BEC7 BOROUGH OF BECKENHAM REPORT ON THE HEALTH of the DISTRICT during 1939 INCLUDING THE Report of 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 1939 INCLUDING THE Report of 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 in 1939 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 op 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, 1939. Chairman: Councillor R. S. JACKSON. Deputy Chairman: Councillor Mrs. E. M. G. BARLAS. HOUSING COMMITTEE Membership from 9th November, 1939. Chairman: Councillor Mrs. E. M. G. BARLAS. Deputy Chairman: Councillor G. L. WOOD. EDUCATION COMMITTEE From 9th November, 1939. Chairman: Alderman Mrs. E. Campbell. Vice-Chairman: Alderman J. A. Collister. l STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health and School Medical Officer T. Philips Cole, M.B., D.P.H. School Dental Officer R. A. Waters, L.D.S., R.C.S. Asst. to the Medical Officer Miss Sheila Thomson, M.B., D.P.H. 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. 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. M. Wells, Cert. R.S.I., Cert. Food Inspector (Appointed 1/8/39). 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. Part-time Health Visitor Mrs. A. White, S.C.M. (Resigned 31/3/39). Dental Nurse Miss I. M. Monck, S.R.N., C.N. Matron of Maternity Home Miss D. Beard, S.R.N., S.C.M. Assistant Matron Miss H. Lomax, S.R.N., S.C.M. Chief Clerk S. W. Collett, Cert. R.S.I., Cert. Food Inspector. Assistants R. C. Rogers, Cert. R.S.I. S. P. Lewis. J. Dungay. S. B. Hawley. Miss H. E. Thomas. The list of Specialist Officers in connection with School Medical work appears at the beginning of the School Report. 2 INTRODUCTION TO ANNUAL REPORT, 1939. The Report for this year is somewhat restricted in scope. Detailed reference to Services which remain the same as in previous years have been omitted, and only such figures as are required for statistical purposes have been included. This does not mean that the careful keeping of records, which form the basis of all reports, has been discontinued: it is desirable to avoid any break in the continuity of records, such as that which occurred during the years 1916—1918; such breaks lead to much valuable information being permanently lost, and give rise at a later date to much difficulty in carrying out the necessary periodical surveys of the Health Services generally, and in assessing the values of any particular procedure. The annual statistics in the report are based on local figures only as we have been advised that there will be considerable delay in the receipt of the Registrar General's figures, and the necessary alterations will have to be made when these figures arrive. 1. On the outbreak of war most of the ordinary activities of the department were suspended for a short period, but the home visiting of infants and the Welfare Centre sessions were never completely interrupted. For one month the Welfare Centre sessions were only held for the purpose of the sale of infant foods and the supervision of special cases. At the end of that time the Centres were transferred to the Aid Posts which had been protected, with the exception of the Alexandra Centre, in which area it was not possible to find another building. To avoid any large gatherings of mothers and infants two sessions per week of one and a half hours each at each Centre have been instituted, instead of the previous arrangement of one weekly session of two hours: a doctor attends at one session each week at every centre. 2. The Health Visitors were all attached to Aid Posts in the first instance and put in a great deal of time in assisting with the preparation and organisation of the posts. They now only do " on call " duty at nights. 3. There is no doubt that a number of families left the Borough during the early days of the war, but this has had no appreciable effect on the amount of work at the Welfare Centres and Clinics. 4. The Specialists' Clinics were in abeyance up to the end of December with the exception of the Ante-Natal and the Obstetric Consultant's Clinics which were maintained. The Dental Clinic re-opened in a modified form in the middle of September. 5. It was decided to close the Maternity Home at 80, Croydon Road and on the 5th September all the patients were evacuated to their homes and a domicilary midwifery service was instituted, sixty-four cases being attended in their homes by Midwives from the maternity home. The new Maternity Home was opened for the reception of cases on the 25th December, and has now been fully developed and is receiving on an average, fifty patients per month. 6. It is very interesting to note that only six cases of infectious 3 disease were notified from September to December. This was particularly noticeable in the case of Scarlet Fever, which had shown a definitely increased incidence from the beginning of the year until the end of August. The sudden cessation in notifications of this disease was remarkable and can only be explained by assuming that although cases continued to occur, they were mild in character, and the assistance of a doctor was not requested. 7. The Sanitary Inspectors were all allocated to special duties in connection with A.R.P. work and for the first three months of the war they gave a great deal of time to the lay-out of the Aid Posts and to instruction of volunteers in anti-gas measures. The amount of slaughtering done during the year showed a further increase over 1938, but owing to government control, slaughtering has entirely ceased in the district during the present time. 8. Housing conditions in the district show no change, and it has not been possible to deal with the large number of applicants on the lists except by the utilisation of the new estate at West Wickham. The cessation of building is to be regretted, as I am of the opinion that there is still a shortage in the Borough of houses for the working classes. 9. The School Medical Service was seriously interfered with owing to the closure of all schools. As soon as possible arrangements were made to pick up the threads of the work again and at the present time the service is being conducted on almost normal lines, although the removal of the children from school to school has created considerable difficulty. 10. The nutrition of children in war time needs special attention and the Committee have authorised the expenditure of £750 for the forthcoming financial year, to supply milk to school children and deserving cases. 11. The statistics shown in the table at the end of the report cover only the work for the first nine months of the year and this fact should be born in mind when making any comparison with last year's figures. 12. I should like to express my unqualified appreciation of the work done by every member of my staff in dealing with the difficulties and problems which arose in the emergency, and I am satisfied that the Beckenham services have been adapted to meet the exigences of war time satisfactorily, although no one can say what the future holds in store for us. I should also like to express my thanks to the Committee for the interest and support which they have given to the work of the department. T. PHILIPS COLE, Medical Officer of Health. VITAL STATISTICS BIRTH RATE. After allowing for inward and outward transfers during the 4 year, local records gave a figure of 871 live births and 19 still-births in 1939, and this gives a live birth rate of 12 21 compared with 12.622 in 1938. 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, 1939, based on information possessed by the Department, is 71,300. 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, 1939, was 194, as compared with 105 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 548 cases, and that 450 cases were admitted for treatment to the Farnborough Hospital. PUBLIC MORTUARY. There were 46 cases of sudden death in the district during 1939, where the public mortuary was used. VENEREAL DISEASES. There is no treatment Centre in the area for these diseases. The K.C.C. provide a Clinic at Dartford. NURSING HOMES REGISTRATION ACT, 1927. At the end of the year there were 12 Homes on the Register; no new applications were received during 1939. The Medical Officer of Health and Assistant M.O.H. paid 30 visits of inspection to the premises and found the records and equipment satisfactory. Local papers are scrutinised for advertisements of unregistered homes and one such advertisement was withdrawn after representations were made by the Department. BOARDED OUT CHILDREN. At the beginning of the year there were 17 registered foster mothers having charge of 18 children. At the end of 1939 there were 38 children under the care of 11 foster mothers. One Nursery Home was established in 1939 with accommodation for 25 children and this accounts for the large increase in the number of " Boarded Out Children " on the Register. The Health Visitors made 48 inspections of the premises on the register, and most of the children were seen at the Welfare Centres. 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. 5 NOTIFICATION OF BIRTHS. The 1,021 entries in the Birth Register during the calendar year included 176 inward transfers and 131 outward transfers, leaving a total of 890 entries, less 19 stillbirths; or 871 infants belonging to Beckenham. ANTE-NATAL WORK. In 241 of the 692 births in and belonging to the area, the services of a private medical practitioner were engaged, and the remaining 451 were attended by Midwives. It is for these latter cases that examination and supervision at the Ante¬Natal Clinics is intended, and 233 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 370 visits during 1939. ANTE- AND POST 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 611 compared with 528 in 1938. The panel contains the names of 34 Doctors practising in the District. During the year the following work was done under the scheme:— Sessions held 70 Number of mothers attending for examination 233 Number of attendances made 611 Number of Doctors attending 35 The arrangements worked smoothly and the appointments were well kept by both doctors and patients. In 11 cases X-Ray examinations were carried out at a local hospital to assist in diagnoses. The Assistant Medical Officer saw 55 new cases, made 75 re-examinations of expectant mothers, and made 34 post-natal examinations. 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. HOME VISITING This work is carried out by the Health Visitors. During 1939 the Health Visitors made a home visit to 554 out of 714 new cases belonging to the district. The work done is summarised below:— 6  Home Visits, New Under One 1 to 5 Special Illness Expectant Mothers Boarded Out No reply to call Total Welfare Visits T.B. Visits Miss Cusack 234 1032 1400 364 134 13 532 3709 13 Miss Smith 86 402 529 106 83 20 250 1476 20 Miss Wheeler 96 375 907 105 71 6 393 1953 6 Mrs. White & Temporary 20 117 252 12 7 — 162 570 — Miss Noble 118 411 662 53 75 9 170 1498 9 Total 554 2337 3750 640 370 48 1507 9206 98 The total number of visits, 9,206 compares with 9,544 in 1938. INFANT WELFARE ATTENDANCES Town Hall C'tre Alexandra C'tre Elmers End C'tre Wickham C'tre Coney Hall C'tre fields C'tre Total 1939 Compara tive Total 1938 Individual Children 539 377 662 397 262 288 2525 2056 Total Attendances 4203 3573 6226 3381 2643 2666 22692 21280 New Cases 166 140 184 193 87 91 861 750 Average Sessional Attendance 70.5 61.6 73.2 56.3 46.4 46.7 63.2 71.1 Sessions 60 58 85 60 59 57 359 299 Cases seen by Medical Officer 1014 664 1740 735 488 853 5494 4959 Sessions attended by M.O. 48 45 73 48 47 44 305 290 Average No. per Session seen by M.O. 21 14 23 15 10 19 18 16.4 The total attendances show a further increase, despite the temporary closure during September. The following figures show the main reasons for medical examinations:— Total seen by Doctor. 5,494 Feeding and Digestion. 1,878 Referred to Special Clinics. 292 Special Cases. 40 General Progress. 2,902 Immunisation. 362 Average Number seen by Doctor per Session. 18.0 7 FOLLOWING-UP OF 2 to 5 YEARS OLD CHILDREN. There are approximately 2,300 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 4880. The following figures show the attendances of children in age groups. It will be seen that the transfer of Centres to First Aid Posts in September made it possible to maintain attendances almost to normal levels:— Year born Total who Attended Quarterly Attendances made Average number of Attendances per Child Mar. June Sept. Dec. 1934 216 417 284 137 67 4.0 1935 306 600 473 327 254 5.4 1936 386 830 622 439 430 6.0 1937 428 1,306 987 576 489 7.8 1938 617 3,377 2,716 1,578 1,077 14.0 1939 572 275 1,355 1,653 2,423 9.9 Total 2,525 6,805 | 6,437 | 4,710 4,740 = 22,692 8.8 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 £1,500 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 gave most valuable assistance at the Beckenham Welfare Centres up to the outbreak of war: Miss Bradford, Mrs. Bridges, Mrs. Buckley, Mrs. T. P. Cole, Miss G. Firmin, Mrs. Forrester, Mrs. Jeffries, Mrs. Harris, Mrs. Holford, Mrs. MacWilliams, Mrs. Matthews, Miss Morland, Mrs. Morrison, Mrs. Porter, Mrs. R. Prebble. Many of these ladies continued to assist after the Centres were restarted in October, while at some Centres the work has been done by volunteers from Aid Posts. The following ladies have continued to give assistance at the West Wickham Centre : Mrs. Chester, Mrs. Lamplugh, Mrs. Lebbon and Mrs. Carey. The following ladies assist at the Coney Hall Centre : Mrs. Jeffreys, Mrs. Reardon and Mrs. Huggins. 8 MATERNITY AND CHILD WELFARE DENTAL REPORT, 1939. 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 746 compared with 740 in 1938. There was an increase in the numbers of children and adults attending, 231 children compared with 207 and 132 adults compared with 116. During the year 27 children and 12 adults were treated at the West Wickham clinic. The following is the summary of the treatment. Mothers Children Attendances 381 364 Number treated 132 231 Extractions 433 254 Fillings 48 242 Dressings 84 105 Silver Nitrate — 41 Local injections 33 6 Nitrous Oxide 83 80 Ethyl chloride — 9 Impressions, etc. 89 — Scalings 21 — Dentures 46 — Repairs to Dentures 2 — Robert A. Waters, L.D.S. Eng. 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 Adienoids. Eye Clinic. U.V. Ray Clinic. Orthopaedic Clinic. Aural Clinic. 1936 187 Infants 23 46 27 110 22 120 Mothers 1937 166 Infants 11 49 21 95 28 128 Mothers 1938 207 Infants 22 52 41 140 26 116 Mothers 1939 231 Infants 18 31 45 123 24 132 Mothers BECKENHAM AND PENGE JOINT MATERNITY HOME. The premises at 80, Croydon Road were closed for the reception of patients on the 5th September as there was no provision for the protection of patients. All cases booked for succeeding months were advised and offered the services of Midwives from the Home to attend them in their own homes. 9 Work on the new Home was delayed by the occupation of part of the premises by troops, but by December 25th it was possible to open a small part. Up to that date 64 patients had been dealt with by the temporary domiciliary service. The new Home was gradually completed and furnished and is now in 1940 dealing with an average number of fifty cases per month. The number of admissions in 1939 up to the date mentioned was 246 compared with 333 in 1938. 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. 54 patients were referred to the Clinic by Midwives during 1939 and 150 examinations were made. ANTE-NATAL WORK. Ante-Natal Clinics are held at the Home. 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. During 1939, 327 expectant mothers (Beckenham 258, Penge 69) attended the Maternity Home Clinic. The number of Sessions held was 156, and the attendances numbered 1,648, a weekly average of 31. 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 5,548 births in the Home and 1,314 on the District, giving a total of 6,862 births up to 5/9/39. There have been in all, 10 maternal deaths, giving a maternal mortality rate of 1.45 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. ANNUAL STATISTICS FOR 1939 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 10 Information Required Particulars 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds) 14 Complement at 31/12/39 in New Home—10. 2a. Number of such beds used for Ante-Natal cases 4 3. Number of maternity cases admitted during the year 246 4. Average duration of stay 14 days 5. Number of cases delivered by: (a) Midwives 195 (b) Doctors 51 (c) Post natal cases — 6. Number of cases in which medical assistance was sought by a midwife in emergency 78 7. Number of cases notified as : (a) Puerperal Fever Nil (b) Puerperal Pyrexia* 4 8. Number of cases of Pemphigus Neonatorum Nil 9. Number of infants not entirely breast-fed while in the Institution 6 Supplementary feeds 10. (a) Number of cases notified as ophthalmia neonatorum Nil (b) Result of treatment in each case – 11. (a) Number of Maternal deaths Nil (b) Cause of death in each case – 12. (a) Number of fcetal deaths : (i) Stillborn 8 (ii) Within 10 days of birth 1 *i.e. rise of temperature to 100.4° F. for 24 hours, or its recurrence within that period. 11 INFECTIOUS DISEASE. The following table gives the number of cases which were notified during the year, the number removed to Hospital, and the age grouping:— Disease. Notified Removed to Hospital Age Groups. Beck. W.W. Total under l yr. 1/2 2/3 3/4 4/5 5/ 10 10/ 15 15/ 20 20/ 35 35/ 45 45/ 65 65 & over Diphtheria 5 8 13 – – 1 4 8 16 111 39 12 8 2 – – Scarlet Fever 171 30 201 — — — — — — 2 5 3 3 — — – Enteric Fever 1 — 1 — — — — — — — — — 1 Pneumonia 39 10 49 — 2 — — — 1 5 2 2 3 13 13 8 Puerperal Pyrexia 7 3 10 – – – – – – – – 1 6 3 – – Erysipelas 9 1 10 — 1 — — 1 — 1 — — 2 — 3 2 Ophthalmia Neonatorum 2 – 2 – 2 – – – – – – – – – – – Measles (from 1/10/39) 2 – 2 – – – – – – – 1 – 1 – – – Whooping Cough (from 1/10/39) – 1 1 – – – – – – 1 – – – – – – Tuberculosis (all Forms) 55 11 66 – 1 — — 1 — 8 31 10 13 2 DIPHTHERIA. Thirteen cases were notified, compared with 22 cases in 1938. Seven of the eight cases notified from West Wickham were patients and nurses in a Hospital. Only two cases occurred during the year in the Elementary Schools in the Borough. Immunisation.—Consents were received in respect of 446 children and 255 of these were under school age ; of the remainder 191 attended Elementary Schools. Most of the children under five years of age were given this treatment at the Welfare Centres, making 362 attendances for this purpose only. SCARLET FEVER. The incidence continued to rise through the early part of the year. In all 201 cases were notified compared with 174 in 1938. The incidence in West Wickham declined to 30 cases compared with 61 in 1938. Cases occurred all over the Borough, the only noteworthy increase in prevalence observed being in the Eden Park Ward during March; this part of the Borough had remained comparatively free from Scarlet Fever during the recent years; by the month of May the incidence in this particular area was again within normal limits. PUERPERAL PYREXIA. Ten cases were notified: four occurred in the Beckenham 12 and Penge Joint Maternity Home, and five in private Nursing Homes. No outbreak occurred in any of the Nursing Homes. TYPHOID FEVER. One case of Typhoid Fever was notified during the year. OPHTHALMIA NEONATORUM. Two cases were notified. TUBERCULOSIS. The total of 66 cases compares with 71, 60, 72, 67 and 69 in the preceding five years. In addition to the 66 new cases there were 27 definite cases transferred from other areas, 1 case restored to the register, and at the end of the year the number of notified cases in the area was:— 146 Pulmonary Males, 134 Pulmonary Females, 46 nonPulmonary Males, and 38 non-Pulmonary Females; a total of 364 cases, which compares with 309 last year. 42 cases were placed off the register for the following reasons: died, 21; cured, 3; left area, 18. Notification.—In 1 case notification was not made until after death. Institutional Treatment.—The Kent County Council provided in-patient treatment in Sanatoria for 67 cases during the year, and 9 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 1939 New cases attending for the first time:— Adults Children Male Female Male Female Pulmonary 21 16 1 – Non-Pulmonary 2 4 — — Negative 16 17 4 3 Total 39 37 5 3 27 "contacts" were examined and all were found to be negative. 67 patients completed a course of residential treatment during 1939. Care Committee.–The Voluntary Tuberculosis Care Committee has given 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 13 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. 104 cases were notified during the year, 51 having a private doctor in attendance, and 7 cases were under five years of age. MEASLES. Measles is not normally a notifiable disease in the district, but medical practitioners are paid a fee for notifying cases among children attending the elementary schools. From the 1st November, 1939, the disease became notifiable. 25 cases were notified to the Health Department during the year, 5 under five years of age, 13 had a private doctor in attendance. CHICKENPOX. 70 cases were notified, 27 being by doctors; no cases were under the age of five years. MUMPS. 8 cases of Mumps were brought to the notice of the Department during the year, 2 being notified by doctors; none 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 594 cases during the year, and 558 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 1939 was:— Disease suspected Total 1939 Results Comparative Total for 1938 Positive Negative Diphtheria 274 5 269 379 Tuberculosis 151 15 136 168 Other Diseases 31 7 24 70 Total 456 27 429 617 14 SANITARY INSPECTION OF THE DISTRICT, 1939 Nature of Nuisances or Defects Remedied. No. of defects remedied. Choked drains 26 Cesspools overflowing — Drains defective or altered 38 Defective gullies 10 Defective W.C. pans 25 Choked W.C. pans 7 Flushing apparatus to W.C. defective 27 Dirty W.C. pans 9 W.C. apartments, dirty or defective 83 Absence of ventilated lobby to W.C. apartments 2 Waste pipes, defective or untrapped 62 Defective channels to waste gullies 3 House sinks, defective 25 Soil pipes, defective 4 Ventilating shafts, choked or defective 4 Fresh air inlets, defective 10 Manhole covers, defective or unsealed 9 Water supply cisterns, uncovered, dirty or defective 6 Galvanised iron dustbins, defective or absent 23 Defective pointing 41 Dampness 150 Rain-water pipes, defective 35 Defective gutters 36 Defective roofs 97 Defective floors 56 Defective walls 82 Defective ceilings 62 Dirty walls 81 Dirty ceilings 86 Yard paving defective or absent 46 Defective stoves 38 Defective coppers 25 Defective airbricks 13 Defective windows and fittings 71 Defective doors 22 Accumulation of offensive material 16 Absence of manure pit, or pit uncovered or defective — Insufficient ventilation to room 11 Verminous rooms 12 Absence of, or defective food cupboards 64 Defective cement rendering 14 Defective stairs and handrails 21 Defective matching 3 Absence of water supply 6 Smoke – Rats, premises freed of 41 Carried forward 1,502 15  No. of defects remedied. Brought forward 1,502 Absence of Statutory Information in Rent Book 34 Miscellaneous Shop Acts, Defects 47 Miscellaneous 42 Total 1,625 Summary of Inspections and Visits Visits and ctions Census for Overcrowding 99 Housing 730 Nuisances 1,632 Cowsheds 52 Milkshops 247 Bakehouses 129 Butchers' shops 278 Other meat shops 122 Slaughterhouses 841 Places where food is prepared 34 Shops where food is stored 214 Factories 275 Workplaces (offices, etc.) 15 Outworkers 13 Rats and Mice Act 252 Houses let in lodgings — Stables 69 Fried fish shops 78 Ice cream vendors 59 Verminous premises 65 A.R.P. Courses and Inspections, etc. 648 Drainage 674 Infectious disease 424 Smoke observations 11 Samples taken under Sale of Food and Drugs Acts 63 Samples of Milk taken for Bacteriological Examinatioin 94 Samples of water 39 Shops Acts 647 Miscellaneous 586 Interviews 1,791 Total 10,181 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. Eleven observations were kept, and no nuisance was found at time of inspection. 16 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 Action taken and result Cowsheds and Milkshops 299 inspections have been made of these premises. One defect was remedied. Bakehouses. 129 inspections and visits have been made of these premises. Five defects were remedied upon notices being served. Fried Fish Shops 78 inspections have been made of these premises. Meat Shops (Butchers) 278 inspections and visits were paid to these premises. One notice was served and the defect was remedied. Other Meat Shops 122 visits were made and the meat, chiefly bacon, was found to be kept under good conditions. Places where food is prepared. 34 inspections were made. Shops where food is stored 214 inspections have been made of these premises. Slaughterhouses These premises were visited on 841 occasions when slaughtering was in progress. During the year 21,195 carcases were inspected. One notice was served and this was complied with. Ice-Cream Shops 59 inspections have been made of these premises. Premises where animals are kept. No contravention of the Byelaws was found during the year. Stables (Manure Pits) 69 inspections were made of these premises. One notice was served upon an occupier. OUTWORKERS. Notices are received, chiefly from London Boroughs, of persons employed as outworkers, in this area; 13 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 three cases during the year: two were under the Shops Acts:— (1) Three fruit pies were exposed for sale when "unsound and unfit for the food of man." A penalty of £5 Os. Od. was imposed in respect of each pie and £3 3s. Od. costs were allowed. 17 (2) The Occupier was "warned" in the case of selling after hours, as it was his first offence. (3) An occupier was summonsed for selling after hours. The defendant was fined £1 0s. 0d. 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 111 cases, and Rooms Disinfected at 62 Houses, an amount of £23 being received for this work. THE SHOPS ACTS. During the year 647 visits were made under the above Acts. The following defects were remedied during the year:— Dirty and defective W.C. apartments 3 Dirty W.C. pans 4 Defective W.C. pans 2 Defective flush to W.C 2 Choked W.C. drain 1 Defective hand basin 1 Absence of washing facilities 6 Dirty walls 2 Dirty ceiling 1 Defective walls 1 Absence of forms 36 Selling after hours 1 Heating, insufficient 2 Assistant working after hours (Early Closing day) 1 OFFICES. During the year Offices were inspected on eleven occasions. Two "defects" outstanding from the previous year were remedied. 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 continuous filtration and chlorination plant is in use, and two-hourly chemical tests are made throughout the time the baths are in use. A monthly summary of these results is submitted to the Medical Officer of Health by the Baths Superintendent. The results obtained have been uniformly good even during the busiest periods. SANITARY CONDITION OF ELEMENTARY SCHOOLS. The schools in the district all have good and adequate sanitary accommodation and water supply. 18 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 275 visits were made to premises on the Register. Eight nuisances mentioned in the attached table were remedied after the service of informal notices:— Dirfy W.C. apartments 3 Absence of light to W.C. apartment 2 Dirty walls and ceilings 3 HOUSING STATISTICS 1.—INSPECTION OF DWELLING-HOUSES DURING THE YEAR (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 613 (b) Number of inspections made for the purpose 613 (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 53 (b) Number of inspections made for the purpose 53 Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil 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 539 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 478 3.—HOUSING ACT, 1936. PART IV. OVERCROWDING. (a) (1) Dwellings overcrowded at end of year 16 (2) Number of families dwelling therein 22 (3) Number of Persons dwelling therein 125 (b) Number of new cases of overcrowding reported during the year 5 (c) (i) Number of cases of overcrowding relieved during the year 2 (ii) Number of persons concerned in such cases 14 19 INSPECTION AND SUPERVISION OF FOODS MILK. Milk was again subjected to bacteriological supervision. The results were very satisfactory. Over 86 per cent, of the samples of ordinary milk purchased in the winter months complied with the standard for Pasteurised milk, and 84 per cent, of the summer samples reached this standard. Bacillus coli was found to be present in many of the specimens of ordinary milk examined. Pasteurised milk was free from this organism. . FOOD INSPECTION IN 1939. MEAT INSPECTION. The number of carcases dressed in the Borough in 1939 exceeded those of the previous year by 1,148. Diseased conditions were found in 1,995 carcases and this necessitated the destruction of 5 tons 2 qrs. 3 lbs. This total was considerably lower than that for 1938. A small quantity of other food was also destroyed. Bovines. The bovines inspected this year were much healthier —only 31.4% being affected with disease. Tuberculosis was, however, present to a larger extent in cows, 21.05% of them being affected. In the oxen there was a marked reduction; 25% as against 63%—of the animals suffered from this disease. In every case the appropriate authority was acquainted with the facts. Calves. Tuberculosis was found in 0.32% of the carcases. Sheep. These animals were very healthy, only 1.54% of the carcases were affected with disease. Pigs. There was a marked improvement in the condition of pigs dressed in 1939. Only 10.6% of the carcases were affected with diseases. Tuberculosis again showed a marked decrease. This year only 3.14% carcases suffered from this complaint— a reduction of over 4% upon the figures for 1938. A detailed account of the animals inspected and of the meat destroyed is given in the following tables : ANIMALS DRESSED IN 1939. Cows. Oxen. Calves. Sheep. Pigs. Goats. Total. 38 102 1,239 1,807 18,009 - 21,195 20 SUMMARY OF CONDEMNED MEAT Animal. Condition. No. affected. Weight. Cows Tuberculosis 8 800 lbs. Non-Tuberculosis 2 186 „ Oxen Tuberculosis 25 859 „ Non-Tuberculosis 9 203 „ Calves Tuberculosis 4 16 ,, N on-T uberculosis 10 122½ „ Sheep Non-Tuberculosis 28 576 „ Pigs Tuberculosis 577 3,767 J ., Non-Tuberculosis 1,332 4,729 „ Totals 1,995 11,259 „ Other Foods 1 qr. 22 J lbs. Total destroyed 5 tons 3 qrs. 25 J lbs. Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed, if known 102 38 1,239 1,807 18,009 Number Inspected 102 38 1,239 1,807 18,009 All Diseases except T.B.: (a) Whole Carcases condemned 1 Nil Nil 10 6 (b) Carcase of which some part or organ was condemned 8 2 10 18 1,326 (e) Percentage of the number inspected affected with disease other than T.B. 9 5.26 0.8 1.54 7.4 Tuberculosis Only: (a) Whole Carcases condemned Nil 1 Nil Nil Nil (b) Carcases of which some part or organ was condemned 25 7 4 Nil 577 (c) Percentage of the number inspected affected with T.B. 25 21.05 0.32 Nil 3.14 21 STATISTICS RELATING TO EDUCATION. Census population of Beckenham (1931) 43,834 Estimated population (June, 1938) 71,300 Number of Elementary Schools 8 Number of Departments 18 Accommodation (31/12/39) 6,764 Number on Roll (31/12/39) 4,711 Special Day School for the Mentally Defective 1 Other Schools:— County Secondary School (Girls) 1 Junior Technical 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 S. Thomson, M.B., D.P.H. 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. (Resigned 29/2/40). Anaesthetist to Dental Clinic (part time): Alan R. Marsh, M.R.C.S., L.R.C.P. Ophthalmic Surgeon (part time): A. E. A. Looseley, F.R.C.S. (Eng.). Orthopaedic Surgeon (part time): H. J. Seddon, F.R.C.S. (Eng.). Aural Specialist (part time): G. H. Howells, F.R.C.S. (Eng.). School Nurses: Miss B. D. Sizer, S.R.N., S.C.M. Miss E. F. Smith, S.R.N., S.C.M., H.V.'s Cert. Miss C. R. Wheeler, S.R.N., S.C.M., H.V.'s Cert. Miss R. Noble, S.R.N., S.C.M., H.V.'s Cert. 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. (Resigned 31/3/40). Orthopaedic Nurse (part time): Miss E. N. Sutton, C.S.M.M.G. Throat Operations: Dr. F. C. Trapnell. Dr. J. K. Moore. Dr. W. G. A: Shuttleworth. 22 INTRODUCTION TO REPORT ON THE SCHOOL MEDICAL SERVICE CLINIC BUILDING, WEST WICKHAM. This building was opened in January, 1939. The provision of these facilities in Wickham area has enabled a much increased amount of work to be carried out. SCHOOL DENTAL SERVICE. As will be seen from the report by the School Dental Surgeon, the appointment of a part-time Dental Surgeon has made it possible to return to the annual programme of inspection and treatment. NUTRITION. For the fourth year a special table appears in the report showing the classification of children separated into four headings. Not one child out of 1,224 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. 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. NEW SCHOOL. The Stewart Fleming School at Witham Road was completed and opened in 1939. The following major improvements have been carried out during 1939 to Churchfields School: Central Hall Senior Girls Department. Dressing Room and Showers „ ,, „ Central Hall Junior Department. Enlargement of Classrooms 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 1939 Total 1938 To cases of Infectious Disease 182 864 Other Cases 1,643 2,148 Follow-up Cases No reply 216 168 Total Home Visits 2,041 3,180 Visits to Schools: re Personal Hygiene 51 63 Children examined 8,184 9,912 Found Unclean 62 51 Children seen at other Visits 1,717 3,114 Clinic Sessions Attended: Minor Ailment Clinics 258 402 Inspection Clinics 106 113 Eye Clinics 37 39 Immunisation Clinics 78 109 Aural Clinics 7 11 Dental Clinic 70 84 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:— 1939 1938 Entrants 342 863 Intermediate 410 651 Leavers 494 476 Other Routine Inspections 21 30 1,267 2,020 These groups have been explained in previous reports. (b) Other Inspections. In addition to the above groups, 2,060 "Special" Inspections were made of children referred to the Medical Inspector either at the School or the Clinic, or to Specialist Clinics for examination. 1,952 re-inspections were made of the above routine or special cases, compared with 3,421 in 1938. (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 441 (b) From other Inspections 561 Total 1,002 Written appointments are given for all the Specialist Clinics. 24 FINDINGS OF MEDICAL INSPECTION The results of Medical Inspection and Treatment are summarised at the end of the Report in Tables I—IV. No special conditions call for comment. WORK OF THE SPECIAL CLINICS TREATMENT OF MINOR AILMENTS. The attendances during the year are shown below, with comparative figures for 1938:— Sessions held Attendances Average per Session 1939 1938 1939 1938 1939 1938 Alexandra 52 73 512 613 9.8 8.4 Churchfields 52 90 1,584 1,762 30.4 19.6 Hawes Down 45 74 389 822 8.6 11.1 Marian Vian 61 83 1,483 2,193 24.3 26.5 Wickham Common 48 82 681 986 14.1 12.0 Totals 258 402 4,649 6,376 18.0 15.9 INSPECTION CLINIC. An Inspection Clinic was held on Tuesdays, Wednesdays and Fridays throughout most of the year. The total attendances were 2,580 as compared with 2,152 in 1938. 30 Tuesday sessions were held; 21 Wednesday sessions, and 55 Friday sessions. The average attendance per session was 24.0. EYE CLINIC 37 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 31.7, which compares with 28.8 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 17 85 33 Attendances by other cases 71 761 205 Total attendances 88 846 238 DENTAL REPORT, 1939. 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. At the outbreak of war the following schools had not been inspected, Alexandra Infants, Marian Vian Infants, Churchfields Junior Mixed and Infants, Wickham Common Junior Mixed and Infants. The two Junior Departments, Churchfields and Wickham Common, returned to school before the end of the year and the routine inspections and treatment were carried out, but none of the Infants departments re-assembled. The problem thus presented, disorganised the routine work of the dental department, as the basis of the dental scheme, rested on the fact of the children being at school. To overcome this 25 difficulty, the parents of the children who had not been inspected, were sent a circular letter inviting them to attend at the clinic for inspection. In addition, information was obtained from the School Attendance Officers of the children attaining the age of five years during 1939, children who would normally have been admitted to school, and the parents of these children were also invited to attend the clinic for inspection. The result of this was not quite so satisfactory as one would have hoped, approximately 50% of those invited attending for inspection. It is probable, however, that of those invited to attend, many were not in Beckenham, private evacuation being fairly considerable and this information was not available at the time. Approximately eight hundred children were thus not inspected during the year. The results of the Annual Inspections were as follows :— No. of inspections 45 „ ,, Children inspected 4,013 „ „ „ referred for treatment 2,934 ,, ,, Children refused treatment 594 The comparable figures of attendances and treatment were as follows:— 1938. 1939. Attendances 4,258 3,538 Children treated 2,584 2,340 Fillings 3,978 3,402 Extractions 3,505 2,882 The extractions of permanent teeth numbered 603 and of these 89 were sound teeth removed for regulation purposes and 5 were supernumerary teeth, making a total of 94, thus reducing the loss of teeth due to caries to 509. The number of cases of irregularity treated by extraction was 57 and by mechanical means 7. Seven dentures were supplied to replace incisor teeth, in one case following severe fracture and in six, following caries due to early neglect. One denture was repaired. Three upper incisors were crowned following accidental fracture. The number of scholars treated from the Secondary Schools was 56 and they made 135 attendances for treatment. Summary of Monthly Reports. Children Inspected 4,013 No. of attendances— New cases 2,340 Old cases 998 Special cases 200 Total attendances 3,538 No. of fillings— Permanent teeth 2,717 Temporary teeth 670 Root fillings 12 Crowns 3 Total fillings 3,402 26 No. of extractions— Permanent teeth 603 Temporary teeth 2,279 Total extractions 2,882 Dressings 412 Silver nitrate 298 Scalings 32 Regulation appliances 7 Dentures 7 Repair to Denture 1 Nitrous Oxide administrations 752 Local Injections 536 I am indebted to Dr. Marsh and Dr. Friedlander for the administration of Nitrous Oxide, to Miss Monck the Dental Nurse, for her valuable assistance and to the Head Teachers for their help and interest in the dental work of the Borough. Robert A. Waters, L.D.S.Eng. REPORT ON WORK OF AURAL CLINIC IN 1939 By G. H. Howells, F.R.C.S. Sessions Total New Cases. Re-examinations, held, attendances. Infants. School. Infants. School. 1938 11 436 23 79 43 291 1939 7 298 17 61 34 186 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 43 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. REPORT ON BECKENHAM ORTHOPAEDIC CLINIC Year ended 31/12/39 By H. J. Seddon, F.R.C.S. The following summary shows the work of this Clinic during 1939, and comparative figures are given for the preceding years: Year. Half-day Sessions held. Surgeons Examinations. New cases. Re-examinations. School. Infants. School. ts. 1936 354 110 46 608 214 1937 340 102 43 557 240 1938 343 139 74 539 197 1939 199 59 53 280 135 Treatment by Nurse. Electrical and other Treatments. Fees paid. Massage. Exercises. 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 1939 222 52 708 11 312 132 14 15 2 Nine children were admitted to Hospital for correction of various deformities. Progress has been satisfactory in every case. 27 ULTRA VIOLET RAY CLINIC The sessions held totalled 126 and the attendances 1,394, of these, 548 were infants. A fee of 6d. per attendance is charged in all but necessitous cases, and a total amount of £20 18s. Od. was received during the year. OTHER WORK OF THE SCHOOL MEDICAL SERVICE DIPHTHERIA IMMUNISATION. This work has been carried out amongst children since 1928, and the percentage of children of school age who have been artificially immunised is very satisfactory. 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 Stewart Fleming Hawes Down Marian Vian Wickham Com. Other Total, 1939 Total. 1938 Chicken Pox 5 5 - - - 36 10 5 2 63 272 Diphtheria - — — 3 - — - — — 4 9 Contacts 1 — - 3 - — - — 2 6 4 Measles - 2 - — - 3 7 — 8 20 617 ,, Contacts - - - - - 1 - - 1 28 ,, German 1 - - - 1 4 - 1 7 6 Mumps 5 - 1 - - - 2 - 1 9 311 Scarlet Fever 29 1 6 27 1 7 36 8 40 155 124 ,, Contacts 46 8 23 36 - 6 33 5 38 195 149 Whooping Cough 3 2 5 16 - - 62 — 9 97 54 ,, Contacts 2 1 - 3 - — 4 - 3 13 1 Impetigo 1 1 1 — - 2 4 — 1 10 26 Ringworm - - 1 - - - - 1 — 2 3 Skin Diseases 1 2 - 1 - - - 1 5 17 Verminous Heads 1 - 3 5 - 2 10 — — 21 13 Bronchitis - - 1 - - - 2 2 - 5 5 I.ungs—Non T.B. - - - - - - - - - - - Tuberculosis - - - - - - 1 - - 1 1 Debility - - - - - - 2 — - 2 4 Ear Conditions — - - 1 - - - - - 1 6 Enlarged Glands - - - 2 - 1 - - 3 19 Eye Conditions - - 2 1 - 4 3 11 - 21 14 Heart Disease 2 - — 1 - — 2 — — 5 6 Nose and Throat 10 4 7 7 - 8 16 12 - 64 79 Miscellaneous 19 5 8 37 - 13 64 18 2 166 217 Totals 127 31 58 143 1 84 262 63 107 876 1985 28 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. 1,005 parents were present, representing 79.36 per cent. Only 4 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:— .4= Excellent. B=Normal. C=Slightly subnormal. Z>=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 8.17 per cent. of the children examined were found to be sub-normal, and no child was considered as coming within the fourth group as "Bad Nutrition." In my previous reports I have given details of records which have been kept of the heights and weights of children inspected, and these records were again kept in 1939. These show that on height and weight alone 10.9 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 456 children have received this daily issue during the year. 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 1939 were:— Dental Clinic 56 cases made 135 attendances. Orthopaedic Clinic 8 „ 11 ,, Eye Clinic 113 ,, 238 „ FEES PAYABLE. The scale for all forms of treatment is set out on page 153 vol. 29 of the Education Minutes. PARKSTONE CONVALESCENT HOME. During the year 22 boys and 21 girls were sent for periods of six weeks' stay; six cases remained for an extra period. All gained in weight and improved in general condition. 29 PROVISION OF MEALS. With the exception of the Special School 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 2,316 Hawes Down 8,833 The Canteens were closed down at the outbreak of hostilities and have not been re-opened. 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. 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, 102 certificates were issued during the year. The number of certificates issued compares with 109 in 1937, and this is evidence that the Byelaws are being effectively enforced. Licences to take part in Stage Plays were issued in 6 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. 30 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. 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 2,677 children under instruction, 1,786 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, 4 children being admitted during the year (3 from Beckenham). The number on roll at 31st December, 1929, was 21 (Beckenham, 6 boys and 12 girls; Penge, 2 boys; Kent, 1 boy). Four children left during the year, in the following circumstances:— Beckenham:— 1 boy aged 14 Admitted to Trade School. 1 girl aged 16 Attained leaving age. 1 girl aged 14 To take up selected employment. 1 girl aged 14 ditto. Provision of Meals.—A mid-day meal is provided at the School, and the number of meals served during the period the school was 31 open was 2,689, the total cost being £44 16s. 4d. towards which the parents contributed £25 17s. 4d. MEDICAL INSPECTION RETURNS, 1939 TABLE I. Medical Inspection of Children attending Public Elementary Schools. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 342 Second Age Group 410 Third Age Group 494 Total 1,246 Number of other Routine Inspections 21 Grand Total... 1,267 B.—Other Inspections. Number of Special Inspections and Re-Inspections 1,890 TABLE II. Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups up to 31/8/39. Age Groups No. of children inspected 'A' Excellent 'B' Normal 'C' Slightly subnormal 'D' Bad No. 0/ /o No. 0/ /o No. % No. % Entrants 342 126 36.85 198 57.89 18 5.26 - - Second Age-group 368 93 25.27 235 63.85 40 10.86 - - Third Age-group 494 145 29.35 308 62.34 41 8.39 - - Other Routine Inspections 20 5 25.00 14 70.00 1 5.00 - - Total 1224 369 30.12 755 61.68 100 8.17 - - TABLE III. (a) Children too blind to attend ordinary schools and not receiving special instruction Nil (b) Children too deaf to attend ordinary schools and not receiving special instruction Nil 32 TABLE IV. Treatment Tables (1) Minor Ailments. Disease or Defect Number of Defects treated, or under treatment, during 1939 Under the local Authority's Scheme Skin: Ringworm (Scalp) X-ray Treatment — Other 7 Ringworm (Body) 2 Scabies 7 Impetigo 3 Other Skin Disease 656 Minor Eye Defects: External and other 118 Minor Ear Defects 74 Miscellaneous: Minor Injuries, Sores, etc. 991 Total 1858 II.—Defective Vision and Squint. No. of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including Squint) 526 - 526 Other defect or disease of the eyes - - — No. of Children for whom Spectacles were (a) Prescribed 96 - 96 (b) Obtained 94 — 94 III.—Treatment of Defects of Nose and Throat. Received Operative Treatment Number of Defects. Tonsils only Adenoids only Tonsils and Adenoids Other defects Received other forms of treatment Total Under the Authority's Scheme 11 12 81 1 211 316 33 IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. Residential Residential Non-residential treatment treatment treatment at an with without Orthopaedic Total education education Clinic 6 — 310 310 V.—Dental Inspection and Treatment. (1) Number of Children who were inspected:— (4) Attendances made by child ren for treatment 3538 (a) Routine Age Groups Aged: Total 4013 (5) Half-days devoted to:— 454 5 ... 275 Inspection 45 6 ... 305 Treatment 409 7 ... 340 8 ... 481 (6) Fillings:— 9 ... 509 10 ... 519 Permanent teeth 2732 11 ... 515 Temporary teeth 670 3402 12 ... 448 13 ... 388 (7) Extractions:— Permanent teeth 603 2882 V14 ... 233 (b) Specials 200 Temporary teeth 2279 (c) Grand Total 4213 (8) Administrations of general anaesthetics for extractions 752 (2) Found to require treatment 2934 (9) Other operations:— Permanent teeth 420 (3) Actually treated 2340 Temporary teeth 865 1285 VI.—Uncleanliness and Verminous Conditions (i.) Average number of visits per school made during the year by the School Nurses 7 (ii.) Total number of examinations of children in the Schools by School Nurses 8,184 (iii.) Number of individual children found unclean 62 (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 Printed by Freame, Manning & Co., Ltd. (T.U.), Lewisham