BEC 9 BOROUGH OP BECKENHAM. REPORT on the HEALTH OF THE DISTRICT during 1941 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. 2. STAFF OP PUBLIC HEALTH DEPARTMENT. Medical Officer of Health, and School Medical Officer T. Philips Cole, M. ., D.P.M., School Dental Officer R. A. aters, L.D.S., R.C.J., Asst. to the Medical Officer Miss Sheila Thomson, ; M.B., D.P.H. Chief Sanitary Inspector E. G. Moore, Cert.R.S.I., I .S.I.A. Sanitary Inspectors H- G. Richards, A.R.S.I., M .S.I.A., Cert. Pood Inspector. E.U. Villams, Cert. R.S.I. , Cert. Food Inspecctor. R. C. Rogers, Cert. R S.I. (On Military Service from 6/3/'-11.) Health Visitors Miss E.P.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. Pol le, S .R . M. , S . C . M. , H.V's Cert. School Purses Miss B.D.'Sizer, S.R.N., S.C.M. Miss I .I.M .Monck, S ,R .N. , C .N . , (On Military Service from 5/12/40) 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. Pood Inspector. Assistants J. Dungay (On Military Service from 13/2/12.) S.P. Lewis (On Military Service from 16/ll/40.) S.B.Hawley (On Miliary Service from 7/4/41.) Temporary StaffMiss G. Portch Miss E. Lindfield Miss J. Buckfield. The list of Specialist Officers in connection with School Medical work appears at the beginning of the School Report. 3 INTRODUCTION TO ANNUAL REPORT FOR 1941 . The work of the Department continued throughout the year on a basis and. scale comparable with the years before the war. For the last eight months of the year the Borough was free from attacks from the air. The figures from the Registrar General- which are necessary for calculating the various statistical notes are unlikely to reach us in time for inclusion in this Report. There were ho significant outbreaks of Infectious Disease during the year. The incidence of Diphtheria remained very low; and there was a sharp drop in the number of cases of Scarlet Fever notified - but this was only in accord with the regular periodical rise and fall in incidence which has been noted in the Borough for many years. There was a limited outbreak of Typhoid Fever in the early autumn: a special,report on this was presented to the Public Health Committee at the time and this has been incorporated in the present Report. Measles was prevalent in two parts of the Borough in the late,Spring and early Summer, and Whooping Cough was prevalent in the Autumn and early Winter. The number of children immunised against Diphtheria was much larger than in any previous year, and this increase may beat tributed to the attention devoted to the subject in the National Press and by the British Broadcasting Corporation. This suggests that many people, who have remained quite uninfluenced by persistent local propaganda, have an implicit faith in what they read in the newspaper or hear over the "wireless". Needless to say the Public Health Official welcomes whole-heartedly, though sometimes with a rather wry smile, such powerful aid. a close watch has been kept on the nutrition of the children. This is a matter which will be of ever-increasing importance as the months go by. There is undoubtedly an increase in the number of children whose nutrition is not entirely satisfactory, and although this has not so far been reflected in an increase of sickness or invalidity, there are no grounds for complacency. It is to be hoped that full advantage will be taken of the arrangements being made by the Education Committee for providing mid-day meals for the School children, and that in the near future every child in the elementary schools who needs it will have the benefit of the extra food which is so essential for proper growth and development. The Government has made a great effort to maintain the milk supply for children, and 85 per cent of the children in attendance have milk at school: there is no reason why this figure should not be 100 per cent. But valuable as milk is it cannot entirely take the place of other 4 first-class proteins of animal origin, the supply of which is so inevitably restricted by the conditions of war. In the latter part of the year the Government provided fruit juices and Cod Liver Oil for the very young children; those were distributed through the Agency of Local Authorities, and in Beckenham over 80 per cunt of those eligible for the issue took advantage of it. The Housing Question is another matter which will cause anxiety. Many houses for the working classes, which have required constant attention to maintain them in a habitable condition, have been internally shaken to their foundations by the explosion in their vicinity of High Explosive bombs. In many instances, although the houses are not in a structurally dangerous condition, evils such as "rising damp" have now passed the stage at which they can be remedied, and the closure of these houses as unfit for habitation is becoming inevitable. The personnel of the Public Health Office has changed repeatedly during the year; the Chief Clerk, Mr. S. ¥» Collett is, at the time of writing, the only member of the pre-war staff remaining with us. The members of the permanent staff spent much time and trouble, prior to their departure to serve with the Forces, in instructing the temporary staff in their duties, and the latter have adapted themselves quickly and creditably to their new work. The Assistant Medical Officer, Dr. 3. Thomson, has relieved me of a great deal of the routine clinical work of the Maternity and Child Welfare and School Medical Services, and I am grateful to her, to Mr. Collett, and to all the members of the staff, professional and clerical, for their loyal and willing service. T. PHILIPS COLE. Medical Officer of Health. 31st March, 1942. 5 NATURAL AND SOCIAL CONDITIONS. Details of the area and character of the district have been given in previous reports. No figures relating to population are being published this year. UNEMPLOYMENT AND PUBLIC ASSISTANCE. The Kent County Council Public Assistance Department state that out-relief was given in Beckenham anc. West Wickham during the year to 201 cases. PUBLIC MORTUARY There were 45 cases of sudden death in the district during 1941, 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 4 homes on the register; no new. applications were received during 1941. The Medical Officer of Health and Assistant M.O.H. paid 26 visits of inspection to the premises and found the records and equipment satisfactory. Local papers were 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 9 registered Foster Mothers having charge of 12 children. At the end of 1941 there were 10 children under the care of 7 Foster Mothers. The Health Visitors made 74 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 children up to the age of five years. 6 NOTIFICATION OP BIRTHS The births registered were lower than for several years past, ANTE-NATAL WORK In 181 of the births in, and belonging to the area, the services of a private medical practitioner were engaged, and the remainder were attended by midwives. It is for these latter cases that examination and supervision at the Ante-Natal Clinic is intended. 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; this work necessitated 454 visits during 1941. 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 685 compared with 830 in 1940. 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 64 Number of mothers attending for examination 222 Number of attendance made 685 The arrangements worked smoothly and the appointments were well kept both by doctors and patients. In 6 cases X-ray examinations were carried out at a local hospital to assist in diagnosis. The Assistant Medical Officer saw 71 now cases, made 52 re-examinations of expectant mothers, and made 2 post natal examinations. The Obstetric Specialist, Mr.D.M.Lindsay, held 25 sessions and saw 12 ante-natal cases and 131 post-natal cases. HOME HELPS A list of approved "Home Helps", that is,women who undertake domestic work and look after the family during a mothers 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 1941, the Health Visitors made a home visit to 483 new cases. The work done is summarised below:- Home Visits, New. Under One. 1 to 5 Special Illness 1 Expectant Mothers A.R.P. Cas Masks for Babies Boarded Out No Reply Total Visits Temporary Nurse 75 114 302 40 45 14 4 110 704 Miss Smith 185 513 766 205 175 158 40 485 2527 Miss Wheeler 90 89 102 76 43 59 7 208 674 Miss Noble 133 1 387 911 180 139 124 23 176 2073 483 1103 2081 501 402 74 979 979 5978 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 Comparatiy Total 1940 Individual Children 362 241 535 29 0 271 488 2198 2202 Total attendances 2267 1713 4324 3636 2256 4698 18894 19743 New Cases 103 46 169 204 92 140 754 786 Average Sessional attendance 44 33 44 38 45 . __ . 46 43 39 Sessions 51 51 97 95 50 101 435 502 Sessions attended by Medical Officer 51 50 50 50 50 52 303 309 Cases seen by Medical Officer 724 397 915 984 591 1283 4894 4706 Average No. per Session seen by M.0. 14 8 18 19 12 22 16 15 8 FOLLOW ING-UP OF 2 TO 5 YEARS OLD CHILDREN. The follwing figures show the attendances of children in age groups. Year born Total who attended. Attendances made. Average number of attendances per child. 1936 169 719 4.2 1937 306 1,587 5.1 1938 411 2,322 5.6 1939 419 3,150 7.5 1940 401 6,057 15.1 1941 492 5,059 10.12 Total 2,198 18,394 8. 5 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 wore sold, FREE MILK TO NECESSITOUS CASES. The supply of milk for children under 5 has been taken over by the Milk Board, and the Council retain only the cation of supplementing supplies in special cases. The Milk Officer reports that since the Scheme came into operation, a very large, number of permits have been issued, 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. SPECIAL TREATMENT. Arrangements have been made for children from i - 5 years of age to participate in the special services available for school children and the use made is shown by the following attendances:- Eye Clinic. U.V. Ray Orthopaedic Aural Clinic, Clinic Clinic. Infants 42 548 114 27 1941 Mothers ETERNITY & . CHILD WELFARE DENTAL REPORT 1941 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 398 compared with 490 in 1940. The number of children treated was 312 compared with 150 in 1940, and the number of adults 72 compared with 109. Adults Childrern Attendances 206 192 Number treated 72 112 Extractions 221 177 Fillings 32 69 Dressings 50 64 Silver Nitrate - 40 Local Injections 15 5 Nitrous Oxide administrations 53 46 Ethyl Chloride administrations - 17 Impressions etc. 47 - Scalings 3 - Dentures 30 - Repair 1 - 10 BECKENHAM AND PENGE JOINT MATERNITY HOME The number of admissions in 1941 was 310, compared with 405 in 1940. 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 Tinder the Ante-Natal Scheme. OBSTETRIC CONSULTANT'S CLINIC In the year 1941, there were twenty-one instances in which Consultant Advice was requested by local practitioners. The cases were distributed under the following headings:- (a) Contracted Pelvis Disproportion - spontaneous delivery Disproportion - Caesarean Section Disproportion - spontaneous delivery Uterine inertia - Forceps Prank Breech - spontaneous delivery Par Via Naturalls (b) Mal Presentations Breech - ante-natal opinion Breech - extended legs, contracted pelvis - Caesarean Section Transverse - external version Irreducible Transverse lie - internal version Irreducible Transverse lie - Caesarean section ( c) Toxemia Albuminuria of Pregnancy Albuminuria of Pregnancy (d) Puerperal Pyrexia Retained membranes Retained membranes Pyelitis Infected episiotomy wound Influenza (e) Miscellaneous Failed forceps - spontaneous delivery - puerperal peritonitis Post maturity - medical induction Retroverted gravid uterus 11 ANNUAL STATISTICS FOR 1941 (Relating to the Beckenham and Penge Joint Maternity Home) [No. Information Required Particulars 1. Name and Address of Institution. Beckenham & Penge Joint Maternity Home. 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 Beckenham 228) 310 admitted during the year Penge 79) Out District 3) 4. Average duration of stay 14 days. 5. Number of cases delivered by:(a) Midwives 236 (b) Doctors 65 (c) Post-Natal Cases 5 (Four patients transferred to Hospitals undelivered) 6. Number of cases in which medical assistance was sought by a midwife in emergency. 103 7. Number of cases notified as:- (a) Puerperal Fever Nil (b) Puerperal Pyrexia 11 8. Number Of cases of Pemphigus Neonatorum. Nil 9. Number of infants not entirely breast-fed while in Institution 15 10. (a) Number of cases . notified as Ophthalmia Neonatorum One (b) Result of treatment in each case Satisfactory, 11. (a) Number of Maternal Deaths Nil. 12. (a) Number of Foetal Deaths: (i) Stillborn 8 (ii) Within 10 days of birth 3 12 INFECTIOUS DISEASE The table on the following page gives the number of cases which were notified during the year, and the age grouping. ... Diphtheria has not been prevalent for several years; the incidence of Scarlet Fever remained low. Measles was prevalent in the first six months of the year. DIPHTHERIA The number of cases notified was 8 the same as in 1940. 6 cases occurred in the original Beckenharm area and 2 were Service cases. The age incidence was:- 0-5 yrs. 5 - 14 yrs. 15 .Yrs & over. Nil. 4 4 DIPHTHERIA IMMUNISATION. Consents were received in respect of 1569 children and 781 of these were under school age. 216 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. SCARLET FEVER. The number of cases notified was 33. This was considerably less than the numbers notified in 1940 and 1939, when the figures were 65- and 201 respectively. The fall in the notifications of Scarlet Fever coincided with the outbreak of war. Nineteen cases occurred in original Beckenharm and 13 in West Wickham, and there was one Service case. The age incidence Was:- 0-5 yrs. 5 - 14 yrs. 15 yrs & over. 5 19 9 MEASLES. The number of cases notified among the civilian population was 244. Of these 65 were in original Beekenharm and 179 in West Wickham. 13 Disease Notified Age Groups 15/20 20/35 35/45 45/65 Over 65 Undr 1 1 22 33 44 55 10/15 Diphtheria 6 - 2 8 2 2 4 Scarlet Fever 19 13 1 33 1 2 2 14 4 3 2 Cerebro-Spinal 5 1 1 1 7 1 1 2 1 2 Pneumonia 24 4 - 28 1 2 3 2 2 1 2 2 3 10 Puerperal Pyrexia, 16 - -16 1 13 2 Erysipelas 6 3 - 91 2 1 1 5 Enteric 5 — - 5 2 1 2 Ophthalmia 1 - - 1 1 Measles 65 179 - 244 10 7 19 10 182 9 3 4 German Leasles - — - - Whooping Cough 96 37 -133 5 4 14 13 6 86 2 1 2 Totals 243 237 4484 6 16 24 38 20 286 21 13 31 7 7 15 bacteriological WORK The number and results of the examinations made at the Public Health Department Laboratory during 1941 was:- Disease suspected Total 1941 Results Comparative Positive Negative Total - 1940 Diphtheria 141 4 137 135 Tuberculosis 92 11 81 94 Other diseases 3 - 3 20 Totals 236 15 221 249 14 GEREBRO -S PI HAL MENINGITIS. The incidence of this disease is greatly increased in war-time. Six out of the seven cases which occurred in 1941 were from the civilian population in Beckenham, and one was a Service case. TYPHOID FEVER. Since the end of July, six cases of Typhoid Fever have come to the notice of the Department. Three cases were notified by Medical Practitioners, one was reported by another Local Authority, and the remaining two were reported by the Medical Officer in charge of the Regional Laboratory of the Ministry of Health. Details of the cases were as follows: Case 1. Male aged 51 Suffield Rd. onset 26.7-^41 • " 2. Male " 17 Sidney Rd. " 1.9.14I. " 3.Female " 19 Tennyson Rd. 11 3«9*U1» " 14. Female " 52 Mackenzie Rd. " l6.9«^l« " 5. Male " 34 Beckenham Rd. " 20.9.U1* 11 6. Female " 18 Parish Lane " 30.9»ijl« It is doubtful if Case 1, was infected from the same source as the other cases; the interval between this case and the next case was very long, and careful enquiries failed to reveal any common factor: nevertheless the possibility cannot be definitely excluded. It will be noted that all cases live in that part of the Borough which lies to the west of the Mid-Kent line; and it is worthy of remark that the homes of cases 1, 2 and 3 were adjacent to bombed sites. However, from the evidence obtained from samples of water regularly taken by this Department, coupled with a report from the Metropolitan Water Board, it was quite clear that this was not a waterborne infection: it also became clear at a very early date that the infection was not caused by the milk supply. Moreover, the small number of cases reported made it unlikely that either water or milk was responsible. Careful enquiries were made into the sources of the food supply of the infected households, and it was found that two sources of food supply were common to all households of cases 2, 3 and 4. The foods which were thus under suspicion were (l) Potted Meat and (2) Fresh Fruit Salads. Neither of these foods are commonly cooked before consumption and both were therefore quite possible sources of infection. During the course of our enquiries, we learnt that there had been two cases of Typhoid Fever in Penge. The 15 Bacteriologist reported that the" infecting' organism in the Penge cases was of the same type as that found in Beckenham cases 2 and 4, thus providing reasonable evidence that there was a common source of infection. The Penge enquiries showed that the two sources of food supply mentioned above figured in both of their cases. It was at this stage that the.Beckenham case 5 was reported; and enquiries made it clear that the patient had not eaten food from either of the two sources under suspicion; this seemed to negative our previous suspicions, however, further examination of this particular patient failed to confirm the diagnosis of Typhoid Fever. Case 5 may therefore be ignored. Case 6 was reported 10 days later, and the same source of supply of Fresh Fruit Salads appeared in this household's shopping list. Investigation had therefore indicated that the infection was conveyed by Presh Pruit or Salads from one particular source. This was in accord with probabilities; the potted meat in question was obtained from a firm which has several shops in the neighbourhood: enquiries from the firm in question showed that this potted meat was made and packed in a Central Depot, whence it was distributed to all of the firm's branches: had the potted meat been .responsible for the infection, one might quite reasonably have expected that cases would have occurred among families who had purchased it from other branches of this firm in the neighbourhood; but this was not the case; all the potted meat purchased came from one particular branch. Suspicion was therefore directed to the establishment which sold the fruit and salads; but on the facts so far known it could be nothing more than suspicion: to definitely establish it, it was necessary to find, out whether there" was a reasonable likelihood of the food being contaminated whilst on the premises from which it was sold. The necessary specimens were obtained from all the persons employed on the premises, and these specimens were examined at the Regional Laboratory of the Ministry of Health. (Similar examination was made of the employees at the shop where the potted meat was sold). The examination disclosed that one of the assistants in the green-grocery business was a carrier of the Typhoid bacillus. This assistant lived in the Urban distric of Penge: he was promptly suspended from work until subsequent examinations proved that he no longer carried the infection. Beckenham Case 6 was the last case to be reported in either Beckenham or Penge, and with the detection of the carrier, the source of the local outbreak was considered to have been reasonably established. Throughout the investigations the Health Departments of Beckenham and Penge worked in close co-operation, and this co-operation contributed very materially to the success achieved. 16 It is noteworthy 'that daring August and September cases of Typhoid Fever were occurring all through the Greater London area, and that in every case the infecting organism proved to be of the same type and strain as the organism responsible for the cases in Beckenham and Penge. It is reasonable to suppose that the agents in each locality were infected from one central source, but up to the present I have seen no report of the Ministry of Health dealing with this limited outbreak. The outbreak shows that surface contamination of food by a carrier can cause outbreaks of Typhoid Pever; but such outbreaks are seldom, extensive, and the number of persons infected is usually small - in marked contrast with the epidemics which are due to infection of the water and milk supplies. PUERPERAL PYREXIA. 16 cases were notified: 11 occurred in the Beckenham and Penge Joint Maternity Home and 5 in private homes. OPTHALMIA NEONATORUM. One case was notified. TUBERCULOSIS . The total of 58 cases compares with 65, 66, 71, 60and 72 in the preceding five years. In addition to the. 58 new cases there were 28 definite cases transferred from other areas, 7 cases restored, to the register and 5 cases were not notified until after death. At the end of the year the number of notified cases in the area was:- 163 Pulmonary Males, 149 Pulmonary Females, 33 non-pulmonary Males, and 37 non-pulmonary Females; a total of 382 cases, which compares with 381 last year. 99 cases were placed off the register for the following reasons: Died 25. Cured 28, Left area 46. 17 TUBERCULOSIS (Cont.) Notification: In 5 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 schemes. PUBLIC HEALTH (PREVENTION Of TUBERCULOSIS) REGULATIONS, 1925 No occasion has arisen during the year to exercise the powers conferred by these Regulations of prohibiting any person engaged in the milk trade from continuing his employment. PUBLIC HEALTH ACT, 1936 (SECTION 169) It has not been necessary to apply for an Order under this Section for the removal of a patient to hospital. WHOOPING COUGH 133 cases were notified during the year by the doctor in attendance. chickenpox No cases were notified by doctors. mumps No 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 302 cases during the year, and 285 of. these were infants under one year of age. 18 SANITARY inspection of the district 1941 Summary of Inspections and Visits. Visits and Inspections Overcrowding 6 Housing 21) 1 Nuisances 1167 Cowsheds 65 Milkshops 253 Bakehouses 135 Butchers' shops 352 Slaughterhouses 4 Places where food is prepared 47 Shops where food is stored 482 Factories 262 Outworkers 18 Rats and Mice Act 333 Stables 108 Fried Fish shops 59 Ice Cream vendors 1 Verminous premises 53 Drainage 614 Infectious disease 59 Samples taken under Sale of Food and Drugs Acts 201 Samples of Milk taken for Bacteriological Examination 12 Samples of Water 37 Shops Acts 90 Miscellaneous 342 Interviews 1897 Civil Defence: A.R.P. Lectures & Demonstrations 459 Bomb damage to premises & drains 1 746 Bomb damage to Food Shops 54 Billeting 3 Shelter Inspections 13 9113 Nature of Nuisance or Defects Remedied. No. of defects Remedied. Choked Drains 414 Drains defective or altered 151 Defective gullies 2 Defective W.C. pans or choked W.C.s 31 Flushing apparatus to W.C. defective 6 19 Nature of Nuisances or Defects Remedied (Cont.) No. of defects remedied Dirty W,C. pans 1 W.C. apartments, dirty or defective 15 Waste pipes, defective or untrapped 7 House sinks, defective 2 Soil pipes, defective 1 Ventilating shafts, choked or defective 2 Fresh air inlets, defective 3 Manhole covers, defective or unsealed 39 Water supply cisterns, uncovered, dirty or defective 4 Galv. Iron dustbins, defective or absent 10 Defective pointing 8 Dampness 54 Rain-water pipes, defective 5 Defective gutters 7 Defective roofs 18 Defective floors 14 Defective walls 18 Defective ceilings 19 Dirty walls 18 Dirty ceilings 20 Yard paving defective or absent 3 Defective stoves 12 Defective airbricks 2 Defective windows and fittings 15 Defective doors 3 Accumulation of offensive material 14 Insufficient ventilation to room 1 Verminous rooms 5 Defective cement rendering 1 Defective stairs and handrails 2 Absence of water supply 5 Rats, premises freed of 27 Absence of Statutory Information in Rent Book 5 Miscellaneous Shop Acts, Defects 6 Miscellaneous 14 Keeping of Animals contrary to Bye Laws 6 991 20 PREMISSS CONTROLLED BY BYE-LAVS 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 318 inspections. One defect remedied. Bakehouses 135 inspections. Six defects were remedied. Pried Pish Shops 59 inspections. Conditions satisfactory. Meat Shops (Butchers) 352 inspections made. Satisfactory conditions. Places where food is prepared 47 inspections. Conditions satisfactory. Shops where food is stored 482 inspections. Conditions satisfactory. Slaughterhouses 4 inspections. Conditions satisfactory. Ice-Cream Shops 1 inspection. Satisfactory Premises where animals are kept Six contraventions of the Byelaws found during the year. All remedied. Stables (Manure Pits) 108 inspections. Conditions satisfactory. The Shops Acts. During the year 90 visits were made under the above Acts. The following defects were remedied during the year: Dirty and defective V.C. apartments 2 Dirty walls and defective walls & ceilings 3 Absence of forms 4 Absence of Sanitary accommodation for females 2 21 Factories. During the year 262 visits were made to premises on the Register. At 6 premises, nuisances were remedied after the service of informal notices, as under:- Dirty W.C. apartments 5 Choked drain 1 Dirty walls and ceilings 2 Dampness 1 Defective Roof 1 Defective gutters 1 Absence of intervening lobby to W.C. 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) 241 (b) Number of inspections made for the purpose 241 (a) Number of dwelling-houses (included under sub-head (1,) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 37 . (b) Number of inspections made for the purpose 37 Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil Number of dwellinghouses (exclusive of those referred to under the preceding subhead) found to be not in all respects reasonably fit for-human habitation 178 2. Remedy of Defects during the Year without service of Formal Notices:- Number of defective dwellinghouses rendered fit in consequence•of informal action by the Local Authority or-Its Officers 185 inspection and supervision of foods. Sampling. There were 201 samples of food"taken during the year. A certificate of adulteration was given by the 22 County Analyst in respect of a sample of mustard which was adulterated to the extent of 15 per cent. of starch. The Vendors were prosecuted but the case was dismissed on payment of £3. 3. 0. costs. Bomb Damage. 54 visits were made to food shops after damage by blast and a large quantity of food examined for the presence of glass particles.Some of the damaged food was used for poultry feeding and a small amount diverted to manufacturing purposes. Meat Inspection. All the slaughterhouses in the district are closed for the duration of the War. Other Poods The various food shops in the area- were frequently inspected and the undermentioned articles surrendered as unfit for food. Whenever possible the articles were put to some other useful purpose. Article Condition Weight in lbs Leg of Pork Extensive bruising 13¼ Mutton Putrid 4¾ Beef Putrid 5 Forequarter of Beef Tuberculosis 129 Horseflesh Putrid 2½ Bacon do. 16½ Rabbits (2 cases) do. 130 Cheese do. 3 3 Tins Ox Tongues do. 25½ 13 tins of Chicken & Ham Roll do. 48½ 1 tin Ham do. 16 3 tins Pork Luncheon Meat do. 18 . Cakes do. 36 2 Tins Meat Roll do. 6 1 Tin New Potatoes do. 1½ Eggs do. 344 13 tins Evaporated Milk do. 455½ 3 Tins Condensed Milk do. Rats & Mice Destruction. The services of a Rat Catcher were retained throughout six months of the year and systematic treatment given to various properties owned by the Corporation. A considerable amount of time was necessary to deal with bombed sites which became infested. 23 INTRODUCTION TO REPORT ON SCHOOL MEDICAL SERVICE The routine examinations of children had been disturbed by irregular school hours but during 1941 all leeway Was made up and in some schools all the children were examined irrespective of age groups. This gave an opportunity of making some comparison with the physique of children in previous years, and under the heading of Nutrition in the report some instructive figures are set out. The Clinic Services have been well maintained and all the Specialist Officers continue to hold well attended Clinics. With the absence of Miss Monclc on Military Service, Miss Sizer has covered all the schools so far as possible with the assistance of a part time nurse. ANNUAL REPORT ON WORK OF THE SCHOOL MEDICAL SERVICE . Statistics Relating to Education, Census population of Beckenham (1931) 43,834 Number of Elementary Schools 8 Number of Departments 18 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 1/3 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) Anaesthetist to Dental: Alan R. Marsh, K.R.C.S. L.R.C.P. Clinic (part-time) Ophthalmic Surgeon :A.E.A. Locseloy, F.R.G.S. (Eng.) (part-time) 24 Orthopaedic Surgeon : J. A. Cholneley, F.R.C.S. (Eng). (part-time) Aural Specialist : G. H. Howells, F.R.C.S. (Eng.) (part-time) School Nurse : Miss B. D. Sizer, S.R.N., S.C.M. Dental Attendant : Miss G. Bradford (5/6ths time to School work) Orthopaedic Nurse : Miss E. N. Sutton, C ,3.M.M.G. (part-time) WORK OF THE SCHOOL NURSE; The home visits to cases of infectious disease, absentees from school, cases who fail clinic appointments, etc. are made by the School Nurse, in addition to attendance at the Minor Ailment, Inspection and Special Clinics: the following figures give some indication of the amount of work done during the year:- Total Total HOME VISITS: 1941 1940 To cases of Infectious Disease 443 208 Other Cases 2,759 2,467 Total Home Visits 3,202 2,675 VISITS TO SCHOOLS: re Personal Hygiene 70 102 Children examined 6,7517,992 Found Unclean 27 51 Children seen at other visits 1,991 1,937 CLINIC SESSIONS ATTENDED. Minor Ailment Clinics 230 265 Inspection Clinics 126 132 Eye Clinics 38 140 Immunisation Clinics 93 89 Aural Clinics 5 19 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:- 25 1941 1940 Entrants 557 495 Intermediate 553 541 Leavers 504 366 Other Routine Inspections 754 - 2,368 1,402 102 sessions were held at the Schools and 791 children were found to have some defect requiring treatment or observation. (b) Other Inspections. In addition to the above groups, 589 "Special" Inspections were, made of children referred to the Medical Inspector either at the School or the Clinic, or to Specialist Clinics for examination. 2,323 re-inspections were made of the above routine or special cases, compared with 1,730 in 1940. (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. Written appointments art 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. The only special condition calling for comment is the nutrition of the children. Nutrition. In all visits to the schools by the medical and nursing staffs, careful attention was paid to the. state :of nutrition of the children. The term "nutrition" must not be considered merely as a question of body-weight; it includes all those factors which enable a child to live an active normal life, and to offer a satisfactory resistance to the many infections to which, in modern civilised communities, children are inevitably exposed. The impression gained by the Medical Officers during the year was that the general condition of the children was reasonably satisfactory. The majority of the children were physically active and mentally alert; tbere was little evidence of anaemia: the eyes were bright and the tone of muscles good: and there was no sign of any diminution in the powers of resistance. But there was no doubt that 26 there were more children in the schools whose nutrition was not quite satisfactory than there wore in the years before the war, and it was noticed that there were many children, otherwise quite healthy, who were decidedly thin; the impression obtained was that these children were maintaining their state of nutrition by drawing on their reserves - a state of affairs which must in the long run have undesirable results. In my Annual Report for the year 1932 I discussed at some length the use of the weight-height ratio as an index of nutrition. I indicated that it was subject to certain limitations, and that it could not be used astan absolute index of physical condition. Since that time careful records have been kept each year of the weight-height ratios of all the children seen at the Routine Medical Inspections in the schools: not because they provided an absolute index, but because they did provide a useful comparison by which to detect any untoward variations. In the Report for 1932 I included tables which showed the percentages of children whose nutrition was unsatisfactory when judged simply by the weight-height ratio. a similar Table has been prepared from the results of the Routine Medical Inspections carried out in 1941. This Table compares rather unfavourably with the 1932 Table, and though, I repeat, the figures cannot be regarded as giving an absolute Index of the children's physical condition, they do indicate that the condition of 1941 was not sosatisfactory as that of 1932. Entrants (5 & 6 yrs) Intermediates (8 yrs) Leavers (12 yrs) Boys Girls Boys Girls Boys Girls 1932 13.4 14.0 21.3 29.1 28.7 44.3 1941 14.25 16.4 26.7 42.8 33. 9 45.9 As in 1932 there were remarkable differences in the different schools. This is illustrated in the following table. (Bromley Road School is not included in the Table, because the numbers examined were too small to provide a reliable figure.) 27  Entrants Intermediates Leavers. Boys Girls Boys Girls Boys Girls. Alexandra 6.06 8.0 23.3 40.7 24.1 - Balgowan 21.2 17.4 - - 23.8 36.2 Churchfield 9.6 8.5 16.6 22.2 - 29.7 Stewart Fleming 22.2 25.0 48.0 40.0 - - Marian Vian 9.5 9.6 4l.2 71.4 42.4 74.2 Hawes Down 20.0 27.6 4.9 18.7 53.2 58.2 Vickham Common 7.1 10.9 12.0 41.2 - - All 14.25 i6.4 26.7 42.8 33.9 45.9 1932 13.5 14.0 21.3 29.1 28.7 44.3 Points worthy of remark are the wide differences between the entrants at Alexandra, Churchfields and Marian Vian Schools on the one hand, and Balgowan and Stewart Fleming schools on the other; and the conflicting differences between the Entrants and Intermediates at Hawes Down and Wickham Common Schools. On the whole, the better figures prevail,in the more densely populated parts of the Borough, There are undoubtedly several factors responsible for these differences, one being the alterations (up and down) in family incomes: but I would repeat that the amount of rent paid is one very important factor; this applies with special force to those families who are purchasing houses through building societies, and whose incomes have been materially reduced by the war. The Table indicates clearly the desirability of proceeding as quickly as possible with the arrangements to provide mid-day meals at.all of the schools: it also indicates that the apparent home circumstances are not an entirely reliable guide in assessing the need for additional nourishment. WORK OF THE SPECIAL CLINICS Treatment of Minor Ailments. The attendances during the year are shown below, with comparative figures for 1940:- 28 School Sessions Held. Attendances Average Per Session. 1941 1940 1941 1940 1941 1940 Alexandra 42 74 284 512 6.7 6.9 Churchfields 44 41 820 594 18.6 14.5 Hawes Down 35 44 639 790 18.2 17.9 Marian Vian 42 38 768 684 19.2 18.0 Wickham Common 39 45 806 514 10.5 11.4 Stewart Fleming 28 10 409 109 14.9 10.9 Totals 230 265 3726 3339 16.2 12.6 Inspection Clinic. An Inspection Clinic was held oh Tuesdays, Wednesdays and Fridays throughout most of the year. The total attendances were 2,165 compared with 1,692 in 1940. The total Sessions held was 126; the average attendance being 15.2 per session. EYE CLINIC, 38 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 21.3.Which compares with 28.8 last year. I.W.C. S . M. S. County Total Attendances by new cases 18 88 23 129 Attendances by other cases 62 482 136 680 Totals 80 570 159 809 DENTAL REPORT 1941. To: The Chairman and Members of the Education Committee. I have the honour to present the Dental Report of the inspection and treatment of the Scholars in the elementary schools. In January the avacuation of school children took place from Alexandra, Churchfields and Stewart Fleming Schools, but apart from the official evacuation, there has been a considerable coming and going of children all the year. This has made it very difficult to keep an accurate check on the school population generally, and from a practical point of view has entailed visiting the schools on more occasions than would have been necessary normally. The inspection and treatment of all the schools was completed in ten months, and the following schools were 29 inspected and treated twice during the year viz: Bromley Road Infants and Junior Mixed and Senior Mixed, Churchfields Senior Girls and Alexandra Senior Boys, The number of children thus dealt with was 358 and for statistical purposes I have classed them as "Specials". The results of the Inspections were as follows:- No. of inspections 42 No. of Children inspected 3845 Routine 358 Specials 24,303 No. of Children referred 2765 Routine 242 Specials 3,007 No. of Children refused 6245 Routine 63 Specials 708 The comparable figures for attendances and treatment:- 19240 1941. Attendances 3,200 3,157 Children treated 2,219 2,299 Fillings 2,865 2,586 Extractions 2,882 3,375 The figure for fillings is lower and that for extractions higher. The fact that there were 2461 more children in the age group 5-8 years accounts for this and also for the increase in the number of anaesthetics cases viz: 88. The extraction of permanent teeth numbered 482 and of these 73 were sound teeth removed for regulation purposes and 4 were supernumerary teeth, a total of 77, thus reducing the loss of teeth due to caries to 405. The number of cases of irregularity treated by extraction was 58, and by mechanical means 11. One denture was supplied to replace a badly fractured upper incisor. The treatment of secondary school children, as indicated in the report for 1940, was carried out by the Kent Education Committee's Dental Surgeon at the Town Hall Clinic each Wednesday. Summary of Terminal Reports. Children Inspected 4,303 No. of attendances: New cases 2,120 Old cases 858 Specials 179 3,157 30 No. of Fillings. Permanent Teeth 2,097 Temporary Teeth 481 Root Fillings 8 2586 No. of Extractions: Permanent Teeth 482 Temporary Teeth 2,893 3375 Dressings 393 Silver Nitrate 183 Scalings 29 Regulation Appliances 12 Denture 1 Nitrous Oxide Administrations 902 Local injections 377 My thanks are due to Dr. Alan Marsh, and Dr. Sheila Thomson for the administration of nitrous oxide, to Miss Brodford the Dental Attendant and to the Head Teachers for the support during the year. ROBERT A, WATERS, L.D.S Eng, REPORT ON WORK OF AURaL CLINIC IN 1941. Sessions held Total Attendances New Cases Re-examinations Infants School Infants School 1939 7 298 17 61 34 186 1940 19 212 13 36 17 146 1941 5 140 7 72 9 52 This Clinic has continued to do useful work during the year, and the majority of cases' cleared up with conservative treatment; many are now under observation only, without needing any active treatment. In 92 cases, the removal'of tonsils and adenoids was recommended, G. H. HCWELLS, FvR.C.S. REPORT ON BECKENHAM ORTHOPAEDIC CLINI0 1941. The following summary shows the work of this Clinic during 1941, and comparative figures are given for the preceding year: Half-day Sessions. Surgeons Examinations. New eases. Re-examinations School Infants. School Infants. 1941 95 64 38 109 73 1940 118 38 34 149 47 31 Year Treatment by Nurse Electrical & other treatments. Fees Paid Massage. Exercises School Infants School Infhnts School Infants 1940 139 61 264 8 122 61 7.13.0 1941 154 207 492 13 101 19 12.10.6 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 88 and the attendances 998 school children and 548 infants. A fee per attendance is charged in all but necessitous cases, ana a total amount of £25. 10. 3» was received during the year, JOHN A CIIOLMELEY, 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. MALNUTRITION AND DEBILITY. The statistical tables at the end of this report include one giving .the classification' into four groups of all children who were examined at routine medical inspections during the year The groups are:- A - Excellent. B.- Normal. C- Slightly subnormal. D - Bad In classifying the cases the general well-being of the child and not the height and weight only were taken into consideration. The table shows that 10.89 per cent of the children examined were found to be sub-normal and no 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 estimates 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. 402 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 1941 were:Orthopaedic Clinic 6 cases made 22 attendances Eye Clinic 79 " " 138 FEES PAYABLE. The scale for all forms of treatment is set out on page 153 vol. 29 of the Education Minutes. PARKSTOHE CONVALESCENT HOME. During the year 6 boys and 6 girls were sent for periods of three weeks' stay and all gained in weight and improved in general condition. The Home was,closed in August owing to the lack of shelter from air attack. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Under the Committee's Byelaws 86 certificates were issued during the year. This number compares with 38 in 1940. The Committee have decided not to issue licences to take part in Stage Plays. SPECIAL SCHOOL FOR MENTALLY DEFECTIVE CHILDREN. The Special Schools under the direction of Miss L. Ross, has continued during the year in temporary premises. Five children have been admitted during the year, and four have left. The number of children on the roll at 31st December, 1941 was 17. (Beckenham; I4. Bromley: 1. Penge: 2.) MEDICAL INSPECTION RETURNS, 1941. TABLE I. Medical Inspection of Children attending. Elementary Schools "A" - Routine Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 495. Second Age Group 541 Third Age Group 366 35 "B': Other Inspections. Number of Special Inspections and Re-Inspections - 2,872 table II. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Number of Children Inspected a b C D Excellent Normal Slightly sub-normal Bad No. % No. % No. % No. % 1940 1394 374 26,83 927 66.5 90 6.46 3 0.21 1941 1614 430 26.65 1008 62.46 176 10.89 0 0.00 TABLE III Treatment of Minor Alliments. Total Number of Defects treated or under treatment during the year under the authority's Scheme was 1,621. Treatment ef Defective Vision and Squint Errors of Refraction dealt with under the Authority's Scheme vere 457. The number of children for whom spectacles were prescribed was 91, end for whom they were obtained was 86. Treatmcnt of/ Defects of Nose and Throat, 61 children received operative treatment under the Authority's Scheme, and 124. received other forms of treatment, making a total cf 185. TABLE IV Dental Inspection and Treatment Particulars of treatment under this heading will be found in the Dental Surgeon's Report. TABLE V. Verminouo Condition. (1) Average number of visits per school made during the year by the School Nurse 11 (2) Total number of examinations of children in the Schools by School Nurse 6,751 (3) Number of individual children found unclean 27 34 TABLE V. Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 17 (2) Total number of examinations of children in the Schools by School Nurses 7,992 (3) Number of individual children found unclean 31 (4) Number of individual children cleansed under Section 87(2) and (3) of the Education Act, 1921 Nil (5) Number of cases in which legal proceedings were taken Nil TABLE VI. Blind and Deaf Children (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