BRO 38 Borough of Bromley 1942 ANNUAL REPORT MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER FOR OFFICIAL USE ONLY. BROMLEY, KENT: Strong & Sons, Ltd., North Street. 2 PUBLIC HEALTH STAFF AT 30.6.43. Medical Officer of Health and School Medical Officer b K. E. Tapper, O.B.E., G.M., M.B., ch.B., D.P.H. Assistaut Medical Officers of Health and Assistant School Medical Officers b Miss G. H. Stinson, M.R.C.S., L.R.C.P. b A. Thomson, M.B., ch.B., D.P.H. (on Military Service). b A. Orgler, M.D., (temporary appt. 5.2.42) Orthopirdic Surgeon a b J. H. Cholmeley, F.R.C.S. Eye Specialist a b R. H. Rushton, M.R.C.S., L.R.C.P. (Locum for Eric Lyle, M.A., M.D., C.L.B., D.O.M.S., on Military Service). Anæsthetists Assistant Medical Officers. Consulting Gynaecologist a b C. K. Vartan, F.R.C.S., M.R.C.O.G. (Locum for Alistair L. Gunn, M.D., F.R.C.S., on Military Service). School Dental Surgeons b J. H. Glen, L.D.S., R.C.S. a b Fairman J. Ordish, L.D.S., R.C.S. C'liief Sanitary Inspector and Chief Sampling Officer (and Inspector under Diseases of Animals Acts and Petroleum Acts b c d e G. E. Woods, M.S.I.A., A.R.SAN.I. District Sanitary Inspectors and Sampling Officers b e d e T. C. Towersey, M.S.I.A. b c d k E. E. H. Hodge, M.S.I.A., M.R.SAN.I. (on Military Service). b c H. Cooper (temporary appt.) One appointment vacant. 3 Health Visitors and School Nurses b f g h Miss L. A. Briggs. b f g h Miss E. B. Crowe. b f g h Miss D. Prime. b f g h Miss E. Rhodes. b f g h Mrs. N. J. Baker (nee Blake). b f g h Miss E. Brooks. Municipal Midwives b f g Miss S. A. Garner. b f g Miss M. R. Jenkins (on Military Service). b f g Miss E. Smith. b g Miss A. M. Winter. b f g Miss E. V. Robathan. b g Miss E. Norman (temporary appt. 17.9.42). Ortliopa-dic Nurse i a b Miss M. Dodge, C.S.M.M.G. Orthoptic Nurse a b Miss B. Binstead (appointed 18.8.42). a b Miss N. F. Balk will (resigned 14.8.42). GENERAL OFFICE STAFF. Chief Clerk b H. E. Lawley. Senior Clerk b S. F. Judd. (on Military Service). Senior Clerk (acting) b W. S. Dench. Clerks b E. H. Andrews. (on Military Service). b Miss R. Brock (on Military Service). b Miss D. Thomas (resigned 2-3.7.42). b Mrs. J. L. H. West (resigned 17.4.43). 4 Temporary Clerks b Mrs. R. M. Watson (nee Aldous). b Mrs. P. M. Warner (appointed 18.5.42). b Miss J. P. Lowe (appointed 27.7.42). Mrs. P. McNeil (appointed 29.3.43). b Mrs. G. E. Durham (appointed 19.4.43). Mrs. E. M. Holland (resigned 25.9.42). Mrs. D. H. Neech (appointed 5.10.42 resigned 27.3.43). Dental Clinic Assistants b Mrs. E. Brooks (appointed 15.3.43). a b Miss M. M. Ellen. b Miss E. B. Fleming (resigned G.3.43). WAR-TIME NURSERY (TEMPORARY APPOINTMENTS). Matron b f l Miss F. E. Hobbs (appointed 9.6.42). Assistant Matron b m Miss K. Minchin (appointed 17.8.42). Staff Nurse b n Miss E. Scaggs (appointed 17.8.42). Warden b n Miss A. Thomson (appointed 22.2.43). In addition there are four student nurses and a domestic staff of one cook and one cleaner. 5 CASUALTY SERVICES (TEMPORARY APPOINTMENTS). Staff Officer b C. R. Minty (appointed 17.9.42). b D. H. Caelill. (resigned 16.9.42). Superintendent—Civilian War Deaths Service b R. W. Uden. Rest Centre Officer b W. G. Redman. Rest Centre Supervisor b Mrs. K. Rosenthal.. OUTDOOR STAFF. Drain Tester and Disinfector J. W. Seager. Market Superintendent a F. J. Ephgrave. a Denotes part-time. g State Certified Midwife. b Exchequer Grants. h U.S.Inst. Health Visitors Cert. c Cert. of R.S.Inst. and Sanitary Inspectors' .Joint Examination Board. k R.S.Inst. Cert, in Sanitary Science applied to Building and Public Works. . d R.S.Inst. Cert. for Meat and Other Foods. l Nursery School Teachers Diploma. m State "Registered Children's Nurse e R.S.Inst. Smoke Cert. n Diploma of the National Society of Children's Nurseries. f General Trained (S.R.N.) 7 BOROUGH OF BROMLEY. Report of the Medical Officer of Health for the year 1942. Mr. Mayor, Ladies and Gentlemen, I beg to submit my 18th Annual Report on the Health Services of the Borough for the year 1942. It is still to be regarded as an abridged and interim report during war-time restrictions. A glance at the health statistics of the area for 19-12 discloses very few causes of sickness and invalidity. The low incidence of serious infectious disease is gratifying, and no points of interest arise for special comment. It says much for the Health Services of the pre-war years that we have withstood so well the stress and strain of four years of war. There are positive signs of improving health of the population; the physique of the young baby and of the child at school show actual improvement. The vital statistics with low Death Bate, increasing Birth Rate and low Infantile and Maternal Mortality Rates, and the comparative absence of subacute infectious disease, are indications of sound health. The reasons are not far to seek; improved financial circumstances of the family and the absence of poverty; the balanced dietary imposed by food control; increased service of meals at school, but perhaps above all an individual urge to be fit in order to win the war. There are, however, certain signs on the debit side; an increased occurrence of antenna in the leaver group at schools; an increase in dental decay in school-children, and an increase in skin complaints. These may be signs of deficiency, but there are other factors to be considered, the lowering of the standard of environment, the disrepair of houses, the shortage of houses, overcrowding into houses are matters not to be dealt with by placid intoler- 8 ance or by easy postponement. The 'skeleton in the cupboard' has been exposed by the state and habits of many children evacuated from our large cities. The skeleton must not be allowed to return to the cupboard. There still exists a widespread mental confusion in the interpretation of the meaning of Health Services and Medical Services. The present efficiency of the former, built up over so many years of Local Government, must not, in the period of re-construction, be swamped in the consideration of present deficiencies in medical services. It is a fundamental of health that the family should be freed of debt and the danger of debt. The individual must correct the present poverty of ideas of social hygiene in its widest sense, and must exercise a little more self-help than he has done in past years. The urge, so prominent in the winning of the war, must continue with the peace. Finally I would express an earnest acknowledgment of the help I have received from my Committees, and from the staff, whose loyal services during these war years has enabled me to carry on the direction of the Health Services of the Local Authority. I am. Your obedient servant, K. E. TAPPER, Medical Officer of Health. 9 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA, 1942. Statistics. Area (in acres) 6,519 Registrar General's estimate of resident population mid-1942 50,480 Number of inhabited houses according to the Rate books (31.12.42) 16,197 Approximate number of habitable premises at 31.3.43:— (a) Bromley 14,170 (b) Added areas (Hayes, Keston) 2,777 — 16,947 Eateable value (31.3.43) £701,240 Product of a Penny Eate (year ending 31.3.44) £2,720 Vital Statistics. The Registrar General in making the annual distribution of the statistics of population, births, deaths and notifiable infectious diseases for the year 1942, comments that recent experience suggests that the different method of assignment adopted during the early war period for Birth rate and Infant or Maternal mortality purposes is no longer of value. One figure only is therefore included, which should be used for the calculation of both Birth rate and Infant or Maternal mortality. Populations are likewise given for calculation of Death or the incidence of notifiable diseases amongst civilians. Estimates of the numbers and distribution of the non-civilian population are not available and the birth rate can only be based on the civilian population of 1942 as used for death rates. The Minister of Health, in his general directions on the lines to be adopted in framing "these reports, again requests that, on the grounds of national security, restrictions in regard to the publication of certain statistics and communications to the Press, etc., should he observed. Thus I have restricted the Report for official use only. 10 Live Births. Total. Male. Female. Birth rate per 1,000 of the estimated resident population: 17.2 Legitimate 823 423 400 Illegitimate 48 27 21 871 450 421 Stillbirths. Total.. Male. Female. Stillbirth rate per 1,000 total (live and still) births: 28.9 Legitimate 25 16 9 Illegitimate 1 — 1 26 16 10 Deaths. Total. Male. Female. From all causes 580 287 293 1 Rate per 1,000 estimated resident population: 11.4 The Registrar General states that a Comparability Factor is not available for 1942 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 Areal Comparability Factors, and the preparation and issue of such factors are being suspended under present conditions. Deaths from Puerperal Causes. Rate per 1,000 total live and still Puerperal Sepsis Nil. births: Other puerperal causes 2 2.23 Deaths of Infants under 1 year of age. Total. Male. Female. Legitimate 27 15 12 Illegitimate 2 1 1 29 16 13 11 Death Rate of Infants under 1 year of age. All infants per 1,000 live births 33.3 Legitimate infants per 1,000 legitimate live births 32.7 Illegitimate infants per 1,000 illegitimate live births 41.6 Deaths from Cancer (all ages) 113 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) 2 Meteorology. The Borough Engineer has kindly supplied the particulars from records kept in his Department:— Year 1942. Total Rainfall 23.60 ins. Mean maximum daily temperature 57.34°F. Mean minimum daily temperature 42.50°F. Highest maximum temperature recorded (6.6.42 and 28.8.42) 89.0° F. Lowest minimum temperature recorded (15.1.42) 15.0° F. Lowest grass minimum temperature recorded (21.1.42) 16.0° F. Population. On the grounds of national security reference to population statistics is curtailed. Births. Duriug the year there were notified to me 803 births. including 783 live births and 20 stillbirths. The official figure for the year, after adjustment by transferred notifications, is 897 births, including 871 live births and 26 stillbirths. The Birth Rate for 1942 is 17.2 per 1,000 of the resident population, compared with 13.3 for 1941. 871 live births is the highest recorded figure for the Borough. I he rate is high by reason of the fact that estimates of the numbers and distribution of the noncivilian population are not available and the Birth Rate 12 must, therefore, be based on the civilian population for 1942 as used for death rates. The following comparative rates have been similarly calculated, except for England and Wales, which thus may be accepted as approximating to what the rate would normally be:— Bromley. England & Wales. Great Towns including London. Smaller Towns. (25000-50000 popn.) London County. 17.2 15.8 17.3 18.4 14.0 Deaths. The total number of deaths for 1942 was 580, which is less by 183 than the total for 1941. It is noteworthy that the total of 479,907 deaths in England and Wales during 1942 (including those caused by enemy action) was the lowest of the four war years. The decrease on 1941 was over 55,000 and compared with 1940, over 100,000. The crude Death Rate for 1942 is 11.4 compared with 15.1 for 1941. The following shows Bromley's rate for 1942 in comparison with the official death rates published:— Bromley. England & Wales. Great Towns including London. Smaller Towns. (25000-50000 popn.) London County. 11.4 ll.6 13.3 12.1 13.9 The main causes of deaths for 1942, together with the corresponding figures for the previous war years, were:— 1942. 1941. 1940. 1939. Heart Disease 139 170 207 158 Cancer 113 123 97 102 Respiratory (non-tuberculosis) 57 93 85 44 Tuberculosis 33 34 29 26 Infantile Mortality. With the large increase in births we record a slight increase in infant mortality. There were 29 deaths, which produces an Infantile Mortality Eate of 33.3 per l,000 live births. This rate compares well with the rest of the country as follows:— Bromley. England & Wales. Great Towns including London. Smaller Towns. (25000-50000 popn.) London County. 33 49 59 46 60 13 Of the 29 deaths occurring, 19 were uuder one week of age, and 24 deaths were attributable to prematurity, congenital malformation or birth injury, emphasising the need of Ante-Natal supervision. The Municipal Midwifery Service of the Local Authority provides for proper and adequate supervision and is available for all cases. Maternal Mortality. Two maternal deaths occurred, producing a Maternal Mortality Rate of 2.23 per 1,000 (live and still) births, compared with 4.68 for 1941. Both cases died in hospital outside the area, the causes being:— (1) Toxæmia of pregnancy, heart failure. (2) Pulmonary collapse, forceps delivery and uterine inertia. SECTIONB (1). GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Certain changes and developments have taken place in the following services since the last report and are shown under their appropriate headings as follows:— (a) Laboratory Service.—No change. (b) Ambulance Service.—As from the 10th March, 1943, the Civil Ambulance Service was taken over from the Fire Brigade Service by the Public Health Department and is under control of the Emergency Committee. The Ambulance Station is at 147, Widmore Road, and the ambulances are available for the removal of private cases of illness of a non-infectious nature to or from hospitals, residences, railway stations, and also for the removal of such private cases to or from such places outside the Borough, subject to the conditions permitting the use of the service for private purposes upon payment of the prescribed charges. Medical evidence must be furnished as to the necessity for the removal of a patient, and a maximum distance of 25 miles (by road) from the Ambulance Station, Bromley, cannot be exceeded for removals. 14 The Service also deals with accident cases, and there are reciprocal arrangements with Beckenhum and Peuge for the use of their ambulances in the event of both Corporation Ambulances being in use. Fees for use of the ambulance may be reduced, or remitted entirely, in necessity. (c) Nursing in tiie Home.—No change. (d) Treatment Centres and Clinics provided by the Local Authority.—An additional Welfare Centre was opened in June in co-operation with the County Council at Ray's Hall, Southborough, to serve that area and the adjacent district of Petts Wood. A session is held weekly on Friday and replaces the weekly session which was held on Fridays at Princes Plain School Clinic. The County Council hold a separate session on Thursdays and there is reciprocal arrangements between the two Authorities for mothers to use either Centre. The Ante-Natal Clinic service has been augmented by an evening clinic held on Tuesdays for expectant mothers who are in full-time employment, and also for mothers booked under the Midwifery Scheme for Hospital confinements who come under this service for Ante-Natal supervision at the request of the County Hospital. (e) Tuberculosis Dispensary, 2 Park Road.—No change. (f) Venereal Diseases and Treatment Centres.— The County Council provides treatment at various Centres in the County. Efforts were made to establish a centre in Bromley but difficulty in obtaining suitable accommodation was encountered. Venereal diseases are seriously on the increase and the Government has initiated an intensive campaign by stressing the important and very essential part that must be played by educational work to secure the widest possible spread of knowledge of the tragic consequences- of these diseases. There are to be increased facilities for treatment, and expansion, if necessary, of arrangements for treatment, and no part of an area should be more than ten miles from treatment facilities. One feels, 15 however, that this provision is nine miles too far, especially in the case of the infected person who is impervious or unresponsive to education or persuasion and, therefore, not likely to exert or inconvenience themselves by travelling distances. Procrastination in obtaining any type of health treatment is an all too common failing and constancy in attendance often fails if distant travelling is involved. The very nature of venereal infections accentuates this failing; war-time conditions of long working hours and defence duties are other factors which contribute to neglect in obtaining treatment. Treatment provision should be very easily available and, as far as possible, on the spot. Suitable institutions are reluctant to open their doors to V.D. Clinic facilities, as prejudice dies exceedingly hard, but the attack on this disease has got to be relentless if we are to grapple with the problem realistically and with hope of ultimate effectiveness. As a County District Authority we have no obligations in regard to the treatment of Venereal diseases. We are, however, assigned the role of "publicity agents" for local propaganda which is to be worked out in consultation with the County Council and in collaboration with the Central Council for Health Education. (g) Hospitals, Public and Voluntary.—The Phillips Memorial (Homcepathic) Hospital with 20 beds is out of commission for the duration of the war. Public Health Act, 1936. Section 187/195. Nursing Homes.—Two Nursing Homes were newly registered during 1942, and at the en d of the year there were G Nursing Homes on the register. They provided beds for 75 patients, including (a) 31 Maternity and (b) 44 others. During the year one Home ceased business. Sixteen visits of inspection were carried out by Dr. G. H. Stinson, Assistant Medical Officer of Health, and no infringements of regulations were reported. 16 SECTION B (II). MATERNITY AND CHILD WELFARE. NATAL SERVICES. Municipal Midwifery Service. Owing to the considerable increase in the number of confinements, a temporary Midwife was engaged, thus restoring the pre-war complement of 5 Municipal Midwives. The following comparative statistics for 1942 and 1941 show the general increase in work:— 1942. 1941. Total number of bookings 490 299 divided between: — 1942. 1941. (a) Home confinements 312 233 (b) Hospital ,, 178 66 Number of Confinements attended:— As Midwife 229 164 As Maternity Nurse 55 25 Number of visits by Midwives:— Ante-natal 2756 2066 Post-natal 4690 3128 Domiciliary Medical Practitioner Service. Number of medical examinations made by doctors: Ante-natal 106 161 Post-natal 45 70 Home Helps. Number of patients engaging home helps 135 113 Number of home helps so employed 87 45 The increased number of confinements led to corresponding increase in the demand for the services of home helps. Owing to calls on woman power for National Service, we found the demand difficult to satisfy and steps were taken to appoint two whole-time home helps. Of the 87 home helps engaged, 69 took only one case each. 17 Ante-Natal Clinics. The work of these clinics has grown owing to the increased number of confinements and the additional clinic held on Tuesday evenings. Number of sessions held 70 Number of medical consultations 421 Number of attendances of patients 714 Maternity Hospital Provision. The Municipal Midwifery Service provides inpatient treatment by arrangement with the County Hospital, Farnborough. 147 admissions under finanancial assistance, including pre-natal cases, during 1041, Dental Scheme for Nursing and Expectant Mothers. Mr. J. H. Glen, School Dental Surgeon, has submitted the following figures for 1942:— Number of sessions held 48 Number of attendances of mothers 393 Number of patients discharged—treatment complete 81 Details of Treatment. Attendances for Gas extractions 92 Attendances for local extractions 38 Extractions 574 Fillings 85 Dentures fitted 52 Attendances for denture work G9 Administration of Midwives Acts, 1902-1936. Number of midwives practising in the area at the end of 1942 19 Number of confinements attended:— (a) as midwives 464 (b) as maternity nurses 307 771 Number of cases in which medical aid was summoned during the year under section 14(1) Midwives Act 1918, by a midwife for domiciliary cases 49 18 stitutes a record number. The chief factors contributing to the increase are more births and young wives of serving men having no established homes, there being a scarcity of home attention during the lying-in period. In addition to the foregoing figure, the Bromley, Chislehurst and District Maternity Hospital admitted 325 private patients, and Nursing Homes 161. There were many non-residents included in these figures of private patients. Of the 325 patients admitted to the Maternity Hospital:— (a) Cases delivered by midwives 208 (b) Cases delivered by doctors 117 (c) Expectant mothers admitted for treatment 16 No. of cases notified as:— (a) Puerperal Pyrexia 3 (b) Ophthalmia Neonatorum — (c) Pemphigus Neonatorum — Number of infant deaths:— (a) Stillborn 12 (b) Within 10 days of birth 2 Number of maternal deaths — Puerperal Pyrexia.—7 cases were notified during 1942 and all received institutional treatment. There was no mortality. POST-NATAL SERVICES. Health Visitors. Home Visiting. 6,853 home visits were made during 1942—an increase of 1,232 over the figures for 1941. Having regard to the large increase in minor ailment treatments at the School Clinics, the additional work in diphtheria immunisation, and the demands of work to be done at the Welfare Centres, it is surprising, but nevertheless very commendable, that the Health Visitors have been able to maintain a high figure of visits. 82 per cent, of births during the year received a primary visit and an average approximating to 2.4 visits to infants wilder one year was accomplished. 19 The following is a tabulation of all visits made during 1942:— Primary visits under 1 year 718 Revisits under 1 year 1382 Revisits 1 to 5 years 2799 Expectant mothers 27 School children 541 Stillbirth enquiries 13 Infant death enquiries 12 Miscellaneous 322 5814 "Ineffectual" visits 1039 Total 6853 Visits to boarded-out children included above 50 Since 1932 record has been kept of the "ineffectual visit, i.e. cases where parents are not receptive to visits. "out" on call, or left district. The following tabulation shows the numbers of primary visits and percentage in relation to the number of births per year, together with the "ineffectual" visits and percentage in relation to total of visits per year. Year. No. of Births. Primary visits. Percentage visited. Total of all visits. "Ineffectual" visits. Percentagc of ineffectual visits. 1932 605 497 82% 7133 1015 14% 1933 598 495 83% 7281 1171 14% 1934 706 631 85% 9371 1431 14% 1935 758 630 83% 9683 1647 17% 1936 780 616 79% 8654 1290 15% 1907 778 653 84% 8481 1267 15% 1938 782 678 86% 8851 1091 12% 1939 835 635 76% 5996 826 14% 1940 770 592 77% 6799 932 14% 1941 671 452 67% 5621 971 17% 1942 871 718 82% 6853 1039 15% Totals 8154 6597 80% 84723 12680 15% 20 The above figures disclose the maintenance of a steady average of 80% visitation except, of course, during 1939/1941 when conditions imposed obvious difficulties. Throughout the period "ineffectual" visits have kept consistently at 15%, which rather leads one to draw obvious conclusions that approximately 15'% of parents are indifferent to advice on mothercraft. The value of personal visits to expectant mothers and nursing mothers is undeniable. The inculcation of practical principles in mothercraft in the home by frequent visitation cannot be adequately replaced Iby alternatives such as dissemination of health teaching by theoretical printed matter or radio. Future planning in public health visualises the development of the Health Centre, which may tend to centralise the activities of the health visitor at treatment and medical inspections with the doctor to the ultimate detriment of visiting time—the individual will be encouraged to attend centres and clinics, which will be all to the good provided the personal contact of home visitation is not impaired. The following is a report of one of the Health Visitors on her impressions of War-time conditions: — THE EFFECT OF THE WAR UPON HEALTH VISITING AND THE HEALTH OF THE CHILD. Health Visiting. District work results in additional ineffective visits due to the mother having to Ro out early for shopping, and also many mothers find it essential to undertake occasional work to supplement their Services' allowances. The Health Visitor is received better on the district than before the War as most mothers have some question re milk, vitamins or query about the babe to ask. Propaganda films and Press notices have educated the people to some extent as to what the public health stands for. Shortage of general practitioners results in the mother making more use of the Health Services and requesting increasing visits by the Health Visitor. The Diphtheria Immunisation campaign is a big task for all Health Visitors and is helping to strengthen the Public Health Service, 21 The Welfare Centre. War-time attendance is good, even during the 1940 "blitz" period. The War, 1 think, is responsible for the difficulty found in maintaining breast feeding. The young mother will fail to attend for test feeds and will not persevere with supplementary feeding. Present day home conditions leave the mother very little time, if any, to rest; in addition there is often mental anxiety over husbands who may be serving over-seas, which circumstances combine to result in an over-tired and nervy condition. The sale or free issue of fruit juice and cod liver oil has "been disappointing. The mothers attending the Centre are advised and instructed upon the value of cod liver oil and vitamins and respond well, but on the district T have found a considerable number who will not take the trouble to collect the oil even on free coupons. Mostly the excuse is that the child will not take it or does not like it, an instance of bad management and lack of discipline. The shortage of certain cereals, bones for soup and fresh fruits, make the advising upon diet during the weaning period a difficult problem. Very few mothers will take the trouble to prepare a good vegetable soup and the use of proprietary brands is taking the place of broth. The 7 to 12 months diets are the most difficult the War has produced. The Health of the Child.—This is good—above pre-war standard, due to: — (1) Extension of Ante-Natal Services. (2) Excellence of Municipal Midwifery Service for the first 14 days of the infant's life. (3) The National Milk and Vitamin Scheme. (4) Woolton diet—cutting out of non-essential foods. The use of National Dried Milk has solved the problem when ibreast feeding fails, with excellent results. The War is responsible for plain but adequate diet for the 2 to 5 year old, with noticeable decrease in acidosis. The food available necessitates careful preparation and cooking to obtain the full food value. 22 The matter of sleep and rest for the.war-time child is a problem, due, I think, to lack of discipline. The noise of aircraft is also disturbing if sleeping out of doors. With health also goes the mental and psychological effect of War-time, upon the child.. The 3 to 5 year ohls appear'more difficult for the mother to manage, Absence of parental authority tends to make the child more .self-willed or they develop a "mother" complex. The War-time Nursery is in some instances a good remedy for lack of discipline and ppor home management. From observation, I should say the war-time child is advanced mentally. He becomes independent at an earlier age and expends more nervous energy. By 4 years of age most ,toddlers wish to go to school and if able to attend a nursery class, settle down and are happy in their nursery work. Welfare Centres. By discontinuing one weekly session at Bromley Common we have been able to open up a new weekly session for the area of Southborough, held at Bay's Hall, Southborough, on Fridays. Again a tribute, must be extended to the voluntary workers for unfailing and invaluable aid a,t the Centres. Without this aid the staff would find the stress of routine at the centres overwhelming. The year 1942 records an improvement in attendances which was not to be expected having regard to the increased employment of mothers on. War work. ' During 1942 a thorough revision of the registers was made by eliminating many of the non-attenders, children entering school, and removals. Thus is presented a comparable figure with the pre-War year 1938. The following table gives a comparison in figures of some of the work of the Centres:- '1942 1941 1940 1939 1938 Total No. of babies on the registers 2521 3885 3671 3389 2749 Total attendances of babies at all the Centres 20071 15989 20433 25993 27105 Total of medical examinations 4247 2793 3085 3535 4174 Total number of weighings 17974 14583 18353 22899 24011 23 Child Life Protection. Fifty routine visits to the homes of foster children were made by the Health Visitors and no unsatisfactory conditions were reported entailing formal proceedings. Clinic Treatment of children under 5 years. Treatments during 1942: — Eye Clinic 52 Minor Ailment Clinic 40 Orthopaedic Clinic 101 Dental Clinic. Appointments kept 111 Number of fillings com- No. discharged treatment pleted 53 completed 92 Number of extractions Attendances for extractions completed 141 under gas 69 Number of dressings Attendances for extractions pleted 12 local anaesthesia 14 War-time Nursery. The establishment of a Day Nursery constituted something of an innovation in this area. The chief consideration was convenient siting in order to eliminate unnecessary transport difficulties. A large house easily adaptable has advantages over the pre-fabricated buildings, specially regarding maintenance of warmth in winter. An attractive site was secured in Elmfield Road and a pre-fabricated War-time Nursery was opened m August, 1942. The Nursery, was well equipped by the Ministry of Health and a trained staff appointed. Miss Florence Horsburgh formally opened the Nursery and the Mayor presided. There is accommodation for 40 children, ranging from 0—5 years and the Nursery is open from 7.0 a.into 7.0 p.m. (except Sunday). To obtain admission the mother must be in full-time work of National importance. The charge per child is Is. per day and one clothing coupon per month is surrendered. At the end of the third week the Nursery was full and a waiting list of 120 njimes now exists. 24 A mobile band of voluntary workers merit special praise for their loyal help and we are indebted to the War Supply Depot and the Women's Voluntary Service for making- all the overalls and knickers, and also to tlie Light Rescue personnel who provided toys and have worked many hours in the garden. The Heavy Rescue personnel built an additional room for storage of beds and a laundry drying room. In September the Nursery became a Training Centre for Nursery Nurses with affiliation to the National Society of Children's Nurseries. Four students are now in training. The Nursery has also been used to train students of the Bromley Technical School taking the Ministry of Health Child Care Reserve Course. The health of the children has been good. Whooping cough of a mild character was responsible for exclusion of a few children. The children enjoyed excellent Christmas arrangements, a Christmas tree being provided by a Father in the Army and toys were made and given by the gills of the County School. Additional Nurseries will be opened in 1943. High tribute is due to the Matron, Miss F. E. Hobbs, for the marked ability with which she has organised and supervised the Nursery. SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. No important developments took place in connection with the following : — Water. Drainage. Public Cleansing—Refuse collection and disposal. Cesspools. Rivers and Streams. During the year C inspections were made and one pollution was.remedied after informal action. 25 SANITARY INSPECTION OF THE AREA. The following tabulation indicates the work carried out by the Sanitary Inspectors for the year 1942:— Type of Inspection or Visit. No of Inspections On Revisits. Total No. of Inspection Nuisances & Defects Complaint. Routine. Found. Remedied Housing 742 93 2297 3132 861 763 Food Preparing Places 28 2213 72 2313 39 38 Factories, etc. 5 426 64 495 44 44 Sampling visits (Food and Drugs, etc.) 1 228 12 241 x - - Trade premises (various) 146 341 256 743 137 120 Miscellaneous 20 399 105 524 59 23 Ministry of Food enquiries - 324 — 324 — - TOTALS 942 4024 2806 7772 1140 988 x 229 samples were taken in connection with these visits. Notices Issued. Preliminary—Housing 439 Others 141 680 Statutory 2 Factories. Factory Premises. Inspections. Written Noticcs. (a) With mechanical power 198 5 (b) Without mechanical power 38 1 (c) Other premises 259 7 495 13 The number of defects found and subsequently remedied, 44. Shop Acts, 1912/1936. Twenty two inspections made and 7 infringements were found and subsequently remedied through informal action. 26 Smoke Abatement. Ten inspections were made but conditions were satisfactory. Swimming Baths and Pools. Four samples were taken from private swimming pools, two of which were contaminated. Appropriate steps were taken to remedy the contamination. Verminous Houses. Sixty-seven inspections were made and 23 infestations were dealt with. 34 additional visits were paid in connection with disinfestation measures. The Property Manager reports that cases of bug infestation in the Council's houses have been few during 1942, and such cases have been dealt with by the same methods as hitherto. Rats and Mice Destruction. Three hundred and eighty inspections regarding the prevalence of rodents were carried out by the Sanitary Inspectors. 57 infestations were dealt with in trade premises and 62 in private dwelling-house properties, and by the end of 1942, in 26 and 34 instances respectively, the nuisances had been remedied and remedial measures were being energetically pursued in the remaining cases. Legal Proceedings. No Court proceedings were instituted under the foregoing headings of this section. SECTION D. HOUSING. The following details of housing inspection indicates that the Sanitary Inspectors have been able to devote considerable attention during 1942 to this very important branch of their duties: — Houses Inspected. On Complaint. Routine. Re-inspections. Total. Nuisances and Defects. Found. Remedied. 742 93 2297 3132 861 763 27 Of 835 houses inspected, 746 were visited for defects of..the general fabric of the houses and the remainder concerned over-crowding (8), verminous conditions (23), dirty conditions (13), water supply (14), earth closets (1), disinfestation purposes (18), and noxious accumulations (12). Two hundred and sixty-three inquiries and disinfection arrangements regarding infectious diseases were made by the Inspectors. On these occasions the houses are inspected and steps are taken to' retoedy defective conditions. Such inspections are included in the above tabulation. . ; SECTION E. INSPECTION AND SUPERVISION OF FOODS. The Chief Sanitary Inspector has relinquished the duties of Enforcement Officer under the Regulations of the Ministry of Food following on administration changes made by the Ministry whereby a full-time officer has been appointed. This change in no way lessens the inspection and supervision of food to, he undertaken as statutory duties by. the Sanitary tors. Milk Supply. One hundred and twenty-one inspections of registered dairy premises were made in 1942 and satisfactory conditions were recorded. Milk was examined in 34 instances in the course of distribution. Registrations of dairy and milk shop premises at the end of 1942: — (i) Premises within the Borough 74 (ii) Premises outside the Borough 25 The Milk (Special Designations) Orders 1936-1938. The Local Authority has issued licences for graded milk as follows:— Pasteuriser's Licence 1 Dealers' Licences:— "Pasteurised" milk 12 "Tuberculin " Tested milk 6 28 Supplementary Licences: — "Pasteurised" milk 4 "Tuberculin Tested" milk- 4 Samples taken by the Inspectors and submitted for examination:— Ordinary milk, bacteriological test 18 Graded milk, bacteriological test 17 Phosphatase test 1 Samples of milk taken under the Food and Drugs Acts are included in the following tabulation:— Food and Drugs Acts. The number of samples taken during 1942, their description and results are shown in the following tables:— Formal. Informal. Genuine. Adulterated or Irrregularity. Arrowroot - l l - Aspirin - l l - Barley, Pearl - l l - Barlova - l l - Batter Flour - l — 1 Boracic Ointment - l l - Chocolate Spread 1 1 2 - Chutney - l 1 - Cochineal - l 1 - Coffee - l 1 - Colouring, yellow - l 1 - Curry Powder - 5 5 - Custard Powder, sweetened 1 - 1 - Drinking Chocolate 2 — 2 - Egg, Dried cooking - 1 1 - Egg, Substitute powder 1 5 6 - Flour, National Wholemeal - 3 3 - Flour, Self Raising - 3 3 - Forcemeat - 1 1 - French loaf - 1 1 - Fruit Preserving tablets - 2 2 - Ginger Essence — 1 1 - Ginger Wine Essence — 1 1 - 29  Formal. Informal. Genuine. Adulterated or Irregularity. Ginger, Ground - 1 l - Herbal Licorice Tablets - 1 l - Jam, Green Tomato. - 1 1 - Lemon Drinks - 2 2 - Lemon Essence - 1 1 - Lime Flavour Cordial - 1 l - Macaroni - 1 l - Margarine, special 2 - 2 - Milk 37 14 47 4 Milk, National Household — 1 1 — Milk, Unsweetened — 1 1 — Milk, Roller skimmed - 1 1 — Mustard — 2 1 1 National Bread — 6 6 — Nutmeg, ground — 1 1 - Onion Essence 1 1 2 — Orange Drinks 2 1 3 — Paste, Chicken, Ham and Tongue - 1 1 — Paste, Ham & Tongue — 1 1 — Paste, Meat — 3 3 — Paste, Turkey and Tongue — 1 1 — Peppermint Essence — 1 1 - Pudding mixture - 2 2 - Raspberry Essence — 1 1 - Rice, ground 1 - 1 - Sausages, beef 3 3 5 1 Sausages, pork 3 7 10 - Sausage meat, beef 7 1 5 3 Sausage meat, pork — 3 2 1 Semolina — 2 2 - Soft drink 1 — 1 - Soup powder — 1 1 - Soya Flour — 1 1 - Spaghetti — 1 1 - Sulphur Ointment — 1 1 - Syrup, Blackcurrant 1 — 1 - Table Cream - 1 1 - Tomatoes, tinned - 1 1 - Tonic Wine 1 — I - Turmeric - 1 1 - 30  Formal. Informal. Genuine. Adulterated or Irregularity. Vinegar 4 l 4 1 Whole Wheat - 1 1 - Yorkshire Pudding Mixture - 2 2 - Zinc Ointment - 2 2 - 68 109 166 12 The following tabluation details the adulterations or irregularities and actidn taken. Article. Formal. Informal. Adulteration or Irregularity. Action taken. Beef sausages. Formal. Contained 302.2 parts of sulphur dioxide. Vendor captioned. Beef sausage meat. Formal. Contained 70.3% of total meat These samples contravened the Ministry of Contained 54.8% of total meat Food Order 62, 1941, which limits meat Contained 59.4% of total meat content of sausages to 45%. Warnings were issued by the Food Control Committee concerned. Miik. Formal. Contained 6.7% of added water In connection with next two samples on delivery. Milk. Formal. Contained 18.5% of added water Fined £5. £2 6s. Od. Costs, Milk. Formal. Contained 25.5% of added water Fined £5. Milk. Informal. Contained 9.8% of added water Taken on delivery in connection with above Milk. Informal. Contained 10.4% of added water two samples. Beef sausag meat. Informal. Contained 371.2 parts of sulphur dioxide per million Preservative discontinued after purchase. Trader's attention drawn to failure to exhibit notice. Mustard. Informal. Contained 17.5% of added flour Sold as a mixture—no contravention. Malt vinegar. Informal. Contained 23.5% excessive water Vinegar purchased outside this area, by a customer for pickling. which showed mould growth. District concerned hotified. Meat and Other Foods. The following is a tabulation of inspection of food surrendered as unfit for human food which was either 31 directed to be destroyed, salvaged for animal food, or for soap making. Certain quantities were recommended to be rendered tit by treatment for human consumption;, Article of Food. Quantity. Approximate weight (ia lbs.) Eggs 1260 156 Canned meat 964 tins 1214 Canned milk 2159 tins 1713 Canned fruit 927 tins 1082 Canned fish 356 tins 188 Canned vegetables 3537 tins 4211 Canned sundry 55 tins 90 Fish 1287 lbs. 1287 Meat 742 lbs. 742 Fats—Margarine, lard 58 lbs. 58 Meat (cooked) 104 lbs. 104 Rabbits 57 120 Poultry 9 30 Vegetables 453 lbs. 453 Fruit 308 lbs. 308 Flour 1023 lbs. 1023 Barley, Pearl 34 lbs. 34 Oats, Rolled 23 sacks 2576 Rice 17 lbs. 17 Semolina 367 lbs. 367 Spaghetti 100 lbs. 100 Custard Powder 178 lbs. 178 Blancmange 70 lbs. 70 Cheese 123 lbs. 123 Sugar 109 lbs. 109 Jam, Marmalade 122 tins, jars 225 Coffee beans 84 lbs. 84 Coffee 204 cartons 51 Miscellaneous 88 lbs. 88 Total 16,801 (Total: 7 tons, 10 cwts., 0 qrs., 1 lb.) SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Tabulation of cases of infectious disease notified, with Age Groups, during 1942 (civilians only):— Disease. Total cases notified Admitted to Hospital Ago Groups. 0-1 1-2 2-3 3-4 4-5 5-10 ' 10-15 15-20 20-35 35-45 45-65 65 and over Scarlet Fever 104 81 - 3 8 3 3 50 21 5 9 2 - - Diphtheria 15 15 - - - - - 7 4 1 2 1 - - Pneumonia 18 5 - - - - - - 2 1 2 3 5 5 Puerperal Pyrexia 7 7 - - - - - - - - 7 - - - Erysipelas 17 3 - - - - - - 1 - 2 2 11 1 Cerebro-Spinal Fever 3 3 - - - - - 2 - 1 1 - - - Encephalitis Lethargica 1 — - - - - - - - - 1 - - Measles 121 3 2 7 6 11 11 62 17 4 — 1 — - Whooping Cough 55 - 3 4 6 10 6 22 3 - 1 — — - Totals 341 117 5 14 20 24 20 143 48 12 24 10 16 6 33 One of the features of the Health statistics of the past year has been the comparatively low incidence of the common types of infectious diseases and, apart from scarlet fever, measles and whooping cough, the number of cases would have been almost negligible. Scarlet Fever. One hundred and four cases were notified in 1942, producing an incidence rate of 2.06 per thousand civilian population. There was no mortality. Of the 101 cases, 81 were admitted to hospital and equivalent to 78X. coinpared with 77% for the previous year. The following tabulation shows the number of children in families in which cases occurred, and how the cases were disposed of, from which one may draw the conclusion that more cases might well have been isolated for home treatment without detriment to the control of spread infection. It is noteworthy that out, of 23 home nursed cases only one secondary case arose, and out of 81 hospital cases there were 8 " return cases." Home Nursed Cases. Cases admitted to Hospital. No. Secondary cases arising therefrom. No. " Return Casas." 1 child in family 9 — 22 - 2 children in family 10 1 25 2 3 children in family 3 — 12 2 4 children in family 1 — 7 2 5 children in family — — 2 — 8 children in family — — 3 2 9 children in family — — 2 — Adult cases with no children in family - - 5 - Adult cases with one child in family - - 2 — Adult cases with five 'children in family - — 1 — . Total 23 1 81 8 Diphtheria. Fifteen cases were notified during 1942 compared with 31 in 1941. One case died. Much publicity has been carried out in this area to stimulate the need for immunisation and the Health Visitors have, in accordance with the wish of the Ministry of Health, concentrated on making special visits of inquiry at the addresses of all children between 1 and 5 years of age who .have not been immunised. 34 _ Notwithstanding extensive propaganda undertaken by the Government throughout the country, together with local efforts, we. still encounter, many, parents who appear to be indifferent about protection for their children against diphtheria, and a few are definitely in opposition. Cerebro Spinal Fever. Out of 3 cases notified, 2 patients died (both were males—ages 32 and 16). Local outbreaks of this serious infection are liable 'to be facilitated by overcrowding, especially in sleeping quarters in cold weather with insufficient ventilation. Proper attention to the general rules of hygiene, particularly in regard to fresh air, affords a good general preventive measure of protection. Other Diseases. One hundred and twenty-one cases of measles and 55 of whooping cough constituted a normal annual incidence of these diseases for the area. All the 7 cases of Puerperal Pyrexia notified were treated iu hospital and no mortality occurred. Tuberculosis. The recordings in the register during 1942 are as follow:- Respiratory. Other forms Total No. of cases. Male. Female Male Female On register 1.1.1942 206 184 75 87 552 New cases notiified 31 23 6 4 64 Number of cases coming to knowledge after death 2 3 2 1 8 Inward transfers 13 8 1 . — 22 Totals 252 218 84 92 646 Deletions deaths, removals and recovery 24 22 5 4 55 On register at 31.12.42 228 196 79 88 591 The above table discloses a net increase of 39 cases att the end of 1942. over the total for the previous year, 35 The: total number of .cases .gives a case rate of 11.7 patients per 1,000 population. The 8 cases diagnosed after'death as suffering from tuberculosis gives a ratio off 1 in' 9 of new cases notified. This' is uU unusually high ratio for the area;' 3 werfe cases of tubercular meningitis diagnosed after death, one of which had first been notified as cerebrospinal meningitis; 2 were new residents in'the'area and their previous medical history unknown; 2 cases died in hospital out of the area, aud 1 case of generalised T.B. in an iufant diagnosed after death in hospital. The following table, of incidence rates of new cases and death rates compare over the past ten years:— New cases Incidence Rates per 1000 population. Death Rates. Respiratory. Other forms. Respiratory. Other forms. 1933 1.01 0.25 0.6 0.12 1934 1.4 0.2 0.2 0.1 1935 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 1942 1.1 0.2 0.4 0.1 New Cases and Mortality, 1942. New cases notified or otherwise revealed, x Deaths Respiratory Non Respiratory Respiratory. Non piratory Agf Periods. M F M F M F M F Under 1 - - — - - - - - 1—5 1 1 2 1 1 - 1 1 5—15 1 — 2 1 - - 1 - 15-25 6 8 4 1 1 4 1 1 25-35 8 7 — 1 1 1 - 1 35-45 7 6 — — 5 6 — — 45—55 8 3 - - 2 4 — — 55-65 2 1 - 1 1 - - — 65 and over - — — - - - - 1 Totals 33 26 8 5 11 15 5 4 x In addition Inward Transfer patients :— Respiratory — M. 13 F. 8 Non-Respiratory — M. 1 F. - 36 Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936, Section 172. No action was necessary under these enactments during 1942. SECTION G. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. Diseases of Animals. Number of movement licences received 53 Animals concerned—pigs 432 Swine Fever. Seven cases of suspected Swine Fever occurred, which were unconfirmed. The prescribed precautions were put into operation in each case. Registries for Female Domestic Servants. Retail Market. There are no special comments to make in connection with the above. Petroleum Acts. Total number of licences issued: — (a) for Petroleum Spirit 87 (b) for Carbide of Calcium 1 BOROUGH OF BROMLEY. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR 1942. 38 INTRODUCTION. The work of the School Medical Service has continued at its pre-War level in spite of the many difficulties associated with War-time. The attendances at the various clinics have, in fact, been in excess of the previous years but it is noted that the response to treatment appears to be longer. This may be due to war conditions, or it may indicate the lack of home care and the tendency of the parent to place the entire responsibility upon local clinics. There is no conclusive evidence that there is lowered resistance to infection of the school child or of lack of recuperative power of the patient. The nutrition of the school child shows no sign of deterioration; in fact, the general impression is one of increased well being, mainly, in my view, due to the establishment of school meals and the provision of a well-balanced diet both at school anil, indirectly, through the control of food by the Ministry of Food. There is, however, a theoretical deficiency of Vitamin C especially in the winter months but there is, as yet no evidence of the result of this deficiency. The provision of milk in school shows a tendency to increase, but there are cases where the mid-morning provision tends to destroy the appetite of the child for the mid-day meal. The increase in child delinquency or of maladjustments is noted, especially in the younger age group of 111—12 years. This coincides with the lessening of parental control, with the father on War service and the mother, in many cases, on work of National importance. The extension of play centres and of organisations for direction of the activities of the child of 10—12 would appear to be desirable and necessary if we are to combat and prevent this increase in the maladjusted child. At certain periods, especially following continuous raiding, a deterioration of cleanliness has been noted— coinciding with this is the increase of skin diseases. This lack of cleanliness is mainly due to overcrowding and to shelter life, and, in some isolated cases, to shortage of water supply following raiding and also, perhaps, due to the short supply of soap. The " submerged tenth " have had a greater opportunity to exercise their neglect and a reasonable excuse for such neglect. 39 An increase in the skin diseases common to the school child is to lie noted, especially in those conditions allied to urticaria. Scabies lias shown periodic prevalence but at no period uncontrolled. The following-up of the family affected has shown the wisdom of the treatment of contacts and has been the reason for satisfactory control within reasonable limits. At this stage of war it is difficult to assess the resisting power of the'young child to any possible widespread epidemic, and it may be that although national signs indicate a healthy and happy young population, this resistance may be a weak one should a virulent infection arise, such as was experienced at the end of the war 1914/18. This introduction to the report would be incomplete without a word of praise and appreciation of the work of the Doctors, Nurses and administrative staff, during: the years of stress. It is their daily routine work which they have carried out in spite of War-time difficulties, that has brought the good results shown in the text of this report. I am also indebted to the Chief Education Officer, Mr. G. P. L. Syms, for his help and co-operation in submitting matters affecting this report and his very helpful action in promoting an efficient School Medical Service. SUMMARY OF STATISTICS. Number of children on the School Rolls 5.145 Number of individual children who attended the Medical Clinics: — (a) North Clinic 1,125 (b) South Clinic 1,230 2.355 Number of individual children medically examined at Schools 1,393 Total number of medical examinations at the Clinics:— (a) North Clinic 2.224 (b) South Clinic 2,995 (c) Special Clinics 785 6,004 40 Number of attendances for treatment by the School Nurses: — (a) North Clinic 7,760 (b) South Clinic 5,220 12,980 Number of attendances of Elementary School children for treatment at the Dental Clinics 5,050 Number of attendances under other Dental Schemes 1,150 Number of treatments at the Eye Clinic 534 Number of spectacles prescribed 192 Number of attendances at the Orthopædic Clinic:— (a) for consultations 302 (b) for treatments, massage 3,460 3,762 Number of attendances for U.V.R. Clinics:— (a) North Clinic 1,649 (b) South Clinic 1,017 2,666 Staff. Particulars of staff are included at the commencement of this Report. Co-ordination. Complete co-ordination exists between the School Medical Service and the General Public Health Services. Thus is achieved continuous health supervision of the child from cradle to school-leaving-age. Hygiene of Schools. This heading refers to the hygienic standard and conditions of school premises. No improvements were undertaken during 1942. To attempt to educate the child in personal hygiene in an environment of antiquity and dilapidation, which I fear are characteristics of some of our older schools, is so much time wasted. These schools have outlived their usefulness and should be scheduled in the period of reconstruction for replacement by 'buildings possessing the necessary hygienic environment. 41 SECTION A. MEDICAL INSPECTIONS. The total number of routine medical inspections at schools:— (a) Entrants 300 (b) Second Age Group 577 (c) Third Age Group 516 (d) Other routine inspections 60 1,453 In addition to the above figure there were 5,219 special medical inspections and re-inspections at the School Clinics. Findings at Medical Inspections. Malnutrition and Cleanliness. Dr. G. H. Stinson, Assistant School Medical Officer, reporting on her findings during the year under review, expresses the view that the school children of 5 to 15 years need more in the way of vitamins, etc., than are at present available for them. Much is done for mothers and babies and their condition generally is good. Dr. Stinson finds that skin troubles, urticaria, sepsis " pink " eye, and many other conditions are frequent in the school children, which she feels may be due to lack of essentials in diet. Dr. Stinson does not think that the giving of milk in the middle of the morning fulfils the requirements, and feels, in fact, that children would eat a better dinner at noon had they not had milk at playtime. She favours the giving of more milk in the home so that plenty is available at breakfast with porridge and other foods; at present very little is available for drinking and other meals. Cold milk is difficult for some children to digest and cold milk given in winter time is a point needing consideration. Dr. Stinson refers to pediculosis and scabies as having given trouble during the year and there remain a few cases, recurrent usually, due mostly to lack of parental co-operation. Dr. Arnold Orgler reports very favourably on the standard of physique of the children and of the 42 efficiency of the services provided by the local Authority. His comments are of special interest as we have here the viewpoint of a man, not only highly experienced in the medical care of children, but of a newcomer to our services. The following table classifies the nutrition of children inspected during the past four years in the routine school inspections:— Nutrition Standard. Children examined at routine inspections. 1942. 1941. 1940. 1939. Excellent 6.68 7.63 8.36 9.38 Normal 84.06 84.25 83.75 78.47 Subnormal 9.19 8.03 7.76 10.03 Dad 0.07 0.08 0.13 2.12 Medical Defects. The following table summarises briefly the defects discovered at routine and special inspections:— Defect or Disease of: Routine Inspections requiring Special Inspections requiring Treatment. Observation. Treatment. Observation. Skin 12 1 679 4 Eyes 12 3 122 5 Ears 60 76 185 5 Nose and Throat 16 59 355 43 Defective Speech — — — 1 Heart 1 10 4 8 Lungs (non T.B.) 1 — 143 9 Tuberc-Pulm — — — — non-Pulm. — — — 1 Nervous system 2 1 20 1 Deformities 56 3 64 1 Miscellaneous 40 12 844 87 200 165 2416 165 43 SECTION B. TREATMENT. The number of treatments for minor ailments during 1942:— Skin diseases 597 Minor eye defects 179 Minor ear defects 128 Miscellaneous 782 1,686 Total number of attendances of children at the Clinics for treatment by the School Nurses 12,980 A noteworthy feature of the above figures is the very high number of attendances for treatment. In addition to the usual treatment at Clinics functioning at the North and South Clinics, it has been found expedient to give some additional treatment facilities at Hayes and Burnt Ash and in a large measure this accounts for the increased attendance. Hitherto many treatments were carried out in the home with the cooperation of the mothers but, with many women engagaed on National work of one kind or another, home treatments become perfunctory, or are not given at all. Thus, in many cases it is in the interests of the children to carry the treatment right through at the Clinics especially in those cases of skin diseases which are stubborn in yielding to treatment and need prolonged attention. Eye Clinic. Statistics for the year 1942:— Number of sessions held during 1942 64 Number of children dealt with for errors of refraction 344 Number of other defects or diseases of the eyes treated 190 Number of spectacles prescribed and obtained 192 44 Mr. R. H. Rushton reports as follows:— Acting in place of my colleague, Major Eric Lyle, I have continued, since the outbreak of war, to hold the Eye Clinics as usual on Wednesday mornings and alternate Friday afternoons. During the past year 344 children were dealt with for errors of refraction and 190 were treated for other defects or diseases of the eyes. As compared with prewar years this shows a proportional increase in the number of eye diseases treated, none of which, however, has been at all serious. Most of the latter cases are treated at the Bromley North Clinic whilst the more severe are admitted for in-patient treatment under my care at the Bromley Hospital. All necessary operations are also carried out at the hospital. Many of the eye troubles seen are indirectly attributable to the war. One case of early keratomalacia occurred. This was due to Vitamin A deficiency and responded immediately to treatment with Cod Liver Oil. Other children complained of symptoms of eye straiu with no demonstrable defect in the eyes and a few mild cases of hysterical blindness were seen. Shelter life in the blitz period two years ago was, I am afraid, harmful to many of the short-sighted children owing to reading in a bad light and in a cramped position. The incidence of squint is still rather high in Bromley, as elsewhere. Most cases develop between three and four years of age. Early treatment is essential, therefore it is very satisfactory being able to see these cases at the Clinic under the treatment scheme for children under five years. The treatment of squint is particularly satisfactory in Bromley owing to our having the < 'rthoptic Department, which is very ably conducted Iby Miss Binstead. In conclusion I should like to thank the permanent and voluntary staffs of the Clinic for their efficient work and I am also very grateful to all at the hospital for their co-operation. (Sgd.) R. H. RUSHTON, m.r.c.s., t..r.c.f. Ear, Nose and Throat Clinic. Specialist Consultative Service and operative treatment for tonsils and adenoids at the School Clinic is 45 still in abeyance. For various throat conditions, 21 cases have been treated at the Clinic. Orthopædic Clinic. Statistics of this Clinic, with its ancillary services of massage and remedial exercises for 1942:— Number of children treated at the Clinic 70 Number of attendances for consultations 302 Number of attendances for massage, treatment, etc. 3460 Number of attendances for Ultra Violet Ray and Infra-red Ray treatment:— (a) North Clinic 1649 (b) South Clinic 1017 Number of cases admitted to Royal National Orthopædic Hospital for in-patient treatment 5 Tabulation of new cases seen by the Orthopaedic Surgeon, 1942:— 1. Congenital defects 11 7. Flat Feet 13 2. Birth Injuries 2 8. Infantile Paralysis 3 3. Rickety Deformities 8 9. Sequelae of Acute Fevers 4. Knock-Knees (non- rickety) 4 10. Fractures 4 5. Postural Defects of the Spine 10 11. Tuberculosis—joints — 12. Other bone diseases — 6. Structural Curvature of Spine 5 13. Osteomyelitis 2 Not classified 8 Orthopaedic Clinic Report for the Year 1942. During the past year there has been a satisfactory attendance at the Orthopædic Clinic, although on account of such measures as evacuation of children and the unavoidable cutting down of the surgeon's visits to once a month, the number of consultation visits has dropped by about 50% compared with pre-War figures; however, the number of attendances for treatment has actually risen by a third. It is encouraging to note that the number of cases admitted to Staumore for treatment has been low—only 5—which is due in no small measure to the early observation of disabilities and deformities at the Welfare and School Clinics and to the efficiency of the treatment carried out at the orthopædic clinic by the masseuse, Miss Dodge. (Sgd.) J. H. CHOLMELEY, f,r.c.s. 46 DENTAL SERVICES. Mr. James II. Glen, School Dental Surycon, reports for 1942 as follows:— I have pleasure in submitting to you a report of the work doue by the staff of the Dental Clinic during the year 1942. In the appended tables I have given the customary comparison with the figures for the previous year, 1941, but I must point out that it is a misleading comparison because the work during that year was upset both by the resignation of Mr. Latham and by more active enemy intervention. The figures do show, however, the possibilities of the Dental Schemes and the direction in which they can be expanded. It will be noticed that, although the Head Teachers of the Secondary Schools were notified in June that no further cases could be accepted unless they were very urgent ones, the total attendance of their scholars has been almost as large as in 1941. This exclusion of Higher Education scholars and a few other adjustments in the routine, has made it possible for us to complete the inspection of all the scholars attending the Elementary Schools. The scholars who were absent during the inspection at the School were later invited to attend either of the Clinics so that only about 8% of the total school population have missed a dental inspection this year and some of these were seen as "Specials." This summer has shown that approximately 70% of the children required some form of dental treatment and approximately 73% actually received treatment. I am indebted to the Head Teachers for their cooperation and suggestions, the several voluntary helpers who have assisted us from time to time, and particularly to my attendant, who has made possible a big improvement in the routine work by accepting all the additional labour of making appointments, etc., that was previously done in the Health Department. (Sgd.) J. H. GLEN, L.D.S. 47 STATISTICAL REPORT OF THE VARIOUS DENTAL SCHEMES. Grand total (all schemes). 1941. 1942. Appointments kept 4792 6200 Number discharged 1819 2645 Attendances for Gas Extractions 1489 1311 Attendances for Local Extractions 137 216 Attendances for Denture Work 179 109 Attendances for Orthodontics 698 Attendances for Other Operations 750 863 Number of Fillings 1896 2095 Number of Extractions 3863 4272 Number of dentures fitted 69 55 Number of sessions employed 518 551 (a) Elementary Children—See Board of Education table. (b) Report of the Maternity and Child Welfare Dental Scheme. Mothers. Appointments kept 429 393 Number discharged 120 81 Attendances for Gas Extractions 115 92 Attendances for Local Extractions 54 38 Number of Extractions 457 574 Number of Fillings 29 85 Number of Dentures fitted 69 52 Attendances for Denture Work 179 69 Number of Sessions devoted 69 48 (e) Welfare Children. Appointments kept 161 111 Number discharged 92 92 Attendances for Gas Extractions 78 69 Attendance's for Local Extractions 4 14 Number of Fillings 23 53 Number of Extractions 248 141 Number of Dressings 7 12 48 (d) County, Commercial, Art and Other Higher Education Schools. Appointments kept 664 646 Number discharged 222 216 Attendances for Gas Extractions 84 106 Attendances for Local Extractions 41 25 Number of Fillings 554 424 Number of Extractions 160 257 Orthodontic Attendances 44 Scaling and Gum Treatment Attendances 76 REPORT FOR THE BOARD OF EDUCATION—1942 1. Number of children inspected by the School Dental Officer, (a) Routine Age Groups inspected:— Age. 5 6 7 8 9 10 11 12 13 14 Number inspected 498 500 494 473 489 535 455 437 457 304 Total 4642 1941. 1942. (b) Special cases 357 335 (c) Total number of children inspected (Routine and special) 3016 4977 2. Number of children found to require treatment 1673 3264 3. Number of children actually treated 1385 2403 4. Total attendances for treatment 3538 5050 5. Half-days devoted to:— (a) Inspections 18 20 (b) Treatment 449 551 Total 467 571 6. Number of fillings completed in:— (a) Permanent Teeth 1108 1550 (b) Temporary Teeth 182 370 Total 1290 1920 49 7. Number of Extractions:— (a) Permanent Teeth 667 1411 (b) Temporary Teeth 2407 1899 Total 3074 3310 8. Administration of General Anaesthetics 1212 1123 9. Other operations—individual cases treated 701 (a) Orthodontic cases (i) completed 31 (ii) under treatment 40 (b) Crowns and Inlays 14 (c) Space retaining appliances 4 (d) Scaling and Gum treatment 503 (e) Temporary Teeth 252 Total 701 844 SECTION C. Infectious Disease. The following is a summary of infectious disease returns from Head Teachers during 1942:— Diphtheria 10 Scarlet Fever 36 Measles 74 German Measles 4 Whooping Cough 24 Mumps 290 Chicken Pox 169 Other 12 The time is long overdue when Head Teachers might be relieved of making these returns as far as notifiable infectious disease is concerned. The returns never agree with the actual figures of notifications received by the Medical Officer of Health from doctors, and cannot he expected to do so, and in any case, all cases and contacts of notifiable disease affecting schools are notified to Head Teachers by the Department. The routine of making these returns was probably imposed as a duty in order to disclose the unnotified case, but we have no instance in the records over a long period of years of such cases being disclosed and thus the routine makes no tangible contribution towards the control of infectious disease. 50 Returns of non-notifiable diseases might be retained is a routine, as to some extent they give a pointer to the incidence of such diseases in the area. During 1942 mumps and chicken-pox were responsible for some loss of school time, but scabies, impetigo and other skin infections, which do not figure at all in the above returns and which involved no less than 597 individual treatments at the clinics alone, were responsible for much loss of school time. OPEN AIR EDUCATION. There is nothing to report on this matter except in so far as it is linked with physical education, which is very adequately dealt with in the statement of the District Organisers of Physical Education as follows:— STATEMENT ON PHYSICAL EDUCATION FOR THE YEAR ENDED 31st DECEMBER, 1942. General. The year has been marked by important changes in the character and scope of the duties of the Or ganisers of Physical Education in this area. Hitherto, these duties had been limited to the organisation and development of this subject in the elementary schools of Beckenham, Bromley, Erith, Gravesend and Penge, and included the training of teachers and the supervision of physical exercises, organised games and swimming, etc. With the introduction of the Government's Scheme of Youth Service, however, the demands for the development of Physical Training and Recreation in Youth Clubs and pre-Service training units, etc., had become so urgent that it was considered advisable to review the terms and conditions of the Organisers' appointment, with the object of extending these services into this new field of development. Thus, as from the 1st February, 1942, under a newly constituted Joint Committee representing the Beckenham, Bromley and Penge and the County Higher Education Committees, the following additional duties were incorporated in the terms of reference governing the organisers' appointment:— (a) The promotion and organisation of Physical Training and Recreative Physical Training classes and Games for adolescents and adults. 51 including the development of such activities in Old Scholars' Associations, Clubs and other organisations for young people. (b) Visiting by arrangement Clubs and Recreative Centres for the purpose of giving advice on Recreative Physical Training and Games. (c) The conduct of such courses in Physical Training for teachers and youth leaders as may, from time to time, be decided upon. (d) Such other assistance with the development of Physical Training in Further Education as may be required from time to time by the Principals for Further Education, and Women Heads responsible for girls' and women's work. It will be sufficient, for the purpose of this statement, meTely to refer to the more obvious advantages of these new arrangements:— (1) By making the "services of the Organisers available to all sections of the public of whatever age, it now becomes possible to create a wider local interest in the subject such as is bound to react favourably on the work in the schools. (2) An important gap in the continuity of arrangements for the physical education of young people is now closed, and a closer linkage established between the school and post-school population. (3) Under a single administrative scheme of this kind, the most advantageous nse can be made of all available facilities—accommodation, teaching staff, etc.—without prejudice to sectional interests. Physical Education in Elementary Schools Although the requirements of youth and adult work have made considerable demands upon the services of the organisers during this first year of operation of the new scheme, the needs of the elementary schools have by no means been neglected. (a) Physical Exercises. The Education Committee, recognising that the provision of plimsolls is indispensable to the maintenance of standards in physical exercises, have again been able, by purchasing from rapidly depleting national stocks, 52 to ensure that no child shall be deprived of the benefits of exercise from lack of suitable footwear. This alone has been of immense importance in preventing what must otherwise have resulted in a serious diminishing of the subject's values to the children, for with the increasing difficulties of staffing and equipment, 'the maintenance of efficient standards in physical training in the schools to-day has become a matter of great concern. Additional facilities for the accommodation of this subject have been provided for the pupils of Burnt Ash School by the renting of the Rangefield Mission Hall, and for those of the Parish School by the provision of a small but useful hall as part of the school's reconstruction scheme. The revival of inter-house physical training competitions in many senior and junior schools has given a pleasing stimulus to the work. (b) Organised Games. Arrangements for regular weekly visits to playing fields have been continued throughout the year, the Education Committee being indebted to the Principal of the Bishop Otter Training College for the use of the college ground by pupils of the Parish and St. Mary's Plaistow Schools. Appreciation is also due to the Committee's groundsmen who, under the direction of the Recreation Grounds Superintendent, have maintained the school playing fields in good condition under trying difficulties. (c) Swimming. It is regretted that it has not been possible to restore our pre-War arrangements for schools' swimming instruction. Lack of shelter accommodation and the heavy seasonal demands of the general public on the use of the town's open air bath are the immediate causes. (d) School Clubs. The problem of juvenile delinquency and the desirability of establishing some link between the school and youth clubs, have suggested a need for giving children some experience of club life while they are still at school. 53 The Education Committee, with the co-operation of Head Teachers have therefore adopted the experiment of offering certain additional facilities for social and recreational activities amongst children in their last year at school. The experiment has already proved popular in the schools and with the continued development of the scheme, it may he anticipated that much good will result. Teachers' Classes. Owing to staffing difficulties it has not been found practicable to resume local arrangements for the special further training of teachers during school hours, such as for several years had been productive of such good results in our elementary schools. The need for Refresher Courses is so urgent, however, that as a temporary war-time expedient it has been necessary to consider the alternative of evening classes of a less specialised nature, arrangements for which have already been made for the coming year. GEO. H. ATKINSON. F. M. BENTLEY. District Organisers of Physical Education. Provision of Meals. In addition to the school canteens already functioning at the end of 1941, six more were opened during 1942. Thus, at the end of 1942 ten out of twelve elementary schools in the Borough were equipped with canteens as follows:— Valley Council School. Raglan Road Council School. Aylesbury Road Council School. Burnt Ash Council School. Princes Plain Council School. Hayes Council School. Southborough Council School. Parish Church of England School. St. Joseph's Roman Catholic School. Keston Church of England School. Children attending Bickley and Widmore Church of England Schools continued to obtain their meals from 54 the County School for Girls, and Plaistow St. Mary's School continued to use the canteens at St. Joseph's or Parish Schools, as desired. Alterations were in progress at the close of the year for extending the canteen kitchen at Raglan Road School to meet increasing demands. During the year no less than 293,017 scholars' meals were served iu the schools. Early in the year, owing to increase in prices of foodstuffs, it was necessary to advance the cost of meals to scholars to 5d. The income scale for assisted cases has been under review, but no alteration was made before the end of the year. At the time of writing, the Board has urged through Circular 1629, an accelerated programme for the expansion of the school meals service until the Government's objective of school meals available for at least 75% of the children throughout the country has been reached. The aim is to secure reasonable precautions for the children against nutritional dangers arising out of the war, planned on a basis to meet their needs for health, growth and energy. I believe the local facilities provided have closely approached the standard urged by the Board. Milk in Schools. The average number of children receiving milk reached 77.02% in 1942, and a return submitted to the Board in the latter part of the year gave the following figures:— Number of children receiving milk. One-third pint. Two-thirds pint. (a) For full payment 1,831 1,420 (b) At half-price 6 30 (c) Free 72 84 (The charge for one third pint remains unchanged at ½d.) 55 SECTION D. Exceptional Children in the Area. Residential Schools. Special Day Schools. Elementary Schools. Not at School. Blind 3 - - - Partially sighted - - - - Deaf 2 - - - Partially deaf - - - - Mentally Defective 9 1 - - Epileptic Children - - - - Physically Defective 7 - - Nursery Schools. At the request of the Ministry of Labour and under arrangements approved by the Board of Education, the Education Committee will extend the Nursery Class at Burnt Ash Infants Council School to accommodate 40 children under 5 years of age instead of 25 as at present and will establish two Play Centres, one at Burnt Ash and the other at Raglan Road Council Schools. The extended Nursery Class and the Centres arc for the children of women war workers only, and are for the purpose of accommodating the children of mothers already in employment and those who would undertake employment if they were relieved of the care of their children during the day. The Class and Centres will be open from 7 a.m. to 7 p.m. (7 a.m. to 1 p.m. Saturdays) and breakfast, dinner and tea will be provided. Secondary Schools. The demands on our services from the Higher Education scholars continues to make extra calls on the staff. The pressure on the Dental Stall will be ameliorated when the additional Dental Surgeon is appointed under the new scheme of increased dental facilities. Parents' Payments. Health Education. Special Enquiries. No noteworthy change requires to be reported under the above-mentioned headings. 56 SECTION E. Occupation Centre for the Mentally Defective. Closure due to war conditions is still in operation. Employment of Children and Young Persons. The School Medical Officers examined 87 children i connection with employment as follows:— South Area. Boys 40. Girls 3. North Area. Boys 35. Girls 5. Unfit—Boys 3 Girls 1 Boot Club Committee. The Boot Club operates in 14 of the 20 School Departments and there are at present 800 contributing members. The annual expenditure for vouchers issued exceeds £500. During 1942 there were 1299 vouchers issued for boots and shoes. The increasing activities of the Boot Clubs is shown by the following figures:— Vouchers issued. Expenditure. 1937-8 451 £120 3 2 1938-39 439 £91 7 5 1942 1299 £520 16 0 Great credit is due to all those who work this scheme voluntarily. The provision of adequate footwear for necessitous cases is of inestimable value to the children from the health point of view and especially in these times of rationing. Bromley Children's Care Committee. War circumstances have circumscribed the normal activities of the Care Committee, as the very valuable assistance given in peace-time is now covered by the Government Schemes, e.g. milk, fruit juices and cod liver oil distribution, also school meals. Extra nourishment for necessitous cases dispensed by the Committee in past years is, of course, limited by rationing restrictions. The Honorary Secretary, Miss M. A. Isard, has, however, been ever ready to assist if occasion arose. SECTION F. Appendix of Statistical Table. The full statistical tables of the Board of Education are not reproduced here but have been compiled and are available in the records of the Department. Extracts only appear under the appropriate headings in this Report,