BRO 36 Borough of Bromley 1940 ANNUAL REPORT medical officer of health AND school medical officer BROMLEY. KENT: Strong & Sons, Ltd., North Street. 2 PUBLIC HEALTH STAFF, 1940. Medical Officer of Health and School Medical Officer Assistant Medical Ofiicers of Health and Assistant School Medical Officers Orthopedic Surgeon Ear, Nose and Throat Specialist Eye Specialist Anesthetist Consulting Gynecologist School Dental Surgeons Chief Sanitary Inspector and Chief SamplingOfficer (and Inspector for Diseases of Animals Acts and Petroleum Acts) Sanitary Inspectors and Sampling Officers 1 2 K. E. Taitek, o.u.e., m.b., ch.b., d.p.h. 2 Miss G. H. Stinson, m.r.c.s., l.r.c.i'. 2 A. Thomson, m.b., ch.b., d.p.h. 2 1 J. A. Cholmeley, f.r.c.s. 2 1 Charles C. Beney, m.a., m.b., ch.b. (Camb.), m.r.c.s. (Service discontinued 31.11.40) 2 1 R. II. Rushton, m.r.c.s., m.r.c'.r. Assistant Medical Officers 2 1 D. M. Lindsey, m.d., m.r.c.o.g. 2 T. S. Latham, l.d.s., r.c.s. 2 1 Fairman J. Ordisii, l.d.s., r.c.s. 5 4 3 2 G. R. Woods, m.s.i.a., a.r.san.i. 5 4 3 2 T. C. Towersey, m.s.i.a. 5 4 3 2 W. H. Sayers, m.s.i.a., a.r.san.i. 0 4 3 2 E. R. H. Hodge, m.s.i.a., m.r.san.i. (Military Service). 3 Health Visitors and School Nurses Municipal Mill wives Orthopedic Nurse Orthoptic Nurse General Office Stuff. Chief Clerk Senior Clerk Clerks Temporary Clerks * 7 * 2 Miss li. xV. Briggs 8 7 r' 2 Miss E. 15. Crowe. 8 7 6 2 Miss 1). Prime 8 7 0 2 Miss E. Rhodes 8 7 0 2 Miss E. M. M. Roherts (appt. 2G.7.40) 8 7 11 2 Miss E. Oakes 8 7 0 2 Miss J. E. B. Dinn (resigned 23.5.40) 7 8 2 Miss S. A. Garner 7 4 2 Miss M. R. Jenkins 7 fi 2 Miss E. Smith 02 Miss A. M. Winter 7 0 2 Miss E. V. Roiuthan 2 1 Miss M. Dodge, c.s.m.m.g. 2 1 Miss J. Bradley (resigned 31.10.40) 2 1 Miss M. F. Balk win. (appt. 1.11.40) 2H. E. JiAWLEY 2S. F. JuDD (Military Service) 2 W. S. Dench 2 E. H. Andrews (Military Service) 2 Miss J. L. H. Huntley 2 Miss R. Brock 2 Miss D. E. Thomas (appt. 1.9.40) Miss R. I. McGowax (appt. 2.9.40) (resigned 14.12.4'11 Miss E. summkkton (appt. 16.12.40) 4 Dental Clinic Assistants Casualty Service. Assistant StaiV Officer (temporary appointment) Outdoor Staff. Drain Tester and Disinfector Market Superintendent 2 Miss E. Thornton (resigned 30.9.40) 2 Miss E. B. Fleming (appt. 1.10.40) 2 1 Mrs. It. A. Waters (appt. 11.11.40) 2 1 Mrs. A. Benzie (resigned 2.11.40) A. V. Gahrod. J. W. Seaokr F. J. Ephorave 1- Denotes part-time. 2. Exchequer Grants (including Board of Education). 3. Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Joint Examination Board 4. Royal Sanitary Institute Certificate for Meat and Other Foods. 5. Royal Sanitary Institute Smoke Certificate. 6. Three years Hospital Trained. State Registered Nurse. 7. State Certified Midwife. S. Royal Sanitary Institute Health Visitors Certificate. 9. Royal Sanitary Institute Certificate in Sanitary Science as applied to Building and Public Works. 5 BOROUGH OF BROMLEY. Report of the Medical Officer of Health ' for the year 1940. To the Mayor, Aldermen and Councillors of the Borough of Bromley. Mr. Mayor, Ladies and Gentlemen, I beg- to submit tlie Annual Report for 1940 in accordance with tlie Ministry of Health's Circular 2-514 of 2Gtb March, 1941. The Report is to be regarded as an interim one and is again very much curtailed in substance as suggested by the Ministry of Health. Fuller details of annual statistics and records have been compiled and are retained for reference in the Department in anticipation of the preparation of a survey report of the war years which is contemplated by the Ministry. It must be confessed that to summarise in a few pages the annual review of all the multiple activities of the health services and of the influences and conditions affecting- the health and physical well-being- of the population, especially during war-time, presents no easytask. A health report comprising terse comments on selected statistical data may easily lead to erroneous conclusions in the absence of a substantial analysis of all facts and points of significance indicated in the figures shown. It is on the grounds of pressure of work, lack of time and paper shortage that we are enjoined l'.v authority to curtail the report, although in actual fait on the score of time and work involved, little saving is really achieved," as the preparation of a curtailed report, together with a " shadow report " of retained statistics and other records, absorbs much time and entails work. 6 It is, nevertheless, expedient in the light of other difficulties that for purposes of war economy an abridged report only should be issued. This curtailment must not be interpreted as indicating that the public health services are in any respect at a standstill, if anything, the services are in greater demand under war stress, and the portents are that the services of public health generally will pass through a severe testing time. Great advances in medicine were made during the last war and similar advances in the light of experience during this war will be just as important. The knowledge we shall acquire will be gathered from harsh experiences, but at least we shall have a sure foundation of accurate information on which to base post-war planning and reconstruction, as assuredly there will be many adjustments and developments in the field of public health work to meet problems of changed social circumstances and conditions. The health resistance of the nation to war conditions gives rise to great satisfaction, and not a little speculation as to the factors mainly responsible for the almost uncanny immunity to ill-health displayed by the nation. }\ e have not far to seek for one factor, and that is the important part played by health administration in the pre-war years, during which greatly improved health standards have been inculcated in the parental mind, thus creating a health conscience. Higher standards of nutrition, clothing and hygiene have been attained to the great benefit of the youth of the present day, and the great advances in provision of maternity, clinic and hospital provision, public assistance, health training, have all played their part in preparing this generation to withstand the rigours of war. The fact, however, that all's well on the health front must not be allowed to foster complacency. We must he prepared for war conditions to repent all the known factors which past experience has taught us are favourable for the spread of infection and which are productive of epidemics. We must be prepared for history to repeat .itself. I here was no excessive cause of sickness, invalidity, or mortality in Bromley during 1940, apart from measles 7 which made tlie usual quinquennial appearance in epidemic form in the autumn, and at the time of writing has not abated. Fortunately up to the present time, the infection is of a mild kind and no seriotis complicated cases have been recorded. Very few cases of scarlet fever (49) and diphtheria (11) were notified. Cerebrospinal fever (13) made an unwelcome appearance in Bromley's statistics after an absence of several years. Incidence in this disease has been common to the country as a whole, being- the one disease showing an increase since 1915. A noteworthy feature of the statistics for 1940 is the remarkably low figure of 17 deaths of infants under one year of age, which gives the lowest Infantile Mortality Rate of 22.6 per 1,000 births ever recorded in Bromley. The work of the staff has been beyond praise, and to Mr. Lawley, Chief Clerk, who has done so much in preparation of this Report, I am especially indebted. That the staff have continued to do their routine PublicHealth duties as in pre-war days, and also given additional service to Civil Defence is a fine tribute to theii own good citizenship. A word of praise is due, also, to the public of Bromley; they have responded magnificently to the " Blitz " conditions. It is a stimulation to all of us in Public Health Service to give of our best and to help where help is needed. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, K. E. TAPPER, Medical Officer of Healtli. June, 1941. 8 SECTION A—STATISTICS AND SOCIAL CONDITIONS OF THE AREA, 1940. Statistics. Area (in acres) 6,519 Registrar General's estimate of—7 (a) Resident population (mid-1940) (1)) Average population appropriate 56,580 to the calculation of death rates (mid-1940) Number of inhabited houses according to tlie rate books (1.4.1941) 16,058 Number of valuation assessments of inhabitable premises (31.3.1941) 17,040 Rateable Value (31.3.1941) £714,OSS Product of a Penny Rate (estimated for year ending 31.3.42) £2,755 Vital Statistics. Live Births. For Calculating Birth Rates. Legitimate Illegitimate Total. 748 22 770 Male. 368 11 379 Female. 380 11 391 | Birtli Rate per 1,000 of the estimated resident population 711 id-1040: 13.2 For Calculating Infant and Maternal Mortality Rates. Legitimate Illegitimate Total. 729 22 751 Male. 359 11 370 Female. 370 11 381 9 Stillbirths. For Calculating Birth Hates. Total. Male. Female. Legitimate 21 14 7 Illegitimate 54 1 26 18 8 For Calculating Iufant and Maternal Mortality Rates. Total. Male. Female. Legitimate 20 13 7 i Illegitimate 5 4 1 25 17 8 Stillbirth Rate per 1,000 total (live and stdl) births :— 33.2 Deaths:— Total. From all causes 733 Male. 368 r Rate per 1,000 Female. I estimated aver*i age resident 0 population: v 12.5 (adjusted) A real comparability Factor as applied to the crude death rate for all causes of deaths 0.97 Deaths from Puerperal Causes:— Rate per 1,000 No. of Deaths. total (live and Puerperal Sepsis 1 still) births 1.28 Other Puerperal Causes — Deaths of Infants under 1 year of age: Total. Legitimate 16 Illegitimate 1 17 Male. Female. 9 7 1 — 10 7 10 Deutli Rate of Infants under 1 year of age: All infants per 1,000 live births 22.6 Legitimate infants per 1,000 legitimate live births 21.9 Illegitimate infants per 1,000 illegitimate live births 45.4 Deaths from cancer (all ages) 97 Deaths from measles (all ages) — Deaths from whooping cough (all ages) — Deaths from diarrhoea (under 2 years of age) 3 Social Conditions. Bromley being a residential area, there are no conditions of an industrial or occupational character prejudicial to the health of the inhabitants to discuss, and there is little to add to my previous reports under this heading. Figures of unemployment are not being issued for publication during the war period. Meteorology. Climate conditions were generally good throughout the year, and, fortunately, the past winter was less severe than tlie previous one, although with the approach of autumn and winter, flooding of Anderson and trench shelters presented a problem. The bunking of the shelters furnished sleeping facilities oft' the ground level, and thus provided some security against ill-health. The Borough Engineer has kindly supplied the following details from records kept by his Department at the Climatologrical Station at Church House Grounds for 1940:— Total Rainfall 25.45 ins. Mean maximum daily temperature 57.2°F. Mean minimum daily temperature 42.0°F. Highest maximum temperature recorded 87.0°F.—5th Aug. Lowest minimum temperature recorded 10.0°F.—20th Jan. Lowest grass minimum temperature recorded 11.0°F.—20th Jan. 11 Population. During- tlie course of the year there lias been some exodus of population to quieter areas. The latest records of valuation assessments gives a figure of 17,040 habitable premises, which on a basis of -3.61 persons per house, represents a potential population of 61,514. The latest number of inhabited houses according to the rate Ixioks is 16,058, which on the same basis of calculation represents an estimated population of 57,969, but I would prefer, however, to estimate the present resident population at 56,000. t The Registrar General's mid-year 1940 estimates are: — (a) Resident population (b) Average population appropriate to the calculation of death rates 56,580 Births. Six hundred and sixty-nine births were notified during 1940, of which sixteen were stillbirths and six hundred and fifty-three live births. The number of births and stillbirths registered by the Registrar General, which have been adjusted by inward and outward transfers, according to the residence of the parents, were 770 live births and 26 stillbirths. The Birth Rate for 1940, calculated on 770 live births, is 13.2, as compared with 13.9 for 1939. Stillbirths. Twenty-six stillbirths were registered and records a welcome reduction on thirty-nine for the previous year. We cannot claim to present a complete statistical record of foetal mortality in its broadest sense until abortions and miscarriages are brought into the field "1 notification. Recent discussion has drawn attention to the prevailing chaotic position in tlie world with regain to the precise legal definitions of abortion, stillbirth and live birth, and the need of clearing up the difficulties of interpretation—the term abortion does not appear in our own legal code. 12 Deaths. There were 733 deaths from all causes during' 1940, giving a Death Kate of 12.5 (adjusted) per 1,000 population as compared with 9.7 for 1939. The Crude Death Rate, unadjusted by the comparability factor (0.97) is 12.9. Predominating causes of deaths were: — Heart Disease 207 Cancer 97 Infantile Mortality and Maternal Mortality. The Infantile Mortality Rate for 1940 is 22.G per 1,000 live births, and is the lowest rate ever recorded for Bromley. The Maternal Mortality Rate for 1940 is 1.28 per 1,000 (live and still) births compared with 3.45 for 1939. SECTION B (1). GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. There are no important changes or developments to report in the following services in respect of 1940: — (a) Laboratory Services. (b) Ambulance Facilities. (c) Nursing in the Home. (d) Treatment Centres and Clinics provided by the Local Authority. (e) Tuberculosis Dispensary, 2, Park Road. (f) Venereal Diseases and Treatment Centres. (g) Hospitals, Public and Voluntary. Public Health Act, 1936. Section 187/195, Nursing Homes. There were eight nursing homes on the register at the close of the year 1940, and fifteen visits of inspection were carried out by Dr. G. 'H. Stinson, Assistant Medical Offi cer of Health. These nursing homes provide beds for sixty patients (a) 25 maternity and (b) oo others. 13 SECTION B (II). MATERNITY AND CHILD WELFARE. This service was in full operation during the year. There have been no important changes or developments to record, and with the exception of the following curtailments, the services available are the same as detailed on page 34 of Annual Report for 1938. (i) 8 welfare sessions are held weekly .instead of 9. (ii) Free milk is dispensed through the National Milk Scheme. (iii) 5 midwives are engaged instead of 4. (iv) Consultant Gynaecologist does not attend the bi-monthly ante-natal clinic, but' is still available for emergency general obstetric work. (v) Ear, Nose and Throat operative treatment at the School Clinic is in abeyance pro tent.' NATAL SERVICES. Domiciliary Midwifery Service. This service has functioned fnlly during 1940. The following figures indicate briefly the extent of the work of the municipal midwives during the year: — Total number of bookings ... 273 Disposed of as follows: Booked for midwife 156 Booked for maternity nurse 43 Booked for hospital 37 Subsequent transfers to hospital 9 Bookings cancelled, evacuation, etc. 2S No. of confinements attended : As midwife 193 As maternity nurse 30 No. of visits by midwives: Ante-natal 2047 Post-natal 3931 14 Domiciliary Medical Practitioner Service. No. of medical examinations made by doctors : Ante-natal 126 Post-natal 05 Home Helps. No. of patients engaging' home helps. 57 No. of home helps so engaged 30 Ante-Natal Clinics. The municipal midwives attend these clinics in addition to the ante-natal supervision exercised by home visitation. Dr. G. H. Stinson, Assistant Medical Officer of Health, attends each session. No. of clinic sessions held 47 No. of medical consultations 167 No. of attendances by patients 172 Dental Scheme for Nursing and Expectant Mothers. No. of sessions held 95 No. of attendances of mothers 504 No. of patients discharged treatment complete 101 Details of Treatments: Gas Administrations 159 Repairs to Dentures 7 Extractions 719 Local anæsthetics 114 Fillings 46 Scalings and Dressings 85 Patients supplied Awaiting Dentines at with dentures ... 46 end of year 24 Administration of Midwives Acts, 1902-36. The Inspector of midwives, Dr. G. H. Stinson, who has carried out periodical inspections, had no occasion to report adversely on the work of the midwives and found their work carried out most satisfactorily. 15 No. of midwives practising in the area at end of 1940 21 No. of confinements attended 668 (a) as midwives 407 (b) as maternity nurse 261 No. of cases in which medical aid was summoned during the year under Sec. 14 (i) Midwives Act, 1918, by a midwife for domiciliary cases 47 Maternity Hospital Provision. Forty-one maternity cases requiring hospital treatment were admitted to the County Hospital, Farnborough, under the Council's Scheme of assisted maternity hospital provision. The Bromley, Chislehurst and District Maternity Hospital, a voluntary hospital, subsidised from public funds through the County Council, had their accommodation of 15 beds in full use during 1940: No. of patients admitted 329 (a) Cases delivered by midwives 202 (b) Cases delivered by doctors 105 (c) Expectant mothers admitted for treatment 22 No. of cases notified as: (a) Puerperal pyrexia 1 (b) Ophthalmia neonatorum 2 No. of infant deaths: (a) Stillborn 8 (b) Within 10 days of birth 6 No. of maternal deaths 0 Puerperal Pyrexia. Only two cases were notified during 1940 as against twenty-two in 1939. Both received institutional treatment, one made a satisfactory recovery, but the other case died on the seventh day after severe hiemorrhage. The patient was forty-one years of age, ante-natal care had been constant, .and obstetric facilities at delivery satisfactory; the birth was stillborn, 16 POST-NATAL SERVICES. Health Visitors. Home Visiting. Having regard to the intensification of work in the casualty services, full resumption of school activities, overseas evacuee inspections and refugee visitation, I am able to record that no less than 6,799 home visits were made by the health visitors during 1940, an increase of over 800 on the previous year. That this satisfactory result has been achieved during these times of great stress of work is a tribute to the enthusiasm of a hard working nursing staff. Welfare Centres. Tlie Centres have been held continuously throughout the year, and with invaluable help given by the voluntary workers, the work of the health visitors in this sphere of their duties has been eased. A falling off of attendances at welfare centres is indicated in the following figures for 1940 as compared with other years, but removals to quieter areas and cancellation of one session per week would account in some measure .for the drop in figures: — 1940 19-39 1938 Total number of babies on the registers at end of year 3671 3389 2749 Total number of attendances of children at all centres 20433 25993 27105 Total number of medical examinations 3085 3535 4174 Total number of weighings 18353 22899 24011 The average attendance in a normal year, 436 welfare sessions, is 62, and .during 1940 the average has dropped to 52 on a basis of 396 sessions. Child Life Protection. Regular visits to the homes of foster children were paid by the health visitors, and no unsatisfactory reports on home conditions provided for these children required action during the year. 17 Clinic Treatment of Children under 5 Years. Facilities for treatment of the child under 5 years were available as hitherto during 1940, except that tonsil and adenoid operative treatment was discontinued. The number treated during 1940 was: — Tonsil and Adenoid Clinic 27 Eye Clinic 58 Dental Clinic 123 Minor Ailments Clinic 41 Orthopaedic Clinic 95 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. The Clerk of the Metropolitan Water Board has kindly furnished the following particulars regarding the water supply : — Various lengths of 3in. and 4in. diameter mains only were laid in the Borough of Bromley during the year, and the water supplied was considered satisfactory both as regards quality and quantity. Routine monthly reports on the results of chemical and bacteriological examinations continue to be forwarded to the Ministry of Health as in normal times. Drainage. \ No extensions or developments of drainage were undertaken during the year. Cesspool Drainage. No buildings were constructed with cesspool drainage during 1940. There is nothing specially noteworthy to add to my report of 1939 on the progress made in the abolition of cesspools in the added areas. 18 Rivers and Streams. During; the year, ten inspections of water-courses were carried out, and in one instance the abatement of a nuisance of a minor character was secured by informal action. Public Cleansing. The arrangements for collection and disposal of refuse were adequate and called for no development. The Salvage-Scheme brought into operation in 19-39 has been fully maintained. SANITARY INSPECTION OF THE AREA. The following is a summary of the work of the Sanitary Inspectors for the year 1940: — Type of Inspections. Nuisances found. No. of Inspections. On Complaint. Routine. Revisits. Total Inspections Housing 778 360 216 2017 2593 Food Preparing Places 44 28 2570 62 2660 Trade Premises 71 3 623 62 6«8 Miscellaneous 136 100 1018 377 1495 Totals 1029 491 4427 2518 7436 Nuisances and Defects Abated. Housing-—Drainage 276 Dampness 295 General items 831 Water supply 67 Trade Premises 78 Food Preparing Places 55 Miscellaneous Premises 131 1733 19 Notices Issued. Preliminary—Housing 403 Others 81 484 Statutory Nil 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 142 8 (b) Without mechanical power 16 5 Other premises 84 6 242 19 The number of defects found and remedied 40 Shops Acts, 1912-1936. Sixty-nine inspections were made and twenty-five minor infringements, mostly relative to the keeping of prescribed forms under the Acts, were remedied on informal action. Smoke Abatement. Twelve inspections were carried out. Swimming Baths and Pools. One sample was submitted for test and found to be satisfactory. Verminous Houses. One hundred and thirty inspections were made, 35 nuisances were discovered, and at the end of tlie year in 20 instances, satisfactory disinfestation had been accomplished—the remaining instances have since been 20 cleared.up. The Property Manager reports that no noteworthy change in bug disintestation routine was made, as applied to infestation occurring in tlie Council's Housing Estates during 1940. The remedial measures advised and carried out remain as reported in 1938. Very few complaints affecting the estates were received during 1940. Rats and Mice Destruction Act, 1919. Three hundred and ninety-four inspections were carried out. Ninety-six rat infestations were reported, of which eighty-six had been effectively dealt with by the end of the year. The Eats Order, 1940, came into force during the year, with a view to securing the prevention of damage by rats to crops, banks or works, Fortunately the absence of refuse dumps in the Borough obviates the existence of what are normally favourable extensive breeding grounds for rats. The Ministry of Food has issued a leaflet designed to help the general public to destroy rats in their houses or gardens, and this has been circulated, where necessary, and is available as required. Legal Proceedings. No proceedings were taken except as reported later in this Heport under the heading Food and Drugs Act, i noo ° SECTION D. HOUSING. Housing Statistics for the Year 1940. No new houses were erected during 1940. I. Inspection of Dwelling-houses during tlie year. 1 (a) Total No. of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 471 (b) No. of inspections made for the purpose 2370 21 2 (a) No. of dwelling-houses (included under subhead 1 (a) above) which were inspected and recorded under tlie Housing Consolidated Regulations, 1925-1932 Nil (h) No. of inspections made for the purpose Nil 3 No. of dwelling-houses found to be in a state so dangerous to health as to be unfit for human habitation Nil 4 No. of dwelling-houses (exclusive of those under preceding sub-bead) found not to be in all respects reasonably fit for human habitation 409 II. Remedy of Defects during tlie year without Service of Formal Notices. Number of defective houses rendered fit in consequence of informal action 403 III. Housing Act, 1936. Part IV. Overcrowding. No report is practicable at the present time. SECTION E. INSPECTION AND SUPERVISION OF FOODS. Milk Supply. Dairy premises came under routine inspection aim sampling was carried out periodically for bacteriological examinations. Meat and Other Foods. Private slaughtering being now in abeyance, the usual tabulation of carcases inspected for disease is omitted. The total' weight of carcases, parts of carcases awl offal rejected for disease, etc., including imported meat and meat condemned after emergency slaughtering' ^as 8,681 lbs. 22 The total weight of other foods surrendered and destroyed: — (a) Poultry, rabbits, fish, vegetables, etc. 2850 lbs. (b) Tinned and bottled foods 239 lbs. Food and Drugs Acts, 1938. Tlie above art came into operation on 1st October, 1939, and, therefore, 1940 is the first complete year of work carried out under the Act in the area. The following tabulation shows the number of samples taken and submitted for analysis: — Formal. Informal. Genuine. Inferior. Adulterated. Almonds, ground 1 l 2 — — Aspirin, tablets — l 1 — — Arrowroot 1 — 1 — — Applerings, dried — 1 1 — — Baking Powder — 1 1 — — Bread 5 5 — — Butter — l 1 — — Barley, Pearl — 1 1 — — Boracic Ointment — l 1 — — Borax (pure) — l 1 — — Coffee —: . 4 4 — — Camphorated Oil — 1 1 — — Cornflour — 1 1 — — Custard Powder l . 1 — — Cocoa l 1 — — Cinnamon, Ground.. — 1 1 — — Curry Powder 1 1 — — Dripping l — 1 — — Epsom Salts — 1 1 — — Flour 3 3 — — Flour, Self Raisinp 1 3 4 — — Ginger, Ground 1 1 2 — — Glauber Salts 1 1 — — Ice Cream 6 6 — — Jam, Greengage 1 1 — — Jam, Strawberry 1 1 — — Jam, Red Plum 1 1 — — Jam, Raspberry — 1 1 — — Jam, Blackcurrant 1 1 — — Jelly 1 1 — — Miik 50 23 66 3 4 23  Formal, Informal. Genuine. Interior. Adulterated. Milk Powder – 1 1 – Margarine – 4 4 Mincemeat – 1 1 – Nutmeg-, Ground 1 1 Peas, Green 1 1 Peas, Tinned l 1 2 __ Pepper, White — 2 2 – – Rice l 2 3 Rice, Ground l 1 Sausages 6 2 8 Sherbert – 1 1 Sugar (Castor) 1 1 1 – – Shredded Suet 1 1 Spice, Mixed – 1 1 – – Salmon and Shrimp Paste – 1 1 – – Sweet Herbs (Thyme) – 1 1 – – Seidlitz Powder – 1 1 – Tapioca 1 2 3 – Tomatoes (Tinned) 1 1 — Vinegar 3 3 — Vitacream – t 1 White Precipitate Ointment – 1 1 – – Zinc Ointment – 1 I – — 84 80 156 3 5 A variety of food and drug items is included in tlie total of 104 samples taken. In normal times this total would be higher, hut having regard to tlie inspectors' extra duties, and the absence of one inspector on military service, the first complete year of working of this Act has given satisfactory results. Special endeavours will be made to increase food sampling as soon as possible. It is satisfactory to note the high rate of 95per cent. of samples taken producing a genuine result 011 analysis, and the Public Analyst reported only 5 per cent, inferior or adulterated. With the exception of one sample of castor sugar, all the inferior or adulterated results concerned milk samples. The adulterated castor sugar was found to contain G7 per cent, of rice, and as there was 24 an implication of inadvertent mixing of sugar and rice starch, another sample was taken which proved genuine. Adulteration in two milk samples was reported for deficiency of fat content, and three samples of milk of inferior quality were found with less than 3 per cent, fat. Two milk samples showed adulteration of added water, and legal proceedings were instituted in one case, which was dismissed on payment of 4s. costs. The Public Analyst, commenting on a sudden decrease in fat content during the month of September when the fat average became subnormal, observes that the diminution in fat content may well be the result- of cold nights experienced, and in some cases the low fat content may not be unconnected with the disturbances of routine caused by air raids. There is also some evidence to show that cows scared by bomb explosions, etc., yield milk with a lower fat content than usual. 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' 1940: — Disease. Age Groups. Total eases notified Admitted to Hospital 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 45 — 1 3 4 2 20 7 6 4 2 — — Diphtheria 11 10 — — — — — 3 1 — 5 1 1 — Pneumonia 26 4 — — — 1 — 1 — 1 3 5 10 5 Puerperal Pyrexia 2 1 — — — — — — — — 1 1 — — Erysipelas 17 4 — — — — — — — 1 1 1 11 3 Ophthalmia Neonatorum 3 2 3 — — — — — — — — — — — Cerebro-Spinal Fever 13 10 — 1 1 1 3 — 1 1 — 1 2 — Dysentery 6 — — — — — — 1 — — 1 1 3 — Typhoid Fever 5 3 — — — — — — 1 — 3 1 — — Measles 141 7 1 13 11 13 10 74 5 5 6 1 2 — Whooping Cough 2 — — 1 — — 1 — — — — — — Totals 275 86 4 15 16 19 15 100 15 14 20 14 29 8 26 Scarlet Fever. Forty-nine rases were notified during 1940, which equals the number of the previous year, thus maintaining; a low incidence rate of 0.86 per 1,000 population. Forty-five of these cases were admitted for hospital treatment—equivalent to 92 per cent. This was a high rate of admission, and investigation into these admissions shows that 19 cases removed came from one-child families, and several cases were adults with no children in the house. Apart from these practical considerations, there was no evidence that severity of infection warranted hospitalization in any of these cases, and home isolation and treatment could have heen effectively carried out. While scarlet fever remains comparatively mild in character, the policy of home isolation is to he stressed on economic grounds, thus freeing hospital beds occupied by mild uncomplicated cases. Research has not proved that hospital isolation has been effective in reducing prevalence or mortality from scarlet fever. Diminution in the mortality rate in recent years is essentially due to decreased severity of the disease, but there has been no diminution of prevalence of the disease. Diphtheria. Eleven cases were notified during 1940, as against 23 in 1939. It is note-worthy to record that only on five occasions in the past fifty years have comparably low figures been recorded in this area. A glance at the following figures shows that 1940 produces the lowest incidence rate per 1,000 population since 1890. We cannot, however, derive much comfort from these isolated figures, as the next tabulation, compiled from statistics over the past fifty years, gives no room for complacency in the campaign to stamp out diphtheria. Year. Cases Notified Incidence Rate per 1,000 population. No. of Deaths. 1895 10 0.40 2 1896 11 0.42 2 1903 9 0.31 1 1932 12 0.25 — 1940 11 0.19 1 27 The following tabulation covering fifty years in five yearly periods gives for comparison the number of cases, deaths and mortality percentage:— Years. No. of Cases. No. of Deaths. Mortality Percentage. 1891—1895 94 39 41.5% 1896—1900 139 21 15.1% 1901—1905 170 21 12.4% 1906—1910 262 20 7.6% 1911—1915 347 21 6.0% 1916—1920 354 21 5.9% 1921—1925 235 4 1.7% 1926—1930 249 9 3.6% 1931—1935 190 10 5.3% 1936—1940 116 6 5.1% A brief study of these figures shows very clearly that although there is some lessening in incidence in recent years, for which the voluntary immunisation scheme operating; in the area since 1929 should be allowed full credit, there is also an insidious upward trend in the mortality percentage during the past fifteen years. It will be seen that the peak of prevalence in these figures occurred during the last Great War years. We h ave got to avoid a repetition of this dangerous infection during the present war. Diphtheria can be stamped out by immunisation, but the successful waging of any campaign requires one hundred per cent. co-operation in the absence of compulsion. Inoculation in this country is voluntary and the success of our efforts to stamp out diphtheria can only be measured by the voluntary response, but, unfortunately, the enemy has no respect for the conscientious objector to immunisation who constitutes, in popular parlance, a "fifth columnist" in the campaign against disease. Every year some 60,000 children in this country contract diphtheria, and upwards of 3,000 die from it, and the tragic side of the story is that practically none of these deaths need occur. The work of the Immunisation Clinic for 1940 is indicated in the following figures:— 28 Total number of primary Schick tests 15 (a) Number giving positive reaction 9 (b) Number giving negative reaction 6 Total number of injections of T.A.M. or A.P.T. 238 Including: (a) First injections 76 (b) Second injections 78 (c) Third injections 84 Total number of final Schick tests 213 (a) Number giving positive reaction 6 (b) Number giving negative reaction 207 An intensification of the immunisation campaign recommenced in 1941 and is proceeding satisfactorily at the present time. Tuberculosis. New Cases and Mortality, 1940. 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 1 .. .. 2 .. .. .. .. 15—25 4 6 1 .. 1 3 .. 1 25 — 35 5 4 3 2 4 4 .. .. 35-45 4 4 1 1 4 2 .. .. 45-55 3 .. 1 1 1 2 .. 1 55—65 4 1 .. 1 3 .. .. .. 65 and over 1 .. .. 1 1 .. .. 1 Totals 22 15 6 8 14 11 .. 4 in addition inward transfer patients as follows:— Respiratory—M.5 F.5 Non-Respiratory—M.l 29 Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936, Section 172. No action under the above enactments was necessary (luring 1940. Efficiency of Notification. There were four cases of unnotified tuberculosis amongst the 30 deaths from tuberculosis, giving a ratio of 1 in 7.5. Tuberculosis Dispensary. Dr. S. Itoy C. Price, Tuberculosis Ofiicer, has kindly furnished the following brief summary of work in respect of the Borough at the Dispensary for 1940:— New Cases. Adults. First Attendances. Children. M. F. M. F. Respiratory 13 11 — — Non-Respiratory 4 4 1 1 Negative 44 29 6 5 61 44 7 6 No. of contacts examined 28 No. of contacts found to be positive 1 (These figures are not included in the above table). Total number of attendances at the Dispensary 2968 30 SECTION G. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. Diseases of Animals. No. of movement licences received 65 Animals concerned:— (a) Pigs 671 (b) Sheep, Lambs 14 There were two cases of swine fever confirmed, and four suspected of swine fever, but not confirmed. Registries for Female Domestic Servants. There were eight registry offices on the register at the end of the year 1940. The usual routine inspection was maintained by the Chief Sanitary Inspector throughout the year. Retail Market. The market has functioned uninterruptedly throughout 1940. Total receipts for 1940 was £356 1s. 0d., an average per month of £29 13s. 5d. compared with £49 8s. 0d. for 1939. Various reasons caused substantial reduction in the letting of stalls, for example, food rationing, petrol rationing and military call-up, were all contributory factors in this reduction. The market, however, is well patronised as usual by shoppers. Petroleum Acts. Total number of Licences issued:— (i) For Petroleum Spirit 90 (ii) For Carbide of Calcium 1 BOROUGH OF BROMLEY. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR 1940. 32 INTRODUCTION. As suggested in Form 6M of the Board of Education (Medical Branch), the Annual Report on the School Medical Services is again abridged for the purpose of war economy. There have been no additions or depletions of the full-time staff, and changes in the nursing and clerical staffs, consequent on resignations and the demands of the fighting services, are shown in the staff list appearing at the commencement of this Report. In spite of war conditions, there was in Bromley no curtailment of normal routine in the Medical Services; in fact, during war-time there is or should be, an intensification of Health Services to safeguard the health of the young child. The staff undertook additional work in connection with refugee children, medical examination of some 700 overseas evacuees, nutritional survey, and the medical and nursing staffs have also voluntarily undertaken first aid post supervisory duties in the Casualty Services, where their skilful services at all times have been of the utmost value to the community. It was found desirable for reasons other than Public Health to discontinue the operative treatment clinic for Tonsils and Adenoids in the early autumn, and the services of the Ear, Nose and Throat Specialist have been with regret dispensed with for the time being. By the end of 1939 the various units of the Casualty Services were working on a stabilised routine within the framework of the Health Department's organisation, and the staff was able to settle down more normally to routine duties during 1940. Although the schools were not in full-time attendance until April and although conditions were not conducive to regular attendance of children at clinics, the work accomplished in the School Medical Services during 1940 compares well with 1939 as indicated in the summary of statistics which follows this introduction. Only extracts from the year's statistics are quoted in this Report, but full statistical records have been compiled and retained in the records for future reference. The nutrition of children has been well maintained; in fact, one gets the general impression (that nutrition 33 has improved rather than deteriorated. The sickness rate has been unusually low. There are a few cases where the nervous instability has been aggravated by war conditions, and in most of these cases we have been able to arrange evacuation to quiet areas through voluntary organisations. Bromley is not an evacuation area, and my firm impression is that the people of Bromley take a pride in their ability to withstand the stress and strain of war. The children themselves are unconsciously making history. The death of Mrs. A. G. Mann, B.A., J.P., on 25th October, 1940, brought to a close a long and valuable voluntary service to education in Bromley, and in particular to the School Medical and Care Committee Services with which she was closely associated since their inception. We cannot pay too high a tribute to the memory of one who rendered for many years exceptional voluntary service to the community. SUMMARY OF STATISTICS, 1940. No. of children on the School Roll 4,187 No. of individual children who attended medical clinics 1,212 No. of individual children medically examined at schools 1,507 No. of medical examinations at the clinics 4,674 (a) North Clinic 1,331 (b) South Clinic 1,605 (c) Special Clinics 1,738 No of attendances by children for Treatment bv the school nurses 7,007 (a) North Clinic 3,638 (b) South Clinic 3,369 No. of inspections for uncleanliness and verminous conditions by the school nurses 7,790 No. of attendances for treatment at the Dental Clinic 4,931 34 No. of treatments at the Eye Clinic 567 No. of spectacles prescribed 227 No. of operations for Tonsils and Adenoids 112 No. of attendances at the Orthopædic Clinic 1,950 (a) For Consultations 272 (h) For treatments, massage, etc. 1,678 No. of attendances at Ultra Violet Ray Clinics 1,461 No. of children referred to the Care Committee 38 Hygiene of Schools. No works of improvements to school buildings could be undertaken during 1940. All interiors of trenches and shelters have been treated with waterproofing material and treated with two coats of washable distemper. Tubular heating was also installed throughout. SECTION A. MEDICAL INSPECTIONS. Total 'No. of routine medical inspections at schools 1,507 (a) Entrants 764 (b) Second Age Group 368 (c) Third Age Group 375 Total No. of special inspections and re-inspections at the clinics (It should be noted that examinations of 700 overseas evacuees and 1,038 inspections carried out at the specialists' clinics are not included in the above figure of 2,936.) 2,936 35 Findings at Medical Inspections. Malnutrition and Cleanliness. The following table summarises the nutrition standards of 1,507 children examined at routine medical inspections, and the results of 1939 are shown by way of comparison:— 1940. 1939. Nutrition Standard. No. of children. Per cent. No. of children. Per cent. Excellent 126 8.36 102 9.38 Normal 1262 83.75 853 78.47 Subnormal 117 7.76 109 10.03 Bad 2 0.13 23 2.12 Dr. A. Thomson, Assistant School Medical Officer, reporting on liis impressions on mitrition and cleanliness in Bromley during 1940, states: "It is necessary to point out prior to the year under consideration I had only a short time in which to make observations on the children on my arrival in Bromley. To attempt any comparison, therefore, involves making use of statistical figures, never a reliable method since so many errors and variation of methods keep intruding themselves. As regards the nutrition of the children, my opinion, in comparison with my previous experience, is that the standard is good in Bromley, as indeed it ought to be, since no physically fit child should go without food in our present society. There are some children who are below par, but I believe the cause in these cases will be found in one or more of three essential factors, namely, bad management in the home, inter-current disease or hereditary. I do not think the environmental factor assumes great importance in a borough such as ours. The question of cleanliness and vermin naturally go hand in hand, and here my impressions probably do not agree with official figures. This is probably due to the fact that I tend to view this from a very high standard, in fact one might say the idealistic point of view. 36 A child who is dirty is always to he viewed with suspicion, not only as regards his own health, but also as a possible source of vermin or infections condition. Keeping this in mind, there is only one method of assessing the state of a child, namely, "clean" or "dirty." A fairly clean child is also a fairly dirty child. Knowing this, it is understandable when I state that there are qnite a large number of dirty children, especially in some of the schools. Vermin 1 do not see much of, a fact which speaks well for the methods of inspection and control exercised by the school nurses. If, however, that control should at any time be withdrawn, one could well imagine what the result would be. It is safe to say that in all these things Bromley is a good population, and will continue to be so while constant supervision is maintained. The Prime Minister's statement regarding the debt of so many to so few might well be applied to a large proportion, if not all, of the population in regard to the Public Health Services." A nutritional survey was commenced in April, 1940, but failed'in its full application owing to the prevailing conditions and limited time available to tbe staff to make the detailed investigation. The survey was taken on broad lines with an endeavour to investigate the cause of so-called malnutrition. The three age groups, 7 years, 10 years, 13 years, were first "heighted" in their various age groups, and from the "height" group a "general appearance" selection was made of those children who appea'red undernourished. This selection of children from the height first, by no means scientific, was an attempt in the early stages of the investigation to eliminate the constitutionally "small" child, who so frequently appeals in malnutrition tables as low grade. This "small" child is, as a rule, a child with sound health. Having selected from the height grouping the child who appeared "undernourished," special investigation was then made in these directions: (1) Class Teacher's report, (2) Health Visitor's report on home environment 37 and physical likeness of the child to Father and Mother and comparison with other children in the family, (3) special medical examination into the defects existing. I regret to say that the survey was unfortunately, interfered with by the evacuation of many children, and by lack of time available to the staff for the first investigation. The following, however, are the generalities of the survey as far as it went:— 7 yrs. 10 yrs. 13 yrs. No. of children surveyed 576 496 336 Average height 46ins. 54½ ins. 62ins. Children "selected" 19 43 14 Average height 45½ins. 51¾ ins. 56¾ins. Average weight 48½lbs. 60lbs. 72½1bs. "Malnutrition" (total) 5 4 2 ,, (familial) 111 ,, (environmental) 1 1 — ,, (illness) 2 11 ,, (underfeeding) 1 1 — No evidence Malnutrition 14 39 12 It is of some interest to note that in the opinion of the Medical Officers examining the selected children, only two appeared not to receive sufficient food, one owing to comparative poverty and one to general mismanagement of home affairs. Of the 76 cases "selected," the Head Teacher's report was not satisfactory on the child's behaviour anil progress at school in 51 cases, and of these: 20 showed irregular school attendance. 16 were unpopular with other children. 5 indicated mental backwardness. The Health visitors' reports on the 76 cases selected showed that more than 90 per cent, came from working class families. 12 showed chronic ill-health of the Mother. 8 showed chronic ill-health of the Father. 20 showed family income below average of £2 15s. and poor home conditions. 38 12 came from large families. 4 were only children. 10 showed no abnormality. In a generalisation of the results obtained from this survey, the opinion is confirmed that malnutrition is a bad term and should not be associated with bad feeding. A proper dieting would have little effect on the selected children; there are so many other factors that play a more important part in this question of poor physique, factors which are the fundamentals of Public Health, lacking even in an area of a good residential type such as is Bromley. As these adverse factors are being eliminated over the years of work by the Local Authority, so do we get improvement in the physique and well-being of the children. That improvement is taking place is visibly obvious to all of us who have been many years in the service of Public Health. Reference to Provision of Meals is made under that heading in Section C of this Report. 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 — 323 7 Eyes 70 43 143 3 Ears 2 2 87 3 Nose and Throat 63 186 242 69 Defective Speech — 6 1 — Heart — 12 13 6 Lungs (non-T.B.) 5 5 56 3 Tuberculosis— Respiratory — 1 — 2 Non-Respiratory — — 2 — Nervous System 5 2 35 1 Deformities 20 6 47 6 Miscellaneous 19 29 529 121 Totals 187 292 1478 221 39 SECTION B. TREATMENT. The number of treatments for minor ailments at the clinics during 1940:— Skin diseases 261 Minor Eye Defects 147 Minor Ear Defects 86 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 670 1164 The total number of attendances of children for treatment by the school nurses was 7,007. Eye Clinic. No special report from the Eye Specialist, Dr. R. H. Rushton, is included this year. The work of the clinic mav be summarised as follows:— Sessions held 66 No. of children dealt with for errors of refraction 440 Re-inspections, included in above figure 325 Other defects or diseases treated 127 Spectacles prescribed and obtained 227 Ear, Nose and Throat Clinic. It was found expedient owing to war conditions, to discontinue the temporary arrangements for operations to be carried out at Frascati Nursing Home in early autumn, and therefore for the time being we have had to dispense with the services of the Specialist, Mr. C. Beney. The work of the clinid up to the time of closure may be summarised as follows:— No. of sessions held 20 (a) Operation 23 (b) Consultation 3 No. of operations 102 (a) Adenoids only 0 (b) Tonsils and Adenoids 102 Other forms of treatment 49 Operations in hospital (apart from the Authority's scheme) 10 40 Orthopaedic Clinic. The Clinic, with its ancillary services of massage, ami remedial exercises, has functioned throughout the year, but the Surgeon attends for one session per month in place of two formerly. No. of children treated at the Clinic 64 No. of children's attendances for consultations 272 No. of children's attendances for massage, etc. 1678 No., of children's attendances for ultra violet rav. etc. treatment 1461 Children receive inpatient treatment at Royal National Orthopa;dic Hospital, Stanmore, ami five cases were admitted. Surgical appliances were provided in seven cases. Costs for inpatient treatment and appliances were recovered according to income scale. The following is a summary of new cases seen by the Orthopaedic Surgeon during 1940:— 1. Congenital Defects. 6. Structural Cvrvature of Spine 0 Hammer toe 0 Spastic paralysis 0 7. Flat Feet 3 Other conditions 3 8. Infantile Paralysis 0 2. Birth Injuries. 9. Sequelæ of Acute Fevers 0 Torticollis 1 3. Rickety Deformities. 10. Fractures 3 Bow legs 5 11. Tuberculosis Joints 0 Knock knees 1 4. Non-rickety Deformities. 12. Other Bone Diseases Schlatter's Disease 1 Kohler's Disease 1 Bow legs 3 Knock knees 6 13. Osteomyelitis 1 5. Postural Dcfects of Spine 2 14. Not classified 11 15. Non-orthopœdic 3 41 REPORT ON THE SCHOOL DENTAL SERVICE, 1940. A perusal of the statistics for the last three years shows that tlie year 1939 was the most disorganised period, .hut the years 1940 and 1938—the last normal year—compare very well together. The number of school dental inspections in 1940 is down on 1938 by 1,009, owing to the schools being partially closed early in the year, non-attendance and evacuations. Attendances during 1940 for dental treatment were 4,931 as against 4,947 for 1938. 2,432 children were discharged in 1940 with treatment complete as against 2,376 for 1938, an increase. The Maternity and Child Welfare Service figures are not so good; we completed 153 children in 1938, hut only 123 in 1940. The figures for mothers are a record in this Service; more than twice as many as ever before. It appears that our Dentures Scheme is attractive. Statistics for Maternity and Child Welfare appear in that Section of this Report under heading Dental Scheme for Nursing and Expectant Mothers. BOARD OF EDUCATION. TABLE VI. DENTAL INSPECTION AND TREATMENT, 1940. 1. No. of children inspected: (a) Routine Age Groups. Age 5 6 7 8 9 10 11 12 13 14 Total No. 175 399 432 424 529 527 420 393 314 287 3,900 Routine Totals 3,900 (b) Specials 440 (c) Total (Routine and Specials) 4,340 42 II. No. found to require treatment 2768 III. No. actually treated 2432 IV. Attendances for treatment 4931 V. Half-days devoted to: Inspections 25 Treatments 508 533 VI. Fillings—Permanent teeth 2116 Temporary teeth 223 2339 VII. Extractions Permanent Teeth 1004 Temporary Teeth 3351 4355 VIII. Administrations of gas for extractions 1603 IX. Other operations—Permanent Teeth 800 Temporary Teeth 37 837 SECTION C. Infectious Disease. No change was made in the routine or regulations concerning- closure of and exclusion from schools in connexion with infectious disease. The prevalence of measles caused widespread non-attendance at school in the autumn months. Open Air Education. There were no developments to record in this direction. 43 STATEMENT OF PHYSICAL EDUCATION DURING THE YEAR ENDED 31st DECEMBER, 1940. 1. Introduction. Conditions which, in the latter part of 1939 did so much to arrest the progress of development of Physical Education in our schools, have continued to react to this subject's disadvantage. During the past year much time, which would normally have been devoted to the teaching of physical exercises and games, has been lost owing to the frequency of Air Raid Warnings and the consequent confining of children to their school shelters. Lack of shelter accommodation has continued to Prohibit the use of excellent facilities for class instruction, and the withdrawal of more men teachers into the services has been a cause of increasing difficulty in the matter of school staffing. Added to these problems has been the difficulty of obtaining replacements of physical training and games apparatus—many of the items previously supplied to schools having become so scarce that firms have been unable to meet more than a fraction of normal demands. Under such adverse conditions, the task of maintaining the standard of Physical Education set up prior to the war, has placed a severe strain upon the resources of the teaching staff, who, in face of other equally urgent problems, have nevertheless neither neglected nor belittled the subject's requirements. 2. Physical Exercises. Limitations of playground space by the siting of Air Raid Shelters has reduced both the scope and value of the Playground Lesson. Preparation of these sites has involved the destruction of large areas of playground surface, the reconditioning of which has been a matter of urgency for some considerable time. In view of this loss of space for exercises and games, it is fortunate that so many of our elementary schools are adequately provided with such excellent indoor accommodation. Our three well-equipped gymnasia and our school halls have proved a real boon to the children of the Borough whose physical education without these facilities would have been far more seriously interrupted. 44 3. Organised Games. The temporary closure of a Playing Field for organised school visits has meant that only those schools with facilities at hand have been able to make any progress in games training. With the completion of shelter arrangements now in progress at the above field, it may be hoped that the Education Committee will shortly be able to restore the arrangements under which parties of school children were conveyed to and from the field for their weekly games lessons. The need for securing temporary alternative accommodation for organised games for the pupils of one School has been met by the kindness and co-operation of the Stockwell College Authorities. 4. Teachers' Classes. It is regretted that local conditions of school staffing and the uncertainty of travelling have made it necessary to continue the postponement of local arrangements for the further training of teachers desirous of specialising in physical education. A number of Voluntary Recreative Classes for men and women have, however, been available in the Borough, and these, although non-technical in character, have been a useful and popular means of extending the teachers' knowledge of and interest in the subject. Geo. H. Atkinson, Florence M. Bentley, Organisers of Physical Eihication. 20.5.41. Provision of Meals. Towards the end of the year, the Education Committee's report on the scheme for the development of school canteens throughout all Elementary Schools was submitted and in general approved by the Board of Education. The schemes outlined therein will materialise during the current year. No new canteens were opened during 1940, but those at Raglan Road, Princes Plain, Keston and Hayes 45 Schools continued to function very satisfactorily, and an increased number of fiieals were served, the approximate average number of meals per day being 450. The provision of milk in schools under the Milk in Schools Scheme provides one-third pint portion of milk daily to approximately 50 per cent. of the Elementary School population. In some instances, amounting to 4 per cent. of the total, children receive a one-third portion in the morning and a further one-third pint portion in the afternoon. SECTION D. Exceptional Children in the Area. Special Day Elementary At no School. Residential. School. School. Blind 1 — — —- Partially Sighted 2 1 — — Deaf 3 — 1 — Partially Deaf — — 3 — Mentally Defective 2 1 9 — Epileptic Children — — 1 — Physically Defective 4 3 16 — There has been no noteworthy change or development to record under the following headings:— Nursery Schools. Secondary Schools. Parents' Payments. Health Education. Special Enquiries. SECTION E. Occupation Centre for the Mentally Defective. The war has necessitated the closing down of all occupation centres in the county as with inadequate protection in the event of air raids, too much responsibility would rest on the supervisors. In order to maintain touch with the children and young persons 46 cerned, a Home Teaching Scheme lias been put into operation, and supervisors of centres have succeeded in providing each child with at least two lessons a week. This effort is proving most helpful to the children and is greatly appreciated by the parents and guardians. Employment of Children and Young Persons. Children medically examined by the School Medical Staff during 1940, and for whom certificates were issued, was as follows:— No. examined 66 Fit Certificates issued 66 Bromley Children's Care Committee. Thirty-eight necessitous cases were referred to the Committee for their attention. 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.