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - General Paralysis of Insane 2 2 - 2 - - - - - - - 1 - - 1 - 1 - - 1 - - - - 2 Cancer 96 41 55 96 - - - - - 1 8 14 30 22 17 4 7 5 10 11 17 15 11 20 96 Diabetes 8 3 5 8 - - - - - - - 2 2 3 - 1 3 - - 3 - - 2 - 8 Cerebral Hæmorrhage 21 10 11 21 - - - - - - - 1 4 7 8 1 3 1 1 4 4 2 5 1 21 Heart Disease 159 72 87 159 1 - - - 2 4 17 19 42 31 24 19 19 12 10 16 24 24 18 36 159 Aneurysm 3 2 1 3 - - - 1 - - - - - 2 - - - - - - 1 - 1 1 3 Other Circulatory Diseases 45 15 30 45 - 1 - 1 - 1 4 2 6 11 12 7 5 5 1 6 10 7 4 7 45 Bronchitis 14 11 3 14 - - - - - - - - 1 6 6 1 - - 1 4 2 3 1 3 14 Pneumonia 28 19 9 28 1 - - - 1 1 3 4 5 8 5 - 4 3 - 4 5 8 3 1 28 Other Respiratory Diseases 7 3 4 7 - - - - - - 1 1 - 4 1 - 2 1 - 1 - 1 - 2 7 Peptic Ulcer 7 6 1 7 - - - - - 1 - 4 - 2 - - - 1 - - 2 2 1 1 7 Infantile Diarrhœa 1 1 - 1 1 - - - - - - - - - - - - - - - - 1 - - 1 Appendicitis 5 4 1 6 - - 1 - - - 1 - 1 2 - - - - - - 2 2 - 1 5 Cirrhosis of Liver - - - - - - - - - - - - - - - - - - - - - - - - - Other Liver Diseases - - - - - - - - - - - - - - - - - - - - - - - - - Other Digestive Diseases 19 10 9 19 - 1 - - 1 - 3 - 2 5 4 3 1 2 - 4 1 4 - 7 19 Nephritis 20 7 13 20 - - - 1 - 1 2 1 - 7 8 - 2 1 1 4 5 4 1 2 20 Puerperal Sepsis 1 - 1 1 - - - - 1 - - - - - - - - - - - 1 - - - 1 Other Puerperal Diseases 1 - 1 1 - - - - - 1 - - - - - - - - - - - - - 1 1 Congenital Debility, etc. 26 16 10 26 24 2 - - - - - - - - - - 1 2 5 3 3 3 2 7 26 Senility 10 4 6 10 - - - - - - - - - 2 6 2 2 2 - 1 2 1 2 - 10 Suicide 6 2 4 6 - - - - - 3 - 2 1 - - - - 1 2 2 1 - - - 6 Other Violence 17 10 5 15 2 - - 1 2 1 1 1 1 5 1 - 3 1 1 2 4 1 1 2 15 Other Defined Causes 59 36 25 61 2 2 1 3 3 5 1 5 5 16 14 4 6 5 4 9 9 8 6 14 61 590 294 296 590 31 6 4 8 18 22 48 62 104 137 107 43 62 45 36 81 100 89 63 114 590 BOROUGH OF BECKENHAM REPORT ON THE MEDICAL INSPECTION OF CHILDREN IN THE ELEMENTARY SCHOOLS DURING 1938 STATISTICS RELATING TO EDUCATION. Census population of Beckenham (1931) 43,834 Estimated population (June, 1938) 70,590 Number of Elementary Schools 7 Number of Departments 19 Accommodation (31 /12/38) 6,134 Number on Roll (31 /12/38) 5,183 Special Day School for the Mentally Defective 1 Other Schools:— County Secondary School (Girls) 1 Trade School 1 Private Schools 27 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 Dental Surgeon (part time): A. E. Carr, L.D.S., R.C.S. Anesthetist to Dental Clinic (part time): Alan R. Marsh, M.R.C.S., L.R.C.P. Opthalmic Surgeon (part time): A. E. A. Looseley, F.R.C.S. (Eng.). Orthopedic 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 Cer 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: Mrs. L. G. Suter, S.R.N. (Appointed 1 /4 /38). Orthopcedic 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. 58 INTRODUCTION TO REPORT ON THE SCHOOL MEDICAL SERVICE CLINIC BUILDING, WEST WICKHAM. This building was opened in January, 1939. A report on the use made of these facilities will appear in next year's report, but it is already evident that the Wickham residents greatly appreciate the advantages provided. 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. A visit by the Board's Dental Officer was made during the year, and an extract from his Report is included on page 64. NUTRITION. For the fourth year a special table appears in the report showing the classification of children separated into four headings. Only one child out of 1,990 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, but a number of cases have been noted where the provision of meals at School is essential and consideration is being given to a scheme to make this possible. "The Milk in Schools Scheme" continues to function but the number of children taking advantage of it has been somewhat reduced. HEALTH PUBLICITY. The issue of "Better Health" was continued throughout the year. 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. 59 The following major improvements have been carried out during 1938:— Balgowan.—One additional Class Room. Hawes Down Juniors.—Two additional Class Rooms. Hawes Down Seniors.—Two additional Class Rooms. 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. 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 1938 Total 1937 To cases of Infectious Disease 864 379 Other Cases 2,148 1,502 Follow-up Cases No reply 168 153 Total Home Visits 3,180 2,034 Visits to Schools: re Personal Hygiene 63 83 Children examined 9,912 11,744 Found Unclean 51 62 Children seen at other Visits 3,114 2,751 Clinic Sessions Attended: Minor Ailment Clinics 402 420 Inspection Clinics 113 108 Eye Clinics 39 41 Immunisation Clinics 109 96 Aural Clinics 11 11 Dental Clinic 84 80 60 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 :— 1938 1937 Entrants 863 749 Intermediate 651 699 Leavers 476 477 Other Routine Inspections 30 42 2,020 1,967 These groups have been explained in previous reports. (b) Other Inspections. In addition to the above groups, 1,100 "Special" Inspections were made of children referred to the Medical Inspector either at the School or the Clinic, or to Specialist Clinics for examination. 3,421 re-inspections were made of the above routine or special cases, compared with 3,130 in 1937. (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 observation or treatment— (a) From School Inspections 784 (b) From other Inspections 539 Total 1,323 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:— 61 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. 1,688 parents were present, representing 83.6 per cent. Only 5 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 5.3 per cent, of the children examined were found to be sub-normal, and one child only 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 1938. These show that on height and weight alone 5.36 per cent, of the children were regarded as definitely underweight. PROVISION OF MILK AT SCHOOL. A sum of £100 was allowed in the estimates to provide milk at school for children selected by the School Medical Officer ; and 362 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 the 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. 62 Half-yearly Statement submitted to the Board of Education 31st March, 1939. 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 251 174 276 162 179 72 706 408 Balgowan 228 169 - - 364 88 592 257 Churchfields 307 278 298 202 233 118 838 598 Bromley Road - - 318 224 130 43 448 267 Marian Vian 437 280 423 231 276 124 1136 635 Hawes Down 367 305 399 244 265 98* 1031 647 Wickham Common - - 429 335 - - 429 335 Special - - 20 20 - - 20 20 Totals 1590 1206 2163 1418 1447 543 5200 3167 *In addition, 33 Children supplied with Horlicks. Percentage of total on roll receiving milk. 59 per cent. Percentage in Infants Schools 76 „ ,, Junior Schools 66 „ „ Senior Schools 38 „ SKIN DISEASES. The number of cases of skin disease remains low. Three cases of Ringworm were discovered during the year, and 17 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 16 cases were referred to the Ear Clinic. 151 children were found with enlarged Tonsils and for Adenoids and operations were carried out in 105 cases. 12 children with defective hearing were referred to the Aural Clinic ; four children were admitted to Golden Square Hospital for operative treatment. 63 HEART DISEASE. There are eleven children in the district with severe heart disease and two of these had periods of institutional treatment during the year. Altogether 58 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— Five cases: 2 active and at home; 1 arrested and at school; 2 active and at Special Institutions. Other Forms— Eighteen cases: 13 at school; 1 not at school; 4 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 126 cases noted, being knock-knees, flat feet, round shoulders and slight spinal curvature. All these cases are referred to the Orthopædic Clinic, and the report of the work done appears on page 72. 64 WORK OF THE SPECIAL CLINICS TREATMENT OF MINOR AILMENTS. Five Clinics were in operation throughout the year. The attendances total 6,376, compared with 4,882 in 1937. Days Held For Children from Marian Vian School Tuesdays & Thursdays Marian Vian School Churchfields School Mondays, Wednesdays and Fridays Churchfields School Alexandra School Mondays & Fridays Alexandra Infants and Junior Mixed and Senior School Hawes Down School Ditto Hawes Down School Wickham Com. School Wednesdays Wickham Com. School The attendances during the year are shown below, with comparative figures for 1937:— Sessions held Attendances Average per Session 1938 1937 1938 1937 1938 1937 Alexandra 73 73 613 663 8.4 9.3 Churchfields 90 106 1,762 1,085 19.6 102 Hawes Down 74 90 822 1,094 111 12.1 Marian Vian 83 96 2,193 1,447 26.5 15.0 Wickham Common 82 55 986 593 12.0 10.7 Totals 402 420 6,376 4,882 15.9 11.6 INSPECTION CLINIC. An Inspection Clinic was held on Tuesdays, Wednesdays and Fridays throughout the year. The total attendances were 2,152 as compared with 1,830 in 1937. 41 Tuesday sessions were held; 33 Wednesday sessions, and 39 Friday sessions. The average attendance per session was 19.0. The children who attended are divided into the following groups:— 1,360 Specials—that is, cases brought by parents or sent by teachers or nurses. 250 referred from Routine Medical Inspection—that is, reinspections of cases seen at School and found to need further observation. 542 Re-inspections—that is heart, rheumatic cases brought up for frequent observation and those of the above cases needing to make further attendances. 65 EYE CLINIC 39 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 28-88, which compares with 26-8 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 22 217 22 Attendances by other cases 135 1,104 . 187 Total attendances 157 1,321 . 209 Treatment given— Glasses prescribed 11 172 15 Lenses altered 3 95 22 Repairs to frames 1 22 3 No glasses required 7 43 5 No change in lenses 135 855 159 Refused treatment 7 93 14 Referred for further observation 49 46 3 DENTAL REPORT, 1938. To the Chairman and Members of the Education Committee. I have the honour to present the Dental Report of the inspection and treatment of the scholars in the Elementary Schools. In July, 1938, Dr. A. J. Wynne, of the Board of Education, made a survey of a number of children in the Borough. The objects of that survey and the results of it, are included in the Board of Education's Report, "The Health of the School Child," for 1937. This survey contains information regarding the results of systematic dental treatment in the Borough, and I feel sure it would be of interest to the Education Committee ; I am therefore including it in this annual report:— A Comparison of the Dental Condition of Children in two Areas. "For some years past these Reports have recorded that the only two Authorities which had no school dental scheme were Falmouth and the Isles of Scilly. Because of its scattered character and geographical situation, the latter Authority is in a less favourable position than any other for organising such a scheme, but during the past year Falmouth decided to initiate arrangements for the dental inspection and treatment of school children. Prior to these arrangements being put into operation it was decided that an officer 66 of the Board should examine in the area a representative selection of children who were nearing the end of their elementary school life, that is to say, about the age of 13 years. It was felt that such an inspection would serve to show the dental condition of children who had never had any facilities for receiving school dental treatment, and that it would provide a useful reminder of what conditions might be in the country generally were it not for the work of the school dental service. It was found possible to carry out a detailed inspection of 150 children, who were all asked whether they had ever been to a dentist; 112 said "Yes," 38 said "No." Only 13 of the children said they had attended a dentist for fillings. It was found on examination that a total of 103 permanent teeth had been extracted, whilst 15 had been filled. At this age (13) the number of temporary teeth still present in the mouths of the children was negligible. As for the permanent teeth, 257 were carious to such an extent as to be unsaveable, whilst carious but saveable permanent teeth numbered 642. The total number of permanent teeth lost, saveable and unsaveable, was therefore 1,002, which is equivalent to an average of 6-7 teeth per child. Of even more interest, perhaps, is the distribution of these teeth amongst the 150 children, which is shown in a subsequent table. These figures provide a somewhat melancholy picture of the ravages of dental disease, but there is no reason to suppose that the incidence of caries is substantially greater in Falmouth than in other parts of the country. Having thus obtained figures relating to an area unprovided with a school dental service, it became clear that an interesting comparison could be made with statistics from a district possessing a well established and efficient dental scheme. An officer of the Board therefore carried out a survey of the dental condition of 150 children at Beckenham, the age group being similar to that inspected at Falmouth. Eight children had naturally sound permanent dentitions, one had attended a private dentist, and in the case of one treatment had been persistently refused. The others had received attention at the clinic, but 14 of these had on one or more occasions declined conservative measures ; 138 permanent teeth had been lost, 21 were so carious as to be unsaveable, 181 were carious but saveable, and 553 had been filled. The number of permanent teeth lost, saveable and unsaveable, was thus 340, or an average of 2-3 per child. To some extent factors other than caries, such as extractions for orthodontic purposes, enter into the question of the loss of permanent teeth at Beckenham, but these do not invalidate the findings generally." 67 For purpose of comparison, a table showing the distribution of carious teeth at Falmouth and Beckenham is appended :— Permanent teeth lost, unsaveable or saveable. Children. Falmouth. Beckenham. None 4 36 1 7 37 2 10 30 3 8 13 4 18 12 5 9 6 6 19 5 7 20 6 8 8 2 9 15 0 10 10 2 11 5 0 12 8 0 13 3 0 14 3 0 15 1 0 16 1 0 17 0 0 18 1 1 ROUTINE INSPECTIONS. All the schools in the Borough were visited for the routine annual inspection with the exception of Hawes Down Senior School. The routine inspection of this school should have taken place in November, but owing to an oversight it was not carried out until January, 1939. Instead, the Junior Department at Hawes Down was inspected, and treated in November and December, but as this school was inspected in the previous January, two inspections took place here in 1938, but statistically the children in Hawes Down Junior School have been included once only; it follows that the numbers inspected and treated are lower this year, and it will also be seen that time was available to complete the inspection and treatment of all the schools during the year had the normal routine been carried out. The number of children at Hawes Down Junior School who were re-inspected was 345. The results of the Annual Inspections were as follows:— No. of Inspections 38 No. of Children Inspected 4,660 No. of Children referred for Treatment 3,311 No. refused Treatment 727 68 The number of children for whom no treatment was needed was 1,349, a percentage of 28-9 compared with 1,338, and a percentage of 27 in 1937. In previous reports I have referred to the importance of maintaining a fairly constant percentage of sound dentitions at the annual inspections, and the comparable figures for the five years are as follows:— 1934 1935 1936 1937 1938 27.5 34.4 24.6 27.0 28.9 an average of 28-5 over the period. The percentage of refusals was 23.3 compared with 23.8 in 1937. The number of children in each year being 727 compared with 862. Although the reduction in this percentage is small, it is a step in the right direction, and when consideration is given to the fact that no restriction in the case of previous refusals takes place in Beckenham, that every child is inspected whether a persistent refusal or not, that the children of parents who state that private treatment will be obtained are also included, the percentage of refusals is not an excessive one. The comparable figures of as follows:— attendances and treatment were 1937 1938 Attendances 4,290 4,258 Children treated 2,747 2,584 Fillings 3,990 3,978 Extractions 3,696 3,505 The extractions of permanent teeth numbered 599, and of these 88 were sound teeth removed for regulation purposes and 5 were supernumerary teeth, making a total of 93, thus reducing the loss of teeth due to caries to 511. The number of cases of irregularity treated by mechanical means was 20, and that by extraction 60. Three dentures were supplied to replace incisor teeth, in two cases following fracture of the teeth accidentally, and in one, the teeth were badly developed and their restriction was not possiblr by conservative means. Three upper incisors were crowned, and in these cases the teeth were fractured accidentally. The number of scholars treated from the Secondary Schools was 73, and they made 126 attendances. 69 The attendance at the West Wickham Clinic have been maintained at the high standard of last year, approximately 900, and Mr. Carr, the Dental Officer, and his attendant, are to be congratulated. Summary of Monthly Reports Children Inspected 4,660 Number of Attendances : New Cases 2,584 Old Cases 1,456 Specials 218 Total Attendances 4,258 Number of Fillings : Permanent teeth 3,077 Temporary teeth 885 Root fillings 13 Crowns 3 Total Fillings 3,978 Number of Extractions: Permanent teeth 599 Temporary teeth 2,906 Total Extractions 3,505 Dressings 617 Silver Nitrate 577 Scalings 43 Regulative appliances 20 Dentures 3 Local injections 685 Nitrous oxide administrations 901 I must express my thanks to Dr. Marsh and Dr. Friedlander for the administration of Nitrous Oxide, to Miss Monck, the Dental Nurse, for her valuable and capable assistance, and to the Head Teachers for their much appreciated interest and assistance in the dental scheme generally. Robert A. Waters, L.D.S. (Eng.) 70 REPORT ON WORK OF AURAL CLINIC IN 1938 By G. H. Howells, F.R.C.S. Sessions held. Total attendances. New Cases. Re-examinations. Infants. School. Infants. School. 1936 11 330 13 54 30 233 1937 11 318 5 60 33 220 1938 11 436 23 79 43 291 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 68 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 36 5 Number cured by other treatment 40 7 Failed to complete treatment 27 4 Left area 1 - Failed to keep first appointment 2 1 106 17 The condition of those cases cured during the year was:— School Children. Infants. Tonsils and Adenoids 36 8 Otorrhoea 10 1 Nasal Catarrh 13 - Earache 3 2 Defective Hearing 3 - Mastoid 2 - Miscellaneous 9 1 76 12 71 REPORT ON BECKENHAM ORTHOPAEDIC CLINIC Year ended 31 /12 /38 By H. J. Seddon, F.R.C.S. The following summary shows the work of this Clinic during 1938, and the comparative figures are given for the preceding years : Half-day Sessions Total attendances. Surgeons Examinations. New cases. Re-examinations. Year. held. School. Infants. School. Infants. School. Infants. 1936 354 3,133 798 110 46 608 214 1937 340 2,263 912 102 43 557 240 1938 343 1,877 390 139 74 539 197 Treatment by Nurse. Electrical and Massage. Exercises. other Treatments. Fees paid. Year. School. Infants. School. Infants. School. Infants. £ s. d. 1936 305 412 1,921 3 230 131 31 3 3 1937 231 372 1,127 75 376 233 30 5 2 1938 383 174 1,086 55 515 166 25 4 1 213 children attended as new cases and the diagnoses are tabulated below, In twenty-one cases the diagnosis appears under more than one heading :— Classification No. of Cases No. Condition. 1. Congenital Deformities 26 2. Birth Injuries — 3. Rickety Deformities 12 4. Knock Knees (non rickety) 48 4 a. Bow Legs (non rickety) 9 5. Postural Defects 35 6. Structural Curvature 1 7. Flat Foot, Pes Cavus, Hallux Ridigus and Foot Strain 66 8. Infantile Paralysis 8 9. Sequelae of other Acute Fevers 1 10. Fractures and other injuries 3 11. Other Bone Disease (non-tuberculous) 1 12. Osteomyelitis 5 13. Other conditions including intoeing (see details below) 1 14. Non-Orthopaedic 12 15. Diagnosis Uncertain 3 16. Diagnosis not Recorded 8 Total 234* *Twenty-one cases appear under combined headings:— *1 and 4: 5 cases; 1 and 7: 1 case; 1 and 14: 1 case; 3, 7 and 15: 1 case; 4 and 4a: 1 case; 4 and 5: 1 case; 4 and 7: 4 cases; 4 and 8: 1 case; 4 and 14: 1 case; 5 and 7: 1 case; 5 and 14: 1 case; 7 and 13: 1 case; 7 and 15: 1 case. 72 The one case placed under heading 13 was as follows :— Case 1, Born 1928. Hallux Valgus. Fifteen children were admitted to Hospital for correction of various deformities. Progress has been satisfactory in every case. One case was re-admitted after a period of convalescence. ULTRA VIOLET RAY CLINIC Three sessions of one hour each are held weekly. The sessions totalled 146 and the attendances 1,568; of these, 515 were infants A fee of 6d. per attendance is charged in all but necessitous cases, and a total amount of £24 16s. 6d. was received during the year. 73 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; not all of these are still on the roll. A full report of the work done during the year appears on page 27 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, 1938 Totals, 1937 Chicken Pox 41 2 16 119 6 71 6 11 272 166 Diphtheria — — — 1 — 1 — 7 9 3 „ Contacts — — — 2 — — — 2 4 17 Measles 59 102 — 114 104 75 125 38 617 2 „ Contacts 3 1 — 1 — 3 4 16 28 — „ German — — 1 — 1 — 4 — 6 6 Mumps 5 18 24 53 119 7 68 17 311 139 ,, Contacts — — — — — — — — — — Scarlet Fever 22 5 2 12 10 20 13 40 124 105 „ Contacts 14 6 3 18 10 56 11 31 149 133 Whooping Cough 6 27 2 2 8 2 4 3 54 271 „ Contacts — 1 — — — — — — 1 46 Impetigo 1 3 — 3 9 2 2 6 26 14 Ringworm — — — — 2 — 1 — 3 10 Skin Diseases — — 3 5 6 2 1 — 17 40 Verminous Heads — 1 — 3 2 5 2 — 13 20 Bronchitis 1 — 1 1 1 — 1 — 5 20 Lungs—Non T.B. — — — — — — — — — — Tuberculosis 1 — — — — — — — 1 — Debility — — — 1 2 1 — — 4 18 Ear Conditions. — — 2 1 2 — 1 — 6 5 Enlarged Glands 2 5 — 6 5 — 1 — 19 8 Eye Conditions — 2 2 2 6 2 — — 14 3 Heart Disease — — — 3 1 2 — — 6 3 Nose and Throat 5 10 10 27 16 3 6 2 79 95 Miscellaneous 25 25 17 38 43 41 16 12 217 233 Totals 185 208 83 412 353 293 266 185 1985 1357 74 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 is very useful. Of 2,669 children under instruction, 1,641 could swim. PHYSICAL TRAINING. The report of the organisers of Physical Training in the Schools stresses the value of the scheme now in operation and the expansion which will follow from the further training of teachers and the provision of equipment. SPECIAL SCHOOL for MENTALLY DEFECTIVE CHILDREN. The Special School, under the direction of Miss L. Ross, has continued during the year, 8 children being admitted during the year (7 from Beckenham). The number on roll at 31st December, 1938, was 20 (Beckenham, 5 boys and 12 girls; Penge, 2 boys; Kent, 1 boy). Six children left during the year, in the following circumstances:— Beckenham:— 1 boy aged 15 Notified to County for supervision. 1 boy aged 15 To take up selected employment. 1 boy aged 15 ditto. 1 girl aged 14 ditto. 1 girl aged 15 ditto. Bromley:— 1 boy aged 14 ditto. Provision of Meals.—A mid-day meal is provided at the School, and the number of meals served was 3,954, the total cost being £65 18s. towards which the parents contributed £36 9s. 4d. 75 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. The Education Officer 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, 109 certificates were issued during the year. The number of certificates issued compares with 103 in 1937, and this is evidence that the Byelaws are being effectively enforced. Licences to take part in Stage Plays were issued in 10 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. 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. 76 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 1938 were:— Dental Clinic 73 cases made 126 attendances. Orthopaedic Clinic 18 ,, 37 ,, Eye Clinic 106 „ 209 „ 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 20 boys and 24 girls were sent for periods of six weeks' stay; three cases 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 75) 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, 1939, was:— Marian Vian 7,988 Hawes Down 27,383 INSURED WORKERS. The Ministry of Health provide a card on which medical practitioners can request information from the Health Department as to the medical records of young insured workers coming on to the panel system. This is welcomed by the Health Department as previous attempts have been made to pass on the valuable information collected during the school life of children, and it is hoped that many local practitioners will avail themselves of this opportunity. 77 MEDICAL INSPECTION RETURNS, 1938 TABLE I. Medical Inspection of Children attending Public Elementary Schools. ,4.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 863 Second Age Group 651 Third Age Group 476 Total 1,990 Number of other Routine Inspections 30 Grand Total 2,020 B.—Other Inspections. Number of Special Inspections 1,100 Number of Re-Inspections 3,421 Total 4,521 C.—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. For defective vision (excluding squint). For all other conditions recorded in Table IIA. Total. (1) (2) (3) (4) Entrants 3 62 64 Second Age Group 36 58 92 Third Age Group 27 38 62 Total (Prescribed Groups) 66 158 218 Other Routine Inspections 2 8 10 Grand Total 68 166 228 78 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1938. Excluding Defects of Nutrition, Uncleanliness and Dental Disease. DEFECT OR DISEASE Routine Inspections Special Inspections No. of Defects. No. of Defects. Requiring Treatment Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin—Ringworm (Scalp) 1 — 2 — Scabies 1 — 8 — Impetigo — — 20 — Other Diseases (Non-Tuberculous) 7 — 34 — Eye—Blepharitis 2 — 2 — Conjunctivitis 4 — 12 — Other Conditions (excluding Defective Vision and Squint) 1 — 4 2 Defective Vision (excluding Squint) 78 13 64 2 Squint 14 2 9 — Ear—Defective Hearing 12 — 8 — Otitis Media 2 — 14 — Other Ear Diseases 2 — 26 2 Nose and Throat—Chronic Tonsillitis only 30 44 18 4 Adenoids only 12 4 10 2 Chronic Tonsillitis and Adenoids 6 2 5 2 Other Conditions 28 33 42 24 Enlarged Cervical Glands (Non-Tuberculous) 8 12 9 3 Defective Speech 6 — 27 — Heart and Circulation—Heart Disease : Organic 2 1 2 — Functional 23 22 5 3 Anaemia 16 7 5 2 Lungs—Bronchitis 10 2 7 — Other Non-Tuberculous Diseases 7 4 20 8 Tuberculosis—Pulmonary: Suspected 3 4 4 — Non-Pulmonary: Glands — — 1 — Bones and Joints 1 — 2 — Nervous System—Epilepsy 1 1 — 2 Other Conditions 1 3 11 7 Deformities—Spinal Curvature 24 1 3 — Other Forms 65 26 64 2 Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 54 47 177 85 Total Number of Defects 430 228 609 150 79 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 863 306 35.46 515 59.67 41 4.76 1 0.11 Second Age-group 651 189 29.03 430 66.05 32 4.92 — 0.00 Third Age-group Other Routine 476 145 30.47 300 63.02 31 6.51 — 0.00 Inspections 16 4 25.00 9 56.25 3 18.75 — 0.00 Total 2006 644 32.10 1254 62.51 107 5.33 1 0.06 TABLE III. Return of all Exceptional Children in the Area, 1938 (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 2 (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 17 At no school or institution 5 At other Institutions 1 At Public Elementary Schools Nil (g) Children with severe epilepsy Nil (h) Tuberculous children— i. Pulmonary tuberculosis— At Public Elementary Schools 1 At no school or institution 2 At other institutions 2 80 ii.Non-pulmonary tuberculosis— At Public Elementary Schools 13 At other institutions 2 At no school or institution 1 (i) Delicate children— At Public Elementary Schools 6 At Certified Special Schools 5 At other institutions 1 At no school or institution 2 (j) Crippled children— At Certified Special Schools 3 At Public Elementary Schools 9 At no school or institution 1 (k) Children with Heart Disease— At Certified Special Schools 2 At Public Elementary Schools 7 At no school or institution 2 TABLE IV. Treatment Tables.—Group I. Minor Ailments. Disease or Defect Number of Defects treated, or under treatment, during 1938 Under the local Authority's Scheme Skin: Ringworm (Scalp) X-ray Treatment — Other 3 Ringworm (Body) — Scabies 10 Impetigo 30 Other Skin Disease 803 Minor Eye Defects: External and other 142 Minor Ear Defects 120 Miscellaneous: Minor Injuries, Sores, etc. 1086 Total 2194 81 TABLE IV. Group II. Defective Vision and Squint. No. of Defects dealt with. Under the Authority's Scheme Otherwise. Total Errors of Refraction (including Squint) 353 — 353 Other defect or disease of the eyes — — — No. of Children for whom Spectacles were (a) Prescribed 172 — 172 (b) Obtained 168 — 168 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 26 10 67 1 243 347 Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. Residential treatment with education Residential treatment without education Non-residential treatment at an Orthopaedic Clinic Total 9 — 341 341 82 Group V.—Dental Inspection and Treatment. (1) Number of Children who were :— (a) Routine Age Groups Aged: 5 539 6 582 7 584 8 574 9 542 10 512 11 430 12 331 13 392 14 174 Total 4660 (b) Specials 421 (c) Grand Total5081 (2) Found to require treatment 3311 (3) Actually treated 2584 (4) Attendances made by children for treatment 4254 (5) Half-days devoted to:— Inspection 39 Treatment 424 463 (6) Fillings:— Permanent Teeth 3093 Temporary Teeth 885 3978 (7) Extractions:— Permanent teeth 599 Temporary teeth 2906 3505 (8) Administrations of general anaesthetics for extractions 901 (9) Other operations:— Permanent teeth 663 Temporary teeth 1288 1951 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 9,912 (iii.) Number of individual children found unclean 51 (iv.) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 Nil (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil (b) Under School Attendance Byelaws Nil 83 Sainsbury (Printers) Ltd., Anerley, S.E. 20.