BROMLEY AC. 4412 (1) BROMLEY KENT BRO Borough of Bromley. 1939 ANNUAL REPORT Medical Officer Of Health AND School Medical Officer BROMLEY, KENT: Strong & Sons, Ltd., North Street. Borough of Bromley. 1939 ANNUAL REPORT Medical Officer Of Health AND School Medical Officer BROMLEY, KENT: Strong & Sons, Ltd., North Street. 3 PUBLIC HEALTH STAFF. Particulars of staff are given on pages 7-8 of Annual Report for 1938, and the following changes have been made since the publication of that Report. Assistant Medical Officer 2 Alexander Thomson, of Health and School M.B., CH.B., D.P.H. Medical Officer, and (Appointed 1.8.1939). Anaesthetist 2 N. M. Macdonald, M.B., CH.B., D.P.H. (Resigned 31.7.1939). Orthopaedic Surgeon 2 1 J. A. Cholmeley, F.R.C.S. (Appointed 26.2.1940). 2 1 H. J. Seddon, F.R.C.S. (Resigned Dec., 1939). Eye Specialist 2 1 Eric Lyle, M.A., M.D., CH.B., D.O.M.S. (On military service). 2 1 R. H. Rushton, M.R.C.S., M.R.C.P. (Locum Tenens. 1.11.1939). Consulting Gynaecologist 2 1 Alistair L. Gunn, M.D., F.R.C.S. (On Military Service). 2 1 D. M. Lindsey, M.D., M.R.C.O.G. (Locum Tenens 3.3.1940) Municipal Mid wives. 7 6 2 Miss E. V. Robathan (Appointed 1.12.1939). General Office Staff. Senior Clerk 2 S. F. Judd (Appointed 1.7.1939). 4 Dental Clinic Assistants 2 Miss E. Thornton (Appointed 1.10.1939). 2 1 Miss J. Staden (On War Service). 2 1 Mrs. A. Benzie (Appointed 18.1.1940). 2 Miss E. Colin (Resigned 30.9.1939). Civil Defence—Casualty Service. Assistant Staff Officer A. V. Garrod (temporary appointment) (Appointed 11.9.1939) 1. Denotes part-time. 6. Three years Hospital Trained.State 2. Exchequer Grants (including Board Registered Nurse. of Education). 7. State Certified Midwife. , 3. Certificate of the Royal Sanitary 8. Royal Sanitary Institute Health Visitors Institute and Sanitary Inspectors' Certificate. ... Joint Examination Hoard 9. Diploma of Royal Institute of Public 4. Royal Sanitary Institute Certificate Health and Hygiene. for Meat and Other Foods. 0. Royal Sanitary Institute Certified in 5. Royal Sanitary Institute Smoke Sanitary Science as applied to Building Certificate. and Public Works. 5 BOROUGH OF BROMLEY. Report of the Medical Officer of Health for the year 1939. To the Mayor, Aldermen and Councillors of the Borough of Bromley. Madam Mayor, Madam and Gentlemen, The Report for the year 19.39 is drawn up in accordance with the Minister of Health's circular 1961 of 16th February, 1940, and circular 2067 of 19th July, 1940. The Minister is satisfied that an entire discontinuance of annual reports during the war period would not be in the interests of local government, but has directed that matter, which usually appears, may be omitted and the Report limited to a record of essential statistics required by the Ministry and to important alterations, improvements or developments during the year. The usual detailed tables of statistics have been completed and will be retained in the records of the Department for future reference. From past experience, the general standard of health is likely to be affected by the present world wide conflict. Migrations of populations from war zones, and "internal" evacuations will give rise to change affecting "herd immunity." We should anticipate the creation of conditions favourable to the spread of infectious disease, especially in those areas which have hitherto perhaps enjoyed prolonged immunity to certain diseases. Standards of living we know will be altered, the community will be called upon to live hard, but a period of' spartan living should not, however, be without its benefits. The National Milk Scheme for the supply of cheap and free milk to expectant and nursing mothers and 6 children under five years of age will provide an essential foodstuff to counter to some extent the ravages of illnourishment. I do not propose to discuss in detail here the many administrative perplexities brought about by the organisation of the Casualty Services within the framework of the Health Department. All this complex organisation has demanded an unprecedented effort from the staff; the stress of this work, which dates from 1938, has been great, but with the excellent co-operative effort between staff and civil defence personnel I feel confident that when the supreme test is applied the services will adequately meet any demand. Following the outbreak of war the routine work of the Department suffered curtailment, which was necessary whilst the first-aid posts, stretcher party depots, and ambulance services were placed on a war footing. The Municipal Midwifery Service carried on in full and essential public health matters only were dealt with. Within two or three weeks of the outbreak of war the welfare centres were again fully functioning, the work of the Dental Clinic, Minor Ailment Treatment Clinics and the Special Clinics were resumed, although the schools were functioning on a voluntary part-time basis. With the re-opening of the schools in January, 1940, it was an easy step to place into operation a full school medical service and to begin the special nutrition survey. We were fortunate during the autumn in being singularly free of notifiable infectious disease, in fact, the whole year gives a very low incidence of the common types of infectious disease, especially scarlet fever and diphtheria. Also, fortunately, there was no excessive causes of sickness or invalidity in the area, if one excepts the prevalence of influenza (so called) during the earlier months of the year. New and important statutory powers and duties were conferred on the Council under the Food and Drugs Act, 1938, which came into operation on 1st October, 1939. This is a consolidating Act repealing and re-enacting with amendments previous legislation in order to secure simplification, uniformity and conciseness in the law regarding 7 purity of food and drugs and registration of certain food premises. Premises used for sale, preparation or storage of ice-cream, sausages or potted, pickled or preserved food are controlled by registration, and byelaws may be made with respect to the observance of hygienic practices in the handling, wrapping and delivery of food and the sale of food in the open air. The Act also provides for the notification of food poisoning by medical practitioners. It must therefore be regarded as an Act which strengthens the supervision and control of foodstuff's and which in normal times will go far to securing and maintaining a higher standard of purity of food for the public. An interesting outbreak of food poisoning occurred at Hayes in November, the cause being traced to a Staphylococcus Aureus in a tin of condensed milk. The attack was sudden in onset and symptoms very severe, affecting 38 persons of adult age. There were no fatalities. The bacteriological investigations were skilfully undertaken by Dr. E. R. Jones of the County Laboratory at Maidstone, and Dr. J. C. Colbeck of the Emergency Public Health Laboratory at Downe. Their investigations have been filed for reference as such outbreaks of food poisoning from Staphylococcus Aureus are rare. Measles and whooping cough were made compulsorily notifiable in November, 1939. This Report was ready for publication in July, but the final printing could not be completed as receipt of the Annual Statistics from the General Register Office was unavoidably delayed until October. It was thought wise to wait for the official figures. I am, Madam Mayor, Madam and Gentlemen, Your obedient servant, K. E. TAPPER, July, 1940. Medical Officer of Health. 8 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA, 1939. Statistics. Area (in acres) 6,519 Registrar General's estimate of— (a) Resident population (mid-1939) 60,000 (b) Average population appropriate to the calculation of death rates (mild-1939) 59,080 Number of inhabited houses according to the rate books (31/3/40) 16,727 Number of valuation assessments of inhabitable premises (1/4/40) 17,301 Rateable Value (31/3/40) £719,994 Product of a Penny Rate (estimated for year ending 31/3/41) £2,880 Vital Statistics. Live Births. Total Male Female. Legitimate 794 434 360 Birth Rate per 1,000 of the estimated resident population mid-1939: 13.9 Illegitimate 41 18 23 Stillbirths. 835 452 383 Legitimate 38 21 17 Rate per 1,000 total (live and still) births: 44.8 Illegitimate 1 — 1 39 21 18 Deaths 593 289 304 Rate per 1,000 estimated average population9.7 (adjusted) Deaths from Puerperal Causes:— Rate per 1,000 total (live and births: Number of deaths. Puerperal Sepsis Nil Other puerperal causes 3 3.45 9 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 28.9 Legitimate infants per 1,000 legitimate live births 29.1 Illegitimate infants per 1,000 illegitimate live births 24.4 Deaths from Cancer (all ages) 102 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 4 Social Conditions. There are no large scale industries carried on in the area, and there is little to add to my previous reports under this heading. Unemployment. The Manager, of the Employment Exchange has kindly supplied the following details:— 1. Recorded unemployment at the end of ber, 1939:— (a) Men 878 (b) Women 572 2. Highest figure reached during 1939:— (a) Men 1258 on 10th January, 1939. (b) Women 725 on 30th October, 1939. The peak figure in the case of men was directly due to stoppage of' work in January, 1939, owing to weather conditions and a large proportion of those work-people were "temporarily stopped," and returned to their former employment as soon as climatic conditions improved. The peak figure for women was due to the war, which resulted in many London employers reducing staffs owing to business falling off and evacuation to a distance beyond daily travelling facilities. By the end of the year under review a marked improvement had begun, due to the employment opportunities resulting from the increasing war effort. 10 Meteorology. There was no evidence that the severe winter penalised the health of the community unduly. Winter food crops undoubtedly suffered, but on the other hand the severity of the weather exercised a beneficial effect on land for the cultivation of essential food crops. The Borough Engineer reports from his records of 1939 as follows:— Total rainfall 31.60 inches Mean maximum daily temperature 57.9° F. Mean minimum daily temperature 43.7° F. Highest maximum temperature recorded 86.0° F. —7th June. Lowest minimum temperature recorded 18.0° F. —28th Dec. Lowest grass minimum temperature recorded 18.0° F. —30th Dec. Population. There is no evidence of exceptional migration of population from the Borough owing to war circumstances. Some of the larger type of houses were vacated, possibly due in many cases to cost of upkeep. These large residences prove useful for temporary business accommodation. Once again the town, within a short period of time, has been called upon to shelter refugees from abroad forcibly deprived of their homes and property. voluntary effort, always a marked characteristic feature of the civic life of the town, simplified the arrangements for reception and billeting. My estimate of population, based on local facts and figures, may be placed at 60,300. The Registrar General's mid-year 1939 estimates are:— (a) Resident population 60,000 (b) Average population appropriate to to the calculation of death rates 59,080 11 Births. Seven hundred and ninety-nine births were notified during 1939, of which 32 were stillbirths and 767 live births. The number of live births and stillbirths registered, as adjusted by inward and outward transfers relative to residence of the mothers, were 835 and 39 respectively. The Birth Rate based on 835 live births is 13.9 compared with 13.1 for 1938. Stillbirths. Thirty-nine stillbirths registered during 1939 produces a rate of 44.8 per 1,000 births. This is a further increase over previous years and remains a disturbing factor in the vital statistics of the area. Deaths. The total deaths from all causes during 1939 was 593. This figure gives a rate of 9.7 per 1,000 population. Predominating causes of deaths were:— Heart disease 158 Cancer 102 Infantile Mortality and Maternal Mortality. The Infantile Mortality Bate for 1939 is 28.9 per 1,000) live births. The Maternal Mortality Rate for 1939 is 3.45 per 1,000 (live and still) births. SECTION B (I). GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. There are no important changes or developments to report in the following services in respect of 1939, except as indicated:— (a) laboratory Services.—The existing facilities for bacteriological diagnostic work has been augmented by the Medical Research Council in consultation with the Ministry of Health as a war-time measure. This scheme 12 does not interfere with the normal laboratory services which are still maintained. One such emergency laboratory has been established within easy situation of the Borough and has already been of service on several occasions. (b) Ambulance Facilities. ' (c) Nursing in the home. (d) Treatment Centre and Clinics provided by the Local Authority. (e) Tuberculosis Dispensary, 2, Park Road. (f) Venereal Diseases and Treatment Centres. (g) Hospitals, Public and Voluntary. For details see Annual Report for 1938. Public Health Act, 1936. Section 187/195, Nursing Homes. Vigilance in the discovery of unregistered nursing homes is exercised by the officers of the department during routine visitation of the district, noting advertisements of such premises, and scrutinising weekly returns for recurring birth or deaths at any address, when enquiries would be instituted. There were 10 nursing homes on the register at the close of the year 1939, of which 3 were new registrations The homes are regularly inspected by an Assistant Medical Officer of Health, and no action in regard unsatisfactory homes was necessary during 1939. SECTION B (II). MATERNITY AND CHILD WELFARE. This service functioned to its full extent throughout the year, with the exception of some temporary curtailment of activities in the first two weeks of the war. The services available are the same as detailed on page 34 of my Annual Report for 1938. 13 NATAL SERVICES. Domiciliary Midwifery Service. This service was in full operation throughout the year. In December, 1939, it was necessary to appoint a | fifth midwife, thus bringing the staff up to the approved complement of five. Prior to this step being taken, the additional midwife had been employed on a temporary basis. The service was further developed during the year by the inclusion of a scheme for treatment and provision of dentures for nursing and expectant mothers. The work of the midwives is tabulated below:— Total No. of bookings in 1939 330 Disposed of as follows:— Booked for midwife 206 Booked for maternity nurse 62 Booked for hospital 28 Subsequent transfers to hospital 14 Bookings cancelled, evacuation, etc. 20 No. of confinements attended:— As midwife 194 As maternity nurse 56 No. of visits by midwives:— Aute-natal 2,311 Post-natal 4,251 The total number of medical examinations made by doctors under the general practitioner domiciliary scheme was:— Ante-natal 254 Post-natal 108 Home Helps. N°. patients engaging home helps 93 N°. of home helps so engaged 37 14 Ante-Natal Clinics. The Municipal Midwives attend these clinics, in addition to the ante-natal supervision they exercise in the homes as shown above. 46 clinics were held, with Dr. G. H. Stinson, Assistant Medical Officer of Health, in attendance. 171 mothers were medically examined. Dental Scheme for Nursing and Expectant Mothers. No. of sessions held 45 Total No. of attendances of mothers 209 Patients discharged treatment complete 89 Details of Treatments:— Gas administrations 43 Local anaesthetics 99) Extractions 262 Scalings 22 Fillings 25 Dressings 11 Dentures supplied 6 Awaiting dentures 8 Administration of Midwives Acts, 1902-36. The Inspector of Midwives, Dr. G. H. Stinson, has carried out periodical inspections and reports that the work of the midwives is very satisfactory. The number of midwives practising in the area at the end of 1939 was 21, and the number of confinements attended was 789: (a) as midwives, 396; (b) as maternity nurses, 393. Medical aid was called in on 57 occasions. Maternity Hospital Provision. Maternity cases requiring hospital treatment are now accepted at the County Hospital, Farnborough, under an agreement completed in February between this Authority and the Kent County Council. Previously such cases were admitted to the Bromley, Chislehurst and District Hospital. Thirty-five cases were admitted to the County Hospital during the year, and in addition 6 cases which had previously booked with the Bromley, Chislehurst and District Maternity Hospital were admitted at the beginning of the year. Two hospital cases were transferred to Queen Charlotte's Hospital Isolation Block. 15 Puerperal Pyrexia. Since the outbreak of war the arrangements with Queen Charlotte's Hospital Isolation Block for isolation and treatment of puerperal pyrexia patients occurring in the area, are in abeyance. Such cases for the time being will be admitted to the County Hospital, Farnborough. During 1939 twenty-two cases of puerperal pyrexia were notified of which 11 received hospital treatment wider the Council's scheme, 9 were otherwise treated in hospitals and 2 were home nursed. POST-NATAL SERVICES. Health Visitors. Home Visiting. The total number of visits paid by health visitors during 1939 was 5,996, a very creditable total having regard to the stress of work occasioned by the casualty services. Welfare Centres. The welfare centres were interrupted only for a short period at the outbreak of war. The following extracts from the records show to some extent the work of the centres during 1939:— Total No. of babies on the registers at end of 1939 3,389 Total No. of attendances of children at centres 25,993 Total No. of medical examinations 3,535 Total No. of weighings 22,899 The help given by the Voluntary Workers week by week has been invaluable in lessening the abnormal pressure of' work on the staff. Child Life Protection. Regular visitation of foster children was carried out by the health visitors, and there were no adverse reports on the home conditions provided for these children. 16 Clinic Treatments of Children under 5 years. Facilities for treatment of children under 5 year were fully operative throughout the year. The number of children treated were as follows:— Tonsil and Adenoid Clinic 9 Eye Clinic 49 Dental Clinic 137 Minor Ailments Clinic 40 Orthopaedic Clinic 74 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. The Clerk of the Metropolitan Water Board has kindly furnished the following information:— "No new source of supply was instituted in the Borough of Bromley during the year 1939, and the length of distribution mains laid was very small compared with previous years. The supply was satisfactory as regards quantity. Monthly reports by the Board's Director of Water Examination on the results of the chemical and bacteriological examinations were forwarded to the Ministry of Health." Drainage. During the year a soil sewer was constructed in Oakfield Lane, Keston, to replace cesspool drainage. Cesspool Drainage. Two buildings were constructed with cesspool drainage during 1939. Progress with abolition of cesspools in Hayes and Keston continued satisfactorily. During the year 14 cesspools were abolished and the premises concerned were connected to main drainage. Public Cleansing. The services have been maintained, and the Groverment Salvage Scheme was brought into operation. 17 SANITARY INSPECTION OF THE AREA. The following is a summary of work of the Sanitary Inspectors for the year 1939:— Type of Inspections. Nuisances found. No. of Inspections. On Complaint. Routine. Revisits. Total Inspections Housing 1953 555 381 2595 3531 Food Preparing Places 41 3 2986 •24 3013 Trade Premises 308 12 883 187 1082 Miscellaneous 140 113 677 358 1148 Totals 2442 683 4927 3164 8774 Nuisances and Defects Abated. Housing—Drainage 397 Dampness 505 General items 1719 Water supply 59 Trade premises 278 Food preparing places 37 Miscellaneous premises 122 Total 3117 Notices Issued. Preliminary—Housing 489 Others 320 809 Statutory Nil Shops Acts, 1912-1936. —278 inspections carried out. Smoke Abatement.—11 inspections carried out. Swimming Baths and Pools.—12 samples taken. Verminous Houses.—86 inspections carried out. 18 Rats and Mice Destruction Act, 1919.—447 inspections carried out. The usual routine work was carried out under the foregoing headings. No alteration or development occurred during 1939, which calls for special note, except that owing to stress of work the annual Rat Week activity was curtailed. Legal Proceedings. A case of selling cigarettes after hours was taken to court and a fine of 20/- was imposed. Factories. The following figures indicate the work carried out by the inspectors under the Factories Act, 1937: — Factories: Premises. Inspections. Written Notices. (a) With mechanical power 183 25 (b) Without mechanical power 79 36 Other premises 92 17 354 78 The No. of defects found and remedied 95 SECTION D. HOUSING. Housing Statistics for the Year, 1939. New houses erected during 1939: — (a) By private enterprise 176 houses 50 flats (b) By Local Authorities Nil I. Inspection of Dwelling-houses during the year. 1 (a) Total No. of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 718 (b) No. of inspections made for the purpose 3219 19 2 (a) No. of dwelling-houses (included under sub-head 1 (a) (above) which were inspected and recorded under the Housing Consolidated Regulations, 1925-1932 119 (b) No. of inspections made for the purpose 579 3 No. of dwelling-houses found to he in a state so dangerous to health as to be unfit for human habitation (*Through voluntary action, 1 closed, 1 rendered fit and 1 demolished). 4 No. of dwelling-houses (exclusive of those under preceding sub-head) found not to be in all respects reasonably fit for human habitation 641 II. Remedy of Defects during the year without Service of Formal Notices. Number of defective houses rendered fit in consequence of informal action 581 III. Housing Act, 1936, Part IV. Overcrowding. 1 (a) No. of dwelling-houses overcrowded at end of year 68 (b) ,, families dwelling therein 78 (c) ,, persons ,, ,, 456 2 (a) ,, new cases of overcrowding reported during the year 1 3 (a) ,, cases of overcrowding relieved during the year 15 (b) ,, persons concerned in such cases 93 20 SECTION E. INSPECTION AND SUPERVISION OF FOODS. Milk Supply. Routine inspection of dairy premises was carried out, and milk samples were taken periodically for bacteriological examinations. Meat and Other Foods. Carcases Inspected and Condemned. Total Cattle excluding Cows) Cows Calves Sheep and Lambs Pigs Number killed (if known) 5225 457 140 439 2662 1527 Number inspected 5221 457 140 435 2662 1527 All Diseases except Tuberculosis Whole carcases condemned 14 — 1 — 2 11 Carcases of which some part or organ was condemned 354 80 36 - 93 145 Percentage of the number inspected affected with disease other than tuberculosis ... 7.05% 17.50% 26.43% — 3.56% 10.22% Tuberculosis only. Whole carcases condemned 8 1 2 2 - 3 Carcases of which some part or organ was condemned 167 24 43 1 - 99 Percentage of the number inspected affected with tuberculosis 3.35% 5.47% 32.14% 0.69% _ 6.68% 21 The total weight of carcases, parts, offal, etc., rejected for disease:— (a) On inspection at slaughterhouses 8,201 lbs. (b) At depots and butchers' shops 1,832 „ (c) Imported meat at shops 1,114 „ The total weight of other foods surrendered and destroyed:— (a) Poultry, rabbits, fish and vegetables 1,817 lbs. (b) Tinned foods 2,014 „ Food and Drugs (Adulteration) Act, 1928. Food and Drugs Act, 1938. The former Act has been superseded by the latter, which came into operation on 1st October, 1939. From this date statutory powers and duties were conferred on the Local Authority, and the sanitary inspectors undertake the sampling duties necessary. Previously the County Council was the responsible authority. During the first nine months of 1939 the County Council's Officer took 111 samples as follows:— Arrowroot 1 Flour 2 Brandy 1 Fruit, dried 1 Butter 4 Gin 1 Cocoa 1 Ginger, Ground 1 Coffee 4 Jam 1 Cornflour 1 Lard 2 Cream 3 Margarine 3 Milk 61 Vinegar 2 Milk, Condensed 2 Whisky 1 Oatmeal 1 Packet Cheese 2 Olive Oil 1 Boracic Acid Ointment 1 Pepper 1 Rice 1 Cod Liver Oil 1 Sausages 2 Tinct. of Iodine 1 Shredded Suet 1 Ammon. Tinct. Quinine 1 Sugar 3 Tapioca 1 Zinc. Ointment 1 Glycerine 1 Samples taken 111 22 6 samples of milk "on delivery" to Bromley dairymen were reported to be deficient in fat content. The necessary action was taken. All other samples were reported to be "Genuine." During the remainder of the year the Local Authority's sampling officers took:— Butter 7 Milk 7 Lard 1 Margarine 5 Mincemeat 6 _ Sausages 2 Samples taken 28 SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. The following table gives particulars of incidence of infectious disease (other than tuberculosis) during 1939:— Disease. Total cases notified Admitted to Hospital Age Groups. 0-1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and over Scarlet Fever 49 36 - - 1 1 4 22 8 5 6 1 1 - Diphtheria 23 23 — - 1 1 2 14 1 - 4 - -- — Pneumonia 27 8 2 - — I 1 1 - 1 4 3 9 5 Puerperal Pyrexia 22 20 - - - - - 3 17 2 - - Dysentery 1 - - - - - - - - - - - 1 - Erysipelas 8 1 - - - - - - - 1 - 1 6 - Ophthalmia Neonatorum 2 - 2 - - - - - - - - - - - Acute Poliomyelitis 3 2 - - 1 - - 2 - - - - - - Typhoid Fever 1 - - - _ - - 1 - - - - - - * Measles 2 - - - 1 - - 1 - - - - - * Whoop ng Cough 3 - 1 - 1 1 - - - - - - - Totals 141 90 5 - 3 5 8 40 10 10 31 7 17 5 * Made notifiable in the area in November. 1939 24 Scarlet Fever. There is a further reduction to record, 49 cases during 1939 as compared with 71 during 1938, which gives a low incidence rate of 0.82 compared with 1.7 for 1938. There are no special noteworthy facts amongst these few cases. Diphtheria. Twenty-three cases were notified during 1939 as against 19 in the previous year, giving an incidence rate of 0.4 compared with 0.32 for 1938. It is difficult to assess the part played by immunisation in the satisfactory continuance of a low incidence of diphtheria in this area, and I am, therefore, reluctant to claim that control of this disease is entirely due to immunisation. Until immunisation is more widely and systematically adopted, we can only record an apparent good result. The work of the Immunisation Clinic for 1939 is indicated in the following figures:— Total No. of primary Schick tests including:— 278 (a) No. giving positive reaction 216 (b) No. giving negative reaction 62 Total No. of injections of T.A.M. or A.P.T 1,335 including:— (a) First injections 403 (b) Second injections 421 (c) Third injections 491 (d) Fourth injections 20 Total No. of final Schick tests including:— 359 (a) No. giving positive reaction 20 (b) No. giving negative reaction 339 25 Tuberculosis. New Cases and Mortality, 1939. Age periods. New cases notified or otherwise revealed. * Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- 1 .. .. .. .. .. .. .. .. 1- 5 1 .. .. .. .. .. .. .. 5-15 2 4 .. 1 .. .. .. .. 15-25 7 9 2 3 3 1 .. .. 25-35 6 12 3 1 2 5 1 1 35-45 5 1 1 .. 2 1 .. .. 45-55 7 2 .. .. 6 1 .. .. 55—65 3 .. .. .. .. 1 .. .. 65 and over .. .. .. .. .. 1 1 .. Totals 31 28 6 5 13 10 2 1 *In addition inward transfer patients as follows: Respiratory M. 10 F. 11 Non-Respiratory M. 2 Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936, Section 172. No action under the above enactments was necessary during 1939. Efficiency of Notification. There were 4 cases of unnotified tuberculosis amongst 25 deaths from tuberculosis, giving a ratio of 1 in 6. Tuberculosis Dispensary. The following brief summary of work during the year at the Dispensary, relative to the Borough, has been supplied by Dr. S. Roy C. Price, Tuberculosis Officer. 26  New Cases. Adults. First Attendances. Children. M. F. M . F. Respiratory 30 26 2 - Non-respiratory 3 3 - - Negative 17 19 8 5 50 48 10 5 No. of contacts examined 6O No. of contacts found to be positive 3 (These figures are not included in the above table). Total No. of attendances at the Dispensary 2,911 No. of patients who completed a course of residential treatment 83 SECTION G. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. Diseases of Animals Acts. No. of Movement Licences received 213 Animals concerned:— (1) Pigs 2,138 (2) Sheep, Lambs 464 There were three casen of swine fever confirmed within the area during 1939. Registries for Female Domestic Servants. There were 9 registry offices on the register at the end of 1939. The Chief Sanitary Inspector made routine inspections during the year. Retail Market. The Market has been held without interruption. Total receipts for 1939 was £592 16s. Od., an average of £49 8s. Od. per month compared with £55 for 1938. Petroleum Acts. Total No. of Licences issued: (1) For Petroleum Spirit 107 (2) For Carbide of Calcium 1 BOROUGH OF BROMLEY. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR 1939. 28 INTRODUCTION. In order to meet the urgent need for economy the report for 1939 has been greatly curtailed and confined only to essential matters as suggested in the Hoard of Education's circular of 28th December, 1939. Only extracts from the year's statistics have been included, but full statistical records have been compiled and retained in the records for future reference. Up to the summer vacation of 1939 the School Medical Service pursued a normal routine, some curtailment since has been unavoidable in order to meet the exigencies of civil defence preparations. These preparations could not have been completed had not the staff given much time voluntarily outside normal working hours. From August to the end of 1939 the schools were closed, but as the long threatened aerial onslaught failed to materialise, most of the schools opened on a part-time voluntary basis. By October the medical, dental and nursing staff were operating a partial school medical service, and in November the service was fully available in readiness for the full-time re-opening of the schools after Christmas. The specialists' clinics for Orthopædic and Tonsils and Adenoids, were in abeyance but have been resumed since January, 1940. Both School Clinics have been adapted for use as First-Aid Posts. With the exception of operations for Tonsils and Adenoids, which are being carried out pro term at a nursing home, the Clinics are now fully used by the School Medical Service, and their efficiency as First-Aid Posts, should the need arise, has not been impaired. Staff changes are shown at the commencement of this report. Since the close of the year 1939, additional work has accrued to the staff as a result of influx of refugee children, the undertaking of special nutrition survey of children at the request of the Board and medical examination of some 700 overseas evacuees These matters will be the subject of future reports. 29 SUMMARY OF STATISTICS, 1939. No. on the School Roll 5,581 No. of individual children who attended medical clinics 1,047 No. of individual children medically examined at schools 1,087 No. of medical examinations at the clinics 5,025 (a) North Clinic 1,818 (b) South Clinic 2,183 (c) Special Clinics 1,024 No. of attendances of children for treatment by the school nurses 6,964 (a) North Clinic 3,164 (b) South Clinic 3,800 No. of inspections for uncleanliness and verminous conditions by the school nurses 8,294 No. of attendances for treatment at the Dental Clinic 3,761 No. of treatments at the Eye Clinic 527 No. of spectacles prescribed 178 No. of operations for Tonsils and Adenoids 119 No. of attendances at Orthopaedic Clinic 2,175 (a) For consultations 426 (b) For treatments, massage, etc 1,749 No. of attendances at Ultra Violet Ray Clinics 1,591 No. of children referred to the Care Committee 78 Hygiene of Schools. Aylesbury Boys' Council School was demolished and a new council School for 320 senior girls has been erected. Owing to the outbreak of war causing the abandonment of the re-organisation of other schools in the Central area, 30 the new school is not at present being used solely for senior girls. With the concurrence of the Managers of Masons Hill C.E. School, that school has been closed during the war and the Masons Hill scholars are being accommodated at the new Aylesbury Council School. SECTION A. MEDICAL INSPECTION. Total No. of routine medical inspections at schools 1,087 (a) Entrants 32 (b) Second Age Group 507 (c) Third Age Group 455 (d) Other routine inspections 33 Total No. of special inspections and inspections at the clinics 5,020 Findings at Medical Inspections. Malnutrition. A classification of nutrition of 1,087 children inspected up to 31st August, 1939, in the routine age groups gives the following results. The figures for The figures for 1938 are included by way of comparison :— 1939 1938 Nutrition Standard. No. of children Per cent. No. of children. Per cent. Excellent 102 9.38 148 8.32 Normal 853 78.47 1436 80.81 Subnormal 109 10.03 178 10.01 Bad 23 2.12 15 0.84 1,087 1,777 There is further reference to nutrition under the heading of Provision of Meals. 31 Medical Defects. Defects found on routine medical and special inspections may be briefly summarised as follows:— Defect or Disease of: Routine Inspections requiring Special Inspections requiring Treatment. Observation. Treatment. Observation. Skin 3 - 414 3 Eyes 73 98 283 2 Ears 7 1 134 10 Nose and Throat 23 83 230 57 Heart 2 14 8 19 Lungs (non-T.B.) 3 4 315 32 Tuberculosis— Respiratory - - - - Non-Respiratory - - 2 2 Nervous System 2 5 27 6 Deformities 38 3 28 1 Miscellaneous 40 26 809 162 Totals 191 234 2.250 294 Special attention may be drawn to the fact that of the figure 238 requiring treatment for eye defect, 134 were cases of conjunctivitis. SECTION B. TREATMENT. The following is a summary of treatments for minor ailments at the clinics during 1939:— Skin diseases 292 Minor Eye Defects 250 Minor Ear Defects115 Miscellaneous 725 (e.g. minor injuries, bruises, sores, chilblains, etc.) - 1,388 The total number of attendances of children for treat- ment by the school nurses was 6,964. 32 Eye Clinic. Dr. R. H. Rushton has taken over the work of the Eye Clinic during the absence of Dr. Eric Lyle on active military service. No report from the Specialist is included this year, but the following figures indicate the extent of the work performed at the Eye Clinic:— No. of children dealt with for errors of refraction 450 Re-inspections, included in the above figure 308 No. of other defects or disease of eyes treated 77 No. of spectacles prescribed 178 No. of spectacles obtained 175 Ear, Nose and Throat Clinic. Owing to the demands of civil defence upon the accommodation at the North Clinic it was necessary to make arrangements for operations to be performed at Frascati nursing home. These arrangements are entirely under the supervision of the Local Authority's staff, with Mr. C. Beney performing the operations and Dr. A. Thomson, Assistant School Medical Officer, administering the anaesthetics. The patients remain at the nursing home for 24 hours under the care of the Matron of the Nursing Home. Consultations are held at the North Clinic as hitherto. No special report from Mr. C. Beney is included this year. The following figures have been extracted from the records of this Clinic up to August, 1939:— No. of operations 91 (a) Adenoids only 4 (b) Tonsils and Adenoids 87 Other forms of treatment given 45 No. of operations in hospital, etc., (apart from the local Authority's scheme) 28 No. of attendances of children at the Consultation Clinics 111 33 Orthopaedic Clinic. It is with regret that we lose the services of Mr. H. J. Seddon, Orthopaedic Specialist, consequent on his taking up an important university appointment. He has been succeeded by Mr. J. A. Cholmeley. No special report is included for 1939 from Mr. H. J. Seddon. The Orthopaedic clinic was in abeyance at the outbreak of war but was resumed again in January, 1940. The work of massage, remedial exercises, ultra violet ray and infra-red ray treatments were, however, continued by the Masseuse. No. of children treated at the Orthopaedic Clinic 232 No. of consultations held 426 No. of attendances for massage 1749 No. of attendances for Ultra Violet Ray, &c., treatment 1591 The following is a summary of new cases seen by the Orthopædic Surgeon during 1939:— 1 Congenital Defects. 6. Structural Curvature Hammer toe 2 Spine 3 Spastic paralysis 2 7. Flat Feet 24 other conditions 20 8. Infantile Paralysis 4 2. Birth Injuries. 9. Sequelae of Acute Torticollis 1 Fevers 1 3. Rickety Deformities. 10. Fractures 1 bow legs 3 11. Tuberculosis Joints 1 4 Knock Knees. 12. Other Bone Diseases. Non-rickety 13 Apophysitis of the Outward curva- 0s Calcis 1 ture of tibia 4 Depressed Sternum 1 5. Postural Defects of 13. Osteomyelitis - Spine 21 14. Not Classified 9 34 REPORT ON THE SCHOOL DENTAL SERVICE, 1939. Inspection. This year the circuit of schools for inspection is not complete. Four schools have not received an inspection at all, and four schools have been inspected only so far as conditions and attendances have allowed. It is found that a school inspection takes two or three times as long to complete under present conditions owing to the attendance being- limited at any given time. The number of children examined for dental defects was 3,619, and of these 58 per cent. required treatment. It will be interesting to see what effect war conditions have on children's teeth; in the last war many school dentists reported a marked improvement, possibly owing to plainer food and less sugar. Treatment. During the year 4,157 attendances were made for treatment, and 2,045 children received all necessary treatment. The Dental Clinic did not receive patients in September, but in October it was found possible to make a start again, although under difficulties as regards spate and adequate lighting, and 135 attendances were recorded. These patients consisted of a certain number of school children left over since the holidays, and a large number of emergency cases. It will be remembers that during the first month or so of the war almost all hospitals and institutions were closed to out-patients and there was literally nowhere for many of our patients to receive treatment. In November and December, working conditions became easier, and all sessions were well attended and fully occupied, although the sessions at Princes Plain Clinic were reduced from 12 to 8 per month. At the present time the clinic is working in a fairly normal manner, with the exception of the gas clinics. In ordinary times we treat about twenty children at each gas session and this means that at least twenty adults 35 come with them; having regard to the fact that at any moment we are liable to receive orders to prepare the Clinic as a First Aid Post to receive air-raid casualties, it seemed unwise to have forty or so individuals on the premises, so these clinics have been modified and we try to limit the attendance to twenty-five or so. Orthodontics. There is a growing demand for the treatment of irregular and misplaced teeth, as parents appear to be more conscious of the disadvantages of such irregularities. There were 186 attendances for orthodontic treatment, the parents being charged 7s. 6d. for the necessary mechanical appliance. Child Welfare. This service provides dental treatment for children referred from the Welfare Centres by the doctors or nurses, and during the year there were 200 attendances. The work consists of simple fillings and mainly gas extractions. Mothers. Attendance of mothers, in spite of present condi''tions, is good, the total for the year being 209. Since April, I am glad to report, it has been possible to supply artificial dentures, and up to date 11 dentures have been made. Conclusion. Lastly I would like to thank the Committee and Staff for their assistance in my work, nor must I forget the very practical help given at all times by the Volun- tary Workers. T. S. Latham, L.D.S., Eng., School Dental Officer. 36 SECTION C. Infectious Disease. No change was made in the routine or regulations concerning closure of and exclusion from schools in connection with infectious disease. Notifiable infectious diseases were few and no spread of infection occurred in schools. Open-Air Education. There were no developments to record in this direction. STATEMENT ON PHYSICAL EDUCATION DURING THE YEAR ENDED 31st DECEMBER, 1939. 1. Introduction. It is unfortunate that the circumstances of should have seriously interrupted the excellent progress which this subject has enjoyed during the past tew years : playground space has been restricted by the siting of Air Raid Shelters, the use of one large playing; field has been discontinued, as no shelter accommodation is available on or near the site, and future problems consequent on the calling-up of specialist men teachers must soon be faced. In time of war, the subject of Physical Education assumes added importance, for apart from its purely physical and hygienic values, its joyous and discipline activities are invaluable for their effect in counteracting those influences which undermine the child's spirit and confuse his emotions. In spite of these difficulties, however, the subject continues to receive every possible encouragement in our elementary schools. 2. Physical Exercises. In Junior and Infant Schools the standard of has shown marked progress, particularly with regard to Group Work under section leaders. 37 In Senior Schools, with the completion of the building and equipping of three excellent gymnasia, a new phase of the subject's development has been reached. Advanced schemes of physical exercises and gymnastics have been introduced, and the new facilities, which include showers and changing rooms for the children, have greatly enhanced the enjoyment and value of the lessons. 3. Organised Games. During the first six months of the year, when normal school work was possible, regular weekly visits to the Education Committee's playing fields were made by all senior scholars. Courses for teachers in Games and Athletics were organised and conducted by the Committee's Organisers of Physical Education, and resulted in a general stimulus to the work. The introduction of field events, such as Throwing the Javelin and Discus, made an immediate appeal to the senior boys, some of whom, after only a few weeks' practice in these events, put up quite creditable performances. 4. Swimming. Arrangements for the continuation of the Committee's Voluntary Swimming Scheme were again made, and approximately 200 children availed themselves of the facilities offered at the Municipal Open Air Baths. As only one school is within easy distance of this Bath and no transport is available, it has not been found possible to arrange for the use of the Bath during the school hours. by arrangement with the London County Council, facilities were also afforded to classes of children from the Burnt Ash Senior Departments at the Lewisham Swimming Baths. Geo. H. Atkinson, Florence M. Bentley, Organisers of Physical Education. 30.7.1940 38 Provision of Meals. At the request of the Board of Education, this matter received very earnest consideration in its application to the necessitous under-nourished children in the area. Taking under-nourishment in its widest sense, one could find no concrete evidence that school children in the necessitous grade were suffering from serious lack of food. Much of the so-called under-nourishment and malnutrition prevailing in the area appears to be largely due to other factors and to unbalanced diet in the home. This is often the case even where family means do not fall within the necessitous grade. Our answer to undernourishment in the past has been to seek the apparent root cause rather than to advise the adoption of the easy course of provision of free meals at school. Where real lack of nourishing food through poverty has been discovered, the cases have been referred to the Committee, At the present time a nutrition survey is being completed, from which it is hoped we shall be able to determine whether the provision of free meals in normal time; is a policy to be adopted in this area. The new factor of war conditions has, however, created a category of necessitous or partially necessitous children not hitherto strictly existent in this area. The provision of school meals has become desirable. In the meantime the canteens for the provision of hot mid-day meals are being continued at Hayes and Keston Schools, and during 1939 these facilities also became available to Raglan Road and Princes Plan Council Schools. The milk distribution scheme continues in operation. The latest return shows that 2,823 children are receiving milk in schools for payment at ½d. per one third pint per day. This represents 53 per cent. of the total rollThere is a marked disparity between numbers of Junior and Infant scholars receiving milk and the Senior scholars. Generally speaking, about 75 per cent to 30 per cent. 39 SECTION D. There has been no substantial change or noteworthy development to record under the following headings (luring 1939. Full details appear in the Annual Report for 1938. Under heading 2, however, enquiries are being made to ascertain whether there exists any need for a Nursery Centre to assist mothers who may be on munition work, or could undertake munition work if such a centre were available, or who are obliged to supplement the family earnings whilst the husband is on military service. The evacuation of certain Special Schools owing to war conditions has become operative with the result that several of our children in Special Residential Schools have been returned home. 1. Blind, Deaf, Defective and Epileptic Children. No. of children attending at the end of the year:— (a) Residential 15 (b) Special Day Schools 11 2. Nursery Schools. 3. Secondary Schools. 4. Parents' Payments. 5. Health Education. 6. Special Enquiries. SECTION E. Routine work has continued throughout the year in connection with the following activities: — 1. Occupation Centre for the Mentally Defective. 2. Employment of Children and Young Persons. 3. After-Care Work. 4. Bromley Childrens' Care Committee. 40 SECTION F. APPENDIX OF STATISTICAL TABLES. The detailed statistical tables furnished annually to the Board of Education are not reproduced here, but are available for reference in the records of the Department. Extracts from these tables will be found under appropriate headings in the body of this Report.