library bec10 BOROUGH OF BECKENHAM REPORT ON THE HEALTH OF THE DISTRICT DURING 1943 INCLUDING THE Report of the Medical Inspection of Children in the Elementary Schools BY T. PHILIPS COLE, M.B., D.P.H. Medical Officer of Health, School Medical Officer. BOROUGH OF BECKENHAM REPORT ON THE HEALTH OF THE DISTRICT DURING 1943 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. STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health and School Medical Officer T. Philips Cole, M.B., D.P.H. Deputy Medical Officer Miss Sheila Thomson, M.B., D.P.H. School Dental Officer R. A. Waters, L.D.S., R.C.S. Chief Sanitary Inspector E. G. Moore, Cert. R.S.I., M.S.I.A. Sanitary Inspectors H. G. Richards, A.R.S.I., A.R.P.S., Cert. Food Inspector. E. U. Williams, Cert. R.S.I, Cert. Food Inspector L.A.R.P. (On Military Service from 11/8/42). R. C. Rogers, Cert. R.S.I. (On Military Service from 6/3/41). W. Newman, Cert. R.S.I. Health Visitors Miss E. F. Smith, S.R.N., S.C.M., H.V.'s Cert. Miss R. Noble, S.R.N., S.C.M., H.V.'s Cert. (Resigned 31/12/43). Miss M. G. Kendall, S.R.N., S.C.M., H.V.'s. Cert. Mrs. M. Walmsley, S.R.N., S.C.M., H.V.'s Cert. (Appointed 1/11/43). Miss B. N. Chandler, S.R.N., S.C.M., H.V.'s Cert. (Appointed 1/1/44). 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 Home Miss D. Beard, S.R.N., S.C.M. Assistant Matron Miss H. Lomax, S.R.N., S.C.M. Chief Clerk S. W. Collett, Cert. R.S.I., Cert. Food Inspector. Assistants J. Dungay (On Military Service from 13/2/42). S. P. Lewis (Killed on Military Service 17/7/44). S. B. Hawley (Killed on Military Service 17/5/43). The list of Specialist Officers in connection with School Medical work appears at the beginning of the School Report. 2 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 available this year. PUBLIC MORTUARY. There were 47 cases of sudden death in the district during 1943, 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. INFANTILE MORTALITY. The attached Table gives details of 29 local cases, of which records are available:— Under 1 week 1-2 wks. 2-3 wks. 3-4 wks. Total under one mth. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total under one year A. Congenital Malformations. Congenital Heart 5 – – - 5 1 – – – 6 Spina Bifida – – – - - 1 - - - 1 Congenital Hyrdonephrosis - - - - - 1 - - - 1 B. Ante and, Intra Natal Conditions Prematurity 5 - 1 - 6 - - - - 6 Atelectasis 2 - - - 2 - - - - 2 Asphyxia Neonatorum 2 - – - 2 - – – – 2 Intra-cranial haemorrhage 1 - - - 1 - - - - 1 Difficult labour 1 - - - 1 - - - - 1 Convulsions 1 - - - 1 - - - - 1 C. Infections. Bronchopneumonia - - - - - 1 1 1 2 5 Enteritis - - - - - - - 1 1 2 Tubercular Meningitis. - - - - - - - 1 - 1 17 - 1 - 18 4 1 3 3 29 Deaths under one year : 30. Infantile Mortality Rate. Total: 30.15 per 1,000 live births. Legitimate: 30.5 „ „ „ „ Illegitimate : 22.2 „ „ „ „ 3 NURSING HOMES REGISTRATION ACT, 1927. At the end of the year there were 4 homes on the register. The Medical Officer of Health and Assistant M.O.H. paid 10 visits of inspection to the premises and found the records and equipment satisfactory. Local papers were scrutinised for advertisements of unregistered homes. BOARDED OUT CHILDREN. At the beginning of the year there were 13 registered Foster Mothers having charge of 16 children. At the end of 1943 there were 18 children under the care of 13 Foster Mothers. The Health Visitors made 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. NOTIFICATION OF BIRTHS. The births registered were slightly higher than in 1942. ANTE-NATAL WORK. In 334 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 Visitors; this work necessitated 613 visits during 1943. ANTE- AND POST-NATAL PANEL. The scheme approved by the Council whereby the ante-natal examination of expectant mothers would be conducted by medical practitioners practising in the district, continued in operation during the year, and the total attendances were 1,014 compared with 1,043 in 1942. The panel contains the names of most doctors practising in the district. During the year the following work was done under the scheme:— Mat. Home Town Hall Total Sessions held 52 21 73 Number of mothers attending for examination 309 52 361 Number of attendances made— Ante-Natal 617 78 695 Post-Natal 285 34 319 4 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 diagnosis. The Assistant Medical Officer saw 166 new cases, made 542 re-examinations of expectant mothers, and made 75 post-natal examinations. The Obstetric Specialist, Mr. D. M. Lindsay, held 29 sessions and saw 28 ante-natal, cases and 253 post-natal cases who made 273 attendances. HOME HELPS. Owing to the employment of women in industry it is now practically impossible to get suitable people to act as Home Helps, although the need is a very real one. HOME VISITING This work is carried out by the Health Visitors. During 1943 the Health Visitors made a home visit to 822 new cases. The work done is summarised below and the total visits 7,943 compare with 8,236 in 1942:— Home Visits New Under One 1 to 5 Special Illness Expectant Mothers A.R.P. Gas Masks for Babies No Reply Total Visits Miss Smith 292 428 514 468 153 192 350 2,397 Miss Noble 275 435 648 499 188 155 70 2,270 Miss Kendall 228 632 781 547 240 157 248 2,833 Mrs. Walmsley 27 82 197 54 32 — 51 443 Total 822 1,577 2,140 1,568 613 504 719 7,943 INFANT WELFARE ATTENDANCES Town Hall C'tre Alexandra C'tre Elmers End C'tre Wickham C'tre Coney Hall C'tre fields C'tre Total 1943 Compara tive Total 1942 Individual Children 573 351 724 601 376 689 3,314 2,844 Total Attendances 4,338 4,102 8,704 6,154 3,188 7,188 33,674 26,709 New Cases 191 110 222 236 113 190 1,062 1,165 Average Sessional Attendance 84 79 83 62 61 69 72 58 Sessions 52 52 104 99 52 103 462 455 Sessions attended by M.O. 52 52 51 48 51 53 307 305 Cases seen by M.O. 564 1,189 992 710 422 1,571 5,448 5,417 Average No. per Session seen by M.O. 10 23 19 15 8 29 17 17 5 FOLLOWING-UP OF 2 TO 5 YEARS OLD CHILDREN. The following figures show the attendances of children in age groups. Year born Attendances made 1938 664 1939 1,919 1940 2,391 1941 3,981 1942 13,568 1943 11,151 Total 33,674 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 £2,000 were sold. During the year the issue of Fruit Juices and Cod Liver Oil to children up to 5 years of age was undertaken at Welfare Centres and First Aid Posts at the request of the Ministry of Food. A very high proportion of the children in the area had these regular additions to their diet. 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 option 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 a great deal of assistance is also given by volunteers from the Aid Posts. 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 attendances:— Eye Clinic. U.V. Ray Clinic. Orthopaedic Clinic Aural Clinic. 1943, Infants 93 608 387 26 6 MATERNITY AND CHILD WELFARE DENTAL REPORT, 1943 The sessions were held on Friday afternoons and at such other times as circumstances demanded. The estimated number of sessions is 72, and the attendances totalled 430 compared with 500 in 1942. The number of children treated was 111 compared with 123 in 1942, and the number of adults 85 compared with 117. Adults Children Attendances 297 133 Number treated 111 85 Extractions 374 125 Fillings 33 48 Dressings 100 49 Silver Nitrate — 4 Local Injections 21 — Nitrous Oxide administrations 70 42 Ethyl Chloride administrations — 8 Impressions, etc. 53 — Scalings 13 — Dentures 24 — Repair 2 — BECKENHAM AND PENGE JOINT MATERNITY HOSPITAL The number of admissions in 1943 was 581 compared with 570 in 1942, and 310 in 1941. ANTE-NATAL SUPERVISION. The Matron holds a Clinic on three days a week and saw 609 cases who made 2,599 attendances. DISTRICT CASES. Cases who do not wish to enter the Maternity Home for confinement and cannot afford the services of a private doctor, can have the attendance of a County Midwife who may refer her patient to the Clinic under the Ante-Natal Scheme. ANNUAL STATISTICS FOR 1943 Relating to the Beckenham and Penge Joint Maternity Hospital Information Required Particulars 1. Name and Address of Institution Beckenham and Penge Joint Maternity Hospital, Stone Park Avenue, Beckenham. 7 Information Required Particulars 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds) 30 2a. Number of such beds used for Ante-Natal cases 4 3. Number of Maternity cases admitted during the year Beckenham 453 581 Penge 128 4. Average duration of stay 13.6 days 5. Number of cases delivered by : (a) Mid wives 436 (b) Doctors 144 (One patient transferred undelivered) 6. Number of cases in which medical assistance was sought by a midwife in emergency 170 7. Number of cases notified as: (a) Puerperal Fever Nil (b) Puerperal Pyrexia 25 8. Number of cases of Pemphigus Neonatorum Nil 9. Number of infants not entirely breast-fed while in Institution 45 10. (a) Number of cases notified as Ophthalmia Neonatorum 1 (b) Result of treatment in each case Satisfactory 11. (a) Number of Maternal Deaths 2 12. (a) Number of Foetal Deaths: (i) Stillborn 14 (ii) Within 10 days of birth 10 8 OBSTETRIC CONSULTANT'S SERVICE. Mr. D. M. Lindsay was asked by local doctors to see 30 patients at the Maternity Hospital. The conditions are summarised below Ante-Partum Haemorrhage: Placenta Prævia 1 Toxaemias: Hepatic insufficiency 1 Albuminuria 2 Contracted Pelvis: General Contraction 6 Flat Pelvis 1 Ricketty Pelvis 1 . Associated with malpresentation 4 Malpresentation: Transverse 1 Brow 1 Extended breech 2 R.O.P. extended head 1 Prolonged Labour: Uterine inertia 3 Post-partum: Perineal repair 3 Caesarean section was performed on 16 occasions:— For Placenta Prævia 3 For Contracted Pelvis 6 For Contracted Pelvis with malpresentations 3 For Malpresentations 2 For Prolonged labour 2 CLINIC ATTENDANCES. The Consultant's clinic was held at the Maternity Hospital on 29 occasions during the year and the attendances were :— Ante-Natal cases Post-Natal cases Re-examinations Total Average per session 28 253 23 304 10.3 The final conditions of these cases is set out below:— Health unimpaired 214 cases 84.6 per cent. Slight impairment 39 cases 15.4 per cent. Serious impairment Nil 0.0 per cent. 9 INFECTIOUS DISEASE The following table 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 increased slightly. Measles was prevalent in the first six months of the year. Infectious Disease Summary, 1943. Disease Beck. WW. Service Total 0/1 1/2 2/3 3/4 4/5 5/ 10 10/ 15 15/ 20 20/ 35 35/ 45 45/ 65 Over 65 Total Scarlet Fever 199 62 – 261 – 8 8 9 17 168 29 6 5 5 6 – 261 Diphtheria 11 5 – 16 – – – 1 1 6 3 3 1 – 1 – 16 Erysipelas 15 3 – 18 – – – – – – 1 – 1 7 7 2 18 Pneumonia 34 25 1 60 1 1 1 1 1 8 2 2 7 15 13 8 60 Poliomyelitis – 1 – 1 – – 1 – – – – – – – – 1 Cerebro-Spinal 2 — — 2 – – — — — — 1 — 1 — 2 Dysentery 2 – – 2 1 – 1 2 Puerperal Pyrexia 25 5 – 30 – – – – – – – 3 22 5 – – 30 Ophthalmia 2 1 – 3 3 – – – – – – – – – – – 3 Malaria 1 -— – 1 – – – – – – 1 — — — 1 Measles 173 118 1 292 7 14 7 19 22 187 28 5 3 – 292 Mumps 105 17 – 122 – – – 4 4 84 26 – 3 1 122 Chickenpox 26 44 1 71 1 – 2 2 50 10 3 2 – 1 — 71 Whooping Cough 30 9 — 39 2 5 2 6 4 19 1 – – – – – 39 Totals 625 290 3 918 14 28 18 43 51 522 101 22 46 33 29 11 918 DIPHTHERIA. Sixteen cases were notified during the - year, eleven in the original Beckenham area and five in West Wickham. 0—5 5—14 15 and over Beckenham 1 7 3 West Wickham 1 2 2 Total 2 9 5 The only matter requiring comment is a limited outbreak of six cases in the Churchfields School during October and November. Of the six cases, five had previously been immunised; the period between the completion of the protective inoculations and the attack of the disease varied from 22 months to 8 years. All cases were of moderate severity; the infecting bacillus in all cases was of the "gravis" type (the most virulent of the known types of Diphtheria bacilli). I feel sure that if the general level of protection in Churchfields School had not been so high, there would have been an extensive 10 outbreak, and there would probably have been some fatal cases. Opportunity was taken to protect a number of children in the school who had not so far been presented for immunisation. At the same time, children in this and other schools, who had been protected in earlier years, received an additional injection to raise the level of their defences, which had dropped to some extent, owing to the very low incidence of diphtheria in the area for a number of years. It must be remembered that the test which is always applied after the completion of the course of injections, consists of an accurately measured dose of standardised material, and is therefore an arbitrary standard : if the test is negative, it indicates that there is a definite degree of protection against Diphtheria in the body, and this degree of protection has been found to be sufficient to withstand any ordinary invasion by the bacillus of Diphtheria: it is quite understandable that occasionally an exceptionally massive infection of a highly virulent type will break through these defences and cause an attack of the disease. In the Special Report on Diphtheria immunisation in the Schools, presented to the Council last year, it was mentioned that conferred immunity might decline in an area which remained free from Diphtheria over a number of years. Our experience last autumn suggests that, although this can happen, it will probably be limited to a small proportion of individuals, and that the reappearance of the disease will soon restore the general degree of protection to a satisfactory level. Paradoxical as it may sound, the limited outbreak in the autumn, actually testifies to the value of large scale immunisation against Diphtheria. SCARLET FEVER. There were 261 cases notified during the year, compared with 75 in 1942 and 31 in 1941. Of these 199 were in original Beckenham and 62 in West Wickham. The incidence increased gradually throughout the year, rising sharply in September and continuing at a high level for the remainder of the year. The age incidence was :— 0—4 5—14 15 and over Beckenham 32 152 15 West Wickham 10 45 7 Total 42 197 22 The disease is caused by a specific organism, known as the Streptococcus : there are at least 30 strains of this organism which are capable of producing the disease, and infection by any one strain does not confer absolute protection against subsequent infection by any one of the others. In this connection, it is worth 11 noting that four individuals each had two separate attacks of the disease during the twelve months. There were 240 Primary cases : in 18 homes there was more than one case : in all there were 21 Secondary cases. Of the secondary cases, eleven were classed as " Return " cases (i.e., cases which developed in a house within three weeks after the primary cases returned home from hospital); eight cases occurred within four days after the notifications of the primary cases in their homes ; and two cases did not occur until more than four weeks after the notification of the primary cases. Of the 261 cases, 151 were removed to the Isolation Hospital, and 110 were treated in their own homes. In the 151 homes whence the cases were removed to hospital, there were 147 contacts between the ages of 9 months and 15 years who had not had the disease: in the 110 homes where the cases ware treated at home, there were 57 contacts of similar ages who had not had the disease. The table shows the percentage of the above mentioned contacts in each group (a) who developed the disease within four days of the primary case and (b) who developed the disease at least four weeks after the primary case. Hospital cases. Cases treated at home. Within four days 3.4% 3.5% After four weeks 7.4% 5.2% This suggests that the risks of early secondary cases is the same whether the primary case is removed to hospital or not (and this is not surprising, because the patient is probably most infectious in the early stages before the diagnosis is established) : with regard to the late secondaries (cases which occur after the original case has returned from hospital, or has been released from isolation at home) there is a slight but definitely greater risk in the homes where the original case was removed to hospital. The probable reason is that cases who go to hospital have opportunities of becoming infected with strains of the infecting organism other than the one which caused the original attack, and can thus introduce an entirely new infective agent into their homes on their return : whilst those who remain at home are not subjected to this risk. If the contacts of the home treated case do not get infected before the original case is isolated, there is less chance of their becoming infected with the same organism at a later, stage, than there is of their becoming infected by an organism of a different strain. This does not imply that there is any lack of care by the staff of the Infectious Diseases Hospital in discharging cases : cases may be perfectly free from infection on discharge, but owing to an attack of simple catarrh of the nose and throat, may again become infectious. This is a well-known risk and cannot be avoided : in the series of cases under review it happened in just over 8% of the cases—a figure which is rather higher than is generally found. 12 Nevertheless, since Scarlet Fever is a very mild disease nowadays, it is probably better for the patient and his family far him to be treated at home, if circumstances permit. Removal to hospital will always be necessary if the attack is a severe one or if the home circumstances are such that it is not possible for the patient to have a separate room. It will be noticed that during the year, 42% of the cases of Scarlet Fever were treated in their own homes. BACTERIOLOGICAL WORK. The number and results of the examinations made at the Public Health Department Laboratory during 1943 was:— Disease suspected Total 1943 Results Comparative Total for 1942 Positive Negative Diphtheria 214 14 200 141 Tuberculosis 81 10 71 121 Other Diseases 6 - 6 2 Total 301 24 277 264 INFLUENZA EPIDEMIC. Special measures were taken to provide help through the W.V.S. and Civil Defence Personnel. PUERPERAL PYREXIA. Thirty cases were notified: 25 occurred in the Beckenham and Penge Joint Maternity Hospital, 2 in nursing homes, and 3 in patients' own homes. OPHTHALMIA NEONATORUM. Three cases were notified. TUBERCULOSIS. The total of 71 cases compares with 76, 58, 65, 66 and 71 in the preceding five years. In addition to the 71 new cases there were 15 definite cases transferred from other areas, 5 cases restored to the register and 7 cases were not notified until after death. At the end of the year the number of notified cases in the area was:— 193 Pulmonary Males, 183 Pulmonary Females, 37 nonPulmonary Males and 34 non-Pulmonary Females; a total of 447 cases, which compares with 424 last year. 75 cases were placed off the register for the following reasons: Died, 25; Cured, 16; Left area, 34. Notification.—In 7 cases notification was not made until after death. 13 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 oceasion 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. 39 cases were notified during the year by the doctors in attendance. CHICKENPOX. 71 cases were notified by doctors. MUMPS. 122 cases of Mumps were 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 579 cases during the year. SCABIES. During the war years there has been a considerable increase in the cases of scabies requiring treatment. Arrangements have been made for the treatment to be given at the Baths First Aid Post by the Staff on duty there, and the following statement shews the number of cases dealt with ; there were very few cases of reinfestation. The staff of the Aid Post are to be congratulated on the excellent. results of the treatment and the way they have dealt with this task. Treatment of Scabies at Baths Cleansing Station. Attendances Persons Treated Males Females Re-infested 30 days interval Under 14 yrs. Over 14 yrs. Under 14 yrs. Over 14 yrs. 1942 556 357 74 46 102 135 4 1943 733 429 98 50 115 166 32 14 SANITARY INSPECTION OF THE DISTRICT, 1943. Summary of Inspections and Visits. Visits and Inspections. Overcrowding 6 Nuisances 3,021 Cowsheds 56 Milkshops 189 Bakehouses 129 Butchers' shops 390 Slaughterhouses 25 Places where food is prepared 136 Shops where food is stored 860 Factories 215 Outworkers 4 Rats and Mice Act 520 Stables and Piggeries 92 Fried Fish Shops 100 Verminous premises 14 Drainage 448 Infectious disease 288 Samples taken under Sale of Food and Drugs Acts 96 Samples of Milk taken for Bacteriological Examination 29 Samples of Water 41 Shops Acts 21 Miscellaneous 324 Interviews 1,854 Civil Defence: A.R.P. Lectures and Demonstrations 40 Bomb damage to drains 555 Bomb damage to premises 155 Bomb damage to food 17 767 Total 9,625 Nature of Nuisance or Defects Remedied. No. of defects remedied. Choked drains 139 Drains defective or altered 44 Defective gullies 5 Defective W.C. pans or choked W.C.s 18 Flushing apparatus to W.C. defective 35 W.C. apartments, dirty or defective 25 Waste pipes, defective or untrapped 18 House sinks, defective 7 Soil pipes, defective 6 15  No. of defects remedied. Ventilating shafts, choked or defective 3 Fresh air inlets, defective 6 Manhole covers, defective or unsealed 11 Water supply cisterns, uncovered, dirty or defective 3 Galvanised iron dustbins, defective or absent 19 Dampness 81 Rain-water pipes, defective 13 Defective gutters 18 Defective roofs 95 Defective floors 60 Defective walls 28 Defective ceiling 41 Dirty walls 30 Dirty ceilings 29 Yard paving defective or absent 6 Defective stoves 33 Defective airbricks 1 Defective windows and fittings 37 Defective doors 7 Accumulation of offensive material 4 Verminous rooms 2 Defective stairs and handrails 5 Absence of water supply 8 Rats, premises freed of - Absence of Statutory Information in Rent Book 9 Miscellaneous Shops Acts, Defects 1 Miscellaneous 24 Keeping of Animals contrary to Bye-laws 3 Total 874 Premises Controlled by Bye-laws, etc. The following Table supplies particulars of the premises and occupations in the district which are controlled by Bye-laws or Regulations:— Character of Premises Action Taken and Result Cowsheds and Milkshops 245 inspections. All satisfactory. Bakehouses 129 inspections. Two defects remedied. Fried Fish Shops 100 inspections. One defect remedied. Meat Shops (Butchers) 390 inspections. One defect remedied. Places where food is prepared 136 inspections. Two defects remedied. Shops where food is stored 860 inspections. Conditions satisfactory. Slaughterhouses 25 inspections. Conditions satisfactory. Premises where animals are kept 3 contraventions of the Bye-laws found during the year. All remedied. Stables and Piggeries 92 inspections. Conditions satisfactory. 16 THE SHOP ACTS. During the year 21 visits were made under the above Acts. The following defects were remedied during the year:— Opening on Early Closing Day 1 FACTORIES. During the year 215 visits were made to premises on the Register. At 10 premises, nuisances were remedied after the service of informal notices, as under:— Defective floors 2 Dirty floors 1 Undrained floor 1 Choked drains 4 Dirty W.C. apartment 1 Dirty premises 1 Absence of intervening lobby to W.C. 4 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) 576 (b) Number of inspections made for the purpose 576 (c) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Nil (d) Number of inspections made for the purpose Nil (e) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (f) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found to be not in all respects reasonably fit for human habitation 516 2.—REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES (g) Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or its Officers 524 17 INSPECTION AND SUPERVISION OF FOODS. SAMPLING. 178 samples of food were taken during the year: details are set out below. All were found to be "genuine." Arrowroot 2 Brought forward 130 Butter 16 Mushroom Ketchup 1 Betox 1 Porridge Oats 1 Biscuits 1 Prunes 1 Browning 1 Pepper 4 Beef and Vegetable Extract 1 Paste (Chef) 1 Baking Powder 1 Pudding Mixture 1 Currants 1 Raisins 5 Condensed Milk 3 Sultanas 3 Coffee 3 Seasoned Gravy 1 Coffee Extract 1 Sage & Onion Stuffing 1 Cocoa 1 Self-Raising Flour 2 Cake Mixture 1 Salmon & Shrimp Paste 1 Cream Custard Powder 1 Sugar 12 Corn Flour 1 Steam Pudding Mixture 1 Creamola Pudding 1 Semolina 1 Cake Flour 1 Stuffing 1 Friquick (Savoury) 1 Soya Cream 1 Glenmar Pudding 1 Sausage Meat 1 Golden Syrup 1 Tea 3 Galantine Roll 1 Vegetable Extract 1 Ground Ginger 1 Vinegar (Malt) 1 Honey 1 Worcester Sauce 1 Ham & Beef Paste 1 Yorkshire Pudding 2 Jam 2 Lard 10 Formal Samples: 177 Lemon Biscuit Mixture 1 Informal Sample: 1 Margarine 6 Marmalade 1 Total 178 Mustard 2 Milk 64 Carried forward 130 Informal Sample (Coffee Extract) 1 MEAT INSPECTION. Except for "emergency killing" the slaughterhouses in the district are closed. On 25 occasions animals were dressed for food when 70 pigs were slaughtered. In 5 cases diseased conditions were found. OTHER FOODS. The shops and premises where food is kept were frequently inspected and a large quantity of food unfit for human consumption was surrendered. A considerable proportion was put to some useful purpose. CONDEMNED FOOD. Article Condition No. of Tins, Packages, etc. Lbs. Clod and Sticking Putrid 1 100 Sirloin „ 1 4½ Chopped Beef . „ 1 5 Forequarter ,, 1 128 4 237½ 18 Article Condition No. of Tins, Packages, etc. Lbs. Pigs Head T.B. 2 28 „ „ and Pluck „ 1 30 „ Heart Pericarditis 1 1 „ Lungs Pneumonia 1 1 5 60 9 297½ Cod ... 168 Dabs ... 84 Dogfish ... 351 Fillets, Fresh ... 30 ,, Smoked ... 126 Megrims ... 42 Skate ... 210 Soles ... 84 Witches ... 84 1,179 Rabbits ... 62 62 Tomatoes (Fresh) ... 25 Potatoes ... 152 Prunes (Fresh) ... 56 233 Pudding Paste ... 4 Stew ... 60 64 Bacon Putrid 6 92 Butter „ 3 14½ Cheese „ 6 92 Eggs „ 693 89 Ham „ 1 12 Lard „ 2 8¾ Margarine „ 2 4 713 312¼ Milk, Evaporated „ 339 297 ,, Condensed (Full Cream) „ 165 ,, Condensed (Skimmed) „ 60 „ Dried „ 22 168 586 465 Barley ... 3 49½ Flour ... 2 210 „ (Self Raising) ... 3 9 Oatmeal ... 6 188 Pea Flour ... 10 1¼ Peas, Split ... 1 112 Rice ... 2 32 Semolina ... 6 14 Soya Flour ... 1 90 Cake and Pudding Mixtures ... 7 6 Chocolate ... 6 1½ Eggs, Dried ... 6 3 Tea ... 1 ¾ 54 717 Crayfish ... 2 1 Herrings ... 28 22 Bismarck Herrings ... 1 1 Mackerel ... 13 13 Pilchards ... 142 119 Salmon—Grade 1 ... 6 4½ „ Grade 2 ... 6 6 Grade 3 ... 36 28½ Sardines ... 86 19 320 214 19 Article Condition No. of Tins. Packages, etc. Lbs. Fish Cakes ... 48 12 Fish Roll ... 16 8 64 20 Apples ... 7 28 Blackberries ... 8 11 Cherries ... 1 1 Damsons ... 6 6 Fruit Salad ... 1 1 Gooseberries ... 12 23 Grapefruit ... 1 2 Greengages ... 3 6 Peaches ... 4 9 Pears ... 24 57 Pineapple ... 10 13 Plums ... 213 443 Prunes ... 29 62 Oranges ... 1 1 Rhubarb ... 12 20 Strawberries ... 1 1 Tomatoes ... 5 11 338 695 Jam ... 47 70 Marmalade ... 13 23½ Syrup ... 2 4 Lemon Curd ... 1 2 Other Preserves ... 6 6 69 105½ Boiled Beef ... 2 12 Brisket ... 2 8 Chopped Ham ... 13 30 Corned Beef ... 1 ¾ Irish Stew ... 1 1 Luncheon Meat ... 111 400 Pork Sausage Meat ... 19 33 Rabbit ... 2 3 Steak Pudding ... 3 3 Stewed Steak ... 33 33 Stewed Beef and Vegetables ... 20 22 Suet ... 1 ¼ Tongue ... 2 7 Beef Loaf ... 8 6 Ham Roll ... 1 1 Meat Roll ... 5 6 224 566 Beans in Brine ... 15 15 ,, „ Gravy ... 7 7 „ „ Tomato ... 110 101 „ braised ... 1 1 Butter Beans ... 3 3 Broad Beans ... 22 44 Curried Beans ... 1 1 Haricot Beans ... 26 38 Runner Beans ... 1 2 Beetroot ... 22 51 Carrots ... 28 51 Celery ... 1 2 Peas ... 62 91 Mixed Vegetables ... 14 26 Spaghetti ... 3 3 Spinach ... 3 6 Vegetable Hot-Pot ... 3 3 Vegetables in Gravy ... 24 22 Soup ... 64 98 20 Article Condition No. of Tins, Packages, etc. Lbs. Meat and Vegetable Extracts ... 34 4 Beverages ... 2 1 Cocoa ... 2 ½ Cordials ... 3 3 Pastes—Meat and Fish ... 15 3 Biscuits ... 7 69 Breakfast Cereals ... 7 7 Cheese Roll ... 1 1 Mustard ... 2 ½ Pickles ... 42 29 Sauce ... 7 4 532 687 2,909 5,617 Total 2 tons, 10cwt. 16 lbs. RODENT CONTROL. In June, 1943, the Ministry of Food served a direction upon the Council to carry out a Survey of the area. This was done, and the general conclusions were:— 1. That there was no area in the district which could be regarded as being of the "Reservoir type" of infestation. 2. That under the heading of "Major Primary Infestation" could be placed:— (a) Railway embankments eleven miles in length. (b) Streams, (c) Churchfields and Elmers End Allotments. (d) Croydon Sewage Farm. (e) The Destructor Plant at Electricity works. (f) Dumps at Tiepigs Lane and Monks Orchard Road. 3. That "Minor Secondary infestation" existed in many parts of the district on bombed sites and where poultry and animals were kept. After consideration of the report on this survey, the Ministry served a direction on the Council to take all necessary action to rid local authority premises and lands of rats. The National Campaign of Rat Reporting commenced on October 1st and boxes to receive reports were placed on all the Wardens Posts. Up to 31st December, 390 complaints were received. The Health Committee recommended the Council to engage a Rat Catcher on a full-time basis for six months to cope with the additional work which was evidently necessary. The Reports from residents were summarised and the affected areas inspected. Reports came from widely separated parts of the Borough; many of them revealed the existence of rats in small numbers and the method of "pre-baiting" for three days before placing poisoned bait in position was not practicable or necessary in these cases. 21 In practice it is found that the public regard the act of reporting the presence of rats as the extent of their liability, but the Orders do not remove this responsibility from occupiers. Each complainant was notified that if the Council took action to rid any premises of rats, the cost would be charged to the occupiers. The work is greatly handicapped by the difficulty of finding residents at home and by the end of the year 100 premises had been dealt with and the work is being completed in 1944. SEWER RATS. The next step in the campaign was the inauguration of a London drive to clear sewer rats and under a further direction the Council had to bait and poison all the manholes to the sewers in the Metropolitan Outfall area. This includes the Lawrie Park Ward and the Parish Lane area. The work was done in co-operation with the Borough Engineers Department and entailed the employment of three gangs of three men each for ten days. This campaign entailed the treatment of 172 manholes, each being pre-baited for four days and poisoned bait being laid on the fifth dav. Two treatments were given and the following Table shows the results calculated: the first Treatment gave a "Kill" of 1,433 Rats, the second Treatment a "Kill" of 200 Rats. It therefore appears that the first treatment was successful in greatly reducing the rat population:— Manholes PreBaited Average takes over 4 days Manholes Poison Bait Takes Calculated "Kill" Complete Good Small No Take Not Poisoned Poisoned Complete Good Small No Take First Treatment 1943 Dec. 6th-11th 172 43 39 29 61 20 152 15 43 41 53 1,433 Second Treatment 1944 Jan. 17th-22nd 170 — 8 38 124 124 46 — 3 21 22 200 WAR-TIME NURSERIES. My last Report gave an account of the opening of two War-time Nurseries. This year has shown a persistent and increasing demand for accommodation. At 25. Beckenham Road, there is a constant waiting list, which, while unsatisfactory for mothers anxious to obtain work, is gratifying inasmuch as the children are happy and contented and give no cause for their removal. Our Springfield Nursery has been enlarged to satisfy in some way the growing need there. Steps have been taken to open 22 another Nursery for the Coney Hall district of West Wickham which is in need of this facility. The Matron and staff of the Nurseries are to be congratulated on their enthusiasm and tireless efforts while battling with increasing difficulties of staff and domestic help. Grateful acknowledgment is made for the generous aid given by Voluntary helpers, Aid Post personnel and members of the W.V.S., also appreciation of toys made by the N.F.S. and parcels of toys and clothing sent by friends in Canada. DEMAND FOR ACCOMMODATION. The following statement shows the applications received up to 31st December, 1943, with the occupations of mothers:— A. 25, Beckenham Road 72 Mothers with 80 Children, have applied. Number now on the Roll, 52. Fifteen on the waiting list. B. "Springfield" 62 Mothers with 67 Children have applied. Number now on the Roll, 57. No waiting list. C. Occupations: Beckenham Wickham Total Office work 19 15 34 Factory 31 12 43 Shops 9 15 24 Hospitals and Nursing 2 3 5 G.P.O. — 1 1 Domestics 2 3 5 Teachers - 1 1 Restaurants 4 3 7 Refused 5 9 14 72 62 134 Summary of Attendances at War-time Nurseries, 1943. Month Springfield 25, Beckenham Road. Under Two TwoFive Total No. of Days Open Average Under Two TwoFive Total No. of Days Open Average January 107 272 379 26 14.5 272 466 738 26 28.3 February 50 203 253 24 10.5 214 497 711 24 29.6 March 88 430 518 24 21.5 193 555 748 24 31.1 April 126 496 622 23 27.04 218 472 690 23 30. May 180 700 880 29 30.34 310 504 814 29 28.06 June 177 671 848 23 36.08 349 385 734 23 31.9 July 246 881 1,127 30 37.05 334 719 1,053 30 35.01 August 158 625 783 23 34.04 219 543 762 23 33.13 September 126 661 787 24 32.79 230 536 766 24 31.91 October 269 869 1,138 30 37.93 251 720 971 30 32.36 November 236 588 824 24 34.33 154 530 684 24 28.50 December 175 604 779 23 33.86 152 452 604 23 26.25 1,938 7,000 8,938 303 29.49 2,896 6,379 9,275 303 30.28 23 INTRODUCTION TO REPORT ON SCHOOL MEDICAL SERVICE SCHOOL REPORT. During the year the number of children on the rolls of the Elementary Schools returned to very nearly the pre-war figure. In consequence the number of individual examinations made, and the attendance at the various clinics showed a considerable increase. All of the special clinics operated successfully throughout the year. The general nutrition of the children was satisfactory : cases of subnormal nutrition were very few, and only three children of the 1,925 examined at the Routine Inspections were classed as being seriously undernourished. The percentage of children having Milk at school during the year was 73. STAFF ENGAGED IN MEDICAL INSPECTION School Medical Officer (approximately 1/3rd time): T. Philips Cole, M.B., D.P.H. Assistant to S.M.O. : Miss S. Thomson, M.B., D.P.H. School Dental Surgeon (5/6ths time to School work): R. A. Waters, L.D.S., R.C.S. (Eng.). Anaesthetist to Dental Clinic (part-time): Gordon Lyle, M.R.C.S., L.R.C.P., Lds. (Eng.) Ophthalmic Surgeon (part-time): A. E. A. Looseley, F.R.C.S. (Eng.). Orthopaedic Surgeon (part-time): J. A. Cholmeley, F.R.C.S. (Eng.). Aural Specialist (part-time): G. H. Howells, F.R.C.S. (Eng.). School Nurse: Miss B. D. Sizer, S.R.N., S.C.M. School Nurse Part-time: Miss O. Smith, S.R.N., S.C.M. Dental Attendant (5/6ths time to School work): Miss G. Bradford. Orthopaedic Nurse (part-time): Miss E. N. Sutton, C.S.M.M.G. 24 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 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:— Home Visits: Total 1942 Total 1943 To cases of Infectious Disease 737 806 Other Cases 2,596 2,608 Total Home Visits 3,333 3,414 Visits to Schools : re Personal Hygiene 78 81 Children examined 11,484 13666 Found Unclean 41 30 Children seen at other visits 2,550 2,255 Clinic Sessions Attended: Minor Ailment Clinics 283 315 Inspection Clinics 134 130 Eye Clinics 47 35 Aural Clinics 6 7 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:— 1942 1943 Entrants 1,012 565 Intermediate 588 639 Leavers 363 721 Other Routine Inspections - - 1,963 1,925 105 sessions were held at the Schools and 501 children were found to have some defect requiring treatment or observation. (b) Other Inspections. In addition to the above groups, 544 "Special" Inspections were made of children referred to the Medical Inspector either at the School or the Clinic, or to Specialist Clinics for examination. 3,490 re-inspections were made of the above routine or special cases, compared with 3,218 in 1942. (c) Following up. In connection with children found defective at Routine or 25 Special Examinations, steps are taken to see that they are followed up until treatment is obtained. 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—V. The only special condition calling for comment is the nutrition of the children. SCHOOL CANTEENS. At the end of the year School Canteens were in operation at the following Schools and an average of 1,500 meals were being served daily. It is still desirable that arrangements should be made for these meals to be available in holiday periods:— Stewart Fleming. Wickham Common. Marian Vian—All Departments. Alexandra—Senior, Junior and Infants. Bromley Road—Infants, Junior and Senior. Hawes Down—All Departments. Balgowan School—All Departments. Churchfields—All Departments have use of British Restaurant adjoining School and meals are sent into the School. Approximately 100 children received free meals at school. MILK AT SCHOOL. The issue of milk to schools continued, and an average of 3,461 children obtained this : 365 being free of cost. This represents 73% of the children on Roll, compared to 89% in 1942. WORK OF THE SPECIAL CLINICS TREATMENT OF MINOR AILMENTS. The attendances during the year are shown below, with comparative figures for 1942:— School. Sessions Held. Attendances. Average Per Session. 1943 1942 1943 1942 1943 1942 Alexandra 44 45 954 646 21.6 14.3 Churchfields 44 42 1,601 1,086 36.3 25.8 Hawes Down 47 45 1,379 1,454 29.3 32.3 Marian Vian 46 63 1,411 1,325 30.6 21.0 Wickham Common 42 44 1,143 1,383 20.7 31.4 Stewart Fleming 44 44 881 625 20.0 14.2 Town Hall 48 — 491 — 10.2 — Totals 315 283 7,860 6,520 24.9 23.0 26 INSPECTION CLINIC. An Inspection, Clinic was held on Tuesdays, Wednesdays and Thursdays throughout most of the year. The total attendances were 2,578 compared with 2,679 in 1912. The Sessions held were 130, the average attendance being 19.8 per session. EYE CLINIC 35 Sessions were held, and on some of these the Surgeon put in an average extra half-session, making three instead of two hours. I.W.C. S.M.S. County Total Attendances by new cases 15 142 25 182 Attendances by other cases 78 589 168 835 Totals 93 731 193 1,017 DENTAL REPORT To the Chairman and Members of the Education Committee. I have the honour to present the Dental Report for the year 1943. All the elementary schools were inspected during the year, and treatment was completed, with the exception of 113 cases awaiting appointments. These were treated in January, 1944. The Girls' Secondary School was inspected and treated, but not the Boys' Secondary School, or the Junior Technical School. In April the Kent Education Committee reverted to previous arrangements, and send their own Dental Surgeon to treat the Secondary Schools at the Beckenham Clinic each Wednesday and at the West Wickham Clinic when convenient. This followed a decision of the Beckenham Education Committee to discontinue the inspection and treatment of the Secondary Schools owing to the impossibility of dealing with them, without an increase in Staff. The following table gives the comparative figures for 1942 and 1943:— Elementary and Secondary Schools. 1942. 1943. Attendances 3,316 3,395 Children treated 2,327 2,449 Fillings 2,558 2,421 Extractions 2,858 2,829 27 The results of the inspections in the Elementary Schools were as follows:— Number of children inspected 4,742 Number of children referred for treatment 2,939 Number of children refused treatment 595 The results of treatment:— Attendances 3,240 Children treated 2,344 Fillings 2,246 Extractions 2,788 The extraction of permanent teeth was 288, and of these 66 were sound teeth removed for regulation purposes, and 4 were supernumerary teeth, a total of 70, thus reducing the loss of teeth due to caries to 218. The number of cases of irregularity treated by extractions was 48 involving the loss of 70 teeth, and in addition 19 cases were treated by mechanical means. There is an increase over 1942, the figures for that year being 32 cases treated by extraction and 4 by mechanical means. This arose primarily because in 1942, owing to lack of time, certain cases that would normally have been dealt with, had to be postponed. They were subsequently treated in 1943. The average of the two years compares very favourably with the normal amount of this type of treatment. Four dentures were provided to replace loss of upper incisors in cases where the retention of these teeth by conservative means was not indicated. One upper incisor was crowned following accidental fracture. Summary of Terminal Reports : Elementary Schools:— Children inspected 4,742 Attendances: New cases 2,344 Old cases 896 Total Attendances 3,240 Fillings: Permanent teeth 1,587 Temporary teeth 653 Root fillings 5 Crowns 1 Total fillings 2,246 Extractions: Permanent teeth 288 Temporary teeth 2,500 Total Extractions 2,788 Dressings 449 Silver Nitrate 200 Scalings 29 Regulation Appliances 19 28 Nitrous Oxide Administrations 815 Local Injections 443 Dentures 4 Secondary School for Girls :— Children inspected 363 Attendances 155 Children treated 105 Fillings, Permanent teeth 175 Extractions, Permanent teeth 29 Extractions, Temporary teeth 12 Scalings 6 Dressings 9 Nitrous Oxide Administrations 13 Local Injections 8 My thanks are due to Dr. Gordon Lyle and Dr. Sheila Thomson for the administration of Nitrous Oxide, td Miss Bradford the Dental Attendant, and to the Head Teachers for their support during the year. Robert A. Waters, L.D.S., R.C.S. (Eng.) REPORT ON WORK OF AURAL CLINIC IN 1943 Sessions held Total Attendances New Cases Re-examinations Infants School Infants School 1943 7 282 11 82 15 174 1939 7 298 17 61 * 34 186 1940 19 212 13 36 17 146 1941 5 140 7 72 9 52 1942 6 210 9 85 12 104 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 29 cases, the removal of tonsils and adenoids was recommended. G. H. Howells, F.R.C.S. REPORT ON BECKENHAM ORTHOPAEDIC CLINIC 1943 The following summary shows the work of this Clinic during 1943, and comparative figures are given for the preceding years:— Sessions Surgeons Examinations New cases Re-examinations School Infants School Infants 1943 127 49 30 244 73 1942 130 56 40 182 93 1941 99 64 38 109 73 1940 118 38 34 149 47 29 Year Treatment by Nurse Electrical and other treatments Fees Paid Massage Exercises School Infants School Infants School Infants £ s. d. 1943 160 128 1,331 164 171 14 20 0 10 1942 66 107 986 79 235 17 19 8 1941 139 61 264 8 122 61 7 13 0 1940 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 94 and the attendances 763 school children and 608 infants. A fee per attendance is charged in all but necessitous cases, and a total amount of £30 19s. 0d. was received during the year. John A. Cholmeley, 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. MALNUTRITION AND DEBILITY. The statistical tables at the end of this report include one giving the classifications 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 10.338 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." SECONDARY SCHOOL CHILDREN. The Committee's Specialist Clinics are available for children attending the Secondary Schools. The attendances made during 1943 were:— Orthopaedic Clinic 7 cases made 27 attendances. Eye Clinic 55 „ „ 193 ,, 30 FEES PAYABLE. The scale for all forms of treatment is set out on page 153, vol. 29 of the Education Minutes. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Under the Committee's Bye-laws 66 certificates were issued daring the year. This number compares with 65 in 1942. The Committee have decided not to issue licences to take part in Stage Plays. SPECIAL SCHOOL FOR MENTALLY DEFECTIVE CHILDREN. The Special School, under the direction of Miss L. Ross, has continued during the year in temporary premises. 6 children have been admitted during the year, and 3 have left. The number of children on the roll at 31st December, 1943, was 20 : 15 Beckenham, 3 Penge, 1 Bromley, 1 Kent. MEDICAL INSPECTION RETURNS, 1943 TABLE I. Medical Inspection of Children Attending Elementary Schools. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 565 Second Age Group 639 Third Age Group 721 Total 1,925 B.—Other Inspections. Number of Special Inspections and Re-Inspections 4,034 TABLE II. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. No. of children inspected 'A' Excellent 'B' Normal 'C' Slightly sub-normal 'D' Bad No. % No. % No. % No. % 1942 1,963 549 27.97 1,241 63.21 171 8.71 2 0.11 1943 1,925 560 29.09 1,163 60.416 199 10.338 3 0.156 31 TABLE III. Treatment of Minor Ailments. Total Number of Defects treated* or under treatment during the year under the Authority's Scheme was 3,611. Treatment of Defective Vision and Squint. Errors of Refraction dealt with under the Authority's Scheme were 646. The number of children for whom spectacles were prescribed was 143, and for whom they were obtained was 132. Treatment of Defects of Nose and Throat. 64 children received operative treatment under the Authority's Scheme, and 154 received other forms of treatment making a total of 254. 36 are awaiting treatment. TABLE IV. Dental Inspection and Treatment. Particulars of treatment under this heading will be found in the Dental Surgeon's Report. TABLE V. Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurse 10.25 (2) Total number of examinations of children in the Schools by School Nurse 13,666 (3) Number of individual children found unclean 30 Freame, Manning & Co., Printers (T.U.), 12a, Lee High Road, Lewisham, S.E.13 32