LIBRARY 6/5 BEC 8 BOROUGH OP BECKENHAM REPORT on the HEALTH OF THE DISTRICT during 1940 INCLUDING THE REPORT of the MEDICAL INSPECTION of CHILDREN in the ELEMENTARY SCHOOLS By T. PHILIPS COLE, 1,1.B., D,P.H. Medical Officer of Health. School Medical Officer. 2 STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health and School Medical Officer T. Philips Cole, M.B., D.P.H., School Dental Officer R. A. Waters, L.D.S., R.C.S., Asst. to the Medical Officer. Miss Sheila Thonson, 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 E.U.V/illians, Cert. R.S.I. , Cert. Food Inspector M.Wells, Cert. R.S.I., Cert. Food Inspector(Resigned) R.C.Rogers, Cert. R.S.I., (Appointed 1/12/40) Health Visitors 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. School Nurses Miss B.D. Sizer, S.R.N., S.C.M. Miss I.M.Monck, S.R.N., C.N., (On Military Service from 5/12/40) Matron of Maternity Hone 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 J. Dungay S.P. Lewis (On Military Service from 16/11/40) S. B. Hawley Miss H. E. Thomas(Resigned 30/11/40) Miss D. Netherwood(Appointed 1/12/40) The list of Specialist Officers in connection with School Medical work appears at the beginning of the School Report. T INTRODUCTION TO ANNUAL REPORT FOR 1940 The report for 1940 is restricted to an account of the work of the various Services, and most of the infornation is set out in tabular form. It will be noticed that the report contains no vital statistics: the calculation of the Birth Rate, and the various Death Rates, is dependant on information supplied by the Registrar-General. In normal years this infornation is received by the end of April, but judging from our experience last year, it is improbable that the necessary figures for the year 1940 will reach us until the end of the current year. When the information is available, a supplementary report will be submitted. During the first eight months of 1940, the conditions of life in the Borough remained much the same as in the latter part of 1939. The continued immunity of this country from attacks from the air lead to a greater degree of stability, the disorganisation of the Health Services, caused by the outbreak of war, disappeared, and these Services returned almost to a normal peace-time routine. Following the outbreak of war there was a certain amount of voluntary evacuation from all parts of the Borough, but as the vceks went by many of these families returned to their home s. During the last four months of the year, air-raids were regular and persistent. Day-time raids were, however, infrequent, and little actual interference was caused to the routine work of the Health Services. There was more voluntary evacuation, and this was reflected in diminished attendances at the various Clinics and Infant Wolfare Centres. The air-raids also brought with them their special problems for the Health Department - notably the co-reful inspection of food in the shops in the affected areas, and widespread, though in most instances slight, damage to drains and sewers. At no time was there serious disorganisation of any of the Public Utility Services. The unavoidable delay in reopening the Infants Departments of the Elementary Schools interfered with the work of Diphtheria Immunisation, but the number of children under school ages presented for treatment compared favourably with the response in earlier years. I should like to express my thanks to Dr. Thomson, the Assistant Medical Officer of Health, and to all of the members of my staff, all of whom have undertaken a great deal of voluntary work in the Civil Defence Services in addition to their ordinary duties, for their tireless, willing and cheerful assistance. 28th February, 1941 T. PHILIPS COLE 5 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 by the Registrar General was 71,010. The number of persons evacuated had reduced this figure to about 57,000 at the end of 1940. UNEMPLOYMENT AND PUBLIC ASSISTANCE The Kent County Council Public Assistance Department state that out-relief was given in Beckham and West Wickham. during the year to 597 cases, and that 526 cases were admitted for treatment to the Farnborough Hospital. PUBLIC MORTUARY There were 31 cases of sudden death in the district during 1940, 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 8 Homes on the Register; no new applications were received during 1940. The Medical Officer of Health and Assistant M.O.H. paid 37 visits of inspection to the premises and found the records and equipment satisfactory. Local papers are scrutinised for advertisements of unregistered homes. Two Homes were closed owing to War damage and two others also closed. BOARDED OUT CHILDREN At the beginning of the year there were 11 registered foster mothers having charge of 38 children. At the end of 1940 there were 12 children under the care of 9 foster mothers. The Health Visitors made 93 inspections of the premises on the register, and most of the children were 3een at the Welfare Centres. The Nursery Home established in 1939 with accommodation for 25 children was closed during the year. MATERNITY AND CHILD WELFARE This service deals with the ante-natal care of expectant mothers and the supervision of nursing mothers and children up to the age of five years. 6 NOTIFICATION OF BIRTHS The 917 entries in the Birth Register during the calendar year included 134 inward transfers and 169 outward transfers, leaving a total of 748 entries, less 22 stillbirths; or 726 infants belonging to Beckenham. ANTE-NATAL WORK In 285 of the 614 births in and belonging to tho area, the services of a private medical practitioner were engaged, and the remaining 329 were attended by Midwives. It is for these latter cases that examination and supervision at the Ante-Natal Clinics is intended, and 292 of these were examined at the Clinics, compared with 233 in 1939. 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 412 visits during 1940. 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 wore 830 compared with 611 in 1939. The panel contains the names of most Doctors practising in the District. During the year the following work was done under the scheme:- Sessions held 74 Number of mothers attending for examination 292 Number of attendances made 830 The arrangements worked smoothly and the appointments were well kept both by doctors and patients. In 5 cases X-ray examinations were carried out at a local hospital to assist in diagnoses. The Assistant Medical Officer saw 43 new cases, made 71 re-examinations of expectant mothers, and made 25 post-natal examinations. HOME KELPS A list of approved "Home Helps", that is, women who undertake domestic work and look after the family during the mother's confinement, is kept. 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 1940, the Health Visitors made a home visit to 639 new cases. The work done is summarised below:- 7 Home Visits, New Under One 1 to 5 Special Illness Expectant Mothers A.R.P. Gas Masks for Babies Boarded Out No Reply Total Visits Miss Cusack 162 448 645 180 102 41 52 136 1766 Miss Smith 175 490 720 116 116 98 23 483 2221 Miss Wheeler 131 413 772 84 69 72 6 513 2060 Miss Noble 171 484 729 85 125 90 12 207 1903 639 1835 2866 465 412 301 93 1339 7950 INFANT WELFARE ATTENDANCES Town Hall C'tre Alexandra C'tre Elmers End C'tre Wickham C'tre Coney Hall C'tre Ch'ch field C'tre Total 1940 . Comparative Total 1939 Individual Children 418 294 515 331 221 423 2202 2525 Total Attendances 2802 2695 4144 4165 1969 3968 19743 22692 New Cases 164 81 137 184 79 141 786 861 Average Sessional Attendance 39 38 43 43 26 40 39 63.2 Sessions 71 70 96 97 74 98 502 299 Sessions attended by Medical Officer 50 57 51 51 51 52 309 290 Cases seen by Medical Officer 922 463 847 748 459 1267 4706 4959 Average No. per Session seen by M.O. 19 9 16 14 9 24 15 16.4 The total attendances show a slight decrease due, no doubt, to the conditions prevailing during September and October. The following figures show the main reasons for nodical examinations 8 Total scon Feeding and Referred to Special General by Doctor. Digestion Special Clinics Cases Progress 4706 1817 210 44 2284 Immunisation 551 FOLLOWING-UP OF 2 to 5 YEARS OLF CHILDREN The following figures show the attendances of children in age groups. It will be seen that the attendances have aillon by 2,949. Year born Total who attended. Attendances made. Average number of attendances per child. 1935 179 572 3.2 1936 299 1,254 4.2 1937 310 1,760 5.6 1938 407 3,002 7.4 1939 511 7,785 15.2 1940 496 5,370 10.8 Total 2,202 19,743 8.9 PROVISION OF MILK, MILK FOODS, ETC. A stock of dried milks and other foods is kept at the Centres and sold to the mothers at cost price. During the year foods to the value of approximately £1,500 were sold. FREE MILK TO NECESSITOUS CASES. A sum of £200 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. The supply of milk for children under 5 was taken over by the Milk Board in July and the Council retain only the option of supplementing supplies in special cases. The Milk Officer reports that since the Scheme came into operation, free permits have been given to 565 cases and at 2d per pint to 4,868 cases. VOLUNTARY HELPERS. We are much indebted to the many ladies who give most valuable assistance at the Beckenham Welfare Centres. At all Centres assistance is also given by volunteers from the Aid Posts. 9 MATERNITY AND CHILD WELFARE DENTAL REPORT 1940 The sessions were held on Friday afternoons and at such other tines as circumstances demanded. The estimated number of sessions was 72 and the, attendances totalled 490 compared with 746 in 1939. There was a decrease in the number of children and adults attending, 150 children compared with 231 and 109 adults compared with 132. During the year 28 children and 10 adults were treated at the West Wickham Clinic. The following is the summary of the treatment: Mothers Children Attendances 271 219 Number treated 109 150 Extractions 356 170 Fillings 34 118 Dressings 59 75 Silver Nitrate - 75 Local Injections 25 6 Nitrous Oxide 64 40 Ethyl chloride - 18 Impressions, etc. 55 - Scalings 7 — Dentures 28 - Repairs to Dentures 8 - 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.- clinic. U.V. Ray Orthopaedic Aural 1940 )150 Infants ) Clinic. Clinic. Clinic. ) 109 Mothers ) 51 22 81 13 BECKENHAM AND PENGE JOINT MATERNITY HOME The new Home was actually open on 25th December, 1939 and the following table shows the bookings and admissions for the year. The effect of raids and local evacuation produced a sharp decline in admissions during November and December. The number of admissions in 1940 was 405 compared with 246 in 1939 in the old Home, which was only open for the first eight months of the year. 10 (1940) Month Bookings Cancellations Births BeckenTmm Penge Beckenham Penge January 38 10 1 1 10 February 18 7 - - 20 March 26 1 1 - 25 April 38 7 - - 40 May 31 14 - - 48 June 35 7 1 1 30 July 25 10 1 - 37 August 32 13 3 1 40 September 38 13 7 2 48 October 42 10 15 - 42 November 23 5 5 - 19 December 32 10 12 4 28 (1941) January 33 3 19 - 24 February 27 9 3 3 15 March 22 6 1 1 - April 15 7 1 - - May 8 1 1 - - June 4 3 1 - - July 3 2 - - - August 2 - - - - (These figures are compiled to 17th February, 1941) 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 nay refer her patient to the Clinic under the Ante-Natal Scheme. 98 patients were referred to the Clinic by Midwives during 1940 and 297 examinations were made. This represents almost double the cases and attendances of 1939. 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 1940, 393 expectant mothers (Beckenham 288, Penge 105) attended the Maternity Home Clinics. The number of sessions held was 156, and the attendances numbered 1,505, a weekly average of 30. 11 ANNUAL STATISTICS FOR 1940 (Relating to the Beckenham and Penge Joint Maternity home) No. Information Required Particulars 1. Name and Address of Institution, Beckenham & Penge Joint Maternity Homo. Stone Park Avenue, Beckenham. 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds) 34 2a. Number of such beds used for Ante-Natal cases 4 3. Number of maternity cases admitted during the year 405 4. Average duration of stay 14 days 5. Number of cases delivered by:- (a) Midwives 302 (b) Doctors 95 (c) Post-natal cases 6 (Two patients transferred to Hospitals undelivered) 6. Number of cases in which medical assistance was sought by a midwife in emergency 148 7. Number of cases notified as: (a) Puerperal Fever Nil (b) Puerperal Pyrexia 8 8. Number of cases of Pemphigus Neonatorum. 5 9. Number of infants not entirely breast-fed while in Institution 25 10. (a) Number of cases notified as ophthalmia neonatorum Nil (b) Result of treatment in each case - 11. (a) Number of Maternal deaths 2 (b) Cause of death in each case (a) Septicaemia (b) Concealed Antepartum haemorrhage 12. (a) Number of foetal deaths: (i) Stillborn 9 (ii)Within 10 days of birth 5 12 INFECTIOUS DISEASE The table on the following page gives the number of cases which were notified, during the year, and the age grouping. Speaking generally, the incidence of Infectious Disease in the Borough was low, even after making due allowance for the reduction in population caused by voluntary evacuation. It Is worth while to glance for a moment at the effect of Shelter-life on Infectious Disease. It nay be said at once that the mere congregation of people in Public Shelters will not of itself cause an outbreak of Infectious Disease. If, however, a disease is prevalent In the district, the congregation of people in Public Shelters will give additional opportunities for its spread. Some diseases appear regularly each year, but even these have a definite seasonal prevalence: Pneumonia, Influenza and common catarrhal infections are prevalent in the first three months of the year; Infantile Paralysis is a disease of the late summer and autumn; Cerebro-spinal Meningitis occurs chiefly in the winter months. Other diseases, such as Measles, Diphtheria and Scarlct Fever are with us to a limited extent all the time, yet they may only appear in epidemic form at considerable intervals; Measles usually occurs every other year, in the Spring. Diphtheria, Scarlet Fever, so far as Beckenham is concerned, have only been unduly prevalent every sixth or seventh year. Some of these diseases are notifiable, and so we have reasonably accurate information about their incidence. The following table shows notifications of Infectious Diseases In 1940, in two periods, January to August, when the Public Shelters were not in use, and September to December, when they were used to a very large extent night after night. Jan. to Aug. Sept. to Dec. Diphtheria 7 1 Scarlet Fever 48 17 Pneumonia 32 4 Measles 54 115 Cerebro-spinal Meningitis 7 Diphtheria has not been prevalent for several years; the prevalence of Scarlet Fever has begun to decline after a high incidence in 1938 and 1939. Measles was prevalent in the early autumn. DIPHTHERIA The number of cases notified was 8, compared with 13 in 1939. 5 cases occurred in the original Beckenham area and 3 in West Wickham. Disease Notified Age Groups Non civilian cases incl. in total Beck. W. V. Total. Under 1/2 2/3 3/4 4/5 5/ 10 10/ 15 15/ 20 20/ 35 35/45 45/ 65 Over 65 Diphtheria 5 3 8 1 2 2 3 Scarlet Fever 52 13 65 1 1 2 34 12 6 6 3 Cerebro-Spinal 9 1 10 1 4 3 1 1 3 Pneumonia 31 6 37 2 1 1 2 3 9 2 11 7 1 Puerperal Pyrexia 11 1 12 11 1 Erysipelas 6 6 1 1 3 1 1 Dysentery 1 1 1 Food. Poisoning 7 _ 7 1 3 1 2 Measles 159 12 171 6 6 3 6 146 3 1 2 German Measles 47 47 1 1 1 8 3 8 22 3 29 Whooping Cough 3 2 5 1 2 1 1 Totals 330 39 369 2 9 10 6 11 193 19 26 55 11 15 10 35 BACTERIOLOGICAL WORK The number and results of the examinations made at the Public Health Department Laboratory during 1940 was:- Disease suspected Total 1940 Results Comparative Total - 1939 Positive Negative Diphtheria 135 3 132 274 Tuberculosis 94 10 84 151 Other diseases 20 3 17 21 Totals 249 16 233 456 i'o • • • . < ; 1 .) i i •• . : i 14 DIPHTHERIA (cont.) The age incidence was:- 0-4 years. 5-14 years. 15 year3 and over. 12 2 5 It is many years since so few cases have occurred in Beckenham in children under the age of 15. DIPHTHERIA IMMUNISATION. Consents were received in respect of 511 children and 148 of these were under school age. 89 sessions were held at the Town Hall or Schools. Most of the children under five years of age were given this treatment at the Welfare Centres, making 351 attendances for this purpose only on 42 occasions. SCARLET FEVER. The number of cases notified was 65. This was considerably loss than the numbers notified in 1939 and 1938, when the figures were 201 and 174 respectively. The fall in the notifications of Scarlet Fever coincided with the outbreak of war. Fifty-five cases occurred in original Beckenham and ton in West Wickham. The age incidence was 0 - 4 years. 5-14 years. 15 years and over. Beckenham. 4 38 13 West Wickham 8 2 The Seasonal incidence was:- January to March 14 April to June 18 July to September 24 October to December 9 MEASLES. The number of cases notified among the civilian population was 169. Of these, 152 were in original Beckenham and 17 in West Wickham. For many years Measles has appeared in epidemic form in Beckenham every other year, and the interval bewteen epidemics has been approximately 104 weeks. Although this interval is constant in many areas, there have been certain modifications so far as Beckenham is concerned: the peak month has been March in one epidemic and May in the next one, and this variation has appeared very consistently. According to past history, the peak of this year's outbreak should have been in May, but 15 very few eases were notified in the first six months of the year: the actual peak of the outbreak occurred in September and October. The total number of cases notified was less than half the usual number. Voluntary evacuation may have had something to do with the reduced incidence, but I am unable to offer any explanation which could account for the marked variation in the periodicity. London, where the 104 week interval has been a most regular event, had a similar experience. CEREBRO-SPINAL MINGITIS. The incidence of this disease is greatly increased in war-time. It is spread by direct personal contact only, because the infective parasite cannot survive except in conditions of temperature approximating to that of the human body. Secondary cases in the same house as the original case are rare, and it is seldom possible to definitely connect one case with any previous case: the inference of course is that the parasite is spread by "carriers". In other words, the parasite spreads rapidly through a community but, either because the resistance of the average human being is high, or because the intensity of the infection is too small to provoke a reaction, comparatively few persons actually contract the disease. The increased prevalence of this disease in Army camps and barracks in war-time is understandable, but the reason why it becomes so provalent among the civilian population at the same time is not quite so clear. Congregation of the general Public at night in Public shelters would certainly offer one explanation of the matter, but during the first half of 1940, the general public did not sleep in, or spend any time at all in the Public shelters: whilst in the outbreak of the disease in this country in 1914-15, the living conditions of the civilian population were no different from those existing in peace-time. Six out of the seven cases which occurred in 1940 among the civilian population in Beckenham were in the first six months of the year: and no cases were notified during September, October and November, when the Public shelters wore most fully occupied. TYPHOID FEVER. No cases of Typhoid Fever or of Paratyphoid Fever were notified during the year. A few remarks are desirable on the question of protective inoculation of the general public against Typhoid and Paratyphoid Fevers. Measures for the prevention of any particular infectious disease can be divided into two classes. First the control of the parasite: the power of being able to prevent the parasite from gaining access to the human body. Second, the production of an Immunity in the individual 16 and in the community which will be able to destroy the parasite if it manages to invade the body. The sounder method is that of controlling the parasite. The efficiency of protective inoculation, so far as the prevention of epidemics is concerned, depends on the proportion of the whole community which is successfully protected: the outstanding success of AntiTyphoid Inoculation in the Amy in the last war was due to the fact that nearly 100% of the people at risk were protected. In some diseases, Diphtheria for example, it is impossible to control the activities of the parasite, and so large scale immunisation is our most certain method of prevention. But the parasite of Typhoid Fever can be controlled: and the course of the infection can be discovered and removed, and the means by which it gains access to the human body food and drink - can be safeguarded and, if exposed to infection, can be rendered harmless. Active Public Health measures appear to me to offer a surer means of prevention and protection, than a limited amount of protective inoculation: and past experience suggests very strongly that such inoculation would not be taken advantage of by 40% of the population. Individual protection, however, is another matter: and I think it is reasonable that facilities should be made available for those who desire this extra safeguard to be able to receive it, PUFRPERAL PYREXIA. 12 cases were notified: 8 occured in the Beckenham and Penge Joint Maternity Home and 3 in private Nursing Hones . 0P1HALMIA NEONATORUM. Two cases wore notified, TUBERCULOSIS. The total of 65 cases compares with 66, 71, 60, 72 and 67 in the preceding five years. In addition to the 65 new cases there were 19 definite cases transferred from other areas, 1 case restored to the register and 9 cases were not notified until after death. At the end of the year the number of notifiod cases in the area was:- 154 Pulmonary Males, 137 Pulmonary Females, .45 nonpulmonary Males, and 45 non-pulmonary Females; a total of 381 cases, which compares with 364 last year, 58 cases were placed off the register for the following reasons: died, 28; cured, 2; left area., 28, TUDERCPLOCIS (Cont.) notification: In 9 cases notification was not made until after death. Care Committee: The Voluntary Tuberculosis Care Committee has given considerable assistance to patients in ways which are outside the scope of official ochonos. PUBLIC HEALTH (PREVENTION OP 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 tro.de 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 78 cases were notified during the year by the doctor in attendance. CHICKEN POX 78 cases were notified by doctors; no cases under the age of 5 years. MUMPS 1 case of Mumps was brought to the notice of the Department during the year. 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 446 cases during the year, and 426 of these were infants under one year of age. 17 I BACTERIOLOGICAL WORK 18 The number and.results of the examinations made at the Public Hea1th Department Laboratory during. 1940 was:- Disease suspected Total 1940 Results Comparative Total- 1939 Positive Negative Diphtheria 135 3 132 274 Tuberculosis 94 10 84 151 Other Diseases 20 3 17 21 Total 249 16 233 . 456 SANITARY INSPECTION OF THE DISTRICT, 1940 Summary of Inspections and Visits. Visit and Inspections. Overcrowding 73 Housing 280 Nuisances 2,402 Cowsheds 75 Milkshops 294 Bakehouses 197 Butchers' shops 434 Other meat shops 160 Slaughterhouses 57 Places where food is prepared 53 Shops where food is stored 324 Factories 363 Workplaces (offices, etc.) 10 Outworkers 6 Rats and Mice Act 413 Stables 158 Fried Fish shops 69 Ice Cream vendors 58 Verminous premises 51 Drainage 611 Infectious disease 119 Samples taken under Sale of Food and Drugs Acts 183 Samples of Milk taken for Bacteriological Examination 15 Samples of Water 47 Shops Acts 337 Miscellaneous 579 Interviews 2,020 Civil Defence: A.R.P.Lectures & Demonstrations 564 Bomb damage to premises & drains 216 " " " Food Shops 480 Billeting 30 10,778 19 Nature of Nuisancos or Defects: Remedied. No.of defects Remedied Choked Drains 30 Drains defective or altered 48 Defective gullies 7 Defective W.C. pans 19 Flushing apparatus to W.C. defective 20 Dirty W.C. pans 1 W.C. apartments, dirty or defective 54 Waste pipes, defective or untrapped 27 Defective channels to waste gullies 6 House sinks, defective 6 Soil pipes, dcfective 2 Ventilating shafts, choked or defective 1 Fresh air inlets, defective 5 Manhole covers, defective or unsealed 23 Water supply cisterns,uncovered,dirty or defective 6 Galv.Iron dustbins, defective or absent 6 Defective pointing 20 Dampness 124 Rain-water pipes, defective 11 Defective gutters 27 Defective roofs 61 Defective floors 37 Defective walls 56 Defective ceilings 37 Dirty walls 50 Dirty ceilings 55 Yard paving defective or absent 31 Defective stoves 32 Defective coppers 7 Defective airbricks 15 Defective windows and fittings 37 Defective doors 13 Accumulation of offensive material 9 Absence of manure pit,pit uncovered or defective 2 Insufficient ventilation to room 7 Verminous rooms 5 Absence of, or defective food cupboards 14 Defective cement rendering 2 Defective stairs and handrails 12 Defective matching 1 Absence of water supply 3 Rats, premises freed of 102 Absence of Statutory Information in Rent Book 12 Miscellaneous Shop Acts, Defects 37 Miscellaneous 49 1,129 / : 20 PREMISES CONTROLLED BY BYE-MS, ETC. The following Table supplies particulars of the premises and occupations in the district which are controlled by Byelaws or Regulations Character of Premises. Action taken and result. Cowsheds and Milkshops 369 inspections have been made of these premises Bakehouse 197 inspections and visits have been made of these premises. 6 defects were remedied upon notices being served. Fried Fish Shops 69 inspections have been made of these premises. Meat Shops (Butchers) 434 inspections and visits were paid to these premises. 6 defects were found and remedied. Other Meat Shops 160 visits were made and the meat, chiefly bacon was found to be kept under good conditions. Places where food is prepared 53 inspections were made, 2 defects were found and remedied. Shops where food is stored 324 inspections have been made on those premises. Slaughterhouses These premises were visited on 57 occasions when slaughtering was in progress. 268 carcases were inspected, Ice-Cream Shops . 58 inspections havebeen made of these premises. Premises where animals are kept No contravention of the Byelaws was found during the year. Stables (Manure Pits) 158 inspections were made of these premises. One notice was served upon an occupier. Offices. During the year Offices were inspected on 10 occasions. 21 The Shops Acts. During the year 337 visits were made under the above Acts. The following defects were remedied during the year: Dirty and defective W.C. apartments 1 Dirty walls 1 Dirty ceiling 1 Absence of forms 35 No compensating holiday for Sunday work 1 Factories. During the year 363 visits were made to premises on the Register. At 11 premises, nuisances wore remedied after the service of informal notices, as under:- Dirty W.C. apartments 7 Defective W.C. seats 4 Dirty walls and ceilings 2 Dampness 1 Defective Roof 1 Defective gutters 1 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) 347 (b) Number of inspections made for the purpose 347 (a) Number of dwelling-houses -(included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 47 (b) Number of inspections made for the purpose 47 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 subhead) found to be not in all respects reasonably fit for human habitation 287 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 its Officers 336 : ?' t": 22 INSPECTION AND SUPERVISION OF FOODS Sampling. There were 225 samples of food taken during the year, one of which was an informal sample. A certificate of adulteration was given by the County Analyst in respect of a sample of curry powder which was adulterated to the extent of 23 parts of lead per million. The Vendors were prosecuted and a fine of £2-0-0 imposed with £5-5-0 costs. Bomb Damage. 480 visits were made to food shops after damage by blast and a very large quantity of food examined for the presence of glass particles. It was necessary to condemn a certain quantity of various foodstuffs and eggs. Moat Inspection. The number of carcases dressed in the Borough in 1940 was 268 only. Diseased conditions were found in 7 carcases and this necessitated the destruction of 99 lbs. A detailed account of the animals inspected and of the meat destroyed is given in the following tables: Animals Dressed in 1940 Cows Oxen. Calves. Sheep Pigs Goats Total 4 3 16 54 191 Nil 268 Summary of Condemned Meat Animal Condition No.Affected Weight Cows Tuberculosis 1 42 lbs Sheep Non-tuberculosis 1 18 " Pigs Tuberculosis 3 31 " Non-tuberculosis 2 8 " Totals • • • 7 99 " Other Foods • • • 2 cwt. 3 qrs. 26½ lbs. and 300 eggs. Total destroyed: 3 cwt. 3 qrs. 13½ lbs. and 300 eggs. 23 INTRODUCTION TO REPORT ON SCHOOL MEDICAL SERVICE. The changes in the organisation of the School Departments consequent on the gradual provision of Shelters at the different schools,increased the difficulties of the School Medical Service in arranging the necessary Routine Medical Inspections and Clinic sessions. Whilst the Infants were not attending School regularly, it was not possible to examine many of the Entrants Code Group. These facts, as well as the marked reduction in the numbers on the Registers, and the interference with the work caused by repeated alerts and air-raids during the day-time in September and October, account for the reduced numbers examined at Routine Medical Inspections. Nevertheless, the number examined at these Inspections in 1940 compares very favourably with the number examined during the previous year. School Inspection Clinics and Clinics for the treatment of Minor Ailments were held regularly throughout the year, and the schools were visited frequently by the School Medical Officers and the School Nurses. The various Special Clinics continued to operate, though the number of sessions held and the number of attendances made were naturally lower than in ordinary years. In July, certain changes were made in the duties of the Health Visitors and School Nurses. Prior to that time, of the five Nurses in the Service of the Corporation, one had been a whole-time Health Visitor, one a whole-time School Nurse, whilst the remaining three gave half of their time to each service. In July, three Nurses became whole-time Health Visitors and two became whole-time School Nurses. Owing to the geography of the Borough, this re-arrangement was beneficial to both services, much time previously taken in travelling to and from the Town Hall Clinic being saved. Miss Monck, who had been the Dental Nurse for 14 years, was appointed as the second whole-time School Nurse, her place as Dental Nurse being taken by a Dental Attendant - Miss Bradford. In November, Miss Monck was called up for service with the Q.A.I.M.N.S. In August, a single session v/as instituted in the Schools in place of the regular morning and afternoon sessions. This session was between 9 a.m. and 2 p.m. A short period for relaxation and refreshment was given in the middle of the session. The children brought sandwiches and light refreshment from home, and over 90% had milk under the Milk in Schools Scheme. I visited every department on several occasions, and I found nothing to suggest that this single long session was having a harmful effect on the health of the children: in some respects it was an advantage since 24 it enabled the children to have several hours outdoor recreation in daylight after school, even on the shortest days. I think that adequate arrangements should be made in every school department for heating the milk for those children who prefer hot milk: at present this is only possible in a few schools. Another point which will require renewed consideration before next winter is the question of heating the School Shelters: high temperatures are not required, but the warmth should be sufficient to prevent the dampness which is prevalent in most shelters in the Borough: prolonged stays in a cold damp atmosphere will ultimately affect vitality, and will certainly interfere with the subsequent efforts to concentrate on study. The nourishment of the children has, up to the present, given no cause for alarm. Tho rationing system at present in force throughout the country, whilst allowing plenty of foods required for energy, and sufficient for the production of body-heat, docs not provide enough body-building foods of a desirable quality. Our sheet-anchor here is Milk: every effort should be made to see that the milk consumption of every child at school is increased - even doubled. It must not be forgotten that weight for weight a child requires a higher proportion of first quality bodybuilding food than an adult. The effects of frequent air-raids was very noticeable in most schools; naturally it was most marked in the schools in the areas which had suffered most. In the Alexandra areain November, the nervous and physical condition of many of the children was distressing. Fortunately, at the end of the year, this area, with other adjoining parts of the Borough, became an evacuation area. The response to the offer of evacuation was rather disappointing, but It is satisfactory to know that the facilities and the machinery for further evacuation from these areas exist, and can be put into action at any time. Recently I have noticed an improvement in the condition of the children: they appear to bo less jumpy, and have recovered some of the loss of tone induced by lack of sleep and anxiety. T. PHILIPS COLE ANNUAL REPORT ON WORK OF THE SCHOOL IIEDICAL SERVICE Statistics Relating to Education. Census population of Beckenhan (1931) 43,834 Estimated population (December 1940) 55,000 Number of Elementary Schools 8 Number of Departments 18 Accommodation (31-12-40) 6,714 Number on Roll(31-12-40) 3,580 Special Day School for Mentally Defective 1 Other Schools:- County Secondary School (Girls) 1 Junior Technical School 1 STAFF ENGAGED IN MEDICAL INSPECTION. School Medical Officer: T.Philips Cole, M.B., D.P.H., (approximately l/3rd time) Assistant to S.M.O. : Miss S. Thomson, M.B., D.P.H., School Dental Surgeon : R.A.Waters, L.D.S.,R.C.S.(Eng.) (5/6ths time to School work) Assistant Dental Surgeon: A.E.Carr, L.D.S., R.C.S., (part-time) (Resigned 29/2/40) Anaesthetist to Dental Clinic (part-time) : Alan R.Marsh, M.R.C.S.,L.R.C.P. Opthalmic Surgeon : A.E.A.Looseley, F.R.C.S.(Eng.) (part-time) Orthopaedic Surgeon : H.J.Seddon, F.R.C.S. (Eng.) (part-time) Aural Specialist : G.H.Howells, F.R.C.S. (Eng.) (part-time) School Nurses : Miss B.D.Sizer, S.R.N., S.C.M., Miss I.M.Monck, S.R.N., C.N. Dental Attendant : Miss G.Bradford (5/6ths time to School work) Orthopaedic Nurse : Miss E.N.Sutton, C.S.M.M.G. (part-time) 25 26 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 then during the year:- HOME VISITS: Total 1939 Total 1940 To cases of Infectious Disease 182 208 Other Cases 1,643 2,244 Follow-up Cases 216 223 Total Home Visits 2,041 2,675 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 those inspections during the year was:- 1939 1940 Entrants 342 495 Intermediate 410 541 Leavers 494 366 Other Routine Inspections 21 - 1,267 1,402 78 sessions were held at the Schools and 433 children were found to have some defect requiring treatment or observation. VISITS TO SCHOOLS: re Personal Hygiene 51 102 Children examined 8,184 7,992 Found Unclean 62 51 Children seen at other visits 1,717 1,937 CLINIC SESSIONS ATTENDED: Minor Ailment Clinics ,, ,, 258 265 Inspection Clinics 106 132 Eye Clinics 37 40 Immunisation Clinics 78 89 Aural Clinics 7 19 Dental Clinic 70 50 27 (b) Other Inspections. In addition to the above groups, 1,107 "Special" Inspections were made of children referred to the Medical Inspector either at the School or the Clinic, or to Specialist Clinics for examination. 1,730 re-inspections were made of the above routine or special cases, compared with 1,952 in 1939. (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 332 (b) From other Inspections 439 Total 771 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. 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 1939:- School. Sessions Held. Attendances. Average per Session. 1939. 1940. 1939. 1940. 1939. 1940. Alexandra 52 74 512 512 9.8 6.9 Churchfields 52 41 1,584 594 30.4 14. 5 Hawes Down 45 44 389 790 8.6 17.9 Marian Vian 61 38 1,483 684 24.3 18.0 Wickham Common 48 45 681 514 14.1 11.4 Stewart Fleming - 10 - 109 - 10.9 Totals 258 265 4,649 3,339 18.0 12.6 Inspection Clinic. An Inspection Clinic was held on Tuesdays, Wednesdays and Fridays throughout most of the year. • The total attendandances were 1,692 compared with 2,580 in 1939. The total Sessions held was 132, the a verage attendance being 12.7 per session. ' 28 EYE CLINIC. 40 Sessions were hold, 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 28.8 which compares with 31.7 last year. I.W.C. S.M.S. County Attendances by new cases Attendances by other cases 38 128 109 667 38 171 Totals 166 776 209 DENTAL REPORT 1940 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. The year commenced with most of the school population attending for instruction, some in the mornings, some in the afternoons, with several schools accommodated in one building, but as the shelters at each school were completed the scholars gradually moved back to their own Schools. It was thus possible to carry out the routine inspection at each School as the year advanced. At the end of January, Mr. Carr, the part-time Dental Officer, terminated his appointment to take up a wholetime appointment with the Middlesex County Council. In view of the large evacuation of children privately, it was not considered desirable to appoint a successor. It was also found more convenient to change the Clinical Sessions at West Wickham from Tuesday mornings and Thursday afternoons to Wednesdays - all day. In May, the Kent County Council devided to undertake the dental inspection and treatment of the scholars in the Boy's and Girl's Secondary Schools and the Trade School The Clinic at the Town Hall being used on Wednesdays for this purpose. Prior to these arrangements, Secondary School children were referred through the Headteachers and dealt with by the Beckenham Staff, but this only touched the fringe of the dental needs of these children, as there had been no routine dental inspection. In reviewing the attendances during the year, things went smoothly until the "blitz" commenced, and for a few weeks at that time attendances fell rather badly, but an attendance figure of 32,000 is, in my view, a reasonably good one. It reflects groat credit on the parents of 29 Beckenham who, despite sirens and bombs, are deternined that the dental needs of their children shall not be neglected. The results of the Annual Inspection were as follows: No. of Inspections 38 No. of Children Inspected 3,823 No. of Children referred for treatment 2,924 No. of Children refused treatment 705 The comparable figures of attendances and treatment:- 1939 1940 Attendances 3,538 3,200 Children Treated 2,340 2,219 Fillings 3,402 2,865 Extractions 2,882 3,069 The extractions of permanent teeth numbered 514 and of these 80 were sound teeth removed for regulation purposes and 2 were supernumerary teeth, a total of 82 thus reducing the loss of teeth due to caries to 432. The number of cases of Irregularity treated by extraction was 53, and by mechanical means - 8. One denture was supplied to replace upper incisors lost through caries. Five upper incisors were crowned following accidental fracture. The number of scholars treated, iron the secondary schools was 26, and they made 55 attendances, but as I have stated above, commencing in May, the further treatment of these children was undertaken by the Kent County Council. Summary of Terminal Reports. Children Inspected 3,823 No. of Attendances: New cases 2,219 Old cases 849 Specials 132 3,200 No. of Fillings: Permanent Teeth 2,465 Temporary Teeth 386 Root Fillings 9 Crowns 5 2,865 No. of Extractions: Permanent Teeth 514 Temporary Teeth 2,555 3,069 50 Dressings 379 Silver Nitrate 242 Scalings 20 Regulation Appliances 8 Denture 1 Nitrous Oxide Administrations 814 Local Injections 500 In July this year, Miss Monck, the Dental Nurse, was transferred to the Medical side as School Nurse and I should like to place on record the valuable assistance Miss Monck rendered to the dental service during a period of just over 14 years. Miss Bradford was appointed as dental attendant and has carried out her duties very satisfactorily. I am Indebted to Dr. Marsh and Dr. Friedlander for the administration of nitrous oxide and to the Head Teachers for their help and interest in the dental service. ROBERT A. WATERS, L.D.S. Eng. REPORT ON WORK OF AURAL CLINIC IN 1940. Sessions held Total Attendances New Cases. Re-examinations In faints. School. Infants. School. 1938 11 436 23 79 43 291 1939 7 298 17 61 34 186 1940 19 212 13 36 17 146 This Clinic has continued to do useful work during the year, and the majority of cases cleared up with conservative treatment; many are now onder observation only, without needing any active treatment. In 35 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. G. H. HOWELLS, F.R.C.S. REPORT ON BECKENHAM ORTHOPAEDIC CLINIC 1940. The following summary shows the work of this Clinic during 1940, and comparative figures are given for the preceding years: Half-day Sessions. Surgeons Examinations. New Cases Re-examinations. School. Infants. School. Infants. 1940 118 38 34 149 47 1939 199 59 53 280 135 31 Year. Treatment by Nurse. Electrical and other Treatments. Fees Paid Massage. Exercises School. Infants ,, School. Infants. School. Infants. 1939 222 52 708 11 312 132 14.15.2 1940 139 61 264 8 122 61 7.13.0 The progress of children admitted to Hospital for the •correction of various deformities has been satisfactory in every case. ULTRA VIOLET RAY CLINIC. The sessions held totalled 90 and the attendances 790. Of these 474 were infants. A fee per attendance is charged in all but necessitous cases, and a total amount of £10.1.6 was received during the year. H.J.SEDDON, F.R.C.S. 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. PARENTS PRESENT AT ROUTINE INSPECTIONS. All parents receive written notice of the date of Routine Inspections at Schools and are invited to be present. 1,077 parents were present, representing 76.9 per cent. Only 3 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 cons ideration. The table shows that only 6.67 per cent of the children examined were found to be sub-normal and 3 children were considered as coming within the fourth group as "Bad Nutrition." 32 PROVISION OF MILK AT SCHOOL. A sum of £100 was allowed, in the estlmates to provide milk at school for children selected by the School Medical Officer. Despite considerable difficulty, the provision of milk at cheap rates for consumption at School has been maintained during the year. 317 children have received this daily issue during the year. SECONDARY SCHOOL CHILDREN. The Committee's Specialist Clinics are available for children attending the Secondary Schools. The attendances made during 1940 were:Dental Clinic 26 cases nade 55 attendances Orthopaedic Clinic 3 " " 6 " Eye Clinic 86 " "209 " FEES PAYABLE. The scale for all forms of treatment is set out on page 153 vol.29 of the Education Minutes. PARKS TONE CONVALESCENT HOMES. During the year 12 boys and 13 girls were sent for periods of six weeks' stay and all gained in weight and improved in general condition. The Hone was closed in August owing to the lack of shelter from air attack. EMPLOYMENT OF CHILDREN aND YOUNG PERSONS. Under the Committee's Byelaws, 38 certificates were issued during the year. This nunber conpares with 102 in 1939. No Licences to take part in Stage Plays were issued. SPECIAL SCHOOL for MENTALLY DEFECTIVE CHILDREN. The Special School, under the direction of Miss L.Ross, has continued during the year in temporary premises. 1 child was admitted during the year from Bromley. The number on the roll at 31st December, 1940 was 14. (Beckenhan: 5 boys and 7 girls. Penge: 1 boy. Bromley: 1 boy) MEDICAL INSPECTION RETURNS, 1940 TABLE I. Medical Inspection of Children Attending Elementary Schools. "A" - Routine Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 495 Second Are Group 541 Third Age Group 366 1,402