BRO 37 ( BOROUGH of BROMLEY. 19 4 1 ANNUAL REPORT MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER. CONFIDENTIAL. 2 PUBLIC HEALTH STAFF, 1941. Medical Officer of Health 2 K. E. Tapper, O.B.E.,G.M., and School Medical Officer M.B., Ch.B., D.P.H. Assistant Medical Officers of 2 Miss G. H. Stinson, Health and Assistant School M.R.C.S., L.R.G.P. Medical Officers 2 A. Thomson, M.B. Ch.B., D.P.H. Orthopaedic Surgeon 21 J. A. Cholmeley, F.R.C.S. Eye Specialist 21 R. H. Rushton, M.R.C.S., M.R.C.P. (Locum for Eric Lyle, M.A., M.D., C.L.B., D.O.M.S., or, Military Service ). Anaesthetists Assistant Medical Officers. Consulting Gynaecologist 21 D. M. Lindsey, M.D. M.R.C.O.G. (Locum for Alistair L.Gunn, M.D., F. R. C.S., on Military Service). School Dental Surgeons 2 J. H. Glen, L.D.S., R.C.S., (Appointed 1.12.41). 21 Fairman J. Ordish, L.D.S., R.C.S. 2 T.S. Latham, L.D.S., R.C.S. (Resigned 31.8.41). Chief Sanitary Inspector and Chief Sampling Officer (and Inspector for Diseases of Animals Acts and Petroleum Acts) 5 432 G. R. Woods, M.S.I.A., A.R.San. I. District Sanitary Inspectors and Sampling Officers 5 4 32 T. C. Towersey, M.S.I.A. 9 4 3 2 E. R. H. Hodge, M.S.I.A., M.R.San.I. (On Mi1itary Service) 3 3 2 H. Cooper. (Temporary appointment 28.4.41) 5 4 3 2 W. H. Sayers, M.S.HA. A.R. San.I. (Resigned 27.4.41) j • Health Visitors 8 7 6 2 Miss L. A. Briggs. and School Nurses 8 7 6 2 Miss E. B. Crowe. 8 7 6 2 Miss D. Prime. 8 7 6 2 Miss E. Rhodes. 8 7 6 2 Miss N. J. Blake. ' ' (Appointed 2.5.41.) 8 7 6 2 Miss E. Brooks. (Appointed 8.9.41.) 8 7 6 2 Miss E. Oakes (Resigned 14.3.41) 8 7 6 2 Miss E.M.M. Roberts. (Resigned 13.7.41) Municipal "Midwives 7 6 2 Miss 3. A. Garner. 7 6 2 Miss M. R. Jenkins (On Military Service) 7 6 2 Miss E. Smith. 6 2 Miss A. M. Winter. 7 6 2 Miss E. V. Robathan. Orthopaedic Nurse 2 1 Miss M. Dodge, C.S.M.M.G. Orthoptic Nurse 21 Miss M. F. Balkwill. General Office Staff. Chief Clerk 2 H. E. Lawley. Senior Clerk 2.S. P. Judd (On Military Service) Acting Senior Clerk 2 W. S. Dench Clerks 2 E. H. Andrews (On Military Service) 2 Mrs J.L.H. West (nee Huntley) 4 2 Miss R. Brock (On Military Service) 2 Miss D. E. Thomas Temporary Clerks Mrs E. M. Holland (nee Summerton) 2 Miss R. M. Aldous (Appointed 19.5.41) 2 Miss B. G. Shalders. (Appointed ??? and resigned 10.0.4l) Dental Clinic Assistants 2 Miss E. B. Fleming. 21 Miss M. M. Ellen (appointed 7.8.41) 21 Mrs A. B. Waters (Resigned 7.8.41) Casualty Service (Temporary Appointments.) Staff Officer D. H. Carlill (Appointed 15.9.41). A. V.,Garrod (Resigned 13.9.41). Superintendent Civilian R. W. Uden (Appointed War Deaths 21.1.42 previously voluntary from 31.8.39 ) . Outdoor Staff. Drain Tester and Disinfector J. W. Seager. Market Superintendent 1 P. J. Ephgrave. 1. Denotes part-time. 2. Exchequer Grants. 3. Cert. of R.S.Inst. & Sanitary Inspectors' Joint Examination Board . 4. R.S.Inst. Cert. for Meat and Other Foods . 5. R. S.Inst. Smoke Cert. 6. General Trained (S.R.N.) 7. State Certified Midwife. 8. R.S.Inst. Health Visitors Cert. 9. R.S. Inst. Cert, in Sanitary Science as applied to Building and Public Works. . 5 BOROUGH OF BROMLEY. Report of _Medical Officer of Health for Year 1941. CONFIDENTIA L. Mr. Mayor, Ladies and Gentlemen. I beg to submit the Annual Report for 1941, and at the same time I must express regret for the delay in publication but, although the bulk of the Report had been prepared earlier in the year, its final completion had to be unavoidably deferred owing to stress of work and recurring changes in staff personnel unsettling the smooth running of administrative routine. The Report is an abridged and Interim one, and has been prepared on the lines suggested by the Ministry of Health in Circulars 2604, 2314 and 2067. The Ministrv has suggested that care should be taken to avoid publishing certain statistics and to refrain from referring to activities in connection with public works extensions or developments, in the interests of National security. Previous substantial curtailments of reports together with this further restriction so circumscribes the scope of the Report as to render it of diminished value for general circulation or for future archival interest. It was therefore decided to issue the Report in typescript as a confidential publication, limiting its circulation to official requirements only, thus allowing if necessary any references or quotations without compromising matters of National security. Fuller details of annual statistics have been compiled and are retained for future reference in the Department. It has been truly stated that good health of the Public ranks in war-time as an important munition of war. neglect to control the factors which threaten serious deterioration. of public health might well end in the subversion of the productive effort of the workers and a weakening of the national will to victory. Fortunately there has been no serious health deterioration since the outbreak of war, no serious epidemics, and no apparent signs of general ill-nutrition. There have been, however, certain degrees of deterioration which must not be overlooked-the general rise in both incidence and mortality of tuberculosis; infantile mortality has risen in the ountry-always regarded as an indication of the state Public health-and the prevalence of cerebro-spinal fever and the Intestinal Infectious diseases, apart from [the typhoids, all call for careful vigilance. These are (generalizations applicable to the country as a whole and are not to be applied in particular to the Borough. Post-war planning is very much to the fore these days, land that considerable changes in the public health services will be effected may bo taken for granted. For many years past public health authorities have been mindful of shortcommings and deficiencies in their services, and a study of the annual reports issued during the last quarter of a century will bear witness to the fact that there exists an earnest desire for Improvement and expansion. Our aim should be for an absolute and vigorous national health policy in the future, so that for every citizen in every part of the country there shall be available the maximum benefits that the medical services can confer. All hospitals, medical, health and ancillary services should be more closely co-ordinated into one organisation able to deal adequately and efficiently with the medical and health needs of the people. Broadly we may visualise in the future the establishment of a local Health Centre as the unit of Public Health services organised and fully equipped to render both preventive and curative services completely effective, and linked in close association with hospital and other institutional facilities. into this unit has to.be brought those specialists in fields' other than medicine, the sanitarian, the architect, the engineer, the teacher, the Sociologist, the physical training expert, and all those who make for the wellbeing of the individual and of the environment in which he lives. Health cannot be obtained by the practice of medicine alone. A full purse, and the power and intelligence to enjoy leisure time are fundamentals in the production of positive health. Turning to the health statistics for Bromley for 1941 we find a generally satisfactory state of affairs. The following is a comparison of vital rates during the war years: 1941. 1940. 1939. Population Birth Rate Stillbirth Rate Death Rate Maternal Mortality Rate Infant Death Rate 50,430 13.3 28.1 15.1 4.68 28.8 . 56,580 13.2 33.2 12.5 1.28 22.6 60,000 13.9 44.8 9.7 3.45 28.9 7 Scarlet Fever was prevalent during 1941 with 119 cases compared with 49 1940, but was mild in character and no mortality occurred. Diphtheria was notified in 31 Instances with a mortality of 3 deaths-10 per cent of cases-which underlines the need of immunization. Measles was prevalent in epidemic form from the autumn of 1940 until it reached peak in June Quarter, 1941, when the epidemic almost immediately subsided in July. The infection was mild and mortality was absent. Infantile Mortality continued on a pleasingly low rate of 28 per 1,000 live births, compared with 59 for the country as a whole. Scabies was prevalent and needed our constant attention throughout the year. New factors of spread of infection in this and other infectious diseases have entered into the field of' control and supervision through crowding in shelters and through the communal use of blankets by persons required to sleep at their duty stations during war time, I have pleasure in drawing the attention of the Committees to the. loyal service of all members of the Department; their application to duty during these difficult times is exemplary. 1 am also appreciative of the special help Mr. Lawley, Chief Clerk, has given me during the year, This Report does not cover the "Work of the Officers of the department in the sphere of their Civil Defence duties, but, notwithstanding the additional work occasioned by the Casualty Services, &c., which come Within the scope of the Department, they have maintained their duties in the Health Services at pre-war standards. Atribute too must be paid to the general public for the part they have played in co-operating with us; they have continued to use the services, the centres and clinics in spite of the period of intensive raiding. Their morale is beyond praise, aided as it has been by the Civil Defence work of the Health Visitors and Midwives who have attended to duty under all conditions, I am, Your obedient Servant, K. E. TAPPER, Medical Officer of Health. 8 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA, 1941. STATISTICS. Area (in acres) 6.519. Registrar General's estimate of resident population, mid-1941 50,430. No. of inhabited houses according to the rate books (31.5.41) 15,919. No. of valuation assessments of habitable promises at 31.3.42;- Bromley 14,158 Hayes & Keston 2,772 16,930. Rateable Value (31.3.1942 ) £698,666. Product of a Penny Rate (estimated for year ending 31.3.1942) £2,700. VITAL STATISTICS. Live Births. For calculating Birth Rates. Legitimate Illegitimate Total. Ma1e. Female. (Birth Rate per (1,000 of the (estimated resident (population mid(1941-13.3. 622 321 301 49 18 31 671 339 332 For calculating Infant and Maternal Mortality Rates. Total Male. Female. Legitimate 573 296 277 Illegitimate 49 18 31 622 314 308 Still-Births For Calculating Births Rates. Total. Male. Female. Legitimate 18 6 12 Illegitigimate 2 - 2 20 6 14 For Calculating Infant and Maternal Mortality Rates. Total. Male. Female. (Stillbirth Rate (per 1,000 total (live & still) (births: 28.1 Legitimate 16 6 10 Illegitimate 2 - 2 18 6 12 9 VITAL STATISTICS (Continued). Deaths: Total. Male. Female. (Rate per 1,000 (estimated average (resident population ( 15.1 From all causes 763 343 420 The Registrar General has not issued an Areal Comparability Factor as the variety and magnitude of local population movements and the uneven incidence of civilian war deaths have together combined to frustrate the attempt to secure comparability between local death rates by the use of the Comparability Factor. The preparation and issue of such factors are being suspended under present conditions. Deaths from Puerperal Causes; No. of Deaths. Puerperal Sepsis 2 (Rate per 1,000 total live Other Puerperal Causes 1 (and still births: 4.68 Deaths of Infants under 1 year of age:- Total . Male. Female. Legitimate 16 12 4 Illegitimate 2 – 2 18 12 6 Death Rates of Infants under 1 year of age:- All infants per 1,000 28.8 Legitimate infants per 1,000 legitimate live births 27.9 Illegitimate infants per 1,000 illegitimate live births 40.8 Deaths from Cancer(all ages) 123 Deaths from measles (all ages) 1 Deaths from whooping cough (all ages) – Deaths from Diarrhoea (under 2 years of age) 5 10 Social conditions. Bromley as a wholly residential area has no industrial or occupational conditions liable to exert adverse influence on the health of the population. METROLOGY. The Borough Engineer has kindly supplied the following details from records compiled in his Department:- Year 1941. Total rainfall 25.57 ins. ' Mean maximum daily temperature 57 dog. F. Nean minimum daily temperature 42 deg. F. Highest maximum temperature recorded (8.7.1941) 91 deg. F. Lowest minimum temperature recorded (18.1.1941 & 19.2.1941) 20 deg. F. Lowest grass minimum temperature recorded (17.1.41) 17 deg. F.. POPULATION. The basis of all vital statistics is population, and it is by census that a dependable figure can be obtained. A census It taken, however, only once in ten years, and thus the Very considerable chances that occur during the interconsal period reuder our ??? of population very depondable, expect during the two or three years after the cohsus. It is not without some diffidence that one approaches the problem of estimating the present population of the Borough The call-up, conscription, evacuation and abnormal movements of population must be taken into account when concidering a figure, The latest valuation assessment of inhabitable premises is 16,930 and reckoning 3.61 persons per house gives a potential Population of 61,117, which may be accepted as approximating to the Post-war figure when conditions have reached a general of settlement. A more acceptable figure at the present time is 57,467 derived on the same calculation from the latest return of 15,919 inhabited houses according to the rate books, but this makes no allowance for temporary absence of persons owing to war condition and requirements. 11 The figure of 3.61 persons per house comes from the housing survey of 1936 and is preferred to the 1931 Census figures taken before the amalgamation of 'Bromley with Hayes and Meston. The Registrar General's mid-year estimate for 1941 is 50,430 and full account of population movement is taken in this estimation. This figure forms the basis for calculation of all vital statistical rates, and it follows that rates will be abnormal in comparison with previous years. ' ' BIRTHS. During the year 474 births have been notified to me by doctors and midwives. Of this number 488 were live births and 12 stillbirths. The Registrar General, however, gives a total for the year of 691 births comprising 671 live births and 2.0 stillbirths, which have been adjusted by inward and outward transfers; according to the normal residence of the parents. Many births of Bromley children took place outside the area during the year, owing to the dispersal of population. Although wo continue to receive notifications of a good proportion of the out-of-district births, the routine of notification as between authorities throughout the country is not entirely consistent. Early knowledge of incoming births allows of early visitation by the health visitor. The fortuitous discovery of births by health visitors in the course of routine visitation some six months after birth is not infrequently the occasion of comment by the. mother who thinks. the local. health authorities are at fault. The basic fault in the administration is perhaps to be found in the present dual arrangement of notification and registration of births at differing times controlled by differing authorities, which is not conducive to smooth co-ordination of information between authorities with regard to the inward and outward transfer of birth's. The following is a comparison with the rates for the London area and the whole of the country England & Wales. 14.2 London County. 8.9 Bromley. 13.3 DEATHS. There were 763 deaths from all causes in 1941 (an excess of 30 over the total for 1940) which produces an abnormally high Death Rate for the area of 15.1 This of course is due in part to the low figure of population on which we must base our figures for the year. ... 12 The following is a comparison with the rates for the London area and. the whole of the country England & Wales. 12.9 London County. 16.3 Bromley. 15.1 The main causes of deaths in the total for Bromley were:- Heart disease 170 Cancer 123 Violent causes 120 Respiratory (non-tuberculous) 93 Special attention must be called to three deaths from Diphtheria out of 31 cases notified during the yeara mortality of 9.7 per cent. These children were between the ares of 2 and 5 years and had they been immunised their lives might have been preserved. INFANTILE MORTALITY. A pleasing feature of the vital statistics for 1941 is the continuance of low infantile mortality figures. There were 18 deaths of infants under one year compared with 17 for the previous year. Thus the Infantile Mortality Rate for 1941 is 28.9 per 1,000 live births, which compares well with the record figure of 22.6 for 1940 and coincides with the rate for 1939. A comparison with the rates of the country as a whole and of London area is as follows Engalnd & & Wales. 59 London County. 68 Bromley. 28 It can be said that 50 per cent of deaths occurring during the first month of life are due to prematurity. A feature of the Municipal Midwifery Service is concentration on ante-natal care which cannot fail to exert an influence on the prevention of premature births. The constantwork of the Health Visitor in education on infant feeding and management can be claimed to have played its part in diminishing mortality from debility and marasmus. It is ante-natal care, quality of help given at birth, and the attention to infant feeding and management which have been made prime factors by the Public Health. Service in recent years in order to reduce infantile mortality to its present low level. 13 MATERNAL MORTALITY. The Maternal Mortality Rate for 1941 is 4.68 per 1,000 (live and still) births, compared with 1.20 for 1940. This rate is comparable with the prevailing rates of previous years. There were three deaths, two due to puerperal sepsis and one to other causes. In one case only could death be traceable to neglect to obtain proper medical and midwifery attention. In this case death was recorded as septicaemia from incomplete septic abortion, the patient, who was forty years of age, had given birth to a stillborn child three days prior to admission to hospital. There was no evidence of medical or midwifery attention either at the abortion or during the succeeding days before admission. The facilities provided through the Local Authority's Municipal Midwifery Service ensure that every expectant woman has proper and adequate attention throughout the ante-natal, natal and post-natal periods. These services are complete and available to all. SECTION B(I) GENERAL PROVISION OP HEALTH SERVICES FOR THE AREA. The are no important changes or developments to report in the following services in respect of 1941:- (a) Laboratory Services. (b) Ambulance Services. (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, Fublic and Voluntary. PUBLIC HEALTH ACT, 1936. Section 187/195, NURSING HOME. There were five nursing homes on the register at the close of the year 1941. They provide beds for 52 patients (a) 29 maternity and (b) 23 others. During year three homes closed down. Dr. G. H. Stinson Assistant Medical Officer of Health, who made fifteen visits of inspection reports that records, equipment and the premises were satisfactory. The office routine of recording all deaths whereby inter alia, a frequency of deaths occurring at one address is disclosed was instrumental in bringing to light the existence of an unregistered home. This home 14 had been moved temporarily from a coastal area, where registration had been duly effected and the nursing home keeper thought under the circumstances that further registration was unnecessary. The home conditions were satisfactory, and informal warning was deemed adequate in this contravention. SECTION B (II) MATERNITY & CHILD WELFARE This service was maintained in full operation during the year and no important changes or developments were instituted. NATAL SERVICE. Domiciliary Midwifery Service. The midwives are to be commended for their unfailing devotion to duty during the, trying circumstances of airraiding, Mothers received professional attention at all times whether raiding was in progress or not. The following statistics serve to indicate very briefly the extent of the work accomplished by the four Municipal Midwives during 1941:- Total number of bookings 299 Disposed of as follows:- Booked for midwife 177 Booked for maternity nurse 44 Booked for hospital 57 Subsequent transfers to hospital 9 Bookings cancelled, evacuation, &c 12 No. of confinements attended:- As midwife 164 As maternity nurse 25 No. of visits by midwives:- Ante-natal 2066 Post-natal 3128 Domiciliary Medical Practitioner Service: No. of medical examinations made by doctors: Ante-natal 161 Post-natal 70 15 Home Helps. No. of patients engaging home helps 113 No. of home helps so employed 45 In view of—the increased cost of living the wages of home helps have been increased to 30s. 0d. per week. The patient repays the wages of the home help either in whole or in part, according to the income scale in operation. Ante-Natal Clinics. The Municipal Midwives attend these clinics and by so doing achieve a close co-ordination between the Maternity and Child Welfare Services, the patient and the Doctor in charge of the clinic. Dr. G. H. Stinson, Assistant Medical Officer of Health, attends the clinic. No. of sessions held 48 No. of medical consultations 214 No. of attendances by patients 253 The foregoing figures show a marked, improvement over those for 1940. Dental Scheme for Nursing and Expectant Mothers. The resignation of Mr. T. S. Latham, Dental Surgeon, in August left a gap in the work of this service until his successor, Mr. J. H. Glen, commenced duty in December. Nevertheless the following figures of work indicates that the call on the Dentist's time under this scheme is by no means a diminishing quantity. No. of sessions held 69 No. of attendances of mothers 429 No. of patients discharged, treatment complete 120 Details of Treatment. Attendances for Gas administration 115. Fillings 29. Dentures fitted 69. Attendances for Local anaesthetics 54. Denture work, attendances 179. Extractions 457. 16 Administration of Midwives Acts, 1902-1936. Dr. G. H. Stinson carries out the duties of Inspector of Midwives and during her periodical inspections found the practising midwives were maintaining the good standard we have learnt to associate with their work in the area. No. of midwives practising in the area at the end of 1941 16. No. of confinements attended 468 (a) as midwives 292 (b) as maternity nurse 176 No of cases in which medical aid was summoned during the year under Sec. 14(1) of the Midwives Act, 1918, by a midwife for domiciliary cases 47. Maternity Hospital Provision, 48 patients wore 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, has 15 beds (exclusive of 4 isolation . and labour beds), and is subsidised from public funds through the County Council. The No. of patients admitted to this Hospital during the year 1941 235. (a) Cases delivered by midwives 117 (b) " " " doctors 98 (c) Expectant mothers admitted for treatment 20 No. of cases notified as- (a) Puerperal pyrexia 4 (b) Ophthalmia Neonatorum - (c) Pemphigus " - No. of Infant Deaths: (a) Stillborn 5 (b) Within 10 days of birth 3 No. of maternal deaths — Puerperal Pyrexia. V cases were notified during 1941 in the area as against 2 in 1940. 5 patients received institutional treatment. 17 POST-NATAL SERVICES. Health visitors. Home Visiting. A total of 5,621 visits were made by the Health Visitors during the year. This shows a falling off compared with the total for 1940, but prolonged sick leave and changes in staff were responsible for the decrease. Welfare Centres. The voluntary workers have continued to give unsparingly of their time and this invaluable help at the Centres renders great assistance to the Health Visitors. The Centres accepted responsibility for distributing fruit juices and cod liver oil free to children under two years of age, and later the distribution was extended to children over two years of age. This undertaking causes some congestion and adds to the normal work of the Centres but co-operation with the Food Control Authority has continued, as the Centres appear to provide an efficient and convenient agency through which to make the distribution. The venue of the Masons Hill Centre has been changed from St. Mark's Hall to the William Morris Hall, Masons hill. . The progressive falling off of attendances at Welfare Centres since the outbreak of war is shown in the following comparative table of figures. This falling off may be ascribed to several factors prevailing in these exceptional times, e.g. falling off in births, voluntary dispersal of population to quieter areas, and mothers taking up whole-time and part-time employment in increasing numbers and placing their babies out to the care of friends during the day. Intensive raiding was Process in the early part of the year and that the attendances should be as-high as they are is a tribute the morale of the people and to the necessary good work the centres. 1941. 1940. 1939. 1938. Total No. of babies on the registers at 31.12.41. 3885 3671 3389 2749 Total attendances of babies at all the centres 15989 20433 25993 27105 Total of medical exam'ns 2793 3085 3535 4174 Total No. of weighings 14583 18353 22899 24011 18 Child Life Protection, 32 routine visits to the homes of foster children were made by the Health Visitors and no unsatisfactory conditions were reported. There were 22 boarded-out children on the register at the end of the year. Clinic Treatment of Children under 5 years. Tonsil and adenoid operative treatment is still in abeyance, otherwise the usual facilities for treatment of the pre-school child are in operation. The number treated during the year was:- Tonsil & Adenoid Clinic (other than operative treatment) 3 Eye Clinic 44 Minor Ailments Clinic 84 Orthopaedic Clinic 102 Dental Clinic: Appointments kept 161. No. of fillings completed 23. No. discharged treatment completed 92. No. of extractions completed 248. Attendances for extractions under gas 78 No. of dressings completed 7. Attendances for extractions local anaesthesia 4. SECTION C. SANITARY CIRCUMSTANCES OP THE AREA. There are no important developments to report under following headings:- Water. Drainage. Public Cleansing. Cesspools. 19 RIVERS AND STREAMS. 6 routine inspections of water courses were made during 1941, and in one instance a nuisance existed which was subsequently remedied. STATIC WATER STORAGE. The question of preventing mosquitoes from breeding in tanks and other collections of water reserved in static conditions has been taken in and by the Department. The most common species found breeding in such places seldom attack human beings but are a great source of annoyance in houses and bedrooms. Other and more troublesome species breed in static water contaminated with aquatic vegetation and will bite human beings. During the breeding season, April to September, constant attention to removal of vegetation and floating matter and spraying with suitable solutions will do much to eliminate this insect nuisance. SANITARY INSPECTION OF THE AREA. The following is a summary of the work of the Sanitary Inspectors for the year 1941:- [##]Type of Inspection Nuisances found. No. of Inspections Total Inspections. On Complaint Routine Revisits . Housing 559 420 511 1122 2053 Food Preparing Places 33 - 1594 44 1638 Trade Premises 11 2 233 23 258 Miscellaneous 137 96 293 305 694 Totals 740 518 2631 1494 4643 Mr. G. R. Woods, Chief Sanitary Inspector, has had to devote much time during the year to food control and shelters, and decontamination arrangements and duties as milk officer have devolved on Mr. T.C. Towersey, District sanitary Inspector. Thus in addition to the above figures the following visits and interviews were made;- Food enforcement enquiries 602. A.R.P. Petrol 41. Shelters, trenches 692. Decontamination 42 Interviews 596. 1973 20 nuisances and defects abated. Housing-Drainage 197 Dampness 109 General items- 267 Water supply 45 Food Preparing places 94 Trade premises 122 Miscellaneous 179 1013 NOTICES ISSUED. Preliminary- Housing 413 Others 86 499 Statutory- Nil. FACTORIES. The following, figures indicate the work carried out by Inspectors under the Factories Act, 1937:- Factory Premises. Inspections. Written Notices. (a) With mechanical power 141 9 (b) Without mechanical power 36 3 (c) Other premises 75 18 252 30 The number of defects found and subsquently remedied were 98. SHOPS ACTS, 1912-1956. 15 inspections were made under the above-mentioned Acts and two-infringements were discovered and subsequently remedied through informal action. This is an unusually low figure of visitation for the specific purposes of these Acts, but some 1,896 visits to various food shops and trade premises have also been made and infringements of the Shops Acts are noted and dealt with at the same time. 21 SMOKE ABATEMENT. 15 inspections were carried out and 3 nuisanoes were corrected. SWIMMING BATHS AND POOLS. There is nothing of a special nature to record. VERMINOUS HOUSES. 58 inspections were made and 16 infestations were dealt with.. A further 25 visits were made in connection with disinfestation purposes. With regard to the Council's Housing Estates no noteworthy change in bug infestation routine has been adopted. In point of fact very little verminous conditions have been reported on the Estates during the year. It must not bo inferred from these comments that bug infestation is now a negligible quantity in the area. It is more likely that the opposite is the case, as, with the routine of house-to-house inspection necessarily in abeyance, the principal means of systematic discovery of infestations is therefore not functioning. The hardened culprit who permits verminous conditions to exist will not disclose the fact to the authorities, and it is only the- casual complaint which can be dealt with in these times of stress. RATS AND MICE. The Sanitary Inspectors have given as much available time as possible to. dealing with rodent nuisances. 364 inspections were made in connection with 98 known info stations. The cunning, filth and disease spreading propensities rats and their ability to defile and destroy millions pounds worth of valuable food and produce annually, present difficult problems with regard to adequate control and destruction. The destruction of these pests, if to be really effective, should bo continuously systematic, and complete co-operation in any measures of elimination must be exercised by all parties concerned from the central authorities, local authorities, farmers, warehouse keepers, food store keepers, shop-keepers, right through all the trading concerns to the householder. Amidst their many duties the Sanitary Inspectors cannot hope to deal with more than complaints received. At the time of writing it had been announced that 22 the Ministry of Agriculture had passed their control under, the Rats and Mice Destruction Act, 1919, to,.the. Ministry of Food, The scope of action envisaged and called for by the Ministryof Food would occupy the attention of health staffs to the exclusion of almost overy other duty. LEGAL PROCEEDINGS. No legal proceedings under the foregoing headings were taken, but proceedings under the Food and Drugs Act are reported later in this Report. SECTION D. HOUSING. In the reports of the pre-war years I have deprecated the increasing practice of transforming houses into so-called flats with a minimum attempt to provide separate sanitary, cooking and washing facilities. As a result of raid devastation sub-division of houses has been intensified, but alleviation of this undesirable feature in housing conditions must of necessity be deferred for earnest consideration to the days of reconstruction. This is only one small point arising in the great social reform of re-housing with all its complications which awaits the planning of post-war housing. It would be idle at this juncture to attempt to forecast post-war housing policy, but of one thing we may be certain, a vast housing programme awaits us which must be planned on a nation wide basis. The war will alter many of our pre-war social habits; for example community feeding may continue into the post-war period; the equal employment of women in the labour market will influence the continuance of war-time nurseries and the care and attention of the child in its pre-school age. In the midst of additional duties due to war-time conditions the depleted staff of Sanitary Inspectors have been unable to attend to the essentials of housing inspection during 1941. One complaint 420 houses have been inspected involving a total of 1,630 inspections. Over 600 housing defects of one kind or another have boon abated and houses rendered fit as the result of cordial co-operation between the owners, agents and the staff without resort to any statutory action. Two, instances of gross overcrowding were investigated complaint and the adverse conditions found were abated, is impracticable at this juncture to report on overcrowding conditions. Abnormal cases are being dealt with as and when they arise. 23 SECTION E. INSPECTION AND SUPERVISION OP FOOD. In addition to the normal statutory duties carried out by the Sanitary Inspectors in relation to the inspection and supervision of food under the Food and Drugs Act, the duties of Enforcement Officer under the regulations of the Ministry of Food have been undertaken by the Chief Sanitary .Inspector, at .the special request of the Local Pood Control Committee and with the consent of the Local Authority, The special qualifications for food inspection held by the Sanitary Inspectors, with their extensive knowledge of local conditions, have been of inestimable value in securing effective supervision and co-operation in this particular work. The employment of the personnel normally undertaking food supervision in an area avoids that undesirable element of dual control which experience has demonstrated is so often an irritating factor in co-operation between authorities and the public. MILK SUPPLY. 92 routine inspections of registered dairy shops were made, and 3 instances of defective conditions were found and subsequently abated. In 57 instances milk was examined in the course of distribution. the current register of dairies and milk shops contained the following figures of registration:- (i) Premises within the Borough 76. (ii) Premises outside the Borough 25. The Milk (Special Designations) Orders 1936-1938. The Local Authority has issued licences for graded as follows: Pasteuriser's Licence 1. Dealers' Licence: "Pasteurised" milk 13. "Tuberculin Tested" milk 7. Supplementary Licences: "Pasteurised" milk 3. "Tuberculin Tested" milk 3 . 5 samples of "Tuberculin Tested1' mill: were submit tea for bacteriological examination, and satisfied tie preserved tests. 42 "Pasteurised" milk samples were submit tea test of which 3 were found on examination not to consist of "pasteurised" milk, and in 1 case pasteurisation tad not been thorough; the remainder satisfied the Prescribed tests. 8 ordinary milk samples sent for test were found satisfactory. 24 Detail's of 94 samples of milk taken under the Food and Drugs Act appear under that heading as follows. FOOD AND DRUGS ACTS. The following table gives the number and description of samples taken during 1941: Formal. Informal. Genuine. Adulterated. Alcoholic drink. — 1 1 — Arrowroot 1 — 1 — Aspirin tablets — 1 1 — Brawn 7 — 7 — Barley, Pearl 1 1 2 - Coffee 11 1 10 2 Custard Powder 1 2 3 Cocoa 1 1 2 — Dessert Powder — 1 1 — Flour 1 — 1 — Flour, Self Raising 2 — 2 — Glauber Salt — 1 1 — Jam, Raspberry 1 — 1 - Margarine 9 — 9 - Meat Roll 1 — 1 — Medicinal Paraffin 1 — 1 — Milk 93 1 85 9 Milk, Condensed - 1 1 — Oatmeal 1 — 1 — Peas, tinned 2 1 3 — Pea Flour - 1 1 — Pineapple, tinned - 2 2 — Pepper, white - 1 1 — Rice 1 — 1 — Rice, Ground - 1 1 — Sago 1 1 2 — Salad Oil 1 — 1 — Sausages 17 — 17 — Sausage Meat 2 — 2 — Sweetener 1 — 1 — Tapioca - 1 1 — Vinegar 3 — 3 — Yeast Tablets 1 — 1 — Totals 160 19 168 11 The total number of samples taken during 1941 was 179 compared with 164 for 1940. 94 of the total for 1941 were samples of which 9 were found to be adulterated or other wise inferior in quality. The following tabulation 25 shows details of adulterated samples and action taken: Samples taken formally. Nature of Adulteration or Irregularity. Action taken. Coffee Contained 49.4% of ahicory. Vendor cautioned. Coffee " 48.5% '' '' do. Warm milk " 21.4% of added water. Pined 40/and 12/6 costs. Warm milk 28.3% deficient in fat. Fined 40/and 12/6 costs. Warm milk 12.3% '' '' '' Vendor cautioned. Milk Contained 32.3% of added . water Fined £5. £3.11/costs . Milk '' 45.0% '' '' Fined £5. Warm milk 31.0% deficient in fat and contained 12.4% of added water. Fined 20/and 12/6 costs. Warm milk 21.3% deficient in fat. Fined 20/and 12/6 costs. Warm milk 7.3% '' '' '' Vendor cautioned. Warm milk 7.6% '' '' '' do. 94 per cent of all samples were certified genuine, and, apart from the above irregular samples, the milks sola wore of good quality. The Public Analyst, commenting on the General lack of concentrated feeding stuffs, observes that the result is a diminished yield, but a milk of richer quality than normal. As a result of war conditions many types of food substitutes have appeared on the market, which, entails more work and vigilance on the part of the Food Inspectors in 26 order that the general public may be safeguarded against food compounds which may be deleterious to health. MEAT AND OTHER FOODS. Private slaughtering- remains iji sb eyance during the present emergency, and the usual tabulations of carcases inspected for disease are omitted. Nevertheless there has been no relaxation in the necessary duties of inspection of foodstuffs unfit for human consumption. The Sanitary Inspectors-, have dealt with "a large quantity of food surrendered as unfit for human consumption or uri'suitable for sale to the public, and it is incumbent on them to determine whether unfit food ??? shall .be destroyed, or salvaged as fit for animal food, soap making, or rendered fit by treatment. Unfit food returned to the central depot is dyed green to ensure its being recognised as unfit food after having left the district. The following is a tabulation of unsound and'unwholesome food surrendered and condemned:- / Article of Food. Quantity. Approximate weight ( in lbs ). •/ Eggs 1544 193 Tinned Meat 52 tins 154 " Milk 762 " 571 " Fruit 132 " 273 " Fish 31 " 22 Vegetables 105 " 95 Fish 455 lbs 455 Meat 2256 " 2256 Cheese 7 " 7 Rabbits 582 582 Jam 5 tins 8 Vegetables 2091 lbs 2091 Cake 15 " 15 Fruit 7 " 7 Sago 35 " 35 Cooked meats 876 " 876 Biscuits 39 " 39 Chocolate 53 pkts 6 Total 7685 lbs. (Total: 3 tons 8 cwts 2 qrs 15 lbs. ) 27 SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. The following table gives numbers of cases of infectious diseases notified with age. groups, during 1941:- Disease Total cases notified Admitted to Hospital Age Groups 0-1 l-2 2-3 3-4 4-5 5- 10 10- 15 152O 20- 35 3545 4565 65 & Over Scarlet Fever 119 92 - - 5 7 8 60 22 12 2 1 2 - Diphtheria 31 31 - - 1 3 2 5 5 6 8 1 - - Pneumonia 31 15 - - - 1 - 2 1 1 7 8 6 5 Puerperal Pyrexia 7 5 - - - - - - - - 5 2 - - Erysipelas 13 5 - - - - - - 1 - 1 4 3 4 Ophthalmia Neonatorum 1 - 1 - - - - - - - - - - - Cerebro-Spinal Fever 5 4 - 1 1 - - - - 2 - 1 - Dysentery 5 - - - 3 - 1 - - - - 1 - - Typhoid 1 1 - - - - - - - 1 - — - Acute Poliomyelitis 3 3 - - 1 1 - 2 - - - - - - Measles 645 13 5 30 50 62 77 366 28 12 11 2 2 - Whooping Cough 159 6 9 9 19 27 24 64 5 - 2 — — - Totals 1020 175 15 39 79 102 112 499 62 31 39 19 14 9 28 SCARLET FEVER 119 cases were notified during 1941 compared with 49 in the previous year. The incidence rate per 1,000 population for 1941 is 2.35. This rate is high because it is calculated on the present low estimated population figure of 50,430, The incidence for England & Wales. is 1,47 per 1,000 for 1941, and under normal population conditions our rate should also be in the region of this figure. 92 cases were admitted to hospital - equivalent to 77 per cent compared with 95 per cent admissipn for 1940. This decrease in hospital isolation is a trend in the right direction, but whilst scarlet fever remains comparatively mild in character the policy of home isolation is to be still further encouraged. The following tabulation shows the number of children in families in which cases occurred and how the cases were disposed of: Home Nursed. Secondary cases arising. Admitted to Hospital. Hospital "Return" cases. 1 Child in family 12 — 19 — 2 children family 8 1 23 1 3 " " 4 1 20 2 4 " " — — 3 — 5 " " — — 14 — 6 " " — — 2 — 7 " " — — 2 — Adult cases with no children in family 2 — 4 — Adult cases with 2 children in family 1 — 1 — Non-civilian cases — — 4 — Totals 27 2 92 3 Prom the facts of investigation into the home environment of the above cases, home isolation could have been adequately carried out in the 19 cases of the one child in family group, in the 23 casca of 2 ohil&van in family group, and in the 4 adult cases with no children in the house. Thus one may assert that 46 cases were needlessly hospitalised. insignificant to note that out of 27 home nursed cases 0nly 2 other cases arose in the homes where isolation was carried out. All cases wore generally of a mild character and no amortaitty occurred. 29 ??? ??? cases occurred during 1941 and it is regrettable that 3 cases died - equivalent to nearly 10 per cent of cases. Attempts to control the spread of diphtheria by the time-honoured methods of notification, removal and disin fection have for all practical purposes reached their that of usefulness and "hospitalisation does not control diphtheria, it only promotes the salvage of the diphtheria patient". The reason for this is that the ??? is spread by direct and fairly intimate contact vith a case, or "carrier". Occasionally milk or recently Infected articles as spoons or pencils may be responsible for spread of infection. In recent years it has come to be generally recognised. that in dealing with diphtheria the only procedure even under modern social conditions, which can effectively reduce the incidence of the disease is to employ methods of artificial immunisation. Thus it is that everything is being done at the present time to intensify that campaign for protective immunisation against diphtheria throughout the country. I am satisfied that general Propaganda methods in Bromley will not materially increase the number of cases for immunioation but we are concentrating on the individual approach through school clinics, wolfare centres and private schools. We may claim that approximately only 50 per cent of the children in the town, under 15 years of rage, have been immunised, but until at least 30 per cent of children of pre-school age and at least 70 per cent of those of school age have been immunised, no general effect on the incidence of diphtheria can be reasonably expected. The work of the Immunisation Clinic for 1941 is indicated in the following figures: No; of children immunised in 1941- (a) Under 5 years 565. (b) Over 5 years 1849. 2414. 30 PUERPERAL PYREXIA. 7 cases were notified of which 5 were treated in hospital, and 2 cases died. ACUTE POLIOMYELITIS. 3 cases were notified during the year affecting - children under 10 years of age. 2 cases occurred in one family of whom one died. DYSENTERY. There were 5 cases of Sonne's Dysentery notified. The sources of infection were inconclusive, and all patients made a normal recovery. TYPHOID. One case was notified. The source of infection was not discovered and the case made an uneventful recovery. CEREBROSPINAL FEVER. 5 cases notified during 1941, compared with 10 in the previous year. No deaths occurred. MEASLES. An epidemic of measles which commenced in the autumn of 1940 ran its course until it reached peak in mid-June, 1941, and almost immediately subsided in July. 645 cases were notified and 13 cases were removed for hospital treatment. 56 per cent of cases occurred in the 5-10 age group. Contact in shelters was an additional factor in the spread of infection. fortunately the infection was generally mild in character throughout the epidemic, and there were no known cases with serious after complications except in the case of one death. WHOOPING COTTAR. Whooping cough was mildly prevalent throughout the year - 159. cases being notified. 6 patients were treated in hospital. There was no mortality. 31 TUBERCULOSIS. The recordings in the register during 1941 were as follows: Respiratory. Other Forms. Total No. of cases. Male. Female Male. Female. On register 1.1.1941 197 179 72 85 533 New cases 28 25 7 3 63 Cases coming to knowledge after death 6 7 — — 13 Inward Transfers 6 12 — 1 19 Totals 237 223 79 89 628 Deletions - deaths, removals & recovery 31 39 4 2 76 On Register at 31.12.41 206 184 75 87 552 The following table of incidence rates and death rates conpare over the past ten years New Cases - Incidenco:- Year. per 1,000 population. Death Rates. Respiratory. Other Forms. Respiratory. Other Forms. 1932 1.2 0.3 0.5 0.19 1933 1.01 0.25 0.6 0.12 1934 T H7 r- 1.4 0.2 0.2 0.1 1930 0.9 0.3 0.4 0.03 1936 1.2 0.3 0.5 0.1 1937 1.2 0.2 0.4 0.08 1938 0.8 0.2 0.3 0.08 1939 0.9 0.1 0.4 0.05 1940 0.8 0.2 0.4 0.07 1941 1.3 0.2 0.6 0.08 A disturbing feature in the first table of the above figures is the 13 cases coming to knowledge after death a ratio of 1 in 6 cases notified for the year. 9 of these deaths occurred outside the area, and little information could be discovered regarding the history of the cases, with the exception of two cases, residence here had been of a transitory character or were newcomers to, recently built estates. With the exception of two cases the ages of these patients ranged from 35 to 74 years. Tuberculosis administration being subject to divided 32 control demands very close co-ordination between the county councils, county districts, clinics, institutions and genoral practitioners. We are not without evidence of the need of tightening up the transmission of information between the authorities concerned regarding movements of tubercular patients from one area to another. In practice one suspects that dual notification of the old quiescent cases is a factor not to be overlooked in regard to the increased incidence of cases when at the present time such considerable movement of population is occurring. In the last war there was a brisk rise in tuberculosis which fell away again in 1919, and since the outbreak of the present hostilities there has been a marked increase throughout the country. New Cases and Mortality, 1941. New Cases notified or otherwise revealed. X Deaths. Age periods. Respiratory. Non- Respiratory. Respiratory. NonRespiratory M. F. M. F. M. F. M. F. Under 1 - - - - - - - - 1-5 2 - 1 - 1 - - - 5-15 1 4 4 - - - - 1 15-25 13 10 1 3 1 6 1 1 25 - 55 4 7 - - 1 4 1 - 35 - 45 4 5 1 - 5 3 - - 45 - 55 8 - - - 2 1 - - 55 - 65 2 5 - - 2 1 - - 65 & over - 1 - - - 1 - - Totals 34 32 7 3 12 18 2 2 X In addition inward transfer p atients as follows:Respiratory - Male 6. Female 12. Non-Respiratory - Male Female 1. Public Health (Prevention of Tuberculosis) Regulations, 1925, and Public Health Act, 1936, Section 172. No action under these enactments was necessary during 1941. TUBERCULOSIS DISPENSARY. Dr. S. Roy. C. Price, Tuberculosis Officer, has kindly furnished the following brief summary of work in respect of 33 the Borough, at the Dispensary for 1941:- New Cases attending the Dispensary for the first time for Examination during 1941. Adults. Children Male. Female. Male. Female. Pulmonary 15 18 2 1 Non-Pulmonary - 2 2 - Negative 55 38 7 9 Totals 70 58 11 10 No. of contacts examined during 1941 16 No. of cases found to be positive (not included in above table) 9 No. of attendances at Dispensary 239 Cases which aro under observation are included in "Negative". SECTION G. OTHER SERVICES SUPERVISED by the HEALTH DEPARTMENT. DISEASES OF ANIMALS. No. of Movement Licences received 44. Animals concerned - pigs 493. Swine Fever. There were three cases of suspected Swine Fever which were not confirmed. In each case all the prescribed precautions were put into operation. No. of inspections Under the Diseases of Animals Acts 45. " " interviews " " " 40. REGISTRIES FOR DOMESTIC SERVANTS. There were 8 registry offices on the register at the end of the year. No occasion arose necessitating speical action during the year. RETAIL MARKET. There is nothing special to report. PETROLEUM ACTS. Total No. of Licences issued:- (a) For Petroleum Spirit 86. (b) Carbide of Calcium 1. 34 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER for 1941 SUMMARY OF STATISTICS FOR 1941. No. of children on the School Rolls 4,789. No. of Individual children who attended medical clinics 1,787. No. of individual children medically examined at schools 1,291. No. of medical examinations at the clinics 4,514. (a) North Clinic 1,865 (b) South Clinic 2,053 (c) Special Clinics, 586 No. of attendances for treatments by the School. Nurses 9,279 (a) North Clinic 5,410 (b) South Clinic 3,869 No. of inspections for uncleanliness and verminous conditions by the School Nurses 11,256. No. of attendances of Elementary School Children for treatment at the Dental Clinics 3,538. No. of attendances under other Dental Schemes 1,254. No. of treatments at the Eye Clinic 471. No. of spectacles prescribed 177. No. of attendances at the Orthopaedic Clinic 3,936. (a) For consultations 357. (b) For treatments, massage, 3,579. No. of attendances at Ultra Violet Ray Clinics 1,708. HYGIENE OF SCHOOLS. There is nothing of special interest to report. 35 SECTION A. MEDICAL INSPECTIONS. The total number of routine medical inspections at schools: 1,291 (a) Entrants 526. (b) Second Age Group 357 (c) Third Age Group 362 (d) Other routine inspections 46 The total number of special inspections and re-inspections at school clinics 4,768. In the early part of the year owing to raids many children had been voluntarily evacuated to quieter areas, thus appointment lists for inspections were disorganised and failures to keep appointments were frequent. FINDINGS AT MEDICAL INSPECTIONS. MALNUTRITION AND CLEANLINESS. The following table summarises the statistics of the past three years: 1941 1940 1919 Nutrition Standard. No. of Children. Per Cent. No. of Children. Per Cent. No. of Children. Per Cent. Excellent 95 7.63 126 8.36 102 9.38 Normal 1049 84.25 1262 83.75 853 78.47 Subnormal 100 8.03 117 7.76 109 10.03 Bad 1 0.08 2 0.13 23 2.12 In discussing the subject of malnutrition one is sorely tempted to preface one's remarks with the trite saying "it all depends wafitfc you mean by malnutrition". There are so many factors to be assessed: underfeeding, bad home Management, the inter-currence of disease or here-ditary, are some of the essential factors. The nutritional standard in Bromley, taken as a whole, is good, and during the past three Joars we ars we have been unable to detect any obvious deterioration in the nutrition of the children, Conditions of ill-nutrition are slow in developing and any serious deterioration of nutrition would be disclosed trough increased severity and fatality of the commoner ailments, and this is not occurring at the present time. Reference to provision of meals appears in Section C of this Report. 36 Some increase in unclcanllness is reflected through the tabulated figures of nodical inspections and clinic treatments for skin troubles. Energetic measures to cope with scabies and impetigo Infections were undertaken by the Clinic Staff and as a result the numbers attending for these treatments were largely diminished. Cleanliness plays a large part in the measures to be taken to prevent scabies - dirty clothing harbours the parasite, and it is therefore essential that, clothing worn next the skin is clean. MEDICAL DEFECTS. Defects found on routine medical and special inspections nay be briefly summarised as follows:- Defect or Disease. Routine Inspections. Requiring Special Inspections. Requiring Treatment. Observation. Treatment. Observation. Skin 6 1 673 20 Eyes 6l 40 136 6 Ears l 2 97 4 Nose and Throat 15 110 226 38 Defective Speech — — 2 1 Heart 2 8 4 5 Lungs (non-T.B.) 3 3 86 10 Tuberculosis - Pulm — — — 1 Non-Pulm — — 1 — Nervous System — — 25 8 Deformities 17 4 50 1 Miscellaneous 9 19 701 145 Totals 114 188 2001 239 SECTION B. TREATMENT. The number of treatments for minor ailments during: 1941: Skin Diseases 571 Minor Eye Defects' 133 * Ear " 96 * Throat " 17 Miscellaneous (.e.g. minor injuries, bruises, sores, chilblains &c.) 539 1356 Total attendances for treatment by the School Nurses: 9279. 37 EYE CLINIC. No special report has been called for from Dr. R. H. Rushton, Eye Specialist, in respect of 1941. The work of the Eye Clinic is indicated briefly in the figures as follows:- No. of sessions held during 1941 63. No. of children dealt with for errors of refraction 325 No. of re-inspections included in the foregoing figure 273 Other defects or diseases treated 146 Spectacles prescribed and obtained 177 EAR, NOSE & THROAT CLINIC. Owing to War circumstances operative treatment for tonsils and adenoids has not yet been resumed at the School Clinic. Cases needing urgent treatment are referred to the County Hospital, Farnborough, in most cases. ORTHOPAEDIC CLINIC. The Clinic and its ancillary services of massage anil remedial exercises have been fully operative throughout 1941:- No. of children treated at the Clinic 115. Ho. of children's attendances for consultations 357. No. of chidren's attendances for massage treatment, &c 3579 No. of children's attendances for Ultra Violet Ray, &c treatment 1708. Nine dd.ses received inpatient treatment at the Royal National Orthopaedic Hospital, Stanmore. ihe following tabulation summarises the new cases seen by the Orthopaedic Surgeon during 1941:- 1. Congenital Defects 11. S. Sequelae of acute. 2. Birth Injuries 3* fevers - 3. Hickety Deformities 14 10. Fractures 8. 4. Knock-knees (non-rickety) 19 11. Tuberculosis - Joints - 5. Postural defeots spine 10. 12. Other bone diseases 3. 6. Structural curvature 13. Osteomyelitis 1. of the spine 1, Not classified 24. 7. Flat Feet 20 Infantile paralysis 1. 38. SCHOOL DENTAL SERVICE. Mr, T. S. Latham resigned his appointment as School Dental Surgeon in August, 1541. Aroointed as the first fulltime School Dental Surgeon, Mr. Latham had with unremitting zeal built up an efficient ccrvlce not only for the school children but also inaugurated the dental service for children under 5 years of age, and the dental scheme for nursing and expectant mothers. His successor, Mr. J. H. Glen, who took up his appointment in December, 1941, pays tribute in his report on the year's dental work to the vast amount of work. accomplished. He draws attention to the ever increasing demands by higher education scholars to the exclusion of the elementary scholars with whom the School dental' scheme is primarily concerned, who have been fortunate if time has been found to examine them once a year. The higher education children are examined every six months by the County Dental Officer and have accounted for some 18 per cent of the total attendance a (664). The attendances produced 33 Per cent of the total number of fillings done (554) and 15 per cent of the permanent extractions (160). The question of how best to cope with the growing demands on. the dental services is under consideration at the tine of writing In order that the statutory obligations to the elementary school population may bo fulfilled. The following figures indicate the volume of work accomplished during 1941 notwithstanding the gap between the departure of Mr. Latham in August and Mr. Glen's con.mencenent of duty in December. During this gap we were indebted to Mr. Falrman J. Ordish whose assistance on a part-time basis enablnd us to grapple with the stress of urgent cases. Appointments kept No. discharged treatment complete Attendances - Gas extractions Local " Denture work Regulations and other operations No. of fillings done No. of dentures fitted No. of sessions employed Total of All schemes. 4,792 1,819 1,489 2,378 179 750 3,063 3,863 518 19 BOARD OF EDUCATION-TABLE IV. Dental Inspection And Treatment (l) No. of children inspected by the Dentist (a) Routine age groups. Age 5 6 7 8 9 10 11 12 13 14 Total No, 7 140 301 380 311 414 328 342 230 20 6 2659 (b) Specials 357 (c) Total (Routine and Specials) 3016 (2) No, found to require (7) Extractions treatment 1673. Permanent teeth 667 (3) No, actually Temporary teeth 2407 treated 1385- (8) Administrations of (4) Attendances made by general children for treattics 1212 ment 353 (9) Other Operations (5) Half-days devoted to- Permanent teeth 429 Inspection 13 Temporary teeth 272 701 Treatment 449 467. (6) miinge- permanent tooth 1308. Temporary teeth 182. SECTION G . INFECTIOUS DISEASE. At the time of writing effect will have been given to certain changes in the exclusion of contacts of Infectious disease from school attendance. The changes will be no exclusion of contacts of measles, germ an' measlec, whooping cough; mumps and chicken pox; unless otherwise directed by the Medical Officer of Health. This procedure will lead to a great saving of school attendance with corresponding beneficial results especially easier supervision by school medical and nursing staff and facilitation of early detection of fresh cases whenever the situation demands close supervision. OPEN AIR EDUCATION. There were no developments to record in this direction. STATEMENT on PHYSICAL EDUCATION DURING 1941. 1. INTRODUCTION With the return of more normal conditions for school work and attendance, it has been possible during the past year to restore the subject of Physical Education to a Position much nearer its pre-war level. Improvement has 40 been due partly to the increased regularity of the physical training and games lessons, and partly to general raising of the standard of teaching among those members of school staffs who, since the outbreak of war, have been required to fill the gaps left by their younger colleagues who had been called to the Services, Offsetting this improvement, increasing difficulties have been experienced in obtaining replacements of physical training and games materials, and with the recent rationing of clothing and footwear, the problem of ensuring the satisfactory personal equipment of children for their P.T. lessons has already given cause for concern. The immediate needs of the schools have since been met by the provision of a supply of plimsolls. These shoes are kept at schools and are loaned to individual children, but they remain the property of the Education Committee, The appointment of more young teachers in the sch ols of the area would add to the life and vitality of the subject and increase Its effectiveness. 2. PHYSICAL EXERCISES Loss of continuity of lesson work during the first 18 months of the War resulted in a general slowing down in the rate of progress in all schemes of work Additional efforts on the part of teachers during the past year, however, have largely restored the position and the majority/classes in all schools are again receiving instruction appropriate to their age and physical development. 3. ORGANISED GAMES Increasing difficulties of transport have again restricted the fuller development of organised field games on the Committee's playing fields, nevertheless, it has been possible to arrange for most of our senior school children to enjoy the benefits of a weekly period of organised games throughout the year, Weather conditions have had a very drastic effect on the teaching of field games. Experience has proved during the past year that many weeks have elapsed when the ground has been unfit for use and no teaching possible. Consequently the standard cf play is not at present as good as it might be. 4. SWIMMING Owing to the lack cf shelter accommodation at the Open Air Swimming Bath no arrangements have been possiole for the inclusion of organised Instruction for school children. 41. This is to be regretted since the Bromley children are keen and enthusiastic swimmers If given the opportunity, but safety precautions cannot "be overlooked under present precarious conditions. 5. ADDITIONAL SOCIAL and RECREATIONAL ACTIVITIES The urge for developing facilities for Youth Service in the area encouraged the experiment of opening physical training centres in the 3urnt Ash and Aylesbury Road joint Schools for the Spring and Sunnier terms. All types of schools in the area were notified with the result that an advanced Gymnastics Section was arranged for County, High, and Private School girls, with a considerable amount of previous gymnastic training and an Elementary section organised for the girls who were not quite so proficient. These sections later developed into Open Air Centres where coaching In Tennis, Cricket, Rounders and instruction in Swimming were successfully carried out. Many girls from these Centres assisted on the land during specified weekends for weeding purposes. Acting of the advice contained in the Joint Memorandum on Juvenile Offences Issued by the Board of education and the Home Office, in June, the Chairman of the Education Committee sought the co-operation of Head Teachers and the Organisers of Physical Education with the object of developing facilities for additional social and recreational activities among scholars of 13-14 years of age. A plan for the organisation of "Scholars Clubs" was subsequently approved and it is now hoped that in the near future each senior will have completed its arrangements under which this much neglected sphere of social training can be encouraged and developed. The plan, if successful, should provide a valuable link between the schools and their Old Scholars Associations and might well become an important factor in Youth Service generally. TRAINING OF TEACHERS Existing staffing difficulties in Schools prevent the arrangement of teachers training classes such as were previously held during school hours. Extraneous duties of a varied nature occupy much of the spare time of teachers and also make the arrangement of classes out of schools hours an impossibility. The revival of these classes will be considered at 42 the first available opportunity, for without these useful training and refresher courses, much good work is lost to the children. GEO, H. ATKINSON, FLORENCE M. BENTLEY District Organisers of Physical Education, PROVISION OF MEALS. The scheme referred to in the Report of 1940 for the installations' of canteens will be In operation in 1942 at the following schools: Valley, Burnt Ash, South borough and Aylesbury Road Council Schools, and at St. Joseph's R.C. School. Arrangements for feeding the children of the Bickley and Widmore School at the County School for Girls came into operation on the 1st December, 1941. A canteen is now open at the Parish C. E. School and pupils from St, Mary's Plaistow School have the use of this canteen or the one at St, Joseph's School, The number of meals served at the existing canteens at Raglan Road, Princes Plain, Keston and Hayes Schools has increased. and on 8th December, 1941, the figure reached approximately 600. A number of scholars obtain free meals or seals at half rate and the scale adopted is based on that used by the K.C.C. Assistance Board as under: (a) Total family income, less (b) Expenses (rent, rates, insurance, travelling expenses to and from work and abnormal expenses). (c) Living allowances: Head of household l6/- (All plus 25% Wife 10/- (but less 2/- Dependent adults over 16 16/- (in respect of Children ,over 10, each 6/- (each child of "under 10,each 5/- provided. with free meals. (d) The resulting figure-referred to as available come to be divided by the number in family- if this resulting figure is less than l/-. free meals' should be given, If between 1/- and 2/- at half rate, and if more than 2/- full payment should be made. The scale is also used for determining those children engible for free or half rate milk. IN SCHOOLS SCHEME. During 1941 the average number of children receiving milk reached 67.65 per cent. A return made to the Board on the 43 8th December, 1941, showed the following figures: No, of children receiving milk for full payment:- one-third. pint 2397. Two-third. pint 835. No. receiving free milk:- one-third pint 6. two-third pint 2 The charge made for one-third pint is ½d. SECTION D EXCEPTIONAL CHILDREN IN THE AREA. Residential School. Special Day School. Elementary School. At no School. Blind 3 - - - Partially Sighted - - - - Deaf 2 - - - Partially Deaf - - 3 - Mentally Defective 7 3 9 - Epileptic children - - 1 - Physically Defective 11 2 7 2 The epileptic child classified above as attending school is not in the category of a severe case. nursery schools. A nursery class has "been established at Burnt Ash Infants' Council School with accommodation for 24 scholars under 5 years of ago., and the formation of another class at Valley' Council School was under consideration at the close of the year. secondary schools. The ever increasing number of secondary school children referred to the School Medical Service for treatment of one kind' or another has "become a matter of some concern having regard to our obligation to the elementary school population. The present facilities and Staff available wore designed to cope with the requirements of the elementary scholars and the child under 5 years of age. The pressure on our services from the demands of the higher education scholars is heaviest in the Dental and Eye Clinics. It is of equal importance 44 that the health standards of .these children must be safe- guarded if they are to benefit to the full from.,the Secondary education being imparted 'to them, but this cannot be accomplished at the expense of the elementary scholars, thus it is that the matter at the time of writing is the Subject of negotiation in respect of the Dental Service in order that the problem may be. solved in the interests of all the scholars concerned. PARENTS' PAYMENTS HEALTH EDUCATUION SPECIAL ENQUIRES There has been no noteworthy. change under the foregoing heading. SECTION E. OCCUPATION CENTRE FOR THE MENTALLY DEFECTIVE. Closure owing to war conditions is still in operation. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS Children medically examined" by the School Medical Officers during 1941 and for whom medical certificates were issued: No. examined 94 Fit certificates issued:- 94 (a) Boys employed 81 . (b) Girls” 13 CHILDREN'S CARE COMMITTEE BOOT CLUB COMMITEE. during 1941 the Bromley Elementary Schools Boot Club committee was formed to take over the duties formerly ministered by the late Mrs A. G. Mann. Steps have already been taken to increase the number of boot clubs in the .schools, and the General Interest in them has met with a fair measure of access, The bonus granted to the., contributors to the funds. has been increased to 10 per cent and 43O vouchers were issued during 1941 for boots and shoes. The Committee has also approved payments being made to the Care Committee for the purpose of providing.,free footwear for elementary school. children in financially necessitous cases, much of the work Connected with the Boot. Club falls upon the teachers who undertake collection of contributions and issue of vouchers and the Increased interest shewn by parents in the Club is in no small measure due to their efforts. 45 SECTION F APPENDIX OP STATISTICAL TABLES. The detailed statistical tables furnished annually to the Board of Education are not reproduced here, but are compiled and available for reference in the records of the Department, Extracts from these tables will be found under the appropriate headings in this Report.