AC 4412 (1) BROMLEY BOROUGH OF BROMLEY. 1934 ANNUAL REPORT. medical officer of health and school medical officer. BROMLEY, KENT. The Bromley Printing Co., Sherman Road. BOROUGH OF BROMLEY. 1934 ANNUAL REPORT. medical officer of health and school medical officer. 2 CONTENTS. page Members of the Health and Maternity and Child Welfare Committees 5 Prefatory Letter 6 Staff 10 PartI.—Statistics and Social Conditions of the Area 12 Summary of Statistics 12 Social Conditions 13 Meteorology 14 Unemployment 15 Occupations 15 Population 19 Part II.—Vital Statistics 20 Births 20 Stillbirths 21 Deaths 22 Infantile Mortality 23 Maternal Mortality 24 Part III.—Maternity and Child Welfare 25 Details of Services 26 Centres and Clinics 26—28 Ante-Natal Clinic 28 Natal Services 29 Midwives 29 Midwives Acts, Administration of 29 Midwives, Inspection of 31 Maternity Hospital and Maternity Homes 31 Puerperal Fever and Puerperal Pyrexia 32 Post Natal 32 Home Visiting 32 Welfare Centres 35 Milk in Necessitous Cases 36 Institutional and Convalescent Treatment 36 Minor Ailment Treatments 37 Ophthalmia Neonatorum 37 Diarrhoea and Enteritis 37 Children and Young Persons Act, 1932 38 Part IV.—Summary of General Provision of Health Services 38 Legislation in Force 38—41 Hospitals 41 Maternity and Nursing Homes 41—42 Institutions, various 43 Ambulance Facilities 43 Laboratory Facilities 43 Clinics and Centres 44 Nursing in the Homes: District Nursing Associations 44 Tuberculosis Dispensary 46 Venereal Diseases 46 3 CONTENTS—Continued page Part V.—Sanitary Circumstances 47 Rivers and Streams 47 Drainage and Sewerage 47 Cesspool Drainage 47 Water 48 Scavenging 48 Rats and Mice Destruction Act, 1919 48 Part VI.—Housing Conditions 50 Inspection of District 51 Housing Acts, 1925-1930 51 Housing Inspection 52 Overcrowding 53 Statutory Notices 53 Houses Let in Lodgings 53 Contraventions, Public Health Acts 54 Part VII.—Smoke Pollution 54 Part VIII.—Shops Acts, Contraventions, &c 54 Part IX.—Petroleum Acts 55 Part X.—Factories and Workshops 56 Part XI.—Premises and Occupations Controlled by Bye-Laws, Regulations, &c 56 Part XII.—Inspection and Supervision of Foodstuffs ... 57 Milk 57 Milk, Bacteriological Examinations 57 Milk, Contraventions 58 Meat 58 Meat, Tables A., B„ C., D. and E 58 Meat, Contraventions ... ... ... ... ... 60 Unsound and Unwholesome Food Surrendered ... 60 Food and Drugs (Adulteration) Act, 1928 61 Pakt XIII.—Diseases of Animals Acts 61 Tuberculosis Order, 1925 62 Part XIV.—Rag Flock Acts, 1911-1928 62 Part XV.—Infectious Diseases Control 62 Scarlet Fever 62 Diphtheria 64 Diphtheria Immunisation 64 Smallpox and Vaccination 64 Tuberculosis 65 Appendices.—Statistical Tables I. to XV 67—88 4 CONTENTS—Continued. page School Medical Service. 89 Members of tlie Education Committee 90 Introduction and Summary of Statistics 91 Hygiene of Schools 94 Medical Inspections 95 Treatment 95 Group I.—Minor Ailments 96 Group II.—Eye Clinic 97 Group III.—Ear, Nose and Throat Clinic 98 Group IV.—Orthopaedic Clinic 99 Ultra Violet Ray Clinic 101 Dental Clinic—Report of School Dental Surgeon 102 Group VI. — Uncleanliness and Verminous Conditions 106 Table III.—Exceptional Children 107 Infectious Diseases in Schools 107 Medical Certificates of Exclusion 108 „ „ Table of conditions 108 Report of the Bromley Children's Care Committee 109 Appendices:— Medical Inspection Returns, Tables I. to IV 114—125 Dental Clinic, Details of Treatment 126 Head Inspections 127 5 MEMBERS OF THE HEALTH AND MATERNITY AND CHILD WELFARE COMMITTEES, 1934-1935. HEALTH COMMITTEE— Alderman W. F. Skilton (Chairman). Councillor M. Stafford Smith, m.b.e., b.a. (Vice-Chairman). 'Councillor F. S. Darby (Vice-Chairman). His Wohship tiie Mayor (Councillor C. H. Gunton, j.p.). Councillor G. Allen. Councillor E. C. De'Ath. Councillor W. J. Guthrie, j.p. Councillor S. G. Humerston. Councillor P. Jones. Councillor F. G. Hamilton Spratt (appointed 2/7/35). Councillor W. A. Young. MATERNITY AND CHILD WELFARE COMMITTEE:— Councillor M. Stafford Smith, m.b.e., b.a. (Chairman). 'Councillor F. S. Darby (Vice-Chairman). His Worship the Mayor (Councillor C. H. Gunton, j.p.). Alderman W. F. Skilton. Councillor G. Allen. Councillor E. C. De'Ath. Councillor W. J. Guthrie, j.p. Councillor S. G. Humerston. Councillor P. Jones. Councillor F. G. Hamilton Spratt (appointed 2/7/35). Councillor W. A. Young. Co-opted Members:- Mrs. A. M. Howe (appointed Vice-Chairman 25/6/35). Mrs. A. G. Mann, b.a., j.p. Mrs. M. Pearce. Miss Y. Yincent. Mrs. E. Yolland. *Councillor F. S. Darby resigned from the Council 24/4/1935. 6 Borough of Bromley. Report of the Medical Officer of Health for the Year 1934. To the Mayor, Aldermen and Councillors. Mr. Mayor, Madam and Gentlemen, I beg to submit the Annual Report on the Health of the Borough of Bromley during the year 1934. The general arrangement of the Report is in accordance with that of previous years and follows the requirements laid down in Circular 1417 of the Ministry of Health. The report covers the matters affecting the area of Bromley as extended by the Kent Review Order, 1934, whereby on April 1st, 1934, the area of Bromley was extended by provisional order to include portions of the urban districts of Beckenham and Chislehurst, and portions of the rural district of Bromley, comprising parts of the parishes of Farnborough, Hayes, Keston and West Wickham. The various sections of the report indicate the extent of social services given by the Local Authority and the part they play in the civic government of the Borough. It is noteworthy that as the years pass there is an increasing desire on the part of the burgesses to use these services, a fact which is also true in other areas throughout the country; co-incident with this is the extension of Public Services and increasing State control in matters affecting the welfare of the people as a whole. The following is a list of Acts, Orders, Circulars, Memoranda, etc., which came into operation, or had some bearing on the work of the Public Health Department, during 1934:— Slaughter of Animals Act, 1933. Sheep Scab (Amendment) Order, 1934. Ministry of Health Circular 1370 on Nutrition. Children and Young Persons Act, 1933, Employment of Children Bye-laws. 7 Ministry of Health Circular 1378 on Water Supplies. Order 5190 under Sheep Scab Order of 1928, Part II., made applicable during a period from July-September, 1934. Ministry of Health Circular 1395 on the Bed-Bug and how to deal with it. Ministry of Health Circular 1405, Water Supplies. Ministry of Health Circular 1406 on Nutrition. Ministry of Health Circular 1408 on Birth Control. Public Health (Treatment of Infectious Disease) Regulations, 1934, and accompanying Circular 1418, with respect to the provision of hospitals and temporary places for the reception of the sick. Milk Marketing Board. Accredited Producers' Scheme. Ministry of Health Circular 1425 enclosing summary of the principal provisions of the Housing Acts and Public Health Acts relating to the maintenance of dwelling houses in a fit condition. Shops Act, 1934, and Begulations, etc. Ministry of Agriculture and Fisheries, Circulars with reference to National Bat Week, 1934. Sheep Scab (Amendment) Order, 1934 (No. 2). Ministry of Health Circular 1433 with reference to Maternal Mortality. Order under the Shops (Hours of Closing) Act, 1928, with reference to Christmas closing. Ministry of Health Circular 1453. Slum Clearance. Public Health (Shell-fish) Begulations, 1934, and Circular 1446. Order in Council dated 14/11/1934 amending the Schedule to the Poisons and Pharmacy Act, 1908. Ministry of Health Circular 1437 requiring annual returns with respect to maternity and child welfare, tuberculosis, venereal diseases and hospital treatment. Ministry of Health Circular 1417 with reference to the requirements of annual report of the Medical Officer of Health. Children and Young Persons Act, 1933, Boarding-Out Bules. Board of Education Circular 1437. Provision of Milk for School Children. Board of Education Circular with reference to the School Medical Officers' Beports and Statistical Tables for the year 1934. Board of Education Administrative Memorandum No. 124 with reference to Statistical Beturns and Classification of the Nutrition of Children. The increase of the area of the Borough in April, 1934, palled for additional staffing. The Medical Staff was increased by the appointment of a part-time Eye 8 Specialist and a part-time Anaesthetist, thus freeing the full-time staff for the routine health work of the added areas. Other stall' increases were an additional Sanitary Inspector, two junior clerks (one remains to be appointed), and a part-time Health Visitor. The vital statistics for the year 1934 are again favourable—a Death Rate of 9.5, Birth Kate of 13.3, and Infantile Mortality Rate of 43.9; all compare well with the previous year and with the rates for the country as a whole which are as follows: Death Kate 11.8, Birth Rate 14,8, and Infantile Mortality Rate 59. These statistics are reported on in detail in the body of the report and in the appendices. They in themselves are meaningless unless study is given to them in their compilation. The midyear population for 1934 is given by the Registrar General as 53,890, whereas my own estimate at the end of the year, based on the number of inhabited houses and occupants given in the Census of 1931, yielded a population figure of 57,520. Mere numbers as I have said are meaningless, but what is of more importance is the age and sex grouping of the population, so that we may compare one area with another. Our vital statistics for 1934 are based on the Registrar General's estimate of population so that the rates per 1,000 appear higher than if I had accepted my own estimated figure of population. The main difficulties of giving estimated population lie in the fact that an added area of population has been absorbed into the Bromley population, and a still greater difficulty is that population is in a state of flux in the neighbourhood of London. Thus statistical figures for 1934 must be accepted with some reservation. An endeavour was made during the year to co-ordinate in some way the work of the multiple voluntary agencies and the work of the Local Authority. There is a tendency towards increase of the social worker visitors to the homes of the necessitous families, and when one considers the number of itinerant advertisers who so frequently disturb the housewife, one is not surprised that the health visitor finds a closed door to her visit. 9 Statistics for 1934 show that no less than 1,(147 fruitless visits were made. I would again express to the Committee my appreciation of their interest in our work, and to the Staff for their loyal and untiring support. I am, Mr. Mayor, Madam and Gentlemen, Your obedient Servant, K. E. TAPPER, Medical Officer of Health. 10 PUBLIC HEALTH STAFF, 1934. Medical Officer of Health and School Medical 2 K. E. Tapper, o.b.e.. Officer m.b., ch.b., d.p.h. Assistant Medical Officer of Health and School 2 Miss G. H. Stinson, Medical Officer m.r.c.s., l.r.c.t. Orthopaedic Specialist 2 1 H. J. Seddon, f.b.c.s. Ear, Nose and Throat 2 1 Charles C. Beney, m.a., Specialist m.b., ch.b., (Camb.), m.r.c.s. Eye Specialist 2 1 A. M. Hickley, m.b.c.s., l.r.c.p. Anaesthetist 2 1 F. G. Fbance, m.b., B.s.Lond., M.B.c.s., l.b.c.p. Consulting Gynaecologist 2 1 J. Bbigiit Banister, m.a., m.d., f.r.c.p., f.r.c.s. School Dental Surgeon 2 T. S. Latham, l.d.s., r.c.s. Chief Sanitary Inspector 5 4 3 2 G. R. Woods, m.s.i.a., a.r.san.i. Additional Sanitary 6 4 3 2 T. C. Towersey, m.s.i.a. Inspectors 5 4 3 2 C. J. Clark. 4 3 2 H. Handscomb, m.s.i.a. Health Visitors and 8762 Miss L. A. Briggs, s.r.n. School Nurses 8 7 6 2 Miss E. Connor, s.r.n. 8 7 6 2 Miss E. B. Crowe, s.r.n. 8762 Miss D. Prime, s.r.n. 8 7 6 2 Miss E. Rhodes, s.r.n. (Appointed 14/1/35). 8 7 8 2 Miss P. M. TrickEtt (Resigned 12/1/35). 742 Miss J. Dickson (parttime) (Resigned 9/2/35). 7 6 2 Mrs. F. A. Ptjixew (part-time) (Appointed 4/3/35). 11 Orthopaedic Nurse 21Miss M. Dodge, c.s.m.m.g. Veterinary Surgeon under the Diseases of Animals Acts 1 P. J. Turner, m.r.c.v.s. Inspector under the Diseases of Animals Acts, Shops Acts, and G. R. Woods, m.s.i.a., Petroleum Acts a.r.san.i. General Office Staff: Chief Clerk 2 H. E. Lawley. Junior Clerks 2 Miss B. C. Tucker. 2 Miss L. P. Thorpe. 2 W. S. Dench (Appointed 23/4/34). 2 D. L, Corder (Appointed 23/4/34). Dental Assistant Nurse 2 Miss A. M. Penman. Outdoor Staff: Drain Tester and Disinfector J. W. Seager. Market Superintendent F. J. Ephgrave pointed 31/5/34). Market Toll Collector 1 H. Deane (Resigned 24/5/34). 1. Denotes part-time. 2. Exchequer Grants (including Board of Education). 3. Certificate of the Royal Sanitary Institute and Sanitary Inspectors Joint Examina- tiun Board. 4. Royal Sanitary Institute Certificate for Meat and Other Foods. 5. Royal Sanitary Institute, Smoke Certificate. 6. Three years Hospital Trained. 7. State Certified Midwife. 8. Royal Sanitary Institute new Health Visitors' Certificate (under Memo, 101/MCW). 12 I.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA, 1934. Statistics. Area (in acres) 6,519 Population— Census 1921 35,052 Census 1931 45,374 Mid-year 1934 (Registrar General's estimate) 53,890 Number of inhabited houses— Census 1931 10,764 December, 1934 14,380 Rateable Value (31/3/1935) £617,345 The sum represented by a penny rate (Estimated for year ending 31/3/1936 £2,490 Vital Statistics. The following extracts from the vital statistics relate to the nett births and deaths, after correction for inward and outward transfers, as furnished by the Registrar General:— Live Births. Total. Male. e Legitimate 664 320 344 ' Birth Rate per 1,000 of the estimated resident popvlaturn: 13.3. Illegitimate 42 22 20 706 342 364 Stillbirths. Legitimate 15 7 8 'Rate per 1,000 total (live and still) births: 23.5, Illegitimate 2 - 2 17 7 10 Deaths 521 246 275 Death Rate per 1,000 of the estimated, resident population: 9.5 — adjusted according to comparability factor. 13 Deaths from Puerperal Causes :— Rate per 1,000 total (live and still) births: Number of deaths. From Sepsis 2 2.76 From other causes 2 2.76 Total 4 5.53 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 43.9 Legitimate infants per 1,000 legitimate live births 39.1 Illegitimate infants per 1,000 illegitimate live births 119 Deaths from measles (all ages) 1 Deaths from whooping cough (all ages) 3 Deaths from diarrhoea (under 2 years of age) 7 Social Conditions. Bromley is well described as a Dormitory Town of London. In recent years rapid progress in small house property is filling up the open building spaces, shops are increasing in size and numbers, but we remain fortunate in that we possess within the Southern part of the Borough, the wide open spaces of Hayes and Keston Commons. The Local Authority is fully alive to the necessity of preservation of open spaces, and during the year acquired over 57 acres for public recreation in Bromley Common and Burnt Ash areas, in addition to the commons and open spaces included in the Borough as a result of the extension of the area. The following table shows particulars of land available for public recreation within the Borough at end December, 1934:— 14 Commons and Open Spaces: Acres. Roods. Poles. Acres. Roods. Poles. Keston Common (included under Kent Review Order, 1934) 55 1 24 Hayes Common (at present time administered by a separate Board of Conservators) 213 1 32 Hill Crest, Burnt Ash Lane (acquired 1934) 1 0 1 Husseywell Crescent (included under Kent Review Order, 1934) 2 1 30 The Knoll, Hickhurst Lane (included under Kent Review Order, 1934. 4 1 39 Turpington (Housing Estate) 1 3 10 278 2 16 Public Recreation Grounds: King's Meadow 9 1 0 Martin's Hill 11 0 5 Oakley Road 2 0 0 Queen's Mead 10 3 15 Whitehall 17 1 6 Norman Park (reserved in 1934 —not yet available (or public use) 56 0 0 106 1 26 Public Gardens and Grounds: Church House Grounds 10 3 10 Library Gardens 1 2 0 Queen's Garden 2 1 4 Widmore House Gardens 2 0 15 0 14 400 0 16 Meteorology. The following particulars have been extracted from the records kept at the Climatological Station at Church House Gardens for the year ended 31st December, 1934 Total rainfall 22.44 inches Mean maximum temperature 59.19 degrees Mean minimum daily temperature 43.78 degrees Highest maximum temperature recorded 85 degrees on 17th June 15 Lowest minimum temperature 20 degrees on 24th Janrecorded uary and 3rd February Lowest grass minimum tem- 16 degrees on 3rd Febperature ruary Unemployment. The Manager of the Employment Exchange has kindly supplied the following particulars:— 1. Recorded unemployment at the end of December, 1934:— (a) Men 830 (b) Women 173 Total 1,003 2. The highest figure reached in 1934:— (a) Men 835 on 22, 1, 1934 (b) Women 190 on 5, 2, 1934 Occupations. The following figures have been extracted from the Census figures of 1931 showing the occupations of males and females aged 14 years and over, and also the total "Operatives" and the total "Out of Work" at that time. The sub-totals are an analysis or partial analysis of the total of certain groups. Males. Analysis Total of Group. of Group. Group. I. Fishermen 1 II. Agricultural Occupations 928 Farmers 14 Gardeners and their labourers 837 Agricultural labourers 54 III.- Mining and Quarrying 2 IV. Makers of coal, gas, coke, lime, etc. 27 V. Makers of bricks, pottery, glass 23 16 VI. Workers in chemicals, paints, etc. 43 VII. Metal workers 720 *Foundry workers 7 *Smiths, etc 29 *Metal machinists 11 *Fitters, mechanical engineers, etc. 271 VIII. Workers in precious metals 18 IX. Electrical apparatus makers, fitters 239 X. Makers of watches, clocks, etc.56 XI. Workers in skins; leather goods makers 33 XII. Textile workers 16 XIII. Makers of textile goods and articles of dress 231 *Tailors 50 *Boot, shoe and clog makers 88 XIV. Makers of foods 126 Makers of drinks 16 Makers of tobacco 7 XV. Workers in wood and furniture 543 *Carpenters 337 *Wood carvers and turners 23 XVI. Paper workers, bookbinders, etc. 21 XVII. Printers and photographers 320 XVIII. Builders, bricklayers, etc. 839 *Bricklayers and masons 189 XIX. Painters and decorators, etc. 473 XX. and Workers in miscellaneous XXI. materials 60 XXII. 1. Railway transport workers 2. Road transport workers 948 3. Water and other transport workers 667 Messengers and porters 331 17 XXIII. Commercial and financial occupations 2559 Proprietors and managers of retail businesses 535 Shop assistants in retail businesses 669 XXIV. Public administration and defence 306 XXV. Professional occupations 811 Teachers 158 XXVI. Persons professionally engaged in entertainments, etc. 119 XXVII. Persons engaged in personal service 539 XXVIII. Clerks, draughtsmen, typists 1777 XXIX. Warehousemen, packers 224 XXX. Stationary engine drivers, etc. 91 XXXI. Other and undefined workers 976 General and undefined labourers 540 Unskilled workers in factories, works, etc 240 (*Excluding employers, managers, and foremen). Females. Analysis Total of Group. of Group. Group. I.-XI. (See above) 44 Agricultural occupations 12 Workers in chemical and paints 1 Metal workers 11 Electrical apparatus makers, etc. 10 Workers in skins; leather goods makers 7 XII. Textile workers 3 18 XIII. Makers of textile goods and articles of dress 403 *Tailoresses 52 *Dress and blouse makers 244 *Embroiderers, milliners, sewers, etc. 101 XIV. Makers of foods, drinks, tobacco 15 Makers of foods 14 XV. Workers in wood and furniture 59 XVI. Paper works, bookbinders 10 XVII. Printers and photographers 34 XVIII. (See above) 16 -XXI. XXII. Transport workers 106 *Telegraph and telephone operators 80 XXIII. Commercial and financial pations 707 Proprietors and managers of retail businesses 123 Shop assistants in retail businesses 521 XXIV. Public administration and defence 3 XXV. Professional occupations 029 Midwives, nurses, etc. 224 Teachers 328 XXVI. Persons professionally engaged in entertainments, etc. 24 XXVII. Persons engaged in personal service 4054 Domestic servants 3334 Lodging and boarding house keepers 54 Innkeepers, barmaids, etc. 40 Waitresses 60 Laundry workers 326 Charwomen 88 19 XXVIII. Clerks, typists, etc 1251 XXIX. Warehouse women, packers, etc. 36 XXX.- (See above) 69 XXXI. Unskilled workers in factories, works, etc 34 (*Excluding employers, managers, and foremen). Totals of Occupied Persons over 14, "Operatives" and " Out of Work," etc. Males. Females. Total, all ages (occupied and unoccupied) 20,099 25,275 Total, aged 14 years and over 15,498 20,684 Groups I.-XXXI. Occupied, 14 years and over 14,001 7,463 Operatives in work 10,753 6,674 Out of work (all classes) 688 261 Group XXXII. Unoccupied and retired, 14 years and over 1,497 13,221 Population. The mid-year population figure given by the Registrar General is 53,890, and in the previous mid-year (1933) the figure given was 48,270. Whilst the former figure is below my own estimate, which is based on the number of inhabited houses and the average number of persons per house, it is the figure which must be accepted for statistical purposes, but, it is to be noted that for use with the composite statistics supplied by the Registrar General, a working population figure is also supplied, which has been modified to take account of the fact that the records do not wholly relate to the entire year, viz., 52,762. At the end of 1934 a census of dwelling houses was compiled from information supplied by various departments in order to obtain some indication of the population of the Borough as extended under the Kent Review Order, 20 1934, and, taking into consideration the extensive building operations which became active during 1934, the total of dwellings arrived at was 14,380. The average number of persons per house at the time of the Census of 1931 was 4.2, but experience shows that there has been a diminution in the figure so that a comparative estimate of population at the end of 1934 may be taken as 57,520. A more important factor than numbers is the age and sex distribution of the population. The Registrar General gives an adjusting factor of .97 when consideration is given to the various mortality rates for purposes of comparison with other areas. Thus Bromley in 1934 had a crude death rate of 9.8 per 1,000 of the population based on the Registrar General's figure of population. This death rate is only comparable with death rates of other areas if multiplied by the correcting factor .97. Bromley's comparable death rate is thus 9.5 after due regard has been given to age and sex distribution. II.—VITAL STATISTICS. Births. Birth rate for 1934 is 13.3, a rise compared with the rate of 12.3 for 1933. The Registrar General has furnished the following information:— Live births: Total. Legitimate. Illegitimate. Male 342 320 22 Female 364 344 20 706 664 42 Due allowance has been made for inward and outward transfers of births. During 1934 779 births actually occurred in Bromley, but some of these were extra-district children, and the figure does not necessarily compare with the Registrar General's return which relates to registered births, it being remembered that births need not be registered until the 42 days' grace is about to lapse, whereas births must be notified to a local authority within 36 hours of occurrence. 21 It is to be noted that 42 births, i.e., 6 per cent. of total live births, were born out of wedlock, and statistics show that these births have not the same expectation of life as those born in wedlock. Bromley's annual birth rates are shown in comparison with the rates for England and Wales during the past twelve years:— Birth Bates. Year. Bromley. England and Wales. 1923 16.5 19.7 1924 15.1 18.8 1925 14.6 18.3 1926 14.8 17.8 1927 14.9 16.7 1928 15.9 16.7 1929 14.8 16.3 1930 14.3 16.3 1931 13.5 15.8 1932 12.9 15.3 1933 12.3 14.4 1934 13.3 14.8 Stillbirths. Rate per 1,000 births, 23.5. Seventeen stillbirths were registered in 1934, whereas 15 were notified under the Notification of Births Act, 1907. The latter figure is subject to correction for inward and outward transfers, and therefore the former figure is the accepted one for statistical record. The following table gives the statistics of stillbirths occurring in the area since the inception of compulsory registration of stillbirths in 1927:— Year. Stillbirths. Bate per 1,000 Births. 1927 16 25.2 1928 10 15.3 1929 23 36.8 1930 17 27.0 1931 26 40.4 1932 24 38.1 1933 17 27.6 1934 17 23.5 22 It will be noted that there has been a progressive decline in the rate since 1931, and due credit in some measure may be ascribed to the efficacy of putting into operation increased services for ante-natal supervision in recent years. It would, however, be premature indeed to herald this decline as marking the commencement of a progressive fall to an era giving us a low rate of stillbirth incidence. There are many factors to be overcome which operate against this desirable state of affairs being attained, prominent amongst them being the lack of appreciation by the expectant mother of the prime necessity of adequate ante-natal supervision. It is of interest to note that of the 17 stillbirths during 1934, 13 occurred in the first pregnancy. A tabulation of the causes of stillbirths are as follows:— Complication at labour 6 Renal disease 2 Placental abnormality 1 Malformation 1 Cord abnormality 3 Toxaemia 1 Unknown 3 It is apparent from the above that adequate ante-natal treatment could have prevented some of these stillbirths. Deaths. Death Rate 9.8 (crude). 9.5 (adjusted). 521 deaths were registered during 1934, being 32 more than in the previous year. The adjusted death rate has been arrived at after multiplying the crude death rate of the area (9.8) by a comparability factor (.97) supplied for the area by the Registrar General. This adjusting factor supplied in respect of a given area represents the ratio of the resulting death rate for the national 1931 census population to the similarly obtained hypothetical death rate for the area. The factor may be said to represent the population handicap to be applied to the area, and, when multiplied by the crude death rate experienced in the area, 23 modifies the latter so as to make it comparable with the crude death rate for the country as a whole or with the similarly adjusted death rate for any other area. Year. Bromley Crude Death Bates. England and Wales Death Bates. 1924 11.1 12.2 1925 10.3 12.2 1926 10.04 11.6 1927 10.8 12.3 1928 10.8 11.7 1929 11.7 13.4 1930 9.8 11.4 1931 10.9 12.3 1932 10.7 12.0 1933 10.1 12.3 1934 9.8 11.8 Causes of deaths are tabulated in detail in the Appendix III., from which the following main causes have been extracted for 1934, and shown in comparison with 1933:— 1933 1934 1933 1934 1933 1934 No. of death Bate per cent. of total deaths. Elate per 1,000 of population. liespiratory disease 44 43 8.9 8.2 0.9 0.8 Heart disease 156 151 31.9 28.9 3.2 2.8 Cancer 70 73 14.3 14.0 1.4 1.3 Tuberculosis 37 19 7.5 3.6 0.7 0.3 Premature births 13 17 2.6 3.2 0.2 0.3 Infectious disease 2 9 0.4 1.7 0.04 0.1 Influenza 16 7 3.3 1.3 0.3 0.1 Infantile Mortality. Thirty-one deaths of infants under one year of age were registered, giving a Mortality Rate of 43.9 per 1,000 live births registered. In the following table the rates for Bromley are shown in comparison with those for England and Wales:— 24 Year. Bromley. England and Wales. 1924 58 75 1925 57 75 1926 33.5 70 1927 50 69 1928 49 65 1929 46 74 1930 41 60 1931 47 66 1932 33.05 65 1933 41 64 1934 43 59 It will be observed from the foregoing figures that during the past nine years (1926-1934) the infantile mortality rate has been maintained well below 50 per 1,000 births, the average during this time being 42 per 1,000. During the quinquennial periods of 1910-1914 and 19211925 the rates were 68 and 62 per 1,000 respectively. There is every justification for again claiming that the public health services and teaching in Bromley have played no small part in achieving these encouraging results. Maternal Mortality. Quinquennial periods: Sepsis. Accidents of pregnancy, etc. Rate per 1,000 births. 1911-1915 4 5 2 1916-1920 9 9 6 1921-1925 6 7 4 1926-1930 4 6 3 Quadrennial period: 1931-1934 6 8 5* (*Rate per 1,000 live and still births) Four mothers died in 1934 as a consequence of childbirth, two were from sepsis and two from accidents of pregnancy. I am satisfied that every possible step was taken in each of these cases to prevent these deaths, and after all circumstances have been taken into account I am satisfied that none of the four cases came within the 25 category of causes that could have been prevented. All four cases died in hospital. As a preventive service the Local Authority provide among other services, ante-natal clinics, maternity hospital accommodation, an obstetrical specialist for emergency cases, and under the Midwives Acts the services of a doctor in a midwife's emergency. The problem of maternal mortality must lie in the hands of the skilled midwife and the skilled doctor, but more important than all, the patient herself must practice the principles which make for a healthy pregnancy. There is still too much interference with pregnancy and the undermining of the mother's health by the prevalence of the use of abortifacients. Abortion is treated too lightly by the unthinking mother, and the mother still neglects to accept the advice and care until late on in pregnancy. The other extreme is the mother who takes so much care that she creates an anxiety neurosis and fear of motherhood. Between the two extremes lies the happy medium; the skilled advice and supervision throughout pregnancy and the provision of accommodation for an abnormal confinement. One feels that under the present system there is lack of co-ordination in the maternity services for the necessitous patient. I believe the remedy lies in making the practising midwife a state service; the ante-natal period of all cases under the supervision of the medical practitioner; maternity beds being reserved for the cases selected by the doctor and those showing possible complications, while the normal case can safely be left in the hands of the skilled midwife. There is a tendency to hospitalise the normal case, which is brought out by the fact that in 1934 forty-four per cent. of cases admitted to the Maternity Hospital were accepted as midwives' cases. Our efforts as a local authority should be to promote a safe confinement in the home with a reservation of beds for the complicated, or likely to be complicated, case. III—MATERNITY AND CHILD WELFARE. The Maternity and Child Welfare services consist of the following:— 26 1. Five full-time and one part-time Health Visitors are employed half-time on school medical duties. They attend the centres and carry out the teaching of mothercraft in the homes. 2. Eight welfare sessions are held weekly, with a doctor in attendance at six of these each week. 3. Ante-natal clinics are held three times per month. 4. Maternity Hospital provision for necessitous cases —reservation of four beds. 5. Consulting Gynaecologist, whose services are available for general obstetrics work. f). Hospital treatment, isolation, and Consulting Gynaecologist for Puerperal Fever and Puerperal Pyrexia cases. 7. Dental treatment for expectant mothers, nursing mothers, and children under five years of age. 8. Free milk for necessitous cases. 9. Home visiting of boarded-out children under the Children and Young Persons Act, 1932. 10. Orthopspdic Treatment and Consulting Surgeon for the crippled child. 11. Minor ailment treatment. 12. Ear, Nose and Throat Consultant and Surgeon. Operative treatment at the School Clinic. 13. Ophthalmologist for defective vision. 14. Provision of hospital treatment for cases of Ophthalmia Neonatorum, and for acute cases of complicated measles. 15. Supervision of Midwives under the Midwives Acts. 10. Registration and inspection of maternity homes under the Nursing Homes Registration Act, 1927. Child Welfare Centres. Bromley Common— St. Lukes' Institute, Raglan Road Tuesdays, 2.30 p.m. Fridays, 2.30 p.m. 27 Burnt Ash— Burnt Ash Branch Library, Burnt Ash Lane .Tuesdays, 2.30 p.m. Wednesdays, 2.30 p.m. Hayes and Keston— Village Hall, Hayes Tuesdays, 2.30 p.m. Plaistow— School Clinic, Station Road Wednesdays, 2.30 p.m. Shortlands— Congregational Hall, Martins Road Thursdays, 2.30 p.m. Widmore— Wesleyan New Hall, Tylney Road Fridays, 2.30 p.m. Ante-Natal Clinics. Held at the School Clinic, Station Road, on the first and third Thursdays in every month at 2.30 p.m., and at the Maternity Hospital, Widmore Road, on the fourth Thursday in each month at 2.30 p.m. Dental Clinic. Held at the School Clinic, Station Road, daily for children, and for expectant mothers and nursing mothers at 9.30 a.m. on Saturdays, Orthopaedic Clinic. For children under five years of age with crippling defects, as well as for school children. Held at the School Clinic, Station Road. Mondays at 9.30 a.m. Tuesdays at 9.30 a.m. Thursdays at 2.0 p.m. Fridays at 12 noon. A Consulting Surgeon attends on the first Monday (afternoon) and third Tuesday (morning) in each month. 28 Ultra Violet Ray Clinic. Held at the School Clinic, Station Road, twice weekly: Tuesdays at 2.30 p.m., and Fridays at 2.30 p.m. Diphtheria Immunisation. Held at the School Clinic on Mondays at 2.30 p.m. Ante-Natal Clinic. Comparative Table of Attendances at Ante-Natal Clinic. Year. Individual Attendances. Total Attendances. Medical Consultations. Sessions held. 1922 17 32 26 4 1923 47 73 73 11 1924 47 51 51 12 1925 60 89 78 11 1926 59 90 90 14 1927 109 164 164 23 1928 116 184 184 23 1929 118 212 212 24 1930 125 235 233 24 1931 101 184 180 24 1932 123 199 196 24 1933 133 200 200 31 1934 142 263 251 32 The Ante-Natal Clinic is held on the first and third Thursday of each month at the School Clinic, Station Road, and at the Maternity Hospital on the fourth Thursday of each month. The above figures indicate a greater use of the antenatal services, but they by no means fulfil a complete ante-natal service. Only 18.6 per cent. of total notified births attended the ante-natal clinics, and while there is this complacence one must expect a high stillbirth rate and high maternal mortality rate. A far too large proportion of mothers fail to seek skilled ante-natal advice, and others there are who are too casual in ante-natal hygiene. Much can still be done to prevent mortality. 29 Natal Services. Seven hundred and seventy-nine births were known to have occurred in Bromley during 1934 as follows:— Notified by midwives 396 Notified by doctors and parents 367 " Tin-notified " 16 779 Of these cases the District Nursing Association's midwives attended 210 confinements. Midwives. I. (a) The number of midwives practising in the area served by the Local Authority for maternity and child welfare at the end of the year was 22 (b) Number (i) employed by the Council — (ii) directly subsidised by the Council — (iii) employed by Voluntary Associations 10 (c) IN umber of cases during the year in which the Council paid or contributed to the fee of a Midwife — II. (a) Number of cases attended by midwives during the year:— (i) as midwives 396 (ii) as maternity nurses 268 (b) Number of cases during the year in which medical aid was summoned by a midwife under Section 14 (1) of the Midwives Act, 1918 97 Administration of the Midwives Acts, 1902-1926. No. of midwives practising in Bromley at the end of 1933 21 No. of midwives giving notice of intention to practice during 1934 30 No. of midwives removed from the local register, having left the district 8 No. of midwives practising in the area at the end of 1934 22 30 Notifications Received. Notices summoning Medical Aid 97 (a) Mothers 84 (b) Infants 13 Notices of Artificial Feeding 3 ,, ,, Stillbirths 2 ,, ,, Deaths 3 ,, ,, Laying out a Dead Body 3 ,, ,, Source of Infection 4 Summary of Reasons for Sending for Medical Help. Ruptured perineum 43 Delayed labour 9 Breast condition 1 Varicose veins and leg swellings 1 Inertia 3 Placenta, adherent 4 Abnormal presentation 6 Haemorrhage 6 Ante-natal examination 4 Rise of temperature (puerperal pyrexia) 2 Other causes 5 Infants—Feeble, prematurity, etc. 7 Malformations 1 Cyanosis 1 Eye discharge 4 97 Payment of Doctors called by Midwives, Section 14, Midwives Act, 1918. No. of applications for fees 55 No. of cases where payment of fee lapsed on account of failure to claim within the prescribed period of two months 32 No. of cases where patient was known to have paid the doctor's fee direct 10 Total amount of claims paid £68 No. of necessitous cases in which repayment of claim was waived, or partial repayment of claim was accepted by the Committee 9 31 It is of some interest to note that the midwives of the Maternity Hospital summoned medical aid in 37 per cent. of cases while the District midwives called medical aid in 16 per cent.of cases. Inspection of Midwives. Dr. G. H. Stinson, Assistant Medical Officer of Health, carries out the inspection of midwives at their homes and occasionally at cases in the district. Dr. Stinson reports: "The work of the midwives is well performed, their bags and records being well kept. The new ante-natal register of the Central Midwives Board is creating no difficulty in record keeping, and the records indicate that the ante-natal work of the midwives is well advanced in standard. There were no infringements of the rules, medical aid being summoned in all necessary instances. The midwives are also showing a keener interest in the welfare centres of the town and are giving their co-operation helpfully in this direction. I believe the midwi.ves are now finding my inspection helpful to them and are not looking upon it as primarily an inspection for any neglect of the rules of the Central Midwives Board." Post-Certificate Course. Eight midwives attended this Course at Maidstone, which was again much appreciated and of instructional value. Maternity Hospital and Maternity Homes. The Maternity Hospital admitted 286 Bromley patients and 80 from other districts, making a total of 366. Under the Council's scheme 21 cases were referred to the Maternity Hospital and financially assisted. In addition 25 cases were referred through the Ante-Natal Clinic to other hospitals. Thus the Public Health services were instrumental in arranging hospital treatment in 46 cases of confinement, which would otherwise have taken place in undesirable environmental conditions, or which were 32 cases likely to be complicated by some medical or physical conditions. There are six institutions classified as Maternity Hospitals and Homes within the Borough, which are registered by the Local Authority under the Nursing Homes Registration Act, 1927, and, including the Maternity Hospital, make provision for 33 maternity beds to which 440 cases were admitted during 1934. Details of maternity and nursing homes registered by the Local Authority appear later in this Report under Part IV. dealing with Summary of General Provision of Health Services in the Area. Puerperal Fever and Puerperal Pyrexia. Queen Charlotte's Maternity Hospital, Isolation Block, Ravenscourt Square, Hammersmith, by arrangement with the Local Authority, accept cases coming under the abovementioned heading. Patients are conveyed to the hospital by the London Ambulance Service of the London County Council. In all cases of doubt, or where the cause of pyrexia is not of a minor character the consultant services of Mr. Bright Banister are called upon. It was necessary to call upon his services in two cases during 1934. Post-Natal. Home Visiting. Since the close of the year 1934 the staff of health visitors has been composed of five full-time health visitors and school nurses and one part-time health visitor who devotes three days per week to this work. The total number of visits made by the health visitors during 1934 amounted to 7,724, to which should be added 1,647 "ineffectual" visits, making an aggregate total of 9,371 visits. These 1,647 "ineffectual" visits were made up of visits where no answer was received, the family was found to have removed, or visits were not appreciated. The number of "no answer " visits is aggravated by the 33 number of itinerant hawkers who become such a nuisance to the busy housewife whose only remedy is not to answer the ring or knock on the door. In recent years these visits have been tabulated separately in maternity and child welfare statistics in this area, as obviously they make no substantial contribution to health visiting work and the teaching of motliercraft. Appendix XII. is set out in six areas, areas 1 to 5 being allotted to the five full-time health visitors and school nurses, and area 6 to the part-time health visitor Approximately the areas cover the district as follows:— Area. District. Health Visitor and School Nurse. Welfare Centre. No. of Sessions weekly. No. of Schools. Approx. School Population. 1 Burnt Ash (Downham) 1 full-time Burnt Ash 2 1 1200 2 Central, Plaistovv and Sundridge 1 full-time Plaistow 1 3 850 3 Sliortlands, Bickley (part) anil Widmore 1 full-time Sliortlands Widmore 1 1 4 1200 4 Council Housing Escates Bromley Common (part) Bickley (part) 1 full-time Bromley Common 2 3 850 5 Bromley Common (part) Bickley (part) 1 full-time 2 1200 6 Hayes and Keston 1 part-time Hayes 1 2 400 The number of schools allotted to each area as shown m the above table must not be taken to indicate the actual number of schools in the particular area indicated, the geographical situation of certain schools would not allow 34 of this, so duties in connection with the schools have been allocated as equally as possible to fit the exigencies of the services. Turning again to Appendix XII. it will be observed that out of 779 known births (live and still) 645 primary visits under one year (including 14 stillbirth visits) were made by the health visitors, which shows that approximately 82 per cent. of births received visitation. The total number of children who attended at the welfare centres for the first time during the year and who, on the date of their first attendance, were under one year of age was 391. Of the 631 primary visits to babies under one year of age 62 per cent. were subsequently brought to the welfare centres, and of 748 notified live births, 52 per cent. were enrolled on the welfare centre registers. One hundred and ninety-nine following-up visits were made to 142 expectant mothers who attended the ante-natal clinics, and the advice given at these visits is again supplemented by the doctor and health visitors at the welfare centres as the majority of expectant mothers also attend the centres frequently. Visits to mothers in connection with the Midwives Acts in those cases where a doctor has been summoned in an emergency are placing increasing demands on the health visitors' time. The visits, however, repay the time spent, as the health visitor, in the course of visiting to ascertain economic circumstances of the family in view of the pending claim on the patient by the Local Authority of the doctor's fee, is in a position to get in early touch with the nursing mother, who in many cases is of the type who rarely utilises maternity and child welfare services. In concluding this paragraph it may be of interest to note that out of the total of 9,371 visits, 5,275 (56 per cent.) were made in connection with ante-natal, post-natal and welfare generally of the child up to five years of age. The remainder of visits relates chiefly to school children and tuberculosis, a valuable work which will be dealt with later under the appropriate headings. At the present time we lack the provision of home nursing visits to young children suffering from acute non-notifiable infectious diseases, such as measles, whooping cough, etc., diseases which 35 cause much morbidity and which in many cases are aggravated by the lack of adequate home care. Welfare Centres. The Corporation maintains six welfare centres in the Borough at which eight sessions are held weekly. The following extracts of figures relate to the work carried out during the year 1934:— (a) The total number of attendances at all centres during 1934 15,186 (i) By children under 1 year of age 3,410 (ii) By children between the ages of 1 and 5 11,776 (b) The total number of children who attended at the centres for the first time during 1934 607 (i) Children under 1 year of age 391 (ii) Children between the ages of 1 and 5 216 (c) Total number of children who were in attendance at the centres at the end of 1934 1,779 (i) Children under 1 year of age 324 (ii) Children between the ages of 1 and 5 1,455 The work accomplished by the centres is set out in Appendix XIII. Apart from the increase of work caused by the addition of the Hayes and Keston Welfare Centre, an examination of the figures shows generally an increase also in the volume of the work at the older established centres. No less than 1,779 babies' names appear on the registers, and a total of 15,186 attendances were made by these children. Care is taken not to retain on the registers superfluous names, such as those children who have gone 36 to school, left district, or are irregular attendants, in order to present as truly as possible the real work of the centres. The average attendance of babies for each centre works out at 42—the individual centres show the average attendances for 1934 as follows:— Plaistow 50 Burnt Ash 32 Widmore 42 Bromley Common 50 Shortlands 38 Hayes and Keston 37 There were 20G medical sessions held at which a total of 2,284 medical consultations were given—an average of 11 per session. The total number of weighings made during the year was 12,432, and in this work, as well as in other social aspects of the work of the centres, the Voluntary Workers associated with the welfare centres give much valuable assistance. Milk in Necessitous Cases. During 1934 the number of individual cases granted assisted milk supply was 68. A total of 5,273 pints of milk being distributed at an approximate cost of £70. The following is an analysis of the size of families who received free milk during 1934 No. of Children in Family. 1 2 3 4 5 6 and over No. of Applicants 20 13 9 11 5 10 Percentage of total Applicants 29 19 13 16 8 15 Institutional and Convalescent Treatment. The Department found it necessary during 1934 to refer 21 children under five years of age to institutions for sick or ailing children, and three cases were sent through the good offices of voluntary associations to convalescent homes, including one case where the mother and her baby received convalescent treatment. 37 In the past, in the more serious cases, we have been able without much difficulty to secure treatment through various voluntary agencies, but with greatly increasing population we are at times embarrassed through lack of some definite arrangement of reserved accommodation, or subsidy to voluntary associations, to deal with the many cases of mothers and babies who would greatly benefit by convalescent treatment. Minor Ailments. The pre-school child has the benefit of the facilities of the School Medical Service, and thus the policy of early treatment tends to minimise the gross defects in the school entrant. At the end of the year a routine medical inspection of the child of four years of age was inaugurated in order to correct any condition prior to entry to school life. One hundred and twenty-nine cases received treatment at the School Clinic as follows:— Minor Ailments 32 Tonsil and Adenoid Operations 14 Eye Defects 9 Orthopaedic 74 Dental Clinic. Ninety-four children under five years of age, and 35 expectant or nursing mothers, received treatment at the Dental Clinic. Ophthalmia Neonatorum. Three cases were notified under the Public Health (Ophthalmia Neonatorum) Regulations, 1926. Each case received hospital treatment and completed treatment with vision unimpaired. Diarrhoea and Enteritis. Seven deaths of children under two years of age were recorded during 1934. In 1933 the mortality rate per 1,000 babies born in Bromley was five; for 1934 the rate 38 is 9.9 compared with 5.5 for the whole of England and Wales. This increase in the death rate generally coincides with a dry hot summer, but it is not likely owing to the greater knowledge of mothercraft possessed by mothers to-day that this cause of death in young infants will again become a main cause of infant death as in years gone by- Children and Young Persons Act, 1932. The following particulars have been extracted from the records kept with reference to foster-children and foster-parents:— (a) No. of persons receiving children for reward at the end of the year 1934 37 (b) No. of children on the register 45 (c) No. of Infant Life Protection Visitors (These duties are carried out by the health visitors) 6 Several instances of failure to give the required notice of reception or removal were dealt with informally as in each case the contravention was of a minor character. IV.—SUMMARY OF GENERAL PROVISIONS OF HEALTH SERVICES IN THE AREA. Legislation in Force. Adoptive Acts: The Infectious Disease (Prevention) Act 1890 The Public Health Acts (Amendment) Act (Parts II., III. and V.) 1890 The Public Health Acts (Amendment) Act (Parts II., III., IV., V. and VI., and Sections 81, 84, 85, 86 and 95) 1907 The Public Health Act (Parts II., III., IV. and V.) 1926 The Notification of Births Act 1907 The Local Government and Other Officers Superannuation Act, 1922 1927 39 Bye-Laws: (a) Made by the Town Council:— 1. With respect to the Regulation of Advertisements (Advertisements Regulation Act, 1907) 1910 2. With respect to the lighting of Road Obstructions 1922 3. With respect to (rood Rule and Government of the Borough 1927-1935 4. With respect to Registries for Female Domestic Servants 1927 5. For Public Libraries 1926 6. With respect to Public Pleasure Grounds 1906 7. With respect to Common Lodging Houses, Operating from 1/5/1935 8. With respect to Nursing Homes 1928 9. For imposing on the Occupier of any premises duties in connection with the removal of house refuse so as to facilitate the work of collection Operating from 1/5/1935 10. With respect to the cleansing of earth closets, privies, ashpits or cesspools 1/5/1935 11. With respect to Slaughterhouses 1/5/1935 12. With respect to Nuisances arising from snow, filth, dust, ashes and rubbish, and for the prevention of the keeping of animals on any premises so as to be injurious to health 1/7/1935 13. With respect to Nuisances in connection with the removal of offensive or noxious matters 1/5/1935 14. With respect to New Streets and Buildings, and the drainage of existing Buildings 1926-1934 15. With respect to lodging and accommodation for persons engaged in hop and vegetable picking (Part only of the Borough) 1931 40 16. Providing for Means of Escape from Fire in certain Factories and Workshops Operating from 1/7/1935 17. With respect to School Attendance 1900 18. With respect to the Prevention of Disturbances in School Buildings, etc. 1912 19. With respect to the Employment of Children Operating from 1/3/1936 20. As to Commons (Under Metropolitan Common Scheme Confirmation Act, 1909) (b) Made by the Kent County Council, but in force in part of the Borough for a period of three years from 1st April, 1934, unless previously repealed or altered by bye-laws made by the Town Council (Kent Review Order, 1934):— With respect to the Regulation of Advertisements (Advertisement Regulation Acts, 1907 and 1925) 1912-1927 Orders: 1891: Cap. LXII. 54 and 55. Vict. Supply of Electricity in the urban sanitary district of Bromley. 1934: Kent Review Order, 1934. (Under Local Government Act, 1929: sec. 46). 1922: Hairdressers' Early Closing Order (Made under the Shops Act, 1912). 1930: Midwives Acts 1902-1926 (Order under Section 62 of the Local Government Act, 1929). Regulations: 1. As to Sewer Connections. 2. As to the Movement of Sheep 1933 3. Kent (Music and Dancing) Licensing Regulations, 1928. No. 1 (Made by the Kent County Council under the Home Counties (Music and Dancing) Licensing Act, 1926). 4. As to Cemeteries. 41 Local Act: 1909: Cap. CXXYI. 9. Edw. 7. (To confirm a Scheme under the Metropolitan Commons Acts, 1866 to 1898, with respect to Keston Common and Leaves Green). Hospitals. (1) Infectious Diseases Hospitals: West Kent Isolation Hospital— Recognised accommodation 115 beds. Actual number in use 160 beds. 27 cots. West Kent Smallpox Hospital— Recognised accommodation 39 beds. Actual number in use 39 beds. 9 cots. (2) General Hospitals: Bromley (Kent) and District Hospital 50 beds. Phillips Memorial (Homeopathic) Hospital 18 beds. (3) Maternity Hospital: The Bromley and Chislehurst Maternitv Hospital 19 beds. (In addition there are 2 labour wards and 1 isolation ward). Maternity and Nursing Homes. The following table gives particulars of maternity and nursing homes registered by the Local Authority, and for convenience of tabulation I have included details of the larger hospitals which are exempt from registration under the provisions of the Act:— 42 Address. Total No of Beds. Maternity Beds Patients received 1934 Nursing Staff. Type Of case taken ity. Surgical Medical Total. Resident Living Out. Qualifications. 77, Avondale Road 6 3 25 22 13 4 1 3 1 Gen. Trainedand S.C.M. 2 Gen. Trained. 1 Asst. Nurse. Mixed 40, Bromley Common 10 5 13 60 14 6 5 1 4 Gen. Trained and S.C.M. 2 Gen. Trained. Mixed "Greta," Blytli Road 9 — 5 91 36 7 r 4 3 3Gen.Trainedand S.C.M. 4 Gen. Trained. Nursing 24, Elmfleld Road 10 2 8 — 16 4 4 — 2 Gen. Trained 2 Asst. Nurses. Mixed 3, Elmstead Lane 8 1 4 47 20 5 4 1 3 Gen. Trained. 2 Asst. Nurses. Mixed "Frascati," Masons Hill 15 3 19 24 33 10 10 3 Gen. Trained and S.C.M. 3 Gen. Trained. 1 S.C.M. 3 Asst. Nurses. Mixed 126, Princes Plain 2 — — 1 1 1 — 1 Gen. Trained. Nursing 16, Sundridge Avenue 4 12 1 1 — 1 Male Mental Nurse. (Home under supervision of Resident Medica] practitioner). Nursing 13, Tweedy Road 4 1 1 1 1 Gen. Trained. Fully trained Nurses engaged when necessary, Nursing Maternity Hospital, 118, Widmore Road 19 19 366 11 11 4 Gen.Trained and S.C.M, 2 S.C.M. 5 Asst. Nurses. Maternity Bromley (Kent) and District Hospital, Cromwell Avenue 50 In- patients 735 Out- patients 905 21 21 2 Gen. Trained and S.C.M. 6 Gen. Trained. 1 Masseuse. General Hospital cases Phillips Memorial Hospital. Lownds Avenue 1 18 — — 93 86 6 6 — 12 Probationers. 3 Gen. Trained. 2 Asst. Nurses. 1 Probationar. General Hospital 43 Institutional. (1) The Rochester Diocesan Society for Befriending Women and Girls has a home at 29, Ravensbourne Road, which was opened in October, 1912. Here unmarried expectant mothers are received and arrangements made for their confinement in maternity homes or in the Farnborough Hospital (Public Assistance Institution). Subsequent to confinement the mothers and babies are received into the Home, and kept there until employment is found for the mother. If the employment is not of such a nature as to allow the mother to care for her child, foster-mothers are found by the Society. The Home has no subsidy from public funds. (2) The Blind Hostel, Southlands Road, is a Hostel maintained by the London Association for the Blind, and receives no subsidy out of the rates. (3) Hostel for Women at 10, Crescent Road, is for women and girls, which was opened in September, 1933, by the Bromley National Council of Women. The Hostel has no subsidy from public funds. This Hostel was previously maintained at an address in College Road. Ambulance Facilities. (1) For Infectious Disease Cases: The West Kent Joint Hospital Board has motor ambulances at the Hospital, Bromley Common, for the removal of infectious disease cases. (2) For Non-Infectious and Accident Cases: A motor ambulance, the property of the Corporation, is available at any hour for the removal of sick cases of noninfectious nature, the fee being remitted in necessitous cases. Laboratory Facilities. The West Kent Isolation Hospital undertakes the testing of throat swabs, and the arrangements continue to work satisfactorily. The facilities used for the examination or analysis of clinical material (sputum, etc.), water, milk and foodstuffs are those provided by the Kent County Council, 44 Clinics. The School Clinic, Station Road, was opened in 1928, and makes provision for the following treatments and services, details of which are dealt with in the Maternity and Child Welfare and School Medical sections of this report:— 1. Minor Ailment Treatments. 2. Tonsil and Adenoid Clinic. 3. Eye Clinic. 4. Orthopaedic Clinic. 5. Massage and Remedial Exercises Clinic. 6. Ultra Violet Ray Clinic. 7. Dental Clinic. 8. Diphtheria Immunisation Clinic. 9. Ante-natal Clinic. Welfare Centres are provided for the areas of:— 1. Bromley Common. 2. Burnt Ash. 3. Hayes and Keston. 4. Plaistow. 5. Shortlands. 6. Widmore. Each centre is held weekly, with the exceptions oi Bromley Common and Burnt Ash where two sessions are held weekly. Full particulars of each centre appear under Part III., Maternity and Child Welfare of this report. When the auxiliary School Clinic is completed at Bromley Common it is hoped that the long standing problem of a clinic within easy access for the ever increasing population of the southernmost portion of the Borough will he solved. The extension of the School Clinic, Station Road, is now in hand, and when completed will remedy an inconvenience which has for a long time impeded the work of the Plaistow Welfare Centre. Nursing in the Homes. (1) The Bromley District Nursing Association, which was formed in 1907, provides two general trained nurses for professional district nursing in the homes of those who 45 are unable to provide their own private nursing facilities. Three state certified midwives, on the staff of the Association, undertake midwifery and maternity work. The Association since June, 1932, has undertaken this nursing service throughout the greater portion of the Borough. No fee is charged for general nursing, but patients are asked to contribute as much as they can afford. A fixed fee of £2 2s. 0d. is charged for midwifery and maternity cases, though in cases of economic necessity this may be reduced. Summary for the year 1934. Cases on the Register, January, 1934 26 New cases during the year 493 Visits Paid. General Nursing 4719 Ante-Natal Visits 1425 Maternity and Midwifery 3734 Casual Visits 959 Analysis of New Cases. Medical 155 Surgical 125 Maternity (with Doctor) 52 Midwifery 158 Abortions 1 Cases sent in by: Doctors 226 Visitors and Others 9 Found by Nurse 10 Applied 239 Result of Cases Nursed. Convalescent 434 Sent to Hospital, Infirmary or transferred 33 Died 24 Still on liegister 23 Nursing Staff. (i) General Nurses 2 (ii) Midwives 3 46 (2) The Hayes and West Wickham Nursing Association provide similar facilities for the added areas of Hayes and Keston. Their sphere of activities also covers West Wickham, which is within the area of a neighbouring Local Authority. One general trained and state certified midwife is employed by the Association. Details nursing visits are as follows:— General Nursing 1465 Midwifery 104 Ante-Natal 97 Casual 282 1948 Tuberculosis Dispensary. The Tuberculosis Dispensary is provided and maintained by the Kent County Council. The Tuberculosis Officer in charge of District No. 7, which includes Dispensaries at Bromley and Penge, is Dr. B. G. A. Edelston. The districts covered by these two dispensaries are, Bromley, Beckenham, Penge, Anerley, parts of Sydenham and Upper Norwood, Orpington, Chislehurst and Sidcup. The Dispensary for Bromley is held at 2, Park Road, on Wednesdays, from 1.30 to 3.30 p.m., and on Fridays from 5.0 to 6.0 p.m. The Corporation provides a nurse for attendance at the Dispensary from the Health Visiting staff for the Wednesday dispensary, the Health Visitors carrying out home visiting of patients. The work of the Dispensary is briefly reported on by the Tuberculosis Officer, and appears in a later part of this report. Venereal Diseases Treatment Centres. Provision for treatment is under the administration of the Kent County Council. There is no centre in the Borough. The close proximity of London, where there are ample facilities available at the various London Hospitals, provides an adequate and convenient service for such cases. 4t V.—SANITARY CIRCUMSTANCES. Rivers and Streams. Certain portions of the Ravensbourne and Quaggy watercourses have been culverted during the past year forming part of the gradual covering in of these streams through built-up areas. During the year six inspections were made and in one instance pollution of a minor character was remedied after service of informal notice. Drainage and Sewerage. The main drainage of Bromley links up with the undertaking of the West Kent Main Sewerage Board, whose purification works are at Dartford. Sewerage is there precipitated by gravitation before being discharged into the River Thames.. Works for the digestion of sludge were in course of construction during 1934 and at the time of writing it is reported will shortly be inaugurated. The surface water drainage of the Borough is separate from the system for foul drainage. No important reconstruction schemes have been carried out during 1934, but advantage has been taken where estate development has been proceeded with, to put in sewers of a larger size than could normally be required to be put in by the Estate Developers, thus making provision for future development. Cesspool Drainage. With the incorporation of Hayes and Keston into the Borough of Bromley a survey was made by the Sanitary Inspectors for the purpose of scheduling the methods of drainage of the household property in the added areas on the appointed day 1st April, 1934. This survey showed that of the 361 premises not on main drainage:— Those with Pail Closets 103 89 had sewers available. 14 sewers not available. ,, ,, Cesspools 254 82 had sewers available, 172 sewers not available. ,, ,, Purification Plants 4 4 had sewers available. 48 The non-sewered residential area of Keston Park accounts for 123 of the cesspools, but these will be abolished on the completion of the main drain which the Local Authority is now constructing. Immediate efforts were made by the Department to encourage owners to convert to main drainage, and by the end of the year the inspectors had been successful in the conversion of 55 premises, while a further 35 were in course of conversion. At the time of writing this rate of progress has been maintained, so that we hope to claim that with the undertaking of the added area by the Borough of Bromley we have been instrumental in obtaining the abolition of cesspools and pail closets— antiquated, unhygienic and potentially dangerous methods of household drainage. Water. A piped supply is general throughout the Borough and comes mainly from the Metropolitan Water Board's deep chalk well at Shortlands Valley. The supply is sufficient, very hard, but of high grade purity. For particulars of reservoirs within the district, reference may be made to page 35 of my Annual Report for 1930. Under the Kent Review Order, 1934, certain area of rural character was added to the Borough, and five small houses are situated far from main water supply. Their supply by wells is of an intermittent and unsatisfactory character. Scavenging. The public cleansing services, beyond extension to take in the added area, have been normally carried out. Extensive alterations to the Refuse Disposal Plant have been completed during the year, involving the installation of a Separation Plant, and a more efficient method of cell charging in order to deal with the increased amount of refuse from the enlarged Borough. Rats and Mice Destruction Act, 1919. The arrangements during National Rat Week in Bromley were similar to those of past years. Special 49 attention was paid to the properties owned or occupied by the Corporation, and all sewers were baited. The co-operation of the Chamber of Commerce, and especially of the local chemists, was obtained, the latter making: special window displays. Large and small posters issued by the Ministry of Agriculture and Fisheries were freely displayed throughout the district together with posters furnished by a proprietory firm specialising in rat poison. The Health Department provided rat poison (red squill) free on application and made distribution of handbills at the various centres and clinics in the town. A small exhibition of stuffed rats, specimen baits and specimens of the raw material used in making baits was organised by the Chief Sanitary Inspector. Visitors to the exhibition were instructed in the best methods of dealing with infestations and were given literature on rat destruction, e.g., the Ministry of Agriculture and Fisheries' pamphlets, Advisory Leaflet No. 49 and Advisory Bulletin No. 30. The areas of Hayes and Keston which were added to the Borough in 1934 were specially circularised with propaganda literature. Despite the publicity given again in 1934 by posters, handbills and press notices, one cannot report that the response of the general public was good. The following details relate to applications made to the Health Department for free poisons, etc.:— Total No applicants for free poison 78 (a) From Trade Premises 16 (b) From Private Premises 62 No. of bottles of red squill given free 123 No. of tins of red squill biscuits 28 There was no request for the gassing machine. Apart from the special efforts put forward to stimulate public interest during Bat Week, the Department has always pursued the policy of maintaining interest in rat destruction throughout the year. During 1934 the Sanitary Inspectors made 219 inspections with reference to rat infestations. In 93 instances informal notices were served tQ rid premises of rats, and at the end of 1934 50 abatement- of rat nuisances was secured in 73 instances. At the time of writing the outstanding infestations at the year's end have been mostly cleared up. From experience gained in dealing with rat infested premises one realises the greater need for collective action in the neighbourhood infested—without this, action by individual "occupiers" lias almost negligible results. VI.—HOUSING CONDITIONS. The housing problem of Bromley is one peculiar to a residential area in close proximity to London. The provision of houses is thus one mainly for private enterprise, with necessary restrictions, if one is to keep the area residential. The Local Authority has already provided approximately four per cent. of the total number of dwelling houses in the area, and where industrial development in the district is limited this should be adequate, except in those cases where action is taken under the Housing Acts for the re-housing of displaced tenants. The function of the Local Authority, in so far as housing' is concerned with the public health, must therefore be restricted to the supervision of the erection of new dwellings, and inspecting from time to time inhabited dwellings so that they may be maintained in a state of repair and provided with the essentials that make for a healthy environment. We are nevertheless limited in the power to render houses fit for habitation to a standard in accordance with modern ideas. It is somewhat astounding that even in 1934 so many houses are allowed to be without proper bathing accommodation, and that new houses should be erected without the provision of proper clothes washing accommodation, and in some cases of coal cooking facilities. This latter may be advantageous from the smoke nuisance viewpoint, but it certainly has its economic disadvantage to the tenant. There is too, some evidence that there is an endeavour to relax the new building bye-laws in order to facilitate the erection of new dwellings. One fears with this relaxation that the new 61 dwelling of to-day will not meet the standard of fitness required some twenty years hence. Inspection of District. One thousand one hundred and twenty dwelling houses were inspected, calling for 5,916 inspections. Of these houses 9(50 were found not to be in all respects reasonably fit for habitation, the case of disrepair being in many instances extensive. This re-conditioning of houses is a matter of vast importance when considering the housing question, and is not to be overlooked in the publicity given to the re-liousing of slum areas. Neglect of house repairs (and it is not every landlord who realises liis responsibility) soon makes the house irrepairable and only fit for demolition. Particulars of defects are given in the Appendix. Housing Acts, 1925-1930. In the taking over of the added area certain houses were added to the schedule of unfit houses not repairable at reasonable cost, and, as we are shortly to have a new Housing Act dealing with overcrowding and calling for a survey of the area as a whole, with probably new responsibilities as a Local Authority, it is at this stage important to report progress under the old Acts. In the year 1933 eleven houses were closed as unfit; seven in Hookers Place which remain uninhabited, and will, I hope, shortly be demolished by the owner; four in Widmore Road which were demolished. A further four houses in Gravel Pits were re-conditioned, fitting them for aired counles. In the year 1934 an additional 2!) houses came into the schedule of unfit houses, and the following summary gives the total of houses concerned, the number vacated at the end of the year, and the number of tenants left in occupation and requiring accommodation by the Local Authority should it be necessary to take formal action for demolition under the Housing Acts, 52 Situation. No. of Houses. Vacated. Remaining Tenants. Remaining families. Adults. Under 16. Orchard Place 11 4 19 1 7 Devonshire Square 2 — 6 9 3 Brewery Cottages 5 3 4 1 2 Wood Cottages, Hayes 3 10 5 3 "Pettigrove," Keston 3 2 3 — 1 "Pensioners" Cottages Keston 2 3 2 Jackson Road 2 — 9 — 2 Boots Estate 1 1 — — — Housing Inspection. Inspection by the Local Authority of working class houses is a requirement by statute. This is done in order to keep such property up to the standard of working class property in the area, but where the owner takes an interest in his property this inspection would appear to be superfluous. However, it is noteworthy that in 1934, 200 houses were inspected under the regulations, and a further 1,217 houses were inspected on complaint or for other purposes, and that these houses showed 3,784 defects and nuisances based on the standard of the Housing Acts. This indicates that not every owner is interested in the maintenance of his property in a good state of repair, but the fact that no less than 692 were rendered fit by co-operation between landlords and the sanitary inspectors reflects the willingness of owners to have these properties re-conditioned. The proposed Housing Act which will come into force apparently in 1935, will add to the duties of the inspectors and place further burden on the house owner. By reference to Appendix VII. and Appendix VIII., which have been submitted by Mr. G. E. Woods, Chief Sanitary Inspector, an indication is given of the number and nature of defects and nuisances discovered and remedied. No less than 3,830 visits were made to houses 53 during the period when work was being executed to remedy defects found. Since the inception of the Housing Act, 1930, to the 31st December, 1934, 1,609 houses have been rendered fit in accordance with this Act. The following table is a repetition of the quarterly returns during 1934:— Since the inception of the Act to the 31st December, 1933 1370 March quarter, 1934 62 June quarter, 1934 45 September quarter, 1934 59 December quarter, 1934 73 Since the inception of the Act to the 31st December, 1934 1609 Overcrowding. Twenty-nine houses were visited with regard to overcrowding conditions, 25 of which were visited on complaint received and four during the course of routine work. Nuisance from overcrowding was found to exist in 12 instances, and 10 of these cases had been remedied at the close of the year. Statutory Notices. Nine dwelling-houses were concerned with the service of statutory notices under the Public Health Acts, but no statutory notice was issued under the Housing Act, 1930. Houses Let in Lodgings. There is an increasing tendency to convert the larger residences into flats and the demand for service flats is increasing, primarily as a result of the domestic service problem. This tendency to live in "Community houses" is, in my view, a retrograde step and one that must affect our national social habits. 54 Contraventions. Public Health Acts. Offence. Action taken. 1. Failure to give 24 hours' written notice to the Local Authority of intention to reconstruct a drain Warning given. 2. Refusal to permit entry to inspect a house and subsequent default by owner to abate nuisance Magistrate's Order to Inspect granted, and Statutory Nuisance Notice served. On default of owner, Magistrate's Order to abate nuisance within 28 days was granted. The Orders were finally complied with. VII.—SMOKE POLLUTION. Thirteen routine visits and observations were made, and the inspectors were successful in getting four smoke nuisances abated as a result of informal action. In these four instances it was necessary to make suggestions for improvement in stoking which were willingly carried out. Three of the Sanitary Inspectors hold the special certificate for smoke inspection of the Royal Sanitary Institute. VIII.—SHOPS ACTS. Eight hundred and seventeen visits were made under these Acts. Failure to display statutory notice with reference to the Assistants' Half-Holiday and hours of employment of Assistants under 18 years were remedied in G3 instances. In each case the necessary forms were provided forthwith by the shop-keepers. 56 Contraventions. Nature of Offence. Type of Shop. Action taken. Selling after statutory closing hours. Wireless Appliances. Warning given. Do. Greengrocery and Fruiterer. Do. Do. Cycles, Tobacco and Confectionery. Do. Do. Fish. Do. Do. Greengrocery and Fruiterer. Do. Do. Stationery, Confectionery, etc. Do. Do. Tobacco and Confectionery. Do. Do. Market Stall. Do. Do. Market Stall. Do. Do. Greengrocer and Fruiterer. Proceedings taken. 10/- fine. Assistants employed on statutory half-day closing. Wireless Appliances. Warning given. Do. Gowns. Do. Contravention of Hairdressers and Barbers (Sunday Closing) Act, 1930. Sunday trading. Hairdressers. Do. IX.—PETROLEUM ACTS. Number of Licences issued 100 (i) For Petroleum Spirit 96 (ii) For Carbide of Calcium 4 Total quantity of Petroleum Spirit in gallons 174,554 (i) Bulk storage in gallons 161,295 (ii) Two-gallon can storage in gallons 13,259 Carbide of Calcium in lbs. 668 66 Of the 100 licences issued, 92 were renewals and eight were new or additional licences. Included in the total of 100 licences are 22 licences for combined bulk and can storage. Two hundred and forty-three visits to storage places were made during 1934. The following figures show the increase in licenced storage which has taken place since 1926:— Year. Petroleum Spirit. (in gallons). Licences issued. (Petrol only). 1926 66,915 77 1927 103,025 69 1928 159,335 82 1929 159,746 92 1930 166,308 81 1931 168,925 83 1932 176,090 93 1933 170,789 98 1934 174,554 96 X.—FACTORIES AND WORKSHOPS. Appendix XIV. gives details of statistics with regard to inspections and defects in factories, workshops and workplaces. There are 480 of these premises on the register. XI.—PREMISES AND OCCUPATIONS CONTROLLED BY BYE-LAWS, REGULATIONS, ETC. Four thousand nine hundred and eighty-one visits of inspection were made to the following premises and occupations controlled by Bye-laws, Regulations, etc., i.e., Bakehouses, Butchers' premises, Cinemas, Confectionery, Ice Cream, etc., Dairies, Cowsheds and Milkshops, Factories, Workshops, Workplaces and Outworkers' premiees, Fish shops, Food hawkers, Food shops, Hotels, Restaurants, etc., Licensed premises (public houses), Nursing Homes, Offensive trade (tallow melting), Petroleum Spirit Stores (licenced), Piggeries, Poisons and Pharmacy (licenced), Rag and Bone dealers, Registry Offices, Shops, various, Slaughterhouses, Stables and Tents, Vans and Sheds. 57 XII.—INSPECTION AND SUPERVISION OF FOODSTUFFS. The Sanitary Inspectors continue to devote as much time as practicable to this important branch of the work of the Health Department. Milk. The main supply of milk is pasteurised milk. The following premises are registered for the sale of milk:— Dairies and milk stores:— (i) Premises within the Borough 94 (ii) Premises outside the Borough 21 Dairies licenced for the sale of:— "Pasteurised" milk 13 "Certified " milk 5 "Grade A Pasteurised " milk 1 " Grade A (Tuberculin Tested) " milk 7 The Ministry of Health has granted a producer's licence to sell under the designation "Certified" milk to two farms within the Borough. Seven supplementary licences have been granted for the sale of graded milks, viz,, "Pasteurised," "Certified" and "Grade A (T.T.)" within the Borough from premises outside the district. Bacteriological Examinations. Fifty-two samples of milk were submitted for bacteriological examination and the results are shown in the following table which also includes the results of samples taken at the request of the Ministry of Health from producers holding licences for the production of "Certified" milk:— Samples. Totals. Satisfactory. Unsatisfactory. "Pasteurised" milk 7 7 — "Certified" milk 21 20 — Ordinary milk 24 9 16 52 36 16 58 Five samples of milk were tested for the presence of tubercle bacilli and after inoculation tests the results were negative. The sixteen unsatisfactory samples of ordinary milk were found to have unduly high bacterial counts and presence of bacillus coli. In each case, after the matter had been taken up with the producers concerned, much improvement was effected. Contraventions. No serious cases of contraventions of the Milk and Dairies Order, 1926, were encountered during the year. Meat. There are two licenced and six registered slaughterhouses in the Borough. Regular visits are made to these slaughterhouses, 2,928 animals were known to have been slaughtered and 2,922 were examined by the Sanitary Inspectors after slaughter. Ninety-nine per cent, of the carcases were seen. In addition to carcases examined in butchers' shops, the inspectors also examined on the request of local butchers 395 carcases coming from outside the district. Complete co-operation exists between the local butchers and the Department, and this in many instances has proved helpful to all concerned. The Local Authority granted 20 licences during 1934 to slaughtermen under the Slaughter of Animals Act, 1933. Table A. Total number of animals known to have been slaughtered and carcases inspected. Total. Beasts. Calves. Sheep. Pigs. Animals known to have been killed 2928 202 188 1628 910 Carcases Inspected 2922 202 188 1625 907 59 Table B. Total number of slaughterings, carcases inspected, and found affected with various diseases. Total No. known to have been slaughtered. Total No. of animals inspected Carcases affected with Tuberculosis. Carcases affected with other diseases. Total No. of carcases affected (all diseases). 2928 2922 77 (2.6 per cent) 183 (6.2 per cent) 260 Table C. Total number of carcases rejected for Tuberculosis aud other defined diseases. Disease. Bulls. Cows. Heifers. Bullocks Calves. Sheep. Pigs. Total. Tuberculosis — — I I — — 3 5 Other defined diseases — — - 2 — 2 4 Total -T I i 2 — 5 9 Table D. Total number of all carcases, parts of carcases and offal rejected for all diseases. Disease. Carcases. Parts of Carcases Offals of Carcases. Total number affected. Tuberculosis 5 46 26 77 Other defined diseases 4 8 171 183 Total 9 54 197 260 60 Table E. Total weights of carcases, parts of carcases and offal rejected for all diseases. Tons. Cwts. Qrs. lbs. Total in lbs. Carcases 1 — 2 21 2317 Parts of carcases — 10 2 19 1195 Offal — 11 1 4¾ 1264¾ Total 2 2 2 16 ¾ 4776¾ Contraventions. Carcase and Action parts of carcase. Disease. Premises. taken. Head and collar Tuberculosis Shop Seized and conof Pork demned on Magistrate's Order. Warning given. Head of Pork Do. Do. Warning given. Sheep's pluck Do. Do. Do. Head of Pork Do. Do. Do. Unsound and Unwholesome Food Surrendered. Article of Food. Weight. Meat 214 lbs. Poultry 53 ,, Fish 100 „ Tomatoes 98 ,, Butter 10 „ Potatoes 560 ,, Cream cheeses 125 ,, Cooked meats 179 ,, Rabbits 18 „ 61 Tinned Goods. Quantity. Vegetables 53 tins Fruit 760 ,, Fish 104 „ Approx. 954 „ Milk, Cream 167 „ Meat 67 ,, Miscellaneous 62 ,, Food and Drugs (Adulteration) Act, 1928. The following tabulation gives particulars of the work of the Food and Drugs Inspector in Bromley during 1934:— New Milk 66 Mustard 1 Cream 1 Mixed Pickles 3 Oatmeal 1 Tapioca 1 Dem. Sugar 2 Ground Rice 1 Coffee 5 Gin 2 Raisins 1 Boracic Ointment 1 Cocoa 5 Tinc. of Iodine 1 Rice 3 Camphorated Oil 3 Margarine 7 Ice Foam 1 Custard Powder 1 Preserved Peas 1 Brawn 1 Shredded Suet 1 Pepper 5 G. Cinnamon 4 Lard 5 Citric Acid 1 Butter 5 Flour 2 Sausages 5 Cornflour 2 Whiskey 1 Zinc Ointment 1 S.R. Flour 4 Ground Ginger 2 Herring's roes 1 No. of samples 147 Genuine 147 Adulterated — Inferior — XIII.—DISEASES OF ANIMALS ACTS. The administration of the above Acts within the Borough came under the Department as from 1st April, 1932, and the Chief Sanitary Inspector was appointed Inspector for the purposes of these Acts. 62 No. of movement licences received of animals moved into the Borough 127 Animals inspected: (i) Pigs 846 (ii) Sheep, lambs 294 No. of licences issued by the Local Authority 1 Animals inspected: Sheep 24 No. of inspections made in connection with the above details 118 Tuberculosis Order, 1925. No action was required to be taken under the abovementioned Order. XIV.—RAG FLOCK ACTS, 1911-1928. Three rag flock samples were submitted for examination and all the samples complied with the standard in accordance with the above-mentioned Acts. XV.—INFECTIOUS DISEASES CONTROL. Scarlet Fever. The year saw a continuance of the prevalence of Scarlet Fever which has continued more or less in epidemic form since 1930. An unexpected rise in the incidence curve in 1934 brought the rate to 4.9 per thousand population, the highest incidence since 1921. As in recent years the main source of cases came from the L.C.C. Downham Estate, which was responsible for 38 per cent, of cases.. The influx of population to new housing estates affects this curve of incidence giving a stimulus to the infection. This is borne out by the high return of scarlet fever in the L.C.C. Estate at Downham since 1930, being equivalent to 42 per cent, of all cases notified during that period. There has been too an increase in the number of " return " cases irrespective of the length of stay of cases in hospital. While the disease remains comparatively mild in character, the policy of home isolation is to be 63 encouraged, mainly on economic grounds resulting as a consequence of the freeing of hospital beds occupied by mild uncomplicated cases, and there is much to support the policy 011 Public Health grounds. This policy of home isolation is becoming more active, in 1933 seven per cent, were home nursed, and in 1934 twenty-five per cent, were home nursed. Return Cases, i.e., second cases arising in the same family after discharge of the first case from hospital. Total Cases— Hospital treated 10 Home nursed 1 Period of isolation of first case— Weeks. Hospital Cases. Home Nursed. 5 1 _ 6 3 1 7 1 _ 8 3 _ 11+ 2 _ Period, between discharge from Hospital and infection of return case— Within 10 days 5 15 „ 2 20 „ 1 25 „ 2 Home nursed case, 12 days. On this question of home isolation of the uncomplicated case of scarlet fever it will be of interest to note the findings of the report of the Medical Research Council issued in 1933. This Report covers an epidemiological study in Scarlet Fever in England since 1900. (1) Diminution in the Death Rate of Scarlet Fever during the past thirty years is due essentially to the decreased severity of the disease. The present low level may be, for any evidence to the contrary, merely the trough of the wave. (2) During the period studied no evidence has been found to prove that hospital isolation has been effective in reducing the prevalence, or mortality from Scarlet Fever, 64 (3) Although Scarlet Fever has a decreasing mortality during the past thirty years, there has been no diminution of prevalence. The report of the Committee on Local Expenditure issued in 1932, page 89, states " There is no reason for prescribing a routine period of detention in hospital of more than four weeks in uncomplicated cases of Scarlet Fever . . . nothing to suggest an extension of the routine period of detention lias any effect on the number of return cases or on the incidence of, or mortality from, the disease. We think that the saving to be secured by adoption of the conclusion—would be of the order of £120,000 per annum." " Careful consideration should also be given to the question whether mild cases of scarlet fever might not be dealt with at home." Diphtheria. The anticipated rise in incidence of diphtheria occurred in 1934—43 cases, giving a rate of 0.8 per thousand population. There were two deaths, equivalent to 4.6 per cent, of cases notified. One case was home nursed. A practical step in the prevention of diphtheria epidemic lies in the immunisation of the pre-school child, but to date, although the immunisation clinic has been established since 1928 we have not reached 30 per cent, of immunised children. A minority of parents have responded to the request for immunisation, but it requires a serious epidemic to rouse public opinion to the advantages of this method of prevention. Immunisation during epidemic times, is, in practice, almost valueless, as it takes at least three months to create an immunity. It is during non-epidemic times that diphtheria immunisation must be exercised, especially during the pre-school years. There were 37 sessions held at the diphtheria immunisation clinic, and 539 attendances were made during these sessions. Although the numbers are small it must not be overlooked that they represent the response of the public without any propaganda in the matter. Smallpox. No cases of smallpox were reported, and no cases occurred since we experienced the epidemic of 57 mild cases in 1930. 65 I am indebted to the vaccination officers for the following figures relating to vaccination during 1934. Babies born in 1933. No. successfully vaccinated 310 No. unsuccessfully vaccinated 4 No. of declarations of conscientious objectors 300 No. of Primary Vaccinations of children under 14 years of age in 1934 185 No. of Statutory objections in 1934 261 (Returns in respect of Hayes not received). Tuberculosis. Appendices IX. and X. give incidence and particulars of cases of tuberculosis in Bromley in 1934. The current register shows no less than 370 cases suffering from the infection in either a mild or severe degree. This is equivalent to 7.01 per one thousand population—a high incidence—but it includes many cases in a non-infectious state. Eighty-nine new cases were notified or otherwise revealed to me during 1934, of which 74 were pulmonary and 15 non-pulmonary cases, whilst 19 cases died—12 pulmonary and seven non-pulmonary. I am submitting a table indicating the state of tuberculosis in Bromley since 1925. culosis in Bromley since 1925. This indicates a fall in incidence. New cases Incidence per 1,000 population. Death Bate. Year. Pulin. Non-Pulm. Pulm. Non-Pulm. 1925 1.07 04 0.5 0.16 1926 1.4 0.4 0.6 0.05 1927 1.3 0.6 0.5 0.2 1928 1.3 0.7 0.7 0.1 1929 1.1 0.3 0.6 0.04 1930 1.1 0.4 0.8 0.1 1931 1.1 0.3 0.6 0.06 1932 1.2 0.3 0.5 0.19 1933 1.01 0.25 0.6 0.12 1934 1.4 0.2 0.2 0.1 66 Tlie Health Visitor paid 384 visits to tubercular patients advising on the care of the patient aud on the principles that make for fitness in the contacts. No occasion arose during the year to take any action under the Public Health (Prevention of Tuberculosis) Regulations, 1925 (Relating to Persons suffering from Pulmonary Tuberculosis employed in the milk trade), or under Section 62 of the Public Health Act, 1925 (Relating to the compulsory removal to a Hospital of persons suffering from Tuberculosis). Dr. Edelston, the tuberculosis officer, kindly submits the following statistics on the work of the dispensary— 1934. New Cases who have attended the Dispensary for the first time for Examination during 1934. Adults. Children. Male. Female. Male. Female. Pulmonary 24 20 — — Non-Pulmonary 2 4 2 — Negative 6 11 11 6 Totals 32 35 13 6 No., of contacts examined during 1934 11 No. found to be positive (These figures are not included in the above table) — Total No. of attendances at the Dispensary during 1934 1132 No. of Patients receiving residential treatment during the year 75 APPENDIX. 68 LIST OF APPENDICES. 1. Summary of Statistics, 1934. II. Comparison of Statistics, 1934. III. Causes of Deaths, 1934. IV. Causes of Infant Deaths, 1934—Age Groups. V. Analysis of Infant Deaths, 1930—1934. VI. Analysis of Infant Deaths and Maternal Deaths, 1910—1914, 1921—1925, 1926—1930, and 1931— 1934. VII. Summary of Work of Sanitary Inspectors, 1934. VIII. Summary of Nuisances Abated, 1934. IX. Return of Notifiable Infectious Diseases, 1934, in Wards, giving attack rates and death rates, etc. X. Return in Age Groups of new cases of Tuberculosis notified, and of deaths occurring in 1934. XI. Return of Ophthalmia Neonatorum, 1934. XII. Summary of Health Visitors' Work, 1934. XIII. Summary of Attendances at Welfare Centres, 1934. XIV. Factories, Workshops and Workplaces, Inspections, 1934. XV. Housing Statistics, 1934. 69 APPENDIX I. SUMMARY OF STATISTICS, 1934. Population (mid-year 1934, Registrar General) 53,890 Birth Rate 13.3 Death Rate (crude) 9.8 Infantile Mortality Rate 43.9 Number of Births (live) 706 Number of Stillbirths 17 Number of Deaths 521 Number of Infant Deaths (under 1 year) 31 Death Rate of Respiratory Diseases 0.8 ,, ,, ,, Tuberculosis 0.3 „ ,, ,, Cancer 1.3 ,, ,, ,, Zymotic Diseases 0.1 Notifications of Scarlet Fever 263 ,, ,, Diphtheria 43 ,, ,, Pneumonia 16 ,, ,, Tuberculosis 89 Number of Deaths from Measles 1 ,, ,, ,, ,, Scarlet Fever 3 ,, ,, ,, ,, Diarrhoea (under 2 years) 7 ,, ,, ,, ,, Child Birth 4 Number of Visits by Sanitary Inspectors 13,690 ,, ,, ,, ,, Health Visitors 9,371 i, ,, Babies on the Registers at the Centres, end December, 1934 1,779 70 APPENDIX II. BIKTH RATES, DEATH RATES, AND ANALYSIS OF MORTALITY in the Year, 1934. Rate per 1,000 Total Population Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. All causes. Enteric Fever. Small-Pox. Measles. Scarlet Fever. Whooping Cough. i Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under Two Years). Total Deaths under One Year. Live Births Still Births England and Wales 14.8 0.62 11.8 0 00 0 00 0.09 0.02 0.05 010 0.14 0.54 5.5 59 121 County Boroughs and Great Towns, including London 14.7 0.66 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 0.47 7.4 63 135 Smaller Towns (Populations, 25,000-50,000 at census 1931) 15.0 0.67 11.3 0.00 ... 0.07 0.02 0.04 0.09 0.14 0.42 3.6 53 London 13.2 0.50 119 0.00 0.00 0.20 0.02 0.07 0.11 0.12 0.56 12.6 67 BROMLEY 13.3 0.32 9.5* 0.00 0.00 0.01 0.05 0.05 0 03 0.13 0.31 9.9 43 *Adjusted. Puerperal Sepsis. Others. Total. per 1000 Live Births 2.03 2.57 4.60 The maternal mortality rates for England and Wales are as follows { „ Total Births 1.95 246 4.41 BROMLEY „ „ (live andstill) 2.76 2.76 5.53 71 APPENDIX III. Causes of Death, 1934. Male. Female. Total. 1. Typhoid and Paratyphoid Fevers — — — 2. Measles 1 — 1 3. Scarlet Fever 1 2 3 4. Whooping Cough — 3 3 5. Diphtheria 2 — 2 6. Influenza 4 3 7 7. Encephalitis Lethargica — — — 8. Cerebro-Spinal Fever — — — 9. Tuberculosis of respiratory system 9 3 12 10. Other Tuberculous Diseases 3 4 7 11. Syphilis — — — 12. General paralysis of the insane, Tabes Dorsalis 1 1 13. Cancer (malignant disease) 28 45 73 14. Diabetes 2 2 4 15. Cerebral Hemorrhage, etc. 14 13 27 16. Heart Disease 58 93 151 17. Aneurysm 2 — 2 18. Other Circulatory Diseases 10 14 24 19. Bronchitis 8 6 14 20. Pneumonia (all forms) 14 7 21 21. Other Respiratory Diseases 5 3 8 22. Peptic Ulcer 1 2 3 23. Diarrhoea, etc. (under 2 years) 7 — 7 24. Appendicitis — 3 3 25. Cirrhosis of Liver, — 1 1 26. Other Diseases of Liver, etc. — 5 5 27. Other Digestive Diseases 9 11 20 28. Acute and Chronic Nephritis 7 8 15 29. Puerperal Sepsis — 2 2 30. Other Puerperal Causes — 2 9 31. Congenital Debility, Premature Birth. Malformations, etc. 11 6 17 32. Senility 4 6 10 33. Suicide 8 — 8 34. Other Violence 9 6 15 35. Other defined diseases 28 24 52 36. Causes ill-defined or unknown — 1 1 Totals 246 275 521 72 APPENDIX IV. Infant Mortality, 1934. CAUSES OF DEATHS. Under 1 week. 1 1 and under 2 weeks. 2 and under 3 weeks. 3 and under 4 weeks. Total under 4 weeks. 1 month and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under l year. Measles ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Tuberculosis ... ... ... ... ... ... ... ... ... ... Convulsions 2 ... ... ... 2 ... ... ... ... 2 Bronchitis ... ... ... ... ... ... ... ... 1 1 Pneumonia 1 1 ... ... 2 ... ... 2 ... 4 Diarrhoea ... ... ... ... ... ... ... 1 1 2 Enteritis ... ... ... ... ... ... ... ... ... 4 Gastritis ... ... ... ... ... ... ... ... ... ... Suffocation ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis Malformation 1 2 ... ... 1 ... ... ... 2 2 ... 1 ... 1 ... ... ... 1 2 5 Premature Birth 5 ... ... ... 5 ... ... ... ... 5 Marasmus, etc. 2 ... ... ... 2 ... ... ... ... 2 Other Causes ... ... ... ... 1 2 ... ... ... 3 Syphilis ... ... ... ... ... ... ... ... ... ... Congenital Heart Disease 1 ... ... ... 1 ... ... ... ... 1 Totals ... 14 1 1 1 17 5 3 3 3 31 73 APPENDIX V. Analysis of Causes of Infant Deaths, 1930-1934. 1930 1931 1932 1933 1934 No. of Births 629 617 605 598 706 Total Infantile Mortality Rate 41 47 33 41 43 Premature Birth 7 3 4 5 5 24 Respiratory Diseases 3 5 5 6 5 24 Marasmus and General Debility 4 3 1 4 2 14 Infectious Disease ... 1 ... 1 — 2 Gastro Enteritis 3 4 1 ... 4 12 Convulsions 2 1 ... 2 5 Other Causes 7 10 9 9 13 48 Totals 26 27 20 25 31 129 This table shows that Premature Births and Congenital Debility caused 29 per cent, of the total infant deaths during the past five years, and should be taken as an indication of the great need for AnteNatal supervision. 74 APPENDIX VI. Summary of Infant Mortality Statistics. Three five-year period figures are taken—five years pre-war, five years to 1925, five years to 1930, and 1931-1934. Years Total Births Infant Mortality Rate Total Infant Deaths Age at Death. Maternal Deaths. Deaths under 1 week Deaths 1 week to 4 weeks Deaths 4 weeks to 1 year Sepsis Other 1910—1914 3186 68 220 61 41 118 3 6 1921 624 60 38 10 9 19 1 1 1922 575 74 43 19 7 17 2 2 1923 578 60 35 13 3 19 1 — 1924 535 58 31 11 4 16 1 2 1925 520 58 30 11 3 16 1 2 1921—1925 2832 62 177 64 26 87 6 7 1926 536 35 18 11 7 1 — 1927 574 50 29 12 2 15 — 1 1928 652 49 32 11 4 17 1 3 1929 623 46 29 6 4 19 1 1 1930 629 41 26 11 4 11 1 1 1926—1930 3014 44 134 51 14 69 4 6 1931 617 47 29 10 4 13 1 3 1932 605 33 20 9 1 10 1 1 1933 598 41 25 12 — 13 2 2 1934 706 43 31 14 3 14 2 2 (R.G.'s return 29, Local returns 27). In these figures the following facts are shown :— 1—Reductions in Infantile Mortality Rates. The fall occurs chiefly in the period over 4 weeks of age. 2—Increase in the deaths of infants under 1 week of age. Rate 1910-1914, 28 per cent. Rate 1926-1930, 38 per cent. 3—Increase in Maternal Deaths, Rate 1910-1914, 2.7 per 1.000 births. Ratr 1926-1930. 3.3 per 1,000 births. 1931-1934. 5.5 per 1OOO births (live). 75 APPENDIX VII. Summary of Work of Sanitary Inspectors for the Year 1934. Inspections. Nuisances and Defects found. On Complaint. Routine Inspections. Re- Inspections. Total. Houses Visited— Under Insp. of District Reg 968 — 200 1478 1678 Housing Act, 1930, Sec. 17 128 — 40 206 246 Sec. 19 — — 5 5 Sec. — — — — — Sec. — — — — — For Nuisances 2311 581 143 1540 2264 No. not conf'd (13) Overcrowding 12 25 4 18 47 Verminous houses 29 37 3 15 55 Dirty conditions 1 5 3 4 12 Water supply 2 2 — 2 4 Cesspools 102 8 130 79 217 Earth closets — — — 1 1 Privy pans 1 1 1 20 22 Privy bins 94 — 98 501 599 Infectious Disease 3 — 319 51 370 Disinfection purposes — — 73 14 87 Disinfestation purposes 5 5 2 21 28 Added areas—Properties tabulated 1924 1924 „ „ Drainage system enquiries — — 216 3 219 House let in lodgings 1 1 Magistrates' Order — 1 — 1 Sink refuse water to soakaways 97 — 97 — 97 Houses without separate sinks 23 — 23 — 23 „ „ water supply 3 — 3 — 3 „ served by wells 5 — 5 — 5 Food Preparing Places— Bakehouses—Factories 29 1 52 15 68 Workshops 16 — 26 15 41 Butchers' shops (including Meat Regs.) 14 — 1507 5 1512 Confectionery shops 7 3 15 1 19 Dairies, Cowsheds, etc. 3 1 87 5 93 Fish shops 9 3 345 16 364 Pried Fish shops 4 — 15 3 18 Food hawkers — — 150 — 150 Greengrocery, Fruiterers 3 2 140 2 144 Grocery shops (including Meat Regs.) 2 1 233 4 238 Hotels, Restaurants, etc. 7 1 30 6 37 Ice Cream premises — 3 — 3 Milk Sampling—Bact. Ord — — 24 — 24 „ graded — — 28 — 28 Tuberc. — — 5 — 5 Chemical — — — — — 76 Inspections. Nuisances and Defects found. On Complaint. Routine Inspections. Re- Inspections. Total. Milk examined on highway 2 — 44 — 44 Retail market — — 78 1 79 Slaughterhouses — — 558 4 562 Milk and Dairies Order—Contraventions — — 4 — 4 Milk, Observations on roundsmen — — 2 — 2 Trade Premises— Factories 29 7 20 20 47 Workshops 21 2 33 26 61 Outworkers' premises — — 17 — 17 Under Shops Acts 54 22 783 12 817 Under Petroleum Acts 1 — 210 33 243 Registry Offices 1 — 30 — 30 Diseases of Animals Acts— — — 9 — 9 Inspections — 1 98 — 99 Interviews — — 10 — 10 Offensive trades 1 1 10 — 11 Poisons and Pharmacy licences — — 6 — 6 Viscose Works, Visits to — 3 7 — 10 Viscose Works, Observations made — — 45 — 45 Premises visited re viscose smells — 3 2 — 5 M iscellaneous— Accumulations 36 37 20 31 88 Animal nuisances, from keeping — — 1 — 1 Pigs — — — — — Drain tests—Smoke — 1 35 10 46 Water — 1 63 16 80 10 Colour — — 10 — Chemical — — 1 — 1 Mirror — 3 13 — 16 Food poisoning enquiries — 1 2 1 4 Piggeries — — 13 1 14 Rag and Bone dealers 2 — 7 — 7 Rats and Mice Destruction Act 93 59 54 106 219 Schools 96 1 2 33 36 Small-pox—Visits contacts seen (3) — — 3 — 3 Smoke 4 8 3 2 13 Special visits 2 — 331 — 331 Stables — — 8 1 9 Streams 1 1 2 3 6 Tents, Vans and Sheds — — 1 — 1 Urinals 2 3 38 6 47 Interviews, owners, agents (Total 2178) Rag Flock samples — — 3 — 3 Water Sampling—Bacteriological — — 2 — H Chemical — — 2 — B Totals 4223 830 8526 4336 13692 77 APPENDIX VIII. Nuisances Abated, 1934. HOUSING: Drainage— Re-drained and connected to sewer 55 Cesspools abolished 24 Earth closets „ 3 Privy bins ,, 27 „ pans „ 1 Drains re-laid or repaired 60 Drains unstopped 86 Inspection chambers provided 75 W.C.'s additional or separate provided 12 ,, buildings reconstructed 20 ,, ,, repaired 7 ,, pans renewed or provided 73 ,, ,, cleansed 8 ,, box seats removed 82 ,, disconnected from food cupboards 2 Soil pipes, vent pipes, renewed or repaired 15 Sinks renewed 44 Sink or bath waste pipes ,, ,, 105 Cesspools emptied 12 Sink waste soakaways abolished 25 Surface water drainage provided 34 Dampness— Roofs repaired or renewed 129 Rain water pipes, guttering, etc., repaired or renewed 104 Damp courses:— Vertical plinths provided 34 Walls rendered 9 Horizontal d.c. provided 20 Solutioning 12 Earth removed from walls 3 Walls repointed 90 Weather boarding repaired or renewed 6 78 Solid floors reconstructed 2 Subfloor ventilation provided or improved 8 Brickwork renewed or repaired 32 Footings reinforced (walls under pinned) 2 General— Rooms cleansed 354 W.C. walls, etc., cleansed 40 Entrance hall and staircase cleansed 41 Bathroom cleansed 7 Light and ventilation of rooms improved 10 Plastering repaired or renewed 174 Floors ,, ,, 63 Windows, frames, etc, repaired or renewed 141 Sashcords „ ,, 71 Putty pointing ,, ,, 153 Doors „ ,, 41 Stoves ,, ,, 87 Coppers „ „ 48 Handrails ,, ,, 11 Stair treads, etc. ,, ,, 15 Dustbins provided 177 Dirty conditions remedied Overcrowding abated 10 Defective chimneys repaired 37 External woodwork painted 19 Food preparing place constructed 1 Food stores—Provided 39 Ventilated 15 Cleansed 1 Yard paving renewed or provided 58 Houses disinfested 23 Water Supply— Drinking water service supplied direct from main 25 Fittings renewed, etc 12 Supply reinstated 23 Flushing cisterns repaired or renewed 57 No. of houses closed voluntarily 10 Miscellaneous 153 79 TRADE PREMISES: Factories and Workshops— Want of Cleanliness 7 Other nuisances 11 Sanitary accommodation— Insufficient 9 Unsuitable or defective 7 Not separate for sexes 3 Shops Acts : Contraventions— Asst. half-holiday forms 33 Under 18 years notice 28 Separate sanitary accommodation provided 1 Other 1 Diseases of Animals Acts—contraventions 3 Milk and Dairies Amendment Act, 1922— contraventions 2 FOOD PREPARING PLACES: Defects and nuisances remedied in— Butchers' shops 22 Bakehouses 26 Confectionery shops 3 Dairies, etc. 11 Fish shops 6 Fried fish shops 3 Greengrocery shops 4 Grocery shops 6 Hotels, restaurants, etc. 25 Ice cream premises 1 MISCELLANEOUS: Accumulations removed 60 Nuisances from keeping animals 2 Manure removed 1 Manure receptacles provided 1 Rats and mice nuisances 73 Smoke muisances 4 Stables cleansed 1 Urinals—Cleansed 2 Abolished 1 80 Offensive trades nuisances 3 Schools—Drains relaid 1 New W.C. pans 7 W.C. floors repaired 7 ,, flushing cisterns 7 Doors repaired 7 Gully rendering repaired 10 Total 3484 NOTICES ISSUED: Preliminary— Housing 960 Others 307 Total 1267 Statutory— Housing 9 Total 9 81 APPENDIX IX. Return of Notifiable Infectious Diseases, 1934. Disease. Total. M. F. WARDS. Cases removed to Hospital. Attack Kate per 1,000 population. No. of Deaths. Death Rate. Plaistow Martin's Hill. Town. Sundridge. Bickley. Bromley Common. Hayes & Keston Scarlet Fever 263 111 152 99 14 28 19 36 46 21 198 4.9 3 0.05 Diphtheria 43 12 31 10 14 6 — 2 7 4 42 0.8 2 0.03 Pneumonia 16 10 6 3 4 2 1 4 2 — 3 0.3 21* 0.3 Puerperal Fever and Pyrexia 5 — 5 1 1 1 1 — — 1 4 0.09 2 0.03 Erysipelas ... 12 4 8 2 — 2 1 3 4 — 1 0.2 — — Ophthalmia Neonatorum 3 3 — — — 1 — 1 1 — 3 0.05 — — Tuberculosis—Lungs 74 36 38 22 4 4 8 13 7 16 — 1.4 12 0.2 Tuberculosis—Other Forms 15 9 6 5 — 2 3 3 2 — — 0.2 7 0.1 Totals 431 185 246 142 37 46 33 62 69 42 251 8.1 47 0.8 *Includes Pneumonia (all forms), whereas notifiable types include only acute primary pneumonia and acute influenzal pneumonia. 82 APPENDIX Xla. Notifiable Infectious Disease, 1934. Age Groups. Disease Total 0-1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 & over Scarlet Fever 263 — 2 8 16 22 121 49 12 21 6 6 — Diphtheria 43 — — — 5 2 12 9 4 8 3 — — Pneumonia 16 — — — 1 — 3 — — 3 — 6 3 Puerperal Fever and Pyrexia 5 — — — — — — — — 5 — — — Erysipelas 12 — — — — — — 2 — 1 4 4 1 Oph. Neonatorum 3 3 — — — — — — — — — — — Totals 342 3 2 a 22 24 136 60 16 38 13 16 4 83 APPENDIX X. Tuberculosis. New Cases and Mortality during the Year, 1934. Age Periods. New cases notified or otherwise revealed. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M F. Under 1 ... ... ... ... ... ... ... ... 1—5 ... 1 1 1 ... ... 1 ... 5—10 ... 1 3 ... ... ... ... ... 10—15 ... ... 2 ... ... ... ... 1 15—20 2 2 2 ... 1 ... ... ... 20—25 8 5 ... 1 ... ... ... ... 25—35 9 18 ... 2 2 3 ... 3 35—45 10 5 1 1 3 ... ... ... 45—55 5 3 ... ... 2 ... 1 ... 55—65 2 2 ... 1 1 ... 1 ... 65 and over ... 1 ... ... ... ... ... ... Totals 36 38 9 6 9 3 3 4 APPENDIX XI. Ophthalmia Neonatorum, 1934. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 3 ... 3 3 ... ... ... APPENDIX XII. Summary of Health Visitors' Work, 1934. Areas. Total. Under one year. Revisits over one year. Expectant Mothers. School Children. Baby Deaths. Stillbirths Tuberculosis Special Visits. M'wives Acts enquiries Boarded out Children. Ineffectual Visits. Primary Revisits Area No. 1 1343 109 155 459 51 345 4 ... 77 140 3 13 217 Area No. 2 1349 90 226 618 39 281 7 1 50 22 15 9 258 Area No. 3 1688 143 343 803 23 206 4 6 94 38 28 42 197 Area No. 4 1491 96 206 803 54 246 5 5 51 12 13 37 394 Area No. 5 1286 138 250 503 27 174 6 ... 78 108 2 10 425 Area No. 6 567 55 93 336 5 22 1 2 34 15 4 ... 156 Totals 7724 631 1273 3522 199 1274 27 14 384 335 65 111* . 1647‡ * Also included in routine visits under the various headings. ‡ " Ineffectual " visits are those where 110 answer is received, discovered removed from district, or where visits are resented, and are not included in the total number of visits. TUBERCULOSIS DISPENSARY WORK. Patients on the Dispensary Roll at end of December, 1934 129 Health Visitor's attendances 48 Total No. of special visits to Patients 143 84 85 APPENDIX XIII. Welfare Centres, Attendances, 1934. CENTRE. No. of Babies on Rolls at the end of the Year, 1934. Total Attendances. No. of Sessions held. Medical Consultations. Total No. of Weighings. Babies. Mothers. Total Examined. No. of Sessions held. PLAISTOW 296 2487 2147 49 368 31 2109 WIDMORE 192 2011 1872 48 289 24 1797 SHORTLANDS 221 1928 1856 51 267 28 1362 BURNT ASH 411 2844 2283 89 525 45 2019 BROMLEY COMMON 506 4998 4188 100 551 55 4286 HAYES & KESTON 153 918 310 25 284 23 859 Totals 1779 15186 13156 362 2284 206 12432 Ante-Natal Clinics. Total Attendances. Medical Consultations. Sessions held 263 251 32 Dental Clinic. Discharged treatment. Children. Mothers. 94 35 86 APPENDIX XIV. Factories, Workshops and Workplaces, 1934. I.—Inspections. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories 138 18 ... Workshops 102 21 ... Workplaces (other than outworkers' premises) 57 19 ... Total 297 58 ... II.—Defects. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 25 21 ... Want of ventilation ... ... ... Overcrowding ... ... ... Want of drainage to floors ... ... ... Other nuisances 70 56 ... Sanitary accommodation. insufficient 9 9 ... unsuitable or defective 7 7 ... not separate for sexes 3 3 ... Total 114 96 ... *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts, 87 APPENDIX XV. Housing Statistics for the Year 1934. Total number of inhabited houses at 31st December, 1934 14380 1. Inspection of dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1120 (b) Number of inspections made for the purpose 5916 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 200 (b) Number of inspections made for the purpose 1678 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 29* (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 960 2. Remedy of Defects during the year without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 692 *At the end of the year 10 houses had been vacated under Housing Act, 1930, without resorting to formal action, 88 3. Action under Statutory Powers during the Year:— A. Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners — (b) By Local Authority in default of owners — B. Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 9 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 9 (b) By Local Authority in default of owners — C. Proceedings under sections 19 and 21 of the Housing Act, 1930 Nil.* D. Proceedings under section 20 of the Housing Act, 1930 Nil. *See note above (section 1 sub-section (3). BOROUGH OF BROMLEY. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR 1934. 90 MEMBERS OF THE EDUCATION COMMITTEE OF THE BOROUGH OF BROMLEY, 1934-1935. Alderman F. W. Isard (Chairman of the Education Committee). *D. Copping, Esq, *A. Cowdry, Esq. †Councillor F. S. Darby. Councillor E. C. De'Ath. *Mrs. M. D. Fry. *Rev. Hugh Glaisyer, m.a. *G. J. Gully, Esq., j.p. His Worship the Mayor. (Councillor C. H. Gunton, j.p.). *Rev. J. T. Gurney. Councillor S. G. Humerston. Councillor T. H. Jayes. *Mrs. A. G. Mann, b.a., j.p. Councillor A. McIntosh, d.c.m. *Mrs. E. J. Munn. Councillor G. L, Pyrke. *Rev. Prebendary B. F. Relton, m.a. Councillor L. A. Simmons. Alderman W. F. Skilton. Councillor F. G. Hamilton Spratt. Councillor M. Stafford Smith, m.b.e., b.a. *G. Weeks, Esq. *Rev. O. G. Whitfield, m.a. Councillor W. A. Young. *Co-opted Members. †Resigned from the Council 24/4/1935. 91 Introduction. For some time past we have incorporated with the School Medical Service treatment of the pre-school child, a routine medical inspection of the child being made at the welfare centre at the age of three to four years, prior to entry to school. Children under five years of age attend the special clinics of the School Medical Service, and with the increasing use of the clinics, enlargement of premises has become necessary. The building of a new clinic at Bromley Common will fulfil a need and will also add to the effectiveness of the services provided by the Local Authority. The services increased during the year owing to the extension of the Borough to include the parishes of Hayes and Keston, whereby some 500 children were added to the school rolls. This necessitated bringing in certain part-time medical staff in order to relieve the full-time staff of certain clinics. Dr. F. G. France has been appointed to the Tonsil and Adenoid Clinic and Dental Clinic as Anaesthetist, and Mr. A. M. Hickley as Specialist for the Eye Clinic. There has been no other change in the routine of the service during the year, but a trial is being given to include medical inspection of the 10 years of age group as an additional routine age group. It is too early to report on the value of such inspection prior to the child's entry to a senior school. Three thousand five hundred and nine children passed through the various clinics during the year 1934, requiring a total of 5,086 medical inspections. This does not include the Dental Clinic where 4,101 attendances were made. These figures give some idea of the extent of the services provided by the Local Education Authority for the treatment of minor ailment and for the maintenance of the health of the school child. The results of the work of the School Medical Service have long since proved its value, and the future extension of the services must be to bridge the gap between the leaving age and the employment age. There still remains the tendency to treat the School Medical Service as an Out-patient Service for the sick 92 child, and much of the time of the medical staff is expended on these examinations at the expense of the normal child, the direction on prevention of defectiveness and the maintenance of nutritional fitness. That the Local Authority should treat the minor ailment in order to prevent permanent impairment is a fundamental factor in the School Medical Service, but whether this would or could be. done by a private service without State control is indeed doubtful. There remains, however, a line of demarcation between domiciliary treatment by the private practitioner and clinic treatment by the Local Education Authority with a happy co-operation between both services. I am convinced that physical training is not by any means fully developed so as to have an effective result on the physique of our school children. There appears to be a general slackness in posture especially marked in the leaver group. I have noted too that in this respect schools vary, and that where children have attended the Orthopaedic Clinic for remedial exercises the good results are obvious even months after the attendances have ceased. I believe that if we are to improve the posture of the young child, physical training in our schools must be placed on a more advanced basis than it is at the present time, and at the same time we must inculcate a pride in the physical fitness of the child through inter-school sports and organised games. There is a tendency to-day to rush the child hack to school long before it has sufficiently recovered from illness; the desire to maintain a 90 per cent. attendance may be economical when considered financially but it is certainly not so when considered from the view point of the physical welfare of the child. One factor which is largely outside the control of the School Medical Authorities is the tendency of parents to allow their children late hours and insufficient rest, with consequent lowered resistance to disease. I believe much chronic rheumatism in children has its origin in this factor of fatigue. Home circumstances may prevent the twelve hours rest in bed, but there are cases where the selfishness of the parents demands that the child must either be left 93 unattended at home, or go with the parents to the pictures and other places of amusement. The problem is a social one. The scheme of distribution of milk in schools continued to work smoothly, due entirely to the goodwill of the Head Teachers and the persons concerned in the distribution. All schools in Bromley have this scheme in routine working order, except at the Central School where the Head Teacher reports that he is unable to co-operate without additional staffing for the purpose. In the case of the necessitous family who by ill-chance is not able to provide the 2id. weekly per child for the supply of milk in the school, and the child in consequence is certified as suffering ill-nourishment, it is referred by me to the Children's Care Committee and the milk is provided through them. The scheme works well and without difficulty. As statistics indicate to some extent the work of the School Medical Service, I am here summarising the work carried out during 1934. The work is heavy, and I am indebted to all members of the staff of the Department for their enthusiasm and efficiency. At the same time I would like to record my appreciation of the interest and help I have received from the Committee and the co-operation of Head Teachers and Voluntary Workers at the Clinics to whom no praise can be too great. School Roll 5,785 Number of individual children who attended medical clinics 1,688 Number of individual children medically examined at schools 1,770 Number of medical examinations at the Clinic 5,086 Number of Treatments at the Clinic 5,133 „ ,, ,, Dental Clinic 4,101 ,, ,, ,, Eye Clinic 401 Number of Operation for Tonsils and Adenoids 131 Total Number of attendances at the Orthopædic Clinic 3,528 (1) For Consultations 686 (2) For Treatments, massage, etc, 2,842 94 Total number of attendances at the Ultra Violet Ray Clinic 1,653 Number of children referred to the Care Committee 194 Hygiene of Schools. A special sanitary survey of the Council Schools was made during the year with special reference to the type of sanitary conveniences. It is pleasing to note that the Committee has agreed upon a programme of converting all trough closets into modern and better sanitary fittings. It is obvious that if hygienic principles are to be taught to children at school, the best lesson is the practical demonstration of a sanitary environment. This is apparent when one enters such a School as at Princes Plain (built in 1933) where even the children themselves take pride in their surroundings. The following is a list of improvements carried out in 1934:— Valley Council Schools.—Indoor W.C. accommodation provided for the Staff. Raglan Road Council Schools.—Sanitary arrangements improved by replacement of previous facilities with the provision of 43 new W.C.s, three urinal slabs, 24 trapped hand basins, three vertical jet drinking fountains, one indoor staff cloakroom and W.C., and drinking water in all departments direct from the main. Central Schools.—One additional vertical jet drinking fountain provided. Mason's Hill C. of E. Schools.—One range of new W.C.s provided. Bickley and Widmore C. of E. Schools.—Heating and lighting arrangements improved by the provision of three slow combustion stoves, and additional lighting points. Addison Road C. of E. Schools.—One additional urinal slab and two W.C.s provided. 95 Medical Inspection. The usual routine has been maintained; children under the routine age groups of entrants, intermediates (Second age group) and leavers (Third age group), have been examined at school, while children not necessarily coming under these groups but requiring examination at the clinics, or at request of the parents, head teachers and school attendance officers, have been recorded under " specials." There are other medical examinations made, such as, employed children, children referred for convalescent home treatment, children examined after infectious disease or contacts to infectious disease, who require fit certificates to return to school, and special cases referred for mental defect or for abnormal behaviour, and the special cases referred from the Juvenile Court. The field is a wide and interesting one, but time is all too short to cover the whole field of work to one's entire satisfaction. Table I. in the appendix gives the number of children examined as routine (1,770) and as specials (5,086). Table II. gives further details of these inspections, describing in particular the defects discovered at the various medical examinations. It will be noted that the chief defects are of the throat and nose. Of children examined at routine inspections 140 (9 per cent.) were noted to have defective vision not previously discovered. By further reference to Table II. it will be noted that the 1,770 children coming under routine examination at school suffered from 546 defects requiring treatment. Table IIb. shows that the younger age group are mostly affected whilst the leaver group is comparatively free. This is the statistical proof that the School Medical Service is making for fitness before the age of leaving school. Treatment. It is to be noted that any child discovered with defect is referred for treatment and followed-up until such treatment is obtained either through the School Clinic, private practitioners or hospitals. Appendix Table IV. shows the number of cases treated through the various 96 clinics; Group I. through the medical clinics; Group II. through the Eye Clinic; Group III. through the Ear, Nose and Throat Clink; Group IV. through the Orthopædic Clinic, and Group V. through the Dental Clinic. Each of these Clinics will be dealt with separately in the Report. It is to be recorded that all children requiring domiciliary treatment are referred to their own doctors, and this is the broad line of demarcation between the present State services and general practitioner service. Group I. (page 120). One thousand three hundred and seventy-five cases received treatment at the Medical and Minor Ailment Treatment clinics. Three hundred and sixty-nine received treatment for skin diseases; 175 for minor eye defects, excluding defective vision and squint; 223 minor ear diseases, whilst a large number of children (608) received treatment for minor illnesses. Much of this treatment is carried out by the School Nurses at the Minor Ailment Treatment Clinic which is held each morning. The efficacy of this treatment lies in passing rapidly through the Clinic cases with early defect; the treatment must be short as well as effective otherwise congestion arises. The length of treatment is largely dependent upon the earliness at which the patient attends for treatment. The longer the defect is established before it comes under treatment the longer it must remain under treatment. This is true especially in skin diseases, such as, impetigo, and in minor ear diseases. With this must go skilled treatment if patients are not to drag on and so crowd the Clinic. Irregularity of attendance prolongs the treatment ; this being especially true in cases of chronic otitis media, and it may be necessary in the near future to establish special ear treatment clinics. I would here like to express my appreciation of the assistance given by the Voluntary Workers who attend the Clinic daily to assist in the clerical work and maintain orderliness at the Clinic; without their help the work of the Nurses would be handicapped. 97 Group II.—Special Eye Clinic (page 121). This Clinic is held each week under Mr. A. M. Hickley who gives skilled specialist work in the cases of defective vision and diseases of the eye. Cases discovered with defective vision are referred for Mr. Hickley's attention, and cases previously prescribed glasses are referred for re-inspection in order to ascertain that the glasses are suitable. The following-up of these cases is a difficult matter as there is a common dislike among children to wearing of glasses; breakages are not replaced and many parents still tend to be careless with this necessary provision. The co-operation of teachers is helpful, and needful, if children to whom glasses have been prescribed for defective vision are to continue to wear them in school. Four hundred and eight cases attended the Clinic in 1934; 187 cases were new ones for refraction; 206 re-inspections were carried out; seven were referred to hospital for special treatment, and 236 children had glasses prescribed. The Care Committee provides glasses in necessitous cases, a provision which makes for 100 per cent. of cases prescribed glasses obtaining them. The glasses are obtained from a local firm at special prices. Children with high myopic condition are referred to special classes by arrangement with the London County Council, and persons coming within the provisions of the Blind Persons Act are referred to Mr. Hickley by the Kent County Council. Whilst the Clinic meets the present demand for the patient with eye defect, the scope of the medical services must be widened in the direction of prevention of this impairment. The lighting of Schools, the posture of the child at school and the early discovery of eye defect are the directions in which this service gives its attention. Fortunately these factors are becoming acquired universally, the new schools with modern equipment replacing the out-of-date and ill-equipped schools of the past generation, while the teachers and most parents are alive to the fact that defective sight leads to defective output at school. The convalescence of children after infectious disease such as measles is an important factor 98 in the prevention of eye strain. The returning of children to close work at school whilst the eye muscles are weakened after illness is to be avoided. For the sake of maintaining a high average attendance figure this is not infrequently overlooked with consequent permanent injury. It is the modern tendency of stress and strain to desire to press in knowledge in the shortest possible time. This may save a day or two in school attendance, but leaves the child to suffer a defect that might have been avoided. Group III.—Ear, Nose and Throat Clinic (page 122). This Clinic is held each Wednesday morning, and is attended by Mr. C. Beney, Ear Nose and Throat Specialist. All cases with enlarged tonsils and adenoids, otitis media, etc., are referred to Mr. Beney after selection by the School Medical Officers, and it is left to him to decide and direct the treatment for each individual case. By this means, in the case of enlarged tonsils and adenoids, operation treatment is controlled; approximately 30 per cent. being referred for operation treatment at the Clinic, and, in special cases, at Hospital. Three hundred and twelve children passed through this Clinic; 131 receiving operative treatment at the Clinic; 149 received other forms of treatment while 32 cases were referred for private treatment other than through the Clinic. I am submitting herewith Mr. Beney's report:— " Once more I would submit a short report on the work of the " Ear, Nose and Throat Clinic during the past year. " Forty clinics have been held. There have been 312 consultations " for treatments with the Assistant School Medical Officer. One " hundred and thirty-one cases received operative treatment at the " Clinic and 149 other forms of treatment. " Out of the remaining 32 cases, 28 were admitted to my beds at " St. John's Hospital, Lewisham, and four were treated by their " general practitioners. " The Hospital cases included three mastoids; two boys and one " girl; one case of growth on the palate; one case of sinus disease " and the rest were operated on for tonsils and adenoids namely 23 " cases where some special circumstance or complication made it " advisable to have them under hospital supervision. " No cases of any serious complications arising after operation have " been brought to my notice, and there have been no cases of post " operative haemorrhage. 99 " The Nursing and Voluntary staffs have again carried out their " duties with enthusiasm and it has been due primarily to their " untiring efforts that the Clinic has had such a successful year. " I hope that it will be possible soon to have a special nurse " trained for the treatment of those cases of chronically discharging " ears for which such treatment is so important, if deafness is to be " prevented." Charles Beney, m.a., m.b., n.ch., m.r.c.s. The following-up of operation cases in the homes after their retention at the School Clinic for 24 hours is a heavy task on the School Nurses. Each case is visited for seven days after operation and thereafter until return to school. I am greatly indebted to Miss Vincent and Miss Price who give valuable voluntary assistance at the Clinic at each session. Group IV.—Orthopaedic Clinic (page 123). Mr. H. J.. Seddon, Orthopaedic Specialist, attends at the Clinic twice monthly, and the Masseuse five sessions per week. Incorporated with this Clinic is the Ultra Violet Ray Clinic where 117 children received treatment ou 1,653 occasions. The appendix, Table IV., Group IV., shows that 220 children attended for treatment for orthopaedic and postural defects while the following tabulation gives in detail further statistics :— Statistics. Total attendances 3,528 (i) For consultations 686 (ii) For treatments, massage, remedial exercises 2,842 New Cases seen at the Clinic during 1934: Fractures 18 Wry-neck mastoid torticollis) 3 Other injuries 33 Bow legs 12 Wry-neck (other causes) 2 Knock knees 26 Deformities of the spine 58 Arthritis 1 Synovitis 2 Hat foot, etc. 20 Paralysis (various causes) 4 Deformities of the chest 5 Intoeing 9 Osteomyelitis 1 Club foot 2 Other conditions 23 100 The report of the Surgeon, Mr. H. J. Seddon, gives particulars of the cases treated at the Royal National Orthopaedic Hospital as follows:— "T.W., aged 10, was admitted on 25/5/33 with old tuberculosis of the right hip. In spite of prolonged treatment elsewhere muscle spasm and pain were still present and there was a definite tendency for the hip to go into a deformed position. After preliminary treatment designed to place the hip in a good position the joint was fixed by a grafting operation. The boy has been in and out of hospital twice for change of plaster and is still wearing a walking plaster. He is making satisfactory progress. M.B., age six, was admitted on 1/9/1933, with Perthe's disease of the left hip (an inflammatory condition which generally leads to severe deformity). Thanks to the vigilance of the School Medical Service the diagnosis was made at an extremely early date and treatment was commenced immediately. The result has been most gratifying. The hip gradually returned to normal and the child was discharged on 18/2/35 with a perfect joint. " P.B., age 11, was admitted on 23/4/34, with a congenital deformity of the left little toe for which amputation was performed. She was discharged on 11/5/34. G.R., age 14, had been under observation and treatment at the Clinic for eighteen months on account of spinal curvature. We found however that the curve was increasing in spite of treatment and she was admitted on 8/6/34 for a grafting operation to prevent any further increase in the deformity. The immediate result of the operation was satisfactory and the girl was discharged on 16/11/34. " D.S., age eight, was admitted on 4/7/34, with inflammation of one of the bones in the right foot (Kohler's disease). He also had a curious periodic distension of the abdomen which was investigated at St. Bartholomew's Hospital. No organic lesion was found to account for this and his subsequent progress has been satisfactory. " B.M., age 11, was admitted on 2/8/34 with a recent fracture just above the left wrist which had united in a bad position. The deformity was corrected by operation and the child was discharged in plaster on 5/9/34. His arm is now almost normal. " J.W., age 10, was admitted on 7/9/34 with a deformity of the left foot. An important tendon had been divided by a cut two and half years previously. It was our intention to repair the tendon, but we were prevented from doing this by an infection of the old scar. We decided therefore to supply him with an instrument, and recent examination shows that the foot is now responding rapidly to treatment. He was discharged on 1/2/35. " J.C., age 12, was admitted on 11/10/34 with bilateral hammer toes. She was discharged on 7/12/34. Operative treatment may he required later. " B.S., age nine, was admitted on 18/2/34 for the removal of bony projections on the heels. She was discharged on 15/3/35. " An unusual feature of the work at the Bromley Orthopædic Clinic is the number of cases sent up with fractures and other injuries In my experience traumatic conditions are rarely dealt with at the 101 Orthopaedic Clinics attached to Public Health Departments, which is unfortunate, seeing that neglected injuries sometimes result in serious disability which brings children to the Clinic at a later date when, possibly, it may be too late to remedy the damage that has been done. This inclusion of injuries in the orthopedic work marks a veryreal advance. " The number of children attending with deformities of the spine is large, but probably not above the average. A certain number, fortunately small, develop organic changes for which radical treatment is required. As we see these cases extremely early it is possible to deal with them at a stage when treatment is likely to give good results. The case of "G.R." mentioned in the Hospital report illustrates this well; twenty or even ten years ago the serious condition affecting her spine would probably hare been passed unnoticed until gross and irremedial deformity had developed. "The parents of children attending the Clinic take great interest in the work that is being done, which speaks well for the tact and patience of the Masseuse and those who are responsible for arranging the attendances." H. J. Seddon, f.r.c.s. Ultra Violet Ray Clinic. This Clinic is held on Tuesdays and Fridays at 3 p.m. There were 1,653 treatments given during the year 1934 of which 102 were new cases. Of these 59 were treated for general debility and out of these 52 responded well to the treatment, showing increased weight and improved appetite. The remaining seven cases did not attend long enough for the treatment to be beneficial. Alopecia.—'Three cases were treated, two were cured after six months' application, and the third is still attending and showing steady improvement. I mpetigo.—One case was treated, which cleared up rapidly. Anaemia.—Eight cases, with a tendency to this complaint, were treated, and all showed good progress. Nervous Children.—Twelve cases were treated. Ten showed improvement. They slept better, gained weight and their appetites improved. Two did not continue attendance. Sleeplessness.—Four cases were treated. All showed improvement and were not so restless. Chest Conditions.—Five cases were treated and all showed good progress. 102 Choreic Children.—Two cases were treated. One showed good results, but one did not benefit by the treatment. Septic Spots.—One case was treated which cleared up rapidly. Rheumatic Cases.—Three cases were treated and all showed improvement. Report of the School Dental Surgeon for Year 1934. (Group V.—Page 124). Inspection. During the year every elementary school in the Borough was visited by the Dental Nurse and myself, and a total of 5,158 children were individually examined. I was glad to see a certain number of parents at each inspection, for although they take up a considerable time, their attendance indicates an interest in their children's dental welfare. Twenty-nine sessions were occupied in these inspections; several schools required two visits because of the large number of scholars, e.g., Princes Plain, Raglan Road Boys and all the Departments of Burnt Ash, notwithstanding the fact that an average of 177 individual children were seen per session. This year again St. Joseph's R.C. School, Plaistow Lane, has furnished us with a most striking statistical figure. It will be remembered that in 1933 this School came under the purview of the Education Committee, and for the first time in its history a dental inspection was carried out. It will be seen from the Annual Report for 1933 that I found 84.9 per cent, of the scholars at this school were in obvious need of attention. Treatment was carried out subsequently for all who would accept it. In September, 1934, 1 was sent to inspect the school for the second time and it was found that I had only referred on this occasion 52.7 per cent, for treatment. This figure means that dental sepsis and decay had fallen by 32.2 per cent, as a result of the school being allowed to participate in the Committee's dental scheme. I would submit this is a striking example of what dental treatment can do; not only does the child derive greater comfort and health, 103 hut he is also able to maintain a better standard ot' attendance and so derive greater profit from the education which is provided. The fact that dental treatment lessens absenteeism has long been recognised by progressive commercial firms, and most well known manufacturers and stores provide dental clinics for their staffs, Messrs. Lyons, Cadburys, Selfridges, etc. The manager of one of these firms in an interview last year stated that his firm provided a dental clinic for the staff not from any philanthropic motive, but purely as a matter of business; he considered it economical to allow an employee half-an-hour's leave to visit the dentist and thereby save possibly two or three days' absence from work on account of an acute dental abscess. Our large insurance companies give their members dental benefit—again a matter of profitable business—as thereby their sickness charges are reduced. And so it is with our dental scheme and the school children. The average percentage of children in our Bromley Schools requiring treatment is 55 per cent., and this figure should be compared with the 85 per cent, requiring treatment where no dental scheme exists. Treatment. Two thousand three hundred and fifty-two school children and 94 welfare children from the various welfare centres were treated; the attendance for treatment being 4,101, a record number. Nitrous oxide gas was administered for extractions on 1,201 occasions and 4,100 teeth were taken out. Two thousand and seventy-three fillings, either of copper or porcelain cement, were inserted in permanent teeth, and 295 temporary teeth were also filled. If one compares these figures with those in the 1933 report it will be seen that the number of fillings in permanent teeth has increased from 1,804 in 1933 to 2,073 in 1934, but as regards the temporarv teeth the number of fillings has fallen by 122. This of course is intentional; the number of children in my care increases every year and hence I cannot give each child as much attention as I could six years ago. I am forced more and more to concentrate on 104 the barest essentials; and in this case I have sacrificed the temporary teeth as being of less importance than the permanent ones. However, there is a standard below which it is unprofitable to fall. If decay is passed over untreated no time is really saved in the end, as sooner or later that neglected tooth gives trouble and the child appears at the clinic with toothache, and then a tooth which could have been saved for useful mastication has to be extracted. If we try to work on a basis of annual inspection and treatment, we must treat each child sufficiently well to keep him free of decay and pain for the year. Again this year as in 1933, it was impossible to inspect and treat every scholar requiring attention within the year; and on 31st December, 1934, there were 595 children outstanding. Visiting. The Dental Nurse made 684 home visits during the year to inquire into cases where there was non-attendance over a long period. In some cases attendance is secured, but a large number of these cases are quite unsatisfactory; the children and their parents being difficult in other matters besides dental attention, e.g., school attendancecleanliness. Maternity and Child Welfare. Ninety-four infants, aged two to five years, attended the clinic for treatment, and thirty-five mothers. As regards the adults, no denture work is undertaken; the bulk of the work consists of scaling and cleaning followed by gas extractions. Regulation of Misplaced Teeth. There were 90 attendances for regulation work. Regulation plates are made at the parents' entire expense —7s. 6d. per plate. Propaganda. Besides the demonstrations at the schools at the time of our inspection, one afternoon was devoted to a talk to parents in the school clinic hall; the subject being that most important tooth—" The six year Molar." 105 Conclusion. I must again express my appreciation of the assistance and support given me by the Committee and Staff. I would like to thank the Teachers at the various schools for their co-operation and their influence on the children as regards their keeping appointments. Lastly I would especially thank our Voluntary Helpers for their ungrudging service and practical assistance. T. S. Latham, School Dental Surgeon. Summary of Dental Statistics for Year 1934, with Comparisons. 1932 1933 1934 Remarks. Inspections. No. of Sessions 28 24 29 Three Schools omitted in 1933, through lack of time. No. examined 4531 4685 5158* Referred for Treatment 2653 2539 2785* 55% require treatment. Treatment. Ho. of Sessions 391 393 372 Varies with School holidays. (No leave—no sickness). Individuals discharged 2387 2268 2352 Includes about 90 Infant Welfare cases each year. Attendances 3827 3992 4101* (per Session) 9 10 11 Appointments made 7279 7319 7233 Visits per Child 1.6 1.7 1.6 Gas Cases 962 1103 1201* 1201 cases = 18.4 (per Session) 16 19 18 65 Sessions Extractions 3616 3910 4100* fillings 2244 2231 2368* Permanent teeth 2073 Temporary teeth 295 Nurses Visits 613 989 684 2368 * Record Numbers. 100 School. Department. No. Examined. Number referred for treatment. Raglan Road Infants 218 106 Central Girls 143 90 ,, Boys 134 78 Masons Hill Mixed 272 149 Aylesbury Road Boys 178 89 Plaistow Mixed 85 54 Addison Road Girls & Infants 149 90 Valley Infants 145 91 Hayes Mixed 157 70 Keston ,, 158 90 Bickley & Widmore Infants 166 100 ,, ,, Juniors 120 74 Valley Girls 147 95 Bromley Common Mixed 160 116 Burnt Ash Infants 282 154 ,, ,, ,, 126 65 Parish ,, 143 88 St. Joseph's R.C. Mixed 108 57 Burnt Ash Boys 353 161 ,, ,, Girls 345 164 Raglan Road Boys 254 133 ,, ,, ,, 146 76 Princes Plain Girls 235 128 ,, ,, ,, 168 79 Parish Boys 259 138 ,, Girls 220 107 Raglan Road Juniors 287 143 Totals 5158 2785 Group VI.—Uncleanliness and Verminous Conditions (page 124). Each school is visited by the School Nurses, and every child is examined for cleanliness each term. The cleanliness of the children of to-day shows a vast improvement on that of the children a decade ago. To-day it is the chronic offender who disturbs the clean record of a school, and it is these who appear before the Court under the School Attendance Bye-laws. The appendix shows that 15,249 examinations were made of the school 107 children, and that 407 children were recorded as verminous in varying degrees. It is to be noted that the standard of cleanliness is high; a child with but one nit is recorded in the figure of 407. Only by maintaining a high standard can one eliminate vermin from the schools. Twelve parents were cautioned by the Local Authority under the Attendance Bye-laws with temporary success, and if one could bring under control the younger children in these families the school child would not be " infected " and so suffer the disgrace that is to-day associated with a " dirty head." Table III.—Return of Exceptional Children (page 117). This table indicates the type and number of exceptional children: blind and partially sighted; deaf and partially deaf; mentally defective; epileptic and physically defective children. It further indicates the children who are maintained and educated by the Local Education Authority in special day or residential schools. A list of all exceptional children in the area is compiled from returns made continuously during the year and kept constantly up-to-date. This table is made up from the list of exceptional children as it stands at the end of each calendar year, and therefore it will be appreciated that a certain number of these cases would in some instances have been admitted to special day or residential schools in a previous year and discharged during the course of the year under review, and in other cases have been admitted and discharged during the course of the year. The annual cost of these cases to the Local Education Authority amounts to approximately £900. Infectious Diseases in Schools. The usual routine has been carried out as in previous years. An increase in Diphtheria and Scarlet Fever continued to cause loss of school attendance. The following tabulation gives a summary of the Head Teachers' returns during 1934; which shows the loss of school attendance as a consequence of non-notifiable disease. I believe that if one could have the staff to follow-up measles cases one would be better able to control the spread of the disease. 108 Infectious Disease Returns received from Schools during 1934. Schools. Diphtheria. Scarlet Fever. Measles. ing Cough. Mumps. Chicken Pox. Addison Road - 4 79 15 1 10 Aylesbury Road - 2 7 - - - Bickley & Widmore — - 42 15 - 25 Bromley Common. — - 104 19 1 4 Burnt Ash 2 37 87 11 1 11 Central 1 1 5 - — 4 Hayes — 9 6 — — — Keston — — 41 1 - — Masons Hill - - 23 1 - - Parish - - 88 15 - 28 Plaistow - 5 32 14 7 9 Princes Plain - 4 14 - - 2 Raglan Road 5 17 159 20 - 132 Valley 3 7 67 13 25 — Medical Certificates of Exclusion from School. The summarising of the certificates issued by general practitioners for the exclusion of children from school gives an indication of the type of illness causing loss of attendance. This latter is to be taken in conjunction with Table II. of the Medical Inspection returns to the Board of Education which appear in the Appendix. The returns again show the prevalence of ear, nose and throat defects as a cause of invalidism.. Conditions for which Medical Certificates of Exclusion from School were issued by General Practitioners during 1934. Malnutrition, Debility, etc. 66 Skin 28 Eyes 15 Ears 40 Nose and Throat 294 Enlarged Cervical Glands 46 Heart 4 Lungs 9 109 Nervous Diseases 9 Deformities, Accidents, etc. 24 Operations 9 Measles 254 Whooping Cough 39 Mumps 10 Influenza 27 Chicken Pox 67 Rheumatism 48 Bronchitis 94 Miscellaneous 260 1,343 REPORT OF THE BROMLEY CHILDREN'S CARE COMMITTEE, 1934. This Committee, which has been functioning for twenty-five years, is an adjunct of the School Medical Service, and brings voluntary effort into the services of the Education Committee which is always so valuable to all State services. Children attending elementary schools, who are in need of assistance as recommended by the School Medical Officer, are referred to this Committee for following-up. The home is visited by a member of the Committee who reports back to the School Medical Officer on the family circumstances, and the Committee provides the required assistance to the necessitous case. The assistance given varies from convalescent treatment to the provision of boots, milk, glasses, etc. The parents in turn pay according to their means. In addition to home visiting by the members of the Committee they attend the various clinics and give valued assistance in the smooth running of these clinics. This regular attendance at the School Clinic is an important function of the Committee. There are twenty-one ladies who give at least half a day a week and many give one whole day. The year 1934 saw a fall in the number of cases assisted, one reason being the adoption of the scheme for the provision of milk in schools at a reduced rate of id. per child. Many parents are now able to afford the 2½d. 110 per week, and so do not call tor assistance to the same extent as previously. Further, the establishment of the Rest Room Clothing Department for the Unemployed, organised by the Social Service Committee, has provided facilities for the distribution of boots and clothing for children of unemployed parents, and so relieved the Care Committee of a large part of their responsibility in this direction. The following tabulation gives a summary of the 194 cases assisted during the year:— Convalescent homes 43 Fares to hospitals 7 Extra nourishment 75 Provision of glasses 12 Provision of boots 57 The Committee would like to record their appreciation of the assistance given by Mr. Harris, who has continued to supply glasses at a very reduced rate to those cases recommended by the Care Committee. They would also like to record their appreciation for the many Convalescent Home Letters given by the Queen's Reign Commemoration Fund, and cannot allow this Report to go forward without expressing their regret at Miss Carter's resignation from the Secretaryship and to record their appreciation for her services in the past few years. In October last Miss M. A. Isard was appointed to fill her place. 111 BROMLEY CHILDREN'S CARE COMMITTEE. Statement of Accounts. 1934. Receipts. expenditure. £ s. 1. £ s. d. Balance brought forward 12 8½ Milk 17 5 4½ Bromley Benevolent Association 60 0 0 Boots 18 0 4 Royal Sea Bathing Hospital 29 11 0 Charity Festivities Association 20 0 0 Letters for Royal Sea Bathing Hospital 4 4 0 Raglan Road Parents' Association 3 3 0 Letters for Convalescent Homes 14 14 0 Guv's Hospital 1 8 0 Hospitals Savings Association 1 1 0 Fares 4 16 10 Q.V.J.F. (Repaid) 1 8 0 Clinic Box 1 7 4½ Medicine and Food 1 10 0 Repaid— Convalescent Home 1 7 6 Royal Sea Bathing Hospital 16 16 0 Taxis from Clinic 12 6 Glasses 9 0 Convalescent Homes .. 1 16 6 Glass eye 12 6 Fares 8 0 Balance carried forward 12 11 8 Glasses 2 0 Sale of Cod Liver Oil 8 1½ £107 2 8½ £107 2 8½ Amy G. Mann, Chairman and Hon. Treasurer. M. A. Isard, Honorary Secretary. APPENDIX. 114 TABLE 1.—MEDICAL INSPECTION RETURNS. Year ended 31st December, 1934. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups:— Entrants 646 Second Age Group 610 Third Age Group 462 Total 1718 Number of other Routine Inspections 52 B.—OTHER INSPECTIONS. Number of Special Inspections 2620 Number of Re-Inspections 2466 Total 5086 115 TABLE lla.—Return of Defects found by Medical Inspection in the year ended 31st December, 1934. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring observation Requiring Treatment Requiring observation (1) (2) (3) (4) (5) Malnutrition 12 10 27 6 Skin Ringworm Scalp - - 6 - Body - — 9 - Scabies 2 — 52 3 Impetigo 33 - Other Diseases (non-tuberculous) 7 — 263 31 EYE Blepharitis 2 10 - Conjunctivitis — 78 - Keratitis — — 1 - Corneal Opacities — — 15 - Defective Vision (excluding squint) 134 6 70 6 Squint 12 1 11 - Other conditions 2 1 75 1 Ear Defective hearing 5 8 16 - Otitis Media 2 21 1 Other Ear Diseases 6 — 186 4 Nose and Throat Chronic Tonsillitis only 40 71 45 90 Adenoids only 5 17 21 29 Chronic Tonsillitis and Adenoids 10 57 251 153 Other conditions 7 178 39 Enlarged Cervical Glands (non-tuberculous) 2 11 48 30 Defective Speech 4 - 1 1 and Circulation Heart—Organic 4 2 33 - Functional 24 10 134 1 Anaemia 4 1 7 - Carried forward 283 195 1591 395 116 TABLE IIa.—Continued. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring observation Requiring Treatment Requiring (1) (2) (3) (4) (5) Brought forward 283 195 1591 395 Lungs Bronchitis 5 — 9 - Other Non-Tuberculoiis Diseases 12 — 343 15 tuberculosis Pulmonary Definite — 1 — 1 Suspected — — 1 Non-Pulmonary Glands 2 — 1 — Bones and joints — — — — Skin — — — — Other forms — — 3 Nervous System Epilepsy _ i Chorea 4 — 8 2 Other conditions 12 2 43 8 Deformities Rickets _ — - Spinal Curvature 83 13 12 1 Other forms 52 7 6 1 Other Defects and Diseases (excluding uncleanliness and Dental Diseases) 93 5 611 406 Totals 546 223 2628 830 117 TABLE 11b.—Number of Individual Children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. Prescribed Groups— Entrants 646 162 250 Second Age Group 610 140 22.9 Third Age Group 462 83 17.9 Total (Prescribed Age Groups) 1718 385 22.4 Other Routine Inspections 52 5 9.6 Grand Total 1770 390 22.0 TABLE III.—Return of all Exceptional Children in the Area, 1934. CHILDREN SUFFERING FROM MULTIPLE DEFECTS. At School or no Institution. Mentally Defective and Partially Blind 1 Mentally Defective and Epileptic 1 BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 2 — — — 2 118 PARTIALLY SIGHTED CHILDREN. At Certified Schools for the Blind. At Certified Schools lor the Partially Blind. At Public Elementary Schools. At other Institutions. At no School orlnstitution Total. — 2 1 — — 3 DEAF CHILDREN. At Certified Schools ior the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 5 — — — 5 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partiallj Deaf. At Public Elementary Schools. At other Institutions. At no School orlnstitution Total. — — 5 — — 5 MENTALLY DEFECTIVE CHILDREN. Feeble-Mi nded. At Certified Schools for Mentally Defective Children At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 4 2 1 2 9 MENTAL DEFICIENCY (NOTIFICATION OF CHILDREN) REGULATIONS, 1928. Total Number of Children notified during the year 1934 by the Local Education Authority to the Local Mental Deficiency Authority (i) Children incapable of receiving benefit or further benefit from instruction in a Special School : (a) Idiots _- (b) Imbeciles 2 boys. (c) Others — 119 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 — — — 1 PHYSICALLY DEFECTIVE CHILDREN. At Certified Special Schools At Public Elementary Schools. At other Institutions. At no School or Institution Total. A. I.—Children suffering from Pulmonary Tuberculosis — 3 1 — 4 II.—Children suffering from Non-Pulmonary Tuberculosis — 4 1 1 6 6. Delicate Children — 14 — 2 16 C. Crippled Children 4 15 — 1 20 D. Children with Heart Disease 2 — — 4 6 TABLE IV.—Group 1. Return of Defects Treated during the year ended 31st December, 1934. Minor Ailments (Excluding Uncleanliness for which see Group VI.). Disease or Defects. Number of Defects treated, or under Treatment during the year. Under the Authority's Scheme. Otherwise. Total. Skin— Ringworm—Scalp (i) X-Ray treatment — 6 6 (ii) Other 5 1 6 Ringworm—Body 9 — 9 Scabies 51 1 52 Impetigo 31 2 33 Other Skin Diseases 255 8 263 Minor Eye Defects (External and other, but excluding cases falling in Group II) 171 4 175 Minor Ear Defects 217 6 223 Miscellaneous (e.g., Minor injuries, bruises, sores, chilblains, etc.) 553 55 608 Total 1292 83 1375 121 TABLE IV.—Group II. Defective Vision and Squint (Excluding Minor Eye Defects treated as minor ailments—Group I.). Defect or Disease. No. of Defects dealt with. No. of Children for whom Spectacles were Under the Authority's Scheme. Otherwise. Total. Prescribed. Obtained. Under the Authority's Scheme. Otherwise. Under the Authority's Scheme. Otherwise. Errors of Refraction (including squint) *393 1 394 236 1 236 1 Other Defects or Disease of the Eyes (excluding those recorded in Group I) 8 6 14 — — — — Total 401 7 408 236 1 236 1 *187 Refractions ; 206 Re-inspections. 122 TABLE IV.—Group III. Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received operative Treatment. Received other forms of Treatment. Total Number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (i) (ii) (iii) (iv) — 12 119 — (i) (ii) (iii) (iv) 1 2 26 3 (i) (ii) (iii) (iv) 1 14 145 3 149 312 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. 123 TABLE IV.—Group IV. Orthopædic and Postural Defects. Under the Authority's Scheme. Otherwise. Residential treatment with Education. Residential treatment without Education. Nonresidential treatment at an Orthopaedic Clinic. Residential treatment with Education Residential treatment without Education. Nonresidential treatment at an Orthopaedic Clinic. Total Number Treated. Number of Children treated 8 3 220 — — — 220 124 TABLE IV.—Group V. Dental Defects. (1) Number of Children who were:— : (i) Inspected by the Dentist.— Routine Age Groups Aged: 5 499 „ 6 488 „ 7 467 „ 8 556 „ 9 580 „ 10 534 ,, 11 504 „ 12 489 „ 13 504 „ 14 537 Total 5158 Specials 618 Grand Total 5776 (ii) Found to require treatment 2785 (iii) Actually treated 2352 (2) Half-days devoted to:— Inspection 29 Treatment 372 401 (3) Attendances made by children for treatment 4101 (4) Fillings:— Permanent teeth 2073 Temporary teeth 295 2368 (5) Extractions:— Permanent teeth 642 Temporary teeth 3458 4100 (6) Administrations of general anaesthetics for extractions 1201* 125 (7) Other Operations :— Permanent teeth 344 Temporary teeth 147 491 *In addition there were 880 local anæsthetics. TABLE IV.—Group VI. Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 3 (ii) Total number of examinations of children in the Schools by the School Nurses 15249 (iii) Number of individual children found unclean 407 (iv) Number of children cleansed under arrangements made by the Local Education Authority (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Bye-laws — 126 Dental Treatment and Details of Treatment Given, 1934. Total No. of half-days given to Inspections. Total No. of half-days given to treatments. Total No. of Appointments. S.M.O. and Emergency Cases. Total No. of Permanent teeth Total No. of Temporary teeth. Total No, of Fillings. Anaesthetics. Other Operations, Scalings, Dressings Regulations. Made. Kept. Extracted. Filled Extracted. Filled. Gas. Local. 29 372 7233 4101 618 642 2073 3458 295 2368 1201 880 491 Total Number of Visits to parents made by the Dental Nurse, 684. 127 HEAD INSPECTION,1934. Schools. Depts. FIRST INSPECTIONS. FINAL INSPECTIONS. ALL INSPECTIONS. Individual Inspections. Number Inspected Clean Slightly Verminous Highly Verminous Number Inspected Clean Slightly Verminous Highly Verminous Number Inspected Clean Slightly Verminous Highly Verminous Slightly Verminous Highly Verminous ADDISON ROAD G.& I. 154 150 3 1 155 149 5 1 454 441 11 2 10 2 AYLESBURY RD. B. 182 180 2 — 191 186 4 1 569 559 8 2 7 1 BICKLEY AND WIDMORE I. 122 117 5 — 114 113 — 1 350 340 9 1 6 1 J. 118 114 4 — 127 123 4 — 398 384 12 2 9 2 BROMLEY COM. BURNT ASH J. 163 158 4 1 171 161 4 6 487 463 16 8 8 7 G. 414 402 11 1 421 393 27 1 1219 1152 64 3 47 3 B. 403 395 8 — 436 428 7 1 1246 1229 16 1 13 1 J. 358 347 9 2 308 297 10 1 1065 1032 29 4 27 3 MASONS HILL CENTRAL G. & I. 279 273 5 1 278 274 4 — 840 824 15 1 14 1 B. 91 91 — — 109 109 — — 300 299 — 1 — 1 G. 76 75 1 — 119 116 3 — 273 267 6 — 4 — PARISH B. 233 230 2 1 255 252 3 — 715 707 7 1 2 2 G. 208 201 6 1 214 204 8 2 635 613 17 5 13 3 I. 115 107 4 4 139 134 4 1 414 394 11 9 7 6 PLAISTOW J. 74 68 6 — 73 64 4 5 235 213 12 10 6 8 ST. JOSEPH'S J. 94 88 4 2 98 89 4 5 264 241 11 12 7 8 RAGLAN ROAD B. 492 491 1 — 402 398 3 1 1361 1348 10 3 7 3 J. 251 232 8 11 286 268 15 3 784 736 27 21 16 15 I. 237 221 5 11 204 191 7 6 716 666 29 21 23 9 PRINCES PLAIN G. 429 406 17 6 398 358 39 1 1227 1145 75 7 45 9 VALLEY G. 174 159 11 4 195 180 10 5 524 489 26 9 13 7 I. 132 124 8 — 134 131 3 — 399 381 16 2 12 2 HAYES Mixed 153 151 1 1 158 156 2 — 490 484 4 2 2 1 KESTON Mixed 118 113 4 1 166 157 9 — 284 270 13 1 13 1 Totals 5070 4893 129 48 5151 4931 179 41 15249 14677 444 128 311 96