4412(1) BROMLEY Rent BRO 39 > ■ * Borough of Bromley 1943 ANNUAL REPORT medical officer of health and SCHOOL medical officer FOR OFFICIAL USE ONLY BROMLEY, KENT: Bromley Office Supplies & Printing Co., 46, East Street. 2 PUBLIC HEALTH STAFF, 1943. The personnel of the staff for 1943 was generally comparable with the list as published in my Report for 1942. The principal changes and additions during 1943 which may be noted are as follows :— Additional Dental Surgeon .. Mr. B. S. Birkhahn (Appointed 18.10.43). Health Visitor Miss F. S. Leader (Appointed 13.12.43). " WAR-TIME NURSERIES. Elmfield Road Nursery. Matron Miss K. Minchin (Apointed 3.8.43). On transfer of Miss F. E. Hobbs as Matron of "Draycott" Nursery. Deputy Matron Miss E. Scagcs (Appointed 3.8.43). Nursery Nurse Miss L. Grugeon (Appointed 3.8.43). " Draycott" Nursery. Opened for the reception of children 28.10.43. Matron Miss W. J. Gunyon (Appointed 18.10.43. on the resignation of Miss F. E. Hobbes) Deputy Matron Mrs. E. M. Hood (Appointed 15.11.43). Nursery Nurses Miss I. Rogers. MiSS F. POUNTNEY. (Both appointed 20.9.43). Nursery Assistants Miss B. Temple (Appointed 22.11.43). Mrs. J. Vallins (Appointed 6.12.43). Warden Miss K. M. Whight (Appointed 4.10.43). In addition there are five student nurses and domestic of one cook and two cleaners. 3 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943. Mr. Mayor, Ladies and Gentlemen, I beg to submit my 1943 Annual Report, which is largely statistical in its contents. The vital statistics for the year under review are satisfactory. The health of the people has been maintained at a reasonably high level. The Infantile Mortality Rate is at the low level of 27. There were no deaths of mothers due to pregnancy or confinement. A Death Rate of 11.7 compares with an average of 13.5. for the last five years, whilst the Birth Rate has increased to 17.5 compared with an average of 13.3 for the five pre-war years. There were no unusual epidemics. The routine work of maternity and child welfare services, school clinics, dental and all special clinics have continued rA a pre-war level, and in some cases show a strong tendency to come into increased general use by the public. This brief summary is a pleasing result of the hard and enthusiastic work put in by all the staff of the Department wring past years. The establishment of two war-time nurseries has added a useful and interesting work to our services. The Infantile Mortality Rate, a fairly sound indication of the health of the people and of the efficiency of the local Health Services, is of special interest. The average rate for the war years 1939/1943 is 27.6 per 1,000 births compared with 40.6 for the pre-war years 1934/1938. The general trend of the development of the services in health is towards the care of the family as a unit, and away from the treatment of the individual. It is a fact proved by many social researches that one will find health where the familiy has financial security. There is an ever increasing and apparent desire for the local community to take an interest and responsibility in the development of the health services. This essential, and should be encouraged, if we are to obtain the full benefit from our efforts; no administrative change must be allowed to interfere with it. If we accept the principle that the family is a unit, it follows that must seek for any defects in the environment in which that family lives, works and plays, and the greatest of these factors is the family home. On reference, to statistical tables under the Housing Section of this Report, one is able to extract certain aspects of the home life into which young babies were born in 1943. The figures are extracted from 450 4 maternity cases passing through the Municipal Midwifery) Service and from 767 first visits bv the Health visitors These tables show : 36 per cent, of families (450) had a stated income below £3 10s. per week. 32 ,, ,, paid more than £1 per week rent. 35 ,, ,, were paying more than 25 per cent, of income in rent investigated by the health visitors were living with parents or relatives. 27 ,, ,, (767) 11.3 ,, ,, were living in sub-let rooms or room with only the joint use of cooker, washing and lavatory facilities. 1.4 ,, ,, were living in one room. 5.6 ,, ,, were living in two rooms. It is obvious that if real progress in Public Health is to be made, such conditions as indicated above must be remedial before any other reform. To ignore or neglect them would be grave negligence on the part of administrators. There is, however, an apparent anomaly, that, in spite of these conditions, the Infantile Mortality Rate (i.e., deaths of babies under one year) remains at the remarkably low figure of 27. It perhaps says much for the services provided by the committees that we have been able to save so many lives of infants in spite of the social conditions of many of the families. The whole judgment on public health is, however, something greater than that based on the health of babies alone—the human behaviour factor is of equal importance. Most of the sanitary problems we meet to-day are due to the personal neglect of the ordinary. practice of cleanliness, orderliness, or the result of physical or mental laziness. It is hoped that in the post-war years some use will be made of the services of those persons—wardens, W.V.S. and housewives—who have given such valiant social service during the war years. In this lies a relationship with the public necessary for any development of a social sense and practice I am indebted to Mr. H. E. Lawley, Chief Clerk of the Health Department, for the main compilation of this Report I am, Your obedient servant, K. E. TAPPER. Medical Officer of Health 5 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA, 1943. Statistics. Area (in acres) 6,519 Registrar General's estimate of resident population mid-1943 51,300 Number of inhabited houses according to the rate books at the close of the year 1943 16,424 Number of valuation assessments of habitable premises at 31.3.1944 : (a) Bromley (old Borough area) (b) Hayes & Keston Houses 12,678 2,693 Flats 1,438 72 Farmhouses 13 1 Public houses 34 5 14,163 2,771 16,934 Rateable Value (31.3.1944) £703,254 Product of a Penny Rate (Year ending 31.3.45) £2,770 Statistics. Live Birth Total Male Female Legitimate 845 446 399 Birth Rate per 1.000 of the estimated resident population: legitimate 56 25 31 901 471 430 17.5 Stillbirths: Legitimate Total Male Female 21 12 9 Stillbirth Rate per 1.000 total (live and still) births: Illegitimate 1 1 22 12 10 23.8 6 Deaths : Total Male Female From all causes 604 282 322 Rate per 1,000 estimated resident civilian population : 11.7 Deaths from Puerperal Causes: Puerperal Sepsis—NIL. Other Puerperal Causes—NIL. Deaths of Infants under 1 year of age: Total Male Female Legitimate 22 15 7 Rate Per 1.000 lit' births: 27.7 Illegitimate 3 2 1 4 25 17 8 Death Rate of Infants under 1 year of age : All infants per 1,000 live births 27.7 Legitimate infants per 1,000 legitimate births 26.03 Illegitimate infants per 1,000 illegitimate live births 53.57 Deaths from : Cancer (all ages) 93 Measles (all ages) — Whooping Cough (all ages) 1 Diarrhoea (under 2 years of age) 2 Meteorology. The Borough Surveyor has kindly supplied the follow. details from the records of his Department:— Total rainfall 22.32 inches Mean maximum daily temperature 43° F. Mean minimum daily temperature 38° F. Highest maximum temperature recorded 86° F. on 30.7.43 and 14.5. 43 Lowest minimum temperature recorded 26° F. on 9.1.43 Lowest grass temperature recorded 21° F. on 18.3.40 Population. The Registrar General gives 51,300 as the estimated civilian population for mid-1943, and this figure is used for the calculation of vital rates in this Report. Births. The Birth Rate for 1943 is 17.5 per 1,000 population compared with 17.2 for 1942. 7 The Registrar General gives for 1943 a nett total of 901 live births, after adjustment by transferred notifications, which is a record figure for the Borough. The actual number of births occurring in the Borough during 1943 which were notified to me was 977, of which 17 were stillbirths. Estimates of the numbers and distribution of the non-civilian population are not available, and therefore the following comparative birth rates are based on the civilian population as used for death rates (except for England and Wales) :— Bromley England & Wales Great Towns (incl London) Smaller Towns 25,000-50,000 pop. London County 17.5 16.5 18.6 19.4 15.8 Deaths. The Death Rate for 1943 is 11.7 per 1,000 population compared with 11.4 for 1942. The total of deaths for 1943 is 604 compared with 580 for 1942. Bromley's 1943 Death Rate compares with the rest of the country as follows :— Bromley England & Great Tofons (incl. Smaller Towns London Wales London) 25.000-50,000 pop. County 11.7 12.1 14.2 12.7 15.0 ^lain causes of deaths in Bromley during 1943 compared with the preceding war years were as follows :— 1943 1942 1941 1940 1939 Heart disease 161 139 170 207 158 Cancer 93 113 123 97 102 Inspiratory (non-tuberculous) 77 57 93 85 44 tuberculosis 30 33 34 29 26 Infantile Mortality. The Infant Mortality Rate for 1943 is 27.7 compared with 3 for 1942, This rate compares well with rates for the rest of lhe country Bromley England & Wales Great Towns (incl. London) Smaller Towns 25.000-50,000 pop. London County 27 49 58 46 58 ternal Mortality. Jt is pleasing to record that there were no maternal deaths 111 Bromley during 1943. 8 SECTION B (I). GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (a) Ambulance Service. The following is a brief summary of the work carried out by the Civil Ambulance Service, since taken over by the Health Department from the National Fire Service, as from 10th March, 1943 Total No. of cases conveyed : 1,246 (a) Private 979 (b) Police 267 Total mileage travelled : 9,012 miles (a) Private cases 7,878 (b) Police „ 1,134 Petrol and Oil Consumption:— Petrol Oil gals. gals. No. 1 Ambulance 505 No. 2 Ambulance 252 li 757 8i Both ambulances have been serviced by the Ambulance ata and kept in good running order. There are no changes or important developments in the following services to record in respect of 1943 :— (b) LABORATORY SERVICE. (c) NURSING IN THE HOME. (d) TREATMENT CENTRES AND CLINICS PROVIDED BY TH LOCAL AUTHORITY. (e) TUBERCULOSIS DISPENSARY. (f) VENEREAL DISEASES AND TREATMENT CENTRES. (g) HOSPITALS, PUBLIC AND VOLUNTARY. PUBLIC HEALTH ACT, 1936. SECTIONS 187/195. Nursing Homes.—There were six nursing homes on the register at the end of the year. They provided beds for 81 patients (a) 34 maternity, and (b) 47 others. In addition two homes are closed for the duration of the war. Dr. G. H. Stinson Assistant Medical Officer of Health, carried out 23 visits of inspection during 1943. 9 SECTION B (II). MATERNITY AND CHILD WELFARE. NATAL SERVICES. Municipal Midwifery Service. With the increasing number of births more work accrued for the midwives in respect of follow-up work of bookings, ante-natal clinic, confinement attendances, and ante-natal and post-natal visiting The following is comparaive table of statistics for the past five years :— Total of Confinements Hospital Visiting Year bookings attended cases Ante-natal Post-natal 1939 330 250 35 2311 4251 1940 273 229 41 2047 3931 1941 299 189 48 2066 3128 1942 490 284 147 2756 4690 1943 529 275 242 2893 4596 Domiciliary Medical Practitioner Service. Number of medical examinations made by doctors :— Ante-natal 29 Post-natal 25 54 A falling-off in this service has been inevitable, consequent on the war service calls on doctors. Home Helps. No. of Home Helps employed:— (a) Whole-time 2 (b) Occasional 71 No. of cases attended 113 Applications for home helps have been hard to meet owing to the exigencies of National Service demands. Ante-natal Clinics. No. of sessions held: (a) By Doctor 50 (b) By midwives only 52 - 102 Attendances : (a) For Doctor's examinations 467 (b) For Midwives „ 500 .967 All cases seen by the midwives at the Ante-natal clinics have either been examined by the doctor or referred to the factor at least once. 10 Dental Scheme for Nursing and Expectant Mothers. Mr. J. H. Glen, School Dental Surgeon, has submitted the following figures for 1943 :— Number of sessions held 65 Number of attendances of mothers 409 Number of patients discharged—treatment complete 105 Details of Treatment : Attendances for gas extractions 93 Attendances for local extractions 23 Extractions 600 Fillings 92 Dentures fitted 54 Administration of Midwives' Acts, 1902-1936. Number of midwives practising in the area at the end of 1943 20 Number of confinements attended : (a) As midwives 548 (b) As maternity nurses 429 977 Number of cases in which medical aid was summonea during the year under Section 14 (1) Midwives' Act, 1918, by a midwife :— (a) For domiciliary cases 43 (b) For cases in institutions 3 46 Note. Cases in the Maternity Hospital are medically supervised, and are not included in the above figures. Maternity Hospital Provision. 242 maternity patients were admitted through the Municipal Midwifery Service to the County Hospital during 1942. The prevailing scarcity of home accommodation and home attention are reasons for this large number of admissions. The Bromley and Chislehurst Maternity Hospital admitted 408 private cases for confinement, of whom 293 were delivered by midwives and 115 by doctors. Four cases of puerperal pyrexia were notified from the Hospital, one case of Ophthalmia Neonatorum, and six stillbirths. Puerperal Pyrexia. Five cases were notified during the year. There was no mortality and no spread of infection. 11 POST-NATAL SERVICES. Health Visitors : Home Visiting. 7,576 visits were made during 1943, an increase of 757 over the figure for 1942. 80 per cent, of births received a primary visit, and an average of 2.6 visits to infants under one year of age was accomplished during the year. All visits in 1943 are tabulated as follows :— Primary visits under one year of age ... 767 Re-visits under one year 1,269 Re-visits, one to five years 3,381 Expectant mothers 28 School children 575 Stillbirths—special enquiries 4 Infant deaths Do. 8 Miscellaneous 306 6,338 " Ineffectual " visits 1,238 7,576 Visits to Boarded-out children included above—61. 16.3 per cent, of visits were classified as "ineffectual," and is some what higher than is usually recorded ; but the difficulty of finding the mother at home is increased under war-time conditions. Welfare Centres. The seven welfare centres in the Borough continued to function during the year without change; eight sessions per week being held, there being an extra weekly session at Hayes. Once again It is pleasing to record appreciation of the help given by the voluntary workers. year 1943 shows increased attendances in the following Comparative figures of the war years :— Total number of babies on the registers 1943 1942 1941 1940 1939 3080 2521 3885 3671 3389 Total attendances of babies at all centres 21665 20071 15989 20433 25993 Total of medical examinations 4451 4247 2793 3085 3535 Total number of weighings 19695 17974 14583 18353 22899 12 Child Life Protection. Sixty-one routine visits were made to boarded-out children. Adoption of Children. The Adoption of Children (Regulation) Act, 1939, came into operation on 1st June, 1943. Section 7 of the Act is the section with which Welfare Authorities are concerned. It is now the duty of any person other than the chilcl's parent or guardian or the person with whom the child is placed, who participates in the arrangements for placing of the child to notify in writing the Welfare Authority of the area concerned. In short, as far as we are concerned, it would appear to extend the provisions of the Public Health Act, 1936, as applied to foster children, to those children under nine years of age who an placed for the purpose of adoption, or who have no lega adoption order. The Health Visitor is called upon to exercise supervision by visiting and examining the adopted child to ensure its environmental conditions being satisfactory, and the suitabilitl of the " adopter." Clinic Treatment of Children under 5 Years. Treatments in 1943 :— Eye Clinic 66 Minor Ailments 61 Orthopaedic Clinic 175 Dental Clinic. Appointments kept 94 Fillings completed 12 Discharged — treatment Extractions completed 160 complete 90 Dressings completed 4 Extractions under gas 73 Extractions local 4 War-Time Nurseries. Elmfield Road Nursery.—The Nursery has had a successful year, having kept full to capacity. A number of children were diverted from the waiting list to " Draycott " Nursery, but there remained at the end of the year 51 children over 2 years and 15 under 2 years. 13 There were two isolated cases of scarlet fever and one of German measles. Heavy colds or mild influenza prevailed among the children towards the end of the year. Medical examinations carried out by Dr. G. H. Stinson, Assistant Medical Officer of Health, disclosed no serious physical defects among the children, but a few needed specialised treat- ment or dieting. Both the sand pit and the climbing frame made by the Rescue Squads have proved valuable acquisitions for the amusement of the children. "Draycott" Nufsery.—This Nursery was available for use on 20th September, 1943, and Miss W. J. Gunyon has been appointed Matron. By the 28th October, 1943, the 'first batch of children had been received, and students' classes had previously commenced. The Nursery was officially opened by Mrs. H. V. Enthoven, Honorary Secretary of the National Society of Children's Nurseries. Forty-two children were on the books at the end of the year. There were no infectious diseases among the children during 1943, but neither staff nor children escaped the prevailing influenzal infection. Better hygienic conditions for the storage of milk and food by the provision of a refrigerator would appear to be a desirable improvement. At the time of writing, we have been informed by the Ministry of Health that they propose to supply a refrigerator. The pleasant amenities of the garden prove beneficial to the children during the summer months. An expression of appreciation is due to Light Rescue Depot No. 2 for their helpfulness at all times. 14 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. The Clerk to the Metropolitan Water Board reports that the supply of water to Bromley was satisfactory as regards quality and sufficient in quantity during 1943. The supply was constant, and piped supplies were available throughout the Borough. The water supplied by the Board is not plumbosolvent. Cesspools. Refuse Collection and Disposal. Drainage. Rivers and Streams. No improvements or alterations were made in the foregoing services during the year. No action necessary in 1943. SANITARY INSPECTION OF THE AREA. The following tabulation indicates the work carried out bi the Sanitary Inspectors during 1943 :— Type of Inspection No. of Inspections Revisits Total No. of Inspections Nuisances and Defects on Complaint Routine Found Remedied Housing 633 56 2347 3036 908 925 Infectious Disease — 233 — 233 — — Disinfections — 95 — 95 — — Food Preparing Places 48 2335 10 2393 37 36 Factories 25 254 102 381 51 47 Sampling 15 205 5 225 — - Trade premises 211 507 531 1249 199 188 Miscellaneous 21 807 34 862 35 35 Totals 953 4492 3029 8474 1230 1231 Notices Issued. Preliminary—Housing 431 Others 261 692 Statutory Nil Food Condemnation Certificates issued, 1424, 15 Factories. Written Factory Premises. Inspections. Notices. (a) With mechanical power 76 6 lb) Without mechanical power . 49 4 (c) Other premises 239 6 364 16 Number of defects found, 51. Remedied, 47. Shops Acts, 1912/1936. Thirty inspections were made and 24 infringements remedied. Smoke Abatement. Five inspections were made, and in one instance a nuisance was remedied. Swimming; Baths and Pools. Samples taken from the Public Baths during the year proved the water satisfactory on bacteriological examination. Samples taken from a private swimming pool showed unsatisfactory bacterial counts, and steps were taken to eliminate contamination. An application to use a private lake for swimming was disapproved, as samples of the water on examination were found to be contaminated. Verminous Houses. Thirty-seven complaints of verminous conditions were instigated, and 34 infestations were dealt with by the close of the year. On the Council's Housing Estates the Housing Manager reports that a few cases were notified, which were treated by spraying and the temporary removal and burning off of woodwork. Assistance and instructions were given to tenants in the maintenance of cleanly conditions throughout the premises. Rats and Mice Destruction. The Sanitary Inspectors devoted as much time as could be spared from other duties to grapple with the rodent infestation Problem. No less than 794 visits to premises were made : (a) trade premises 350, and (b) private premises 444. Advice on Measures of control and supervision of baiting was undertaken by the inspectors. During the course of the year 156 infestations were written off as remedied. Legal Proceedings. No Court proceedings were instituted under the foregoing heading of this Section of the Report. 16 SECTION D. HOUSING. The following figures indicate to some extent the amount of attention the Sanitary Inspectors have been able to devote to housing inspection during 1943 :— Houses Inspected. On Complaint. Nuisances and Defects. Routine. Re-visits. Total. Found. Remedied. 633 56 2347 3036 908 925 Of 689 houses inspected, 625 were for general defects, 2 for overcrowding, 37 verminous conditions, 9 dirty conditions, 5 water supply, 4 disinfestation purposes and 7 noxious accumulations. 583 houses were found not to be in all respects reasonably ftt for habitation, and 431 were rendered fit in consequence of informal action by the Inspectors. The excess of nuisances remedied over nuisances found is due to the remedying of items outstanding in the previous year. 328 inquiries and disinfection arrangements regarding infectious diseases were made by the Inspectors. Housing Conditions. In order to give some indication of the present housing conditions, I have extracted from the health visitors' records the housing conditions of the family of the new-born during the year, and also as a separate investigation the financial state of those who applied for municipal midwifery service during 1943. The first set of figures relate to 767 babies, the latter to 450 expectant mothers. There is, of course, no direct relationship between the two sets of figures. Table I is an attempt to give statistical returns of the housing conditions of babies visited for the first time in 1943. The broad summary of these figures show that no less than 45 per cent, of these families are unsatisfactorily housed, a condition, no doubt, aggravated as a result of war; but it remains a factor for consideration in post-war reconstruction. Table II, extracted from the midwifery service records, gives the percentage under various income scales. In giving attention to this table it must be remembered that many of these expectant mothers are the wives of serving soldiers, and that the income recording refers in the main to that period when the mother has ceased to work and is dependent upon the 17 Army allowance. It must also be remembered that no attempt has been made to seek into any other source of financial help that may be available to the mother. Table III is a tabulation of the percentage of 450 expectant mothers paying certain scales of rent. Table IV is an attempt to correlate Tables II and III, giving the number of children already in the family, and the amount of rent payed out of salary received. No attempt has been made to investigate other essential expenditure, such as fares to end from work. The table shows that no less than 35 per cent, of mothers are paying more than 25 per cent, of income on rent, and this excludes cases paying board and lodging. The tables, taken on their face value, indicate a grave state of affairs; the balance of income left for food would appear to be reduced below the maintenance level. These are conditions that must place upon administrators a serious problem, and such cases must receive priority of attention in any post-war reconstruction. To neglect them or to be complacent about .their correction would merely torpedo any attempt to improve the health of the people by means of improved medical services. Table I. Health Visitors' Report on Housing of the new born (767 cases). (a) Living in separately occupied houses 421 (b) ,, ,, sub-let rooms 86 (c) ,, with parents 206 (d) „ in one room 11 (e) ,, in two rooms 43 (d) and (e) are not included in (b). Table II. Weekly Income (450 applications for Municipal Midwifery Service). 13 per cent, receiving £2 or less. 23 ,, ,, ,, £2 to £3 10s. 43 ,, „ „ over £3 10s. 21 ,, „ unspecified (no details of income submitted) Table III. Weekly Rent (450 applications for Municipal Midwifery Service). 24 per cent, paying rent 15/- or under. 23 ,, ,, ,, ,, 15/- to £1. 32 ,, ,, ,, ,, over £1. 21 ,, ,, unspecified. 18 Table IV. A Correlation of Tables II and III, giving number of children in the families. Family income per week No. of cases in each category of income No. of , children in family Number of cases paying rentals of: — Under 10/- 10/- - 15/- 15/- - £1 £1 - £1 5/- £1 5/- £1 10/- £1 10/& over £1 5s. 0d. to £2 0s. 0d. 0 9 & 2 B.L. 14 & 5 B.L. 6 & 2 B.L. 7 & 2 B.L. 2 & 4 B.L. — 57 1 — 1 2 1 — - 2 — — — — — - 2 plus — — — — — - £2 0s. 0d. to £2 15s. 0d. 0 2 1 7 4 & 1 B.L. 1 B.L. 1 B.L. 1 1 8 7 2 3 & 2 B.L. 1 B.L. 50 2 2 1 3 - 1 B.L. 2 plus 1 1 — — — — £2 15s. 0d. to £3 10s. 0d. 0 2 6 3 4 2 & 1 B.L. 1 B.L. 1 2 2 2 7 — 1 B.L. 52 2 2 5 4 — — — 2 plus 1 1 5 1 — — £3 10s, 0d. to £4 5s. 0d. 0 1 5 6 7 5 2 B.L. 1 1 5 10 4 3 1 2 - 5 4 2 — 1 2 plus - 4 6 2 1 — £.4 5s. 0d. and over 0 2 4 11 9 9 & 1 b.l. 2 & 3 b.l. 122 1 — 3 4 11 13 2 & 1 b.l. 2 - 3 5 3 6 4 2 plus — 6 18 2 — — 94 unspecified income and. not applying for relief of costs. B.L. = Board and Lodging. 19 SECTION E. INSPECTION AND SUPERVISION OF FOODS. Milk Supply. Ninety-six inspections of registered dairy premises were made in 1943 and 15 nuisances found were abated. Milk was examined on the highway in course of distribution on 40 occasions. Registrations of dairy and milk shop premises at the end of 1943 1. Premises within the Borough 74 2. Premises outside the Borough 25 99 The Milk (Special Designations) Regulations, 1936-43. The Local Authority has issued licences for graded milks is follows:— Pasteuriser's Licence 1 Licences. Dealers' Supplementary " Pasteurised " 12 4 "Tuberculin Tested" 6 4 18 8 Samples taken by the Inspectors and submitted for lamination:— Ordinary milk, bacteriological test 10 Graded milk „ „ 14 Phosphatase test 7 Souring test 13 Mastitis 1 Samples of milk taken under the Food and Drugs Acts appear in the following tabulation. 20 Food and Drugs Acts. The number of samples taken during 1943, and results, are given in the following tables :— Adulterated or Formal. Informal. Irregularity. Arrowroot — 2 — Aspirin — 1 — Barlova — 1 — Butter — 1 '— Blood Cherries — 1 — Baking Powder — 3 — Butter Beans 2 — — Bicarbonate of Soda — 1 — Biscuit Mixture — 1 — Cake Mixture 1 1 — Celery Salt — 1 Cake Decorations — 1 — Coffee — 3 — Cough Linctus — 1 — Camphorated Oil — 2 — Castor Oil — 2 — Carbolic Ointment — 1 — Carraway Substitute — 1 — Choc-o-spread — 1 — Curry Powder — 1 — Custard Powder — 2 — Egg Powder, dried — 3 — Egg Substitute — 3 — Fish Cake Roll — 2 — Flour — 2 — Flour, self-raising — 1 — Fruit Sauce — 1 1 Gelatine 4 2 Ginger Wine Essence — 1 — Glauber Salts — 1 — Ginger, ground — 1 — Ground Nutmeg — 1 — Herbal Licorice Tablets — 1 — Health Salts — 1 — Jam — 2 — Junket Powder — 1 — Lemon Substitute — 1 — Margarine 5 4 — Malted Milk Tablets — 2 — Macaroni — 2 2 Milk 33 23 — Milk, condensed — 1 — 21 Adulteration or Formal. Informal. Irregularity. Milk powder — 1 — Meat Extract — 2 — Mustard — 2 — Nerve Tonic — 1 — Parsley Stuffing — 1 — Pea Flour — 1 — Pudding Mixtures — 1 — Plums, tinned — 1 — Paste colouring — 1 — Powdered Gelatine — 1 — Pastilles — 1 — Pearl Barley — 1 — Pudding & Cake Mixture — 6 — Rice, flaked 1 — — Rice Powder — 1 — Sago Pudding — 1 — Semolina — 2 — Spaghetti — 3 — Soya Flour — 1 — Soup Powder — 1 — Sausages — 7 — Sal Volatile — 1 — Salad Dressing Powder — 1 — Sauce and Pickles — 8 — Scone Mixture 1 — Tea 1 — Tincture of Iodine 1 — Vermicelli 1 — Vegetable Extract - 1 — Wine Essences - 2 — Yorkshire Pudding Mixture - 1 — Zinc Ointment — 1 — 46 139 3 The following tabulation shows in detail the adulteration irregularities and action taken :— Article. Formal. Adulteration or Irregularity. Action taken. Informal. milk. Formal. Contained 10.8% of added water Fined £3 and £1 1s. costs. milk Formal. Contained 5.3% of added water. Case dismissed on payment of 25s. costs. Edible Gelatine Formal. Contained 4256.0 parts of sulphur dioxide per million The wholesaler was prosecuted in another Borough. 22 Meat and Other Foods. The following tabulation gives the results of inspection of food surrendered as unfit for human consumption, which was either directed to be destroyed, salvaged for animal food, or for soap making. Certain quantities were recommended to be rendered fit by treatment for human consumption. Article of Food. Quantity. Approx. weight (in lbs.). Canned meat 1280 tins 1600 Canned milk 2819 „ 2235 Canned fruit 794 „ 928 Canned fish 826 „ 440 Canned vegetables' 1331 „ 1603 Canned sundries 549 „ 972 Fish 2166½ Meat 1342¼ Meat (0cooked) 242½ Fats (margarine, lard, etc.) 179 Poultry 63½ Rabbits 239 522 Vegetables 1133 Fruit 404½ Flour and flour mixtures 1416¼ Bread 822 Cereals 818 Biscuits 2085 Sugar 272½ Coffee, Tea 148¼ Cheese 92½ Jams, marmalade, syrup 376 tins, jars 429 Eggs 96 11 Miscellaneous 346¼ 20,272 (Total: 9 tons, 1 cwt.) Tabulation of cases of infectious disease notified, with age groups, during 1943 (civilians only) :— INFECTIOUS DISEASE, 1943 (Civilians only) Disease Total cases notified Admitted to Hospita Age Groups 0-1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 over Scarlet Fever 204 116 ... 2 2 12 12 101 45 12 10 5 3 ... Diphtheria 4 4 ... ... ... 1 ... ... ... 1 1 ... 1 ... Pneumonia 51 32 1 1 2 ... 3 7 2 ... 4 7 18 16 Puerperal Pyrexia 6 3 ... ... ... ... ... ... ... ... 6 ... ... ... Erysipelas 16 7 ... ... ... ... ... 1 ... ... 1 1 8 5 Dysentery 2 ... ... ... 1 ... ... ... ... 1 ... ... ... ... Cerebro-Spinal Fever 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Ophthalmia Neonatorum 3 1 3 ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis 5 ... ... ... ... ... ... 2 2 ... ... 1 ... ... Measles 537 4 10 96 37 48 62 287 43 7 13 2 2 ... Whooping Cough 94 ... 9 8 8 8 15 43 2 ... 1 ... ... ... Totals 923 167 23 37 50 69 92 442 94 21 36 16 32 11 SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. • 24 Scarlet Fever. Two hundred and four cases were notified in 1943, producing an incidence rate of 3.9 per 1,000 population. This is a higher figure than we have recorded for some years. Fifty per cent, of the cases occurred in the last quarter of the year. The infection was very mild in character, and 43 per cent, of cases were isolated at home under treatment. There was no mortality. Diphtheria. Four cases during 1943 is probably the lowest known figure of incidence in Bromley in any one year. This is an attack rate of 0.07 per 1,000 population as compared with 0.88 for the rest of the country. The ages of the four cases were 3, 17, 28 and 46 years respectively. The infection in each case was nonvirulent and detention for hospital treatment was less than fourteen days in each case. That immunisation has played an effective part in the control of infection, it would be difficult to deny.' The position with regard to immunisation of children to date in Bromley is approximately in children under 5 years 48 per cent., and children between 5 and 15 years 60 per cent. Other Diseases. With 537 notified cases of measles this disease w5s epidemic in the first six months of the year. The infection was generally mild, and only four cases needed hospital treatment. There was no mortality. Ninety-four cases of Whooping Cough were notified, and one death occurred. Fifty-one cases of pneumonia were notified, and 40 deaths from pneumonia were registered ; but it should be noted that deaths include all forms, whereas notified cases include on acute primary and acute influenzal pneumonia. There are no noteworthy comments to add in respect of the other notified diseases shown in the tabulation. One death from Typhoid Fever was recorded, but concerns a Bromley resident who contracted the disease and died an institution outside the ares. 25 1 Tuberculosis. The recordings in the register during 1943 are as follows:— Respiratory, Other forms Total No. of M F M F cases On register, 1.1.1943 228 196 79 88 591 New cases notified 25 30 5 8 68 Cases re-entered on register — 1 — — 1 No. of cases coming to knowledge after death 3 1 - 1 5 Inward Transfers 6 6 - 1 13 262 234 84 98 678 Deletions—deaths, removals and recovery 19 19 4 3 45 On register, 31.12.1943 243 215 80 95 633 There has been a nett increasg of 42 cases at the end of 1943 over the total of the previous year. The total number of cases gives a case rate of 12.3 per 1,000 population. The five cases diagnosed after death as suffering from tuberculosis give a ratio of 1 in 15 of new cases notified. New Cases and Mortality, 1943. few cases notified or otherwise revealed, x Deaths. Age Periods. Under 1 Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M F M F M F M F - — — — — — — 1-5 - 2 3 - 1 — — 5-15 1 1 1 4 1 — 1 15-25 10 14 4 2 2 — 1 15-35 5 5 1 1 2 2 — — 35-45 4 7 - - 5 3 — — 15—55 5 1 - - 2 2 — 55-65 3 2 - - 4 1 — — 65 and over - - - - - 1 — — Totals 28 32 5 9 15 13 — 2 x Inward transfers—Resp. M. 6. Non-Resp. M. —. F. 6. F. 1. Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936. Section 172. No action was necessary under these enactments during 1943, 26 SECTION G. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. Diseases of Animals. Number of movement licences received 27 Animals concerned (pigs) 205 Swine Fever. Eleven cases of suspected Swine Fever occurred, which were unconfirmed. The prescribed precautions were put into operation in each case. Anthrax. Two cases of suspected Anthrax occurred which were unconfirmed. 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 88 (b) for Carbide of Calcium 1 27 BOROUGH OF BROMLEY ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR 1943 28 INTRODUCTION—SCHOOL MEDICAL SERVICE. Throughout 1943 the services continued at their pre-war level, in spite of frequent war-time changes in staff. It is worthy of reiteration that the School Medical Service is not a selfcontained unit, but is part of the general Health Services of the Borough, and, with the exception of domiliciary treatment, covers the field of prevention of disease and the limitation of disease. Such special clinics as eye clinic, orthoptic clinic, orthopaedic clinic, including massage, ultra violet ray treatment and remedial exercises, and a full dental service, including orthodontics, all play an important part in the rehabilitation of the unfit school child. Arrangements are made through hospitals for the operational treatment of ear, nose and throat conditions, and use made of Child Guidance Clinics for direction of the maladjusted child. Not the least important factor for the success of a School Medical Service is the school nurses' knowledge of the defects in the home environment of the patient. In most cases treated at the clinics, and more especially in such conditions as impetigo, success is dependent on the hygienic habits of the child at home. It, therefore, cannot be too often stressed, especially in these days when discussing a National Health Service, that environmental hygiene in the full application of its meaning, at home, at school, at work and at play, is of greater importance in the promotion of health than is the provision for the minor ailment treatment of the disease established. The correlation between malnutrition and dirty and overcrowded environment is well known and is a case in point. The extension of the scheme for milk and meals at school is playing an ever increasing part in the health of the school child. Mr. Atkinson and Miss Bentley, organisers of physical education, whose report appears within this Annual Report, give a significant paragraph:— "Physical exercise has continued to play an important part in the curricula of all schools and may claim, with the excellent arrangements for school milk and meals, to contribute in no small measure to the improved nutrition appearance of our school children." . . . "Good nutrition depends not Only on correct feeding, but also on the ability of the body to make the best use of what food is available to it." 29 This confirms the opinion so often expressed that the greater the proportion of the family income available for expenditure on food, the better the chance of good health in the family; any factor that limits this expenditure below the minimum requirements per head of family will itself counteract any benefit resulting from a complete School Medical Service. Finally, the child is a member of a family, and it is around this family unit that the health and social services must revolve. Give this family the means and the inner urge for health of mind and body and the need for clinics will be a minor problem. SUMMARY OF STATISTICS. Number of children on the School Rolls 5,038 (Avg.) Number of individual children who attended the Medical Clinics:— (a) North Clinic 1,382 (b) South Clinic 1,189 2,571 Number of individual children routine medically examined at Schools 1,080 Number of other routine medical examinations 161 Number of special medical examinations at the Clinics:— (a) North Clinic 3,063* (b) South Clinic 2,940 (c) Specialist Clinics 1,109 7,112 Number of attendances made by children for treatment by School Nurses:— (a) North Clinic 7,364* (b) South Clinic 6,993 14,357 * Including Hayes and Burnt Ash Clinics. Number of attendances for treatment at Dental Clinics:— (a) Elementary school children 4,770 (b) Higher Education children 693 Number of attendances under other Dental Schemes 501 Number of treatments at the Eye Clinic 695 Number of spectacles prescribed 200 Number of attendances at the Orthopædic Clinic:— (a) For consultations 405 30 (b) For treatments, massage and exercises 2,201 2,606 IN umber of attendances for Ultra Violet Ray Clinics:— (a) North Clinic 1,575 (b) South Clinic 972 2.547 It has been stated in the present day discussions on reform of Health Services, that only about fifty per cent. of the public use the centres and clinics provided by the local authorities; but if this be true for the country as a whole (which is open to question), it is certainly not applicable to Bromley, where failures to keep appointments for inspections and treatments are negligible. The above summary of figures discloses that there were no less than 11,914 medical, specialist and dental examinations, and that 26,540 attendances were made by children for minor ailment, dental, eye, massage, corrective exercises and ultra violet ray treatment during 1943. These figures concern elementary school children, and indicate the extent of health facilities provided for and made use of by an average school roll of 5,038 children. The services are also used by higher education children and children under five years, but are not included in the figures quoted. Staff. Particulars of staff are given at the beginning of this joint report. Co-ordination. The three-fold services of Maternity and Child Welfare. School Medical and General Public Health in Bromley have been welded into one unit of service, so that overlapping is non-existent, and a continuous health supervision from babyhood to adolescence is exercised to the fullest capacity. No successful policy will contemplate disintegration of this trinity of services. The Public Health Service, no less than any other organisation or business undertaking, cannot function efficiently as a worth while service to the public if it is to be broken down into a series of administrative units. Hygiene of Schools. The standard of cleanliness continues to be generally maintained in the public elementary schools despite certain difficulties experienced, due to shortage of labour and materials No major improvements have been undertaken during the year. The case of one temporary church school falls far short of a hygienic standard. 31 SECTION A. MEDICAL INSPECTIONS. The number of routine medical inspections at schools during 1943 falls short of the usual quota. This reduction is due to several reasons, viz. : Frequent staff changes, staff illness, staff concentration on diphtheria immunisation, and a considerable increase in special medical inspections at the school clinics, as shown in the following table. The fall in the routine medical inspections occurs principally in the second age group, but we have been able to make good the arrears by stepping up the number of routine medical sessions in the first half of 1944. The figures of inspections for 1943 are as follows :— (1) Entrants 548 (2) Second Age Group 144 (3) Third Age Group 388 (4) Other routine inspections 161 1,241 (5) Special medical inspections and reinspections at the school clinics (not including Specialists' clinics) 6,003 7,244 Findings at Medical Inspections. The following table summarises briefly the defects discovered at routine and special medical inspections during 1943 :- Defect or Disease. Routine Inspections requiring Special Inspections requiring Treatment. Observation. Treatment. Observation. Skin 3 1 731 16 Eyes 17 22 306 22 Ears 1 1 156 3 Nose and Throat 3 44 354 45 Defective Speech — — — — Heart and Circulation 3 2 8 3 Lungs (non T.B ) 4 — 93 3 Tuberc. Pulm. — 1 — — " Non-Pulm. — — 3 3 Nervous System — — 42 5 Deformities 5 — 22 1 Miscellaneous 173 20 820 121 209 91 2535 222 32 Nutrition Standard. Children examined at Routine Medical Inspections. 1943. 1942. 1941. 1940. 1939. Excellent 6.11 6.68 7.63 8.36 9.38 Normal 84.81 84.06 84.25 83.75 78.47 Sub-normal 8.33 9.19 8.03 7.76 10.03 Bad 0.74 0.07 0.08 0.13 2.12 Malnutrition and Cleanliness. Dr. Arnold Orgler, Assistant School Medical Officer, reporting on his findings during 1943, reports that the nutrition of the school children is good. He comments (vide his special report which follows) that on the average the boys and girls about 12—13 years old, are taller and heavier than the boys and girls examined in the last year of peace, 1939. This he ascribes as partly due to the provision of school meals and milk. The nutrition of children of the entrant group and the intermediate group is good taken on the average. The intermediate group show an increase of "nervy" children. As the examination of these children took place during the incidence of air raids, Dr. Orgler thinks the increase may be due to these circumstances. In the cases of scabies and impetigo, Dr. Orgler could find no increase; on the contrary, these diseases showed a slight but certain decline in the last months of the year. Regarding pediculosis, he reports a similar condition as in the previous year. REPORT ON HEIGHT AND WEIGHT OF SCHOOL CHILDREN AVERAGING 13 YEARS. (Comparison between 1939 and 1943) By Arnold Orgler, Temporary Assistant Medical Officer of Health. In the School Medical Examination of the boys and girls between 12½ and 13½ years old, I was impressed by the fact that, in spite of the fourth year of war, these children showed a very good weight and height. It seemed to me an interesting question to investigate whether there is any difference between these children and the children who were about 13 years old in the last year of peace, 1939. 33 I was able to compare 147 boys and 166 girls born in 1930 with 193 boys and 228 girls born in 1926. The average age of these children was, for the boys investigated in 1939, 12 7/12. investigated in 1943, 12 10/12 ; and for the girls respectively 127/12 and 13 years. The average height and weight were as follows:— Table I. Average height in inches. Boys. Girls. 1939 57⅔ 59 1943 58½ 59¾ Table II. Average weight in lbs. Boys. Girls. 1939 85 88½ 1943 84½ 92 These figures do not give the right picture. We can only get a correct idea when we compare the children's distribution over the different groups of height and weight. Then we find the following results:— Distribution of Height and Weight. Table III. (Boys). Height in inches. 1939. 193 boys' records investigated. Avg. age, 12, 7/12. 1943. 147 boys' records investigated. Avg. age. 12. 10/12. 49—51 0.5 per cent. 0.7 per cent. 52—53 6.2 „ 0.7 „ 54—55 10.4 „ 6.8 „ 56—57 24.3 „ 23.1 „ 58—59 30.0 „ 30.6 „ 60—61 18.6 „ 24.5 „ 62—63 6.7 „ 9.5 „ 64—65 0.5 „ 2.7 „ over 65 2.6 „ 1.4 „ Table IV. (Boys). Weight in lbs. 1939. 193 boys' records investigated. Avg. age, 12, 7/12. 1943. 147 boys, records investigated. Avg. age. 12, 10/12 55—60 0.5 per cent. 1.4 per cent. 61—65 3.1 „ 3.4 „ 66—70 8.3 „ 4.1 „ 71—75 9.3 „ 8.2 „ 76—80 13.0 „ 22.4 „ 81—85 18.6 „ 17.7 „ 86—90 17.1 „ 15.6 „ 91—95 11.9 „ 15.0 „ 96—100 8.3 „ 2.7 „ over 100 9.9 „ 9.3 „ 34 Table V. (Girls). Height in Inches. 1939. 228 girls' records investigated. Avg. age, 12, 7/12. 1943. 166 girls' records investigated. Avg. age, 13. 49—51 1.3 per cent. — per cent. 52—53 3.9 „ 2.4 „ 54—55 7.4 „ 6.0 „ 56—57 11.4 „ 8.4 „ 58—59 23.7 „ 25.9 „ 60—61 28.9 „ 19.9 „ 62—63 14.5 „ 24.7 „ 64—65 5.7 „ 7.8 „ 66—67 1.8 „ 4.2 „ 68—69 0.9 „ — „ over 69 0.4 „ 0.6 „ Table VI. (Girls). Weight in lbs. 1939. 228 girls' records investigated. Avg. age, 12, 7/12. 1943. 166 girls' records investigated. Avg. age, 13. 50—55 0.4 per cent. — per cent. 56—60 1.3 „ 0.6 „ 61—65 2.2 „ 1.2 „ 66—70 10.5 „ 6.6 „ 71—*75 7.9 „ 8.4 „ 76—80 12.8 „ 5.4 „ 81—85 10.9 „ 13.2 „ 86—90 12.8 „ 14.7 „ 91—95 11.8 „ 10.2 „ 96—100 10.9 „ 11.5 „ 101—105 3.5 „ 9.6 „ 106—110 4.4 „ 6.6 „ 111—115 4.4 „ 2.4 „ 116—120 1.3 „ 4.2 „ over 120 4.8 „ 5.4 „ When surveying these one can easily form three groups: 1. A small lower group. 2. A medium group, comprising most of the children. 3. A small higher group. 35 Table VII. (Boys). Inches. Height in inches. 1939. 1943. 49—55 17.1 per cent. 8.2 per cent. 55¼—61 73 „ 78.2 „ 61¼—71 9.8 „ 13.6 „ Lbs. Weight in lbs. 1939. 1943. 55¼—75 21.2 per cent. 17.0 per cent. 75¼—95 60.6 „ 70.7 „ 95¼—120 18.2 „ 12.0 „ Table VIII. (Girls). Inches. Height in inches. 1939. 1943. 49—55 12.6 per cent. 8.4 per cent. 55¼—63 78.5 „ 78.9 „ 63¼—71 8.8 „ 12.6 „ Lbs. Weight in lbs. 1939. 1943. 50—75 22.3 per cent. 16.8 per cent. 75¼—100 59.2 „ 55.0 „ 100¼—120 18.4 „ 28.2 „ Comments. When we first study the Table VII of the boys, we see that of the boys in 1943 regarding height, 8.2 per cent. are in the lower group, compared with 17.1 per cent. investigated in 1939. In the medium group are 78.2 per cent. in 1943, compared with 73 Per cent in 1939; in the higher group are 13.3 per cent. in 1943 against 9.8 per cent. in 1939. Regarding weight, from the boys investigated in 1943, 17 per cent. are in the lower group compared with 21 per cent. in 1939: in the medium group are 70.7 per cent. in 1943, compared with 60.6 per cent. in 1939 ; in the higher group are 12.2 per cent. in 1943 against 18.2 per cent. in 1939. From these figures we can infer that the boys investigated in 1943 have definitely improved in height and weight compared with the boys investigated in 1939. That there are fewer boys in the higher group of weight in 1943 is, in my opinion, a favourable sign, as it indicates that less boys are overfed. One might object that the difference in age may have influenced these results, as the average age of the boys in 1943 36 is about three months higher than the average of the boys in 1939. Thus I investigated the average age of the lower group of the boys in 1939 and 1943. If the difference in age would have an influence, then one would expect that only children of average age. or below average age were in this low group. The average age of the boys in the lower group in 1939 regarding height was 12 7/12, and regarding weight 12 6/12. The average age of the boys in the lower group in 1943 was, regarding height, 13 3/12, and regarding weight 13 years. The average age in the lower group of the boys in 1939 was the same as the average age of all the boys investigated in 1939. On the other hand, the average age in the lower group of the boys in 1943 is higher than the average age of all the boys investigated in 1943 regarding height as well as weight. Thus we can infer that the age factor does not influence the results. There must be other conditions causing this remarkable fact. To find out these conditions, I have further investigated the environment of these boys, and I found that most of them come from families in which both parents or one of them are short and thin; some boys showed other constitutional factors, :;uch as prematurity, which caused lower height and weight. The comparison between the girls investigated in 1939 and those investigated in 1943 shows similar differences, as seen in the table. In order to judge these figures, we have to take into consideration two factors—the sex development and the age factor. When we compare the Tables III and IV of the boys with Tables V and VI of the girls, we see that the distribution of the girls for the different height and weight groups occupies a wider range than that of the boys. As the sex development influences the growth of children and adolescents, we may attribute these differences to the sex development of the girls Considering the age factor, we find the average age in the lower group of the girls in 1939 12 6/12, in the girls in 1943 13, regarding height; concerning weight, the average age is 12 6/12 and 12 10/12 respectively. In the higher group the average age of the girls in 1939 is 12 8/12 regarding height and 12 9/12 regarding weight. The average age of the girls in 1943 is respectively 13 1/12 and 13 2/12. As the average age of the girls in 1939 is 12 7/12 and of the girls in 1943 is 13 years, these differences show that in the lower group are the younger girls and in the higher group the older girls. When we take these factors into consideration, we can infer that there is no difference between the girls in 1939 and in the girls in 1943. The finer differences which we have found in the boys were overshadowed in the girls by the sex development of their earlier puberty. 37. Conclusions. I have deliberately chosen the children of this age for my investigation, because the body shows rapid growth in this age. Therefore we can detect in this age most easily if nutrition is inefficient. I was able to prove that these boys and girls in 1943 did not show any signs of deterioration compared with the boys and girls in 1939. Judging from the figures found in the boys, we can conclude that the nutritional standard is a little higher in 1943 than in 1939. SECTION B. TREATMENT. The number of treatments for minor ailments during 1943 compared with 1942:— 1943. 1942. Skin diseases 732 597 Minor eye defects 214 179 Minor ear defects 155 128 Miscellaneous 794 782 1895 1686 Total number of attendances of children at the School Clinics for treatments 14,357 12,980 The figures for 1943, as shown above, have only been exceeded on two previous occasions since my appointment. Eye Clinic. Statistics for the year 1943:— Number of sessions held during the year 73 Number of children dealt with for errors of refraction 512 Number of other defects or diseases of the eye treated 183 Number of spectacles prescribed and obtained 200 Total attendances of children for treatment 695 Ear, Nose and Throat Clinic. Specialist Consultative Service and operative treatment for tonsils and adenoids at the School Clinic is still in abeyance. Twenty cases were referred for operative treatment to hospital, and 173 cases received other forms of treatment under the Authority's Scheme at the School Clinics. 38 Orthopædic Clinic. The work of this Clinic with its ancillary services of massage, remedial exercises and light treatments during 1943, is indicated in the following figures:— Number of clinics held by the Consultant 13 Number of children treated at the Clinic 164 Number of attendances for consultations 405 Number of attendances for massage and exercises, etc. 2201 Number of attendances for Ultra Violet Ray and Infra Red treatments:— (a) North Clinic 1575 (b) South Clinic 1070 Number of cases admitted to the Royal National Orthopaedic Hospital, Stanmore, for in-patient treatment 5 Tabulation of new cases seen by the Orthopaedic Surgeon, 1943:— 1. (a) Congenital Defects:— 6. Structural Curvature of the Spine — Club Foot 2 Dislocation of Hip 1 7. Flat Feet 29 Other conditions 15 8. Infantile Paralysis — (b) Hammer Toes 3 9. Sequelae of Acute Fevers — 2. Birth Injuries:— Torticollis 2 10. Fracture 1 Other conditions 2 11. Tuberculosis—Joints 2 3. Rickety Deformities:— 12. Other Bone Diseases (nontubercular) — Bow Legs 2 4. (a) Bow Legs (non-rickety) 6 13. Osteomyelitis — (b) Knock Knees (nonrickety 2 14. Not Classified 23 15. Non-Orthopaedic 2 5. Postural Defects of the Spine 19 16. No Active Disease 23 Orthopædic Clinic Report for 1943. I do not think there is any special comment to be made on the working of the Orthopaedic Clinic during 1943. The number of attendances for consultation has increased once again, so that the numbers attending each session are now slightly above pre-war figures. I believe that I am correct in stating that the milder and less important disabilities detected at the Welfare and School Clinics often have to wait quite a considerable time before obtaining an appointment at the Orthopaedic Clinic. This is, of course, not a desirable state of affairs, but it can only be solved by increasing the number of surgeon's sessions to the pre-war figure of two per month ; and owing to the shortage of staff at this Hospital and the considerable increase in the number of beds under the Emergency Medical Service Scheme, this is quite impossible at the present time. 39 However, as many of the cases referred have minor and often temporary disabilities and sometimes are within normal anatomical and physiological limits, which can show considerable variation, I do not consider that permanent or serious disabilities are being overlooked or caused by the sometimes inevitable delay. (Signed) J. H. CHOLMELEY, F.R.C.S. DENTAL SERVICES. Mr. James H. Glen, School Dental Surgeon, reports for 1943 as follows:— I have much pleasure in submitting to you a report of the work done by the staff of the Dental Department during the year 1943. In the appended tables I have given the customary comparison with the figures for 1942; the comparison is mostly favourable, but, after a somewhat alarming sequence of resignations, new appointments and sickness, it was found to be impossible both to start the new Higher Education Scheme with the inspection of the County Schools and complete the inspection of all the Elementary scholars after the appointment of Mr. Birkhahn on 18th October. However, now that we have 2⅓ Dental Surgeons employed in the scheme, it is expected that we will be able to carry out the programme of inspecting the higher age groups (from 10 years to 16 years) of all classes of schools twice during the coming year. The Consultant Orthodontic Scheme, started early in the year, has been very helpful, and we are indebted to Mr. L. Russel-Marsh, of King's College Hospital, for his acceptance of our difficult cases, his advice on the course of treatment to adopt, and the type of appliance to be provided. The use of appliances of a newer, if more complicated, type has considerably reduced the number of attendances, although the 56 new cases treated is more than last year. Moreover, as these appliances are worn only at night, there is no interference with the child's education. The condition of the children's teeth remains good, and the number of neglected mouths is extremely small. The majority of the 76 per cent. of the children referred for treatment provide mostly small cavities, or perhaps suspicious fissures, which they are advised to have filled immediately. Others are given appointments so that the parents can be advised of our 40 plans for the future treatment of their child throughout the school life. In this way we try to help the parent to understand that there is such a thing as planned dental treatment, and the Clinic is not merely a "repair shop ' provided for the relief of toothache. The present "acceptance rate'" of the "Mothers" is still disappointing. During the last five years an average of only 20 per cent. of the total number of new ante-natal cases have applied for treatment; yet it is quite possible that all of them really require some form of Dental treatment. It is hoped that a greater publicity of the scheme and, if possible, a dental examination as part of the initial medical examination, will produce better results and be of greater benefit to the futu??? generation. I am indebted to all the Head Teachers for their co-operation to the voluntary helpers who so cheerfully assist us, and to the staff of the Clinics who have worked so hard through a difficult year. (Signed) J. H. GLEN, L.D.S STATISTICAL REPORT OF THE VARIOUS DENTAL SCHEMES. Grand Total (all schemes). 1942. 1943. Total attendances 6200 5964 Number discharged 2645 2856 Attendances for Gas Extractions 1311 1492 „ „ Local Extractions 216 246 „ „ Denture Work 109 200 „ „ Orthodontics 688 414 „ „ Other Operations 863 304 Number of Fillings done 2095 3143 „ „ Extractions done 4272 4322 „ „ Dentures fitted 55 57 „ „ Sessions employed 551 664 „ „ Children inspected 4977 4471 (a) Elementary Children—See Board of Education table. (b) Report of the Maternity and Child Welfare Dental Schemes. Mothers. Appointments kept 393 409 Number discharged 81 105 Attendances for Gas Extractions 92 93 Attendances for Local Extractions 38 23 Number of Extractions done 574 600 „ „ Fillings 85 92 „ „ Dentures fitted 52 54 Attendances for Denture work 69 197 Number of Sessions devoted to treatment 48 65 41 (c) Welfare Children. Appointments kept 111 94 Number discharged 92 90 Attendances lor Gas Extractions 69 73 „ „ Local Extractions 14 4 Number of Fillings done 53 12 „ „ Extractions 141 160 „ „ Dressings 12 4 (d) Higher Education Schools. Appointments kept 646 693 Number discharged 216 387 Attendances for Gas Extractions 106 83 Attendance for Local Extractions 25 20 Number of Fillings done 424 613 Number of Extractions 257 197 Orthodontic attendances 44 62 Scaling and Gum treatment attendances 76 107 Root treatments — 14 Referred for X-ray — 16 Number inspected at School — 930 Number requiring treatment — 328 Half-days devoted to treatment — 22 „ „ inspection — 8 REPORT FOR THE BOARD OF EDUCATION, 1943. 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 320 350 421 288 372 385 379 283 268 198 Total 3264 1942. 1943. (b) Special cases 335 297 (c) Total number of children inspected (Routine and Special) 4977 3561 2. Number of children found to require treatment 3264 2327 3. Number of children actually treated 2403 1621 4. Total attendances for treatment 5050 4770 5. Half-days devoted to— (a) Inspections 20 13 (b) Treatment 551 565 571 578 6. Number of Fillings completed in— (a) Permanent Teeth 1550 1798 (b) Temporary Teeth 370 628 1920 2426 7. Number of Extractions:— (a) Permanent Teeth 1411 1171 (b) Temporary Teeth 1899 2194 3310 3365 42 8. Administration of general anaesthetics 1123 1223 9. Other operations—individual cases treated, including— (a) Orthodontic cases—attendances 608 414 (b) Crowns and Inlays 14 16 (c) Space retaining appliances 4 3 (d) Scaling and Gum treatment 503 308 (e) Temporary Teeth—dressings 252 340 (f) Root treatments — 54 (g) Referred for X-ray — 46 SECTION C. Infectious Disease. The following is a summary of returns of infectious diseases from Head Teachers during 1943:— Diphtheria 2 Scarlet Fever 50 Measles 447 German Measles 106 Whooping Cough 50 Mumps 118 Chicken Pox 206 Other Diseases 18 The routine of making these returns has now been modified, so that Head Teachers are no longer required under the Education Committee's regulations to notify cases of school children suffering from notifiable infectious disease. Open Air Education. There is no special open air school for defective children in Bromley. Physically defective and other delicate children are sent from time to time to open air residential schools. Five children at the end of 1943 were receiving this beneficial treatment. The general welfare of the children of the Borough in relation to physical training and recreational activities is in the capable hands of the Physical Training Organisers, Mr. G. H. Atkinson and Miss F. M. Bentley, and has been highly developed. The following report for 1943 indicates the valuable work undertaken by the organisers. 43 STATEMENT ON PHYSICAL EDUCATION FOR THE YEAR 1943. General. As a branch of the teaching service, Physical Education is still in the process of recovery from the effects of the first two years of war. Complete recovery cannot be expected until our specialist teachers return from their various war duties and bring with them the youth and vitality so essential to the progress and development of this subject in the schools. In the few schools where the teaching staffs have been less handicapped by changes and dilution, outstanding progress in the standard of physical training and organised games has been Made; for the rest, the best that can be said is that they have done their best to maintain pre-war standards in spite of trying difficulties. The provision of additional blackout accommodation in the Borough and the decreasing incidents of enemy raids have resulted in a general increase in the number of evening classes in recreative physical training for adolescents and young people. The Education Committee's foresight in providing for this anticipated development by the erection of dual purpose gymnasia for school and post-school use has already been amply justified. Physical Education in Elementary Schools. (a) Physical Exercises. The subject has continued to play an important part in the curricula of all schools, and may claim, with the excellent arrangements for school milk and meals, to contribute in no small measure to the improved nutritional appearance of our school children. The fact that regular and suitable exercise is an important factor in raising the nutritional index of the growing child is often overlooked ; good nutrition depends not only on correct feeding, but also on the ability of the body to make the best use of what food is available to it. In spite of the Education Committee's readiness to ensure supplies of plimsolls for physical training, the Quantities available under trade restrictions are still inadequate to meet the needs of all school children. Restrictions on clothing have also proved a difficulty, as few parents to-day appear willing to give up the necessary coupons for such articles as "gym" shorts and vests, etc. The question of providing suitable clothing for physical exercises is a matter which should now be seriously considered by this Authority, 44 (b) Organised Games. Arrangements for regular weekly visits to the playing fields for organised games have again been continued for all senior schools, but here again the problem of footwear, especially for football and hockey, makes it impossible for children to derive maximum benefits from their instruction. Amongst the senior girls, however, there is a marked improvement in the standard of winter games. (c) Swimming. The Education Committee is fully aware of the importance of swimming in the general scheme of physical education, and would readily support the view that every child should be taught to swim before leaving school. The practicability of conveying children to and from the open air bath is, however, an impossibility under present conditions, and even were this possible, the problem of overcrowding of the bath by the general public and the brevity of the open air swimming season, would still restrict the development of this subject on really sound lines. It has been estimated that not more than one in ten of the elementary school children in this Borough are able to swim one width of a swimming bath, and little improvement can be expected until provision is made for the erection of a closed bath designed for learners only, and available for instruction the whole year round. (d) Dancing. The introduction of the natural movement type of dancing as now termed "Modern Dance," has been a new development during the past year. Experimental work with selected girls' classes has shown that in the hands of suitable teachers, assisted by good pianists, results have more than justified the claims of this branch of physical education to take a prqminent place in all future schemes. (e) School Club Activities. The importance of educating children in habits of good social behaviour and in the wise use of leisure, has lately received wide recognition, and the Education Committee's interest in fostering the development of school clubs has been well repaid. The following are some of the activities which have proved successful as the means of promoting club ideals within our senior schools : Inter-club games and competitions, boxing, and gymnastics, indoor games, e.g., chess, table tennis, etc., field sketching, handicrafts, 45 visits to theatres and other places of interest, "Make do and mend" groups, etc. As a general rule these clubs are managed by the children's own committees, experience in self-management being considered an important feature of social training. (f) Children's Holiday Games Centres. A most successful experiment has been carried out during the year in connection with "Holidays at Home" arrangements. Two games centres were opened during the school holiday periods, when children were invited to attend either as teams or as individuals to play games under the supervision of teacher leaders. The following table of attendance at these centres will indicate the popularity and success of the scheme:— Centre. Period. Total Attendance. Southborough Playing Field (a) 6th-10th Sept 1580 (b) 13th-17th „ Oakley Playing Field „ „ 440 Youth Clubs and Organisations. The development of physical training and recreational activities amongst the youth of this Borough has made good Progress during the year. Increasing demands have been made on the use of the Aylesbury and Raglan Road Schools gymnasia for evening classes, the former being filled to capacity on most evenings of the week. Through the medium of the Sports' Officers' Committees, the Organisers have assisted in arranging inter-unit competitions in Football, Cricket, Tennis, Swimming, Athletics, Netball, etc., for both voluntary clubs and PreService Training Units. As a result of this development, our school playing fields have been extensively used and have Proved most valuable to the organisations concerned. (Signed) GEO. H. ATKINSON. F. M. BENTLEY. District Organisers of Physical Education. Provision of Meals. During 1943 no great changes took place in regard to the provision of meals. A scheme for increasing the facilities to enable 75 per cent. of all children in elementary schools to receive a mid-day meal has been prepared and only awaits the final approval of the Board to enable the necessary work to be put in hand. 46 In this scheme provision is made for a new kitchen and dining hut to be erected for the use of the scholars at Bickley and Widmore C.E. School, and a new kitchen for Plaistow St. Mary's School scholars. The kitchens at Raglan Road and Princes Plain Schools are to be enlarged, and extra cooking equipment will be provided in most of the existing kitchens. It is hoped that the major part of the work will be carried out during 1944. Under existing arrangements the number of children receiving meals steadily increases, and during the year ending the 31st March, 1943, 357,581 meals were served to children. A slight adjustment was made to the Income Scale in March, 1943, which removed certain anomalies which had arisen. Income Scale. Total Income of Parents, less (a) Expenses (rent, rates, insurances, travelling expenses to and from work, and abnormal expenses which should be clearly stated). (b) Living Allowances: Head of household 16/- Wife 10/- All Dependent adults over 16 10/- plus Children over 10, each 6/- 25 per cent. Children under 10, each 5/- The resulting figure referred to as available income to be divided by the number in family. If this resulting figure is less than 1/- free meals should be given: if between 1/- and 2/- at half rate; if more than 2/- full payment should be made. The income of and allowances for earning children living at home should be disregarded. Milk in Schools. By October, 1943, the average number of children receiving milk reached 78.01 per cent., and a return submitted to the Board at that time showed the following figures Number of children receiving milk. One-third Pint. Two-thirds Pint. (a) For full payment 1,184 1,989 (b) At half rate 11 40. (c) Free of charge 87 88 (The charge for one-third pint remains unchanged at ½d.) 47 SECTION D. Exceptional Children in the Area. Residential Schools. Special Day Schools. Elementary Schools. Not at School. Blind 3 — — — Partially Sighted — — — — Deaf and Dumb 2 — — — Partially Deaf — — — — Mentally Defective 10 1 — 3 Epileptic, 1 — — — Physically Defective 4 — 3 1 Maladjusted 1 — — — Backward — — 2 — Twenty-five of the above-mentioned cases were examined by Dr. A. Orgler during the course of the year. The three mentally defectives not at school are classified as imbeciles. Secondary Schools. The facilities offered by our School Health services have been utilised by many Higher Education scholars. Dental treatment for these scholars is fully dealt with by the School Dental Officer in his annual statement, which appears earlier in this Report. The Eye Specialist has examined 58 of these children, and the Orthopaedic Surgeon four children, all of whom received the appropriate treatment through the services. Parents' Payments. Health Education. Special Enquiries. No noteworthy changes call for comment under these headings. Nursery Classes. During the year 1943 there has been no important change in the nursery classes in Bromley Schools, namely, at the Valley Infants' Council and Burnt Ash Infants' Council Schools, but arrangements are in hand for the opening of an additional nursery class for children whose mothers are engaged in work of national importance at Burnt Ash Infants' School. It is anticipated that the additional class to accommodate a further fifteen children will be opened about Easter, 1944. The class at this School will be opened during the whole of the year, including school holidays, but excepting public holidays, from 7 a.m. to 7 p.m. weekdays, and 7 a.m. to 1 p.m. on Saturdays. A staff of Child Care Reserve assistants and Probationary Helpers will be engaged. A play centre for children whose mothers are engaged in work of national importance was opened at Raglan Road Council School on 31st May, 1943. It operates during school term time 48 only. It is opened at 7 a.m., and Mr. J. W. Pepper, Head Teacher, Raglan Road Junior Council School, has been appointed Supervisor. The Centre is opened from 7 a.m. to 7 p.m. on school days, and 7 a.m. to 1 p.m. on Saturdays. Similar facilities are available at Burnt Ash Council School, but no applications have been received from parents for the admission of their children. SECTION E. Occupation Centre for the Mentally Defective. No change since my last Report. Employment of Children and Young Persons. The School Medical Officers examined 158 children with regard to employment, as follows:— Number Examined. Fit Certificates Issued. (a) Boys 143 143 (b) Girls 15 14 Boot Club. This activity showed satisfactory results during 1943, and reflects great credit on all those who voluntarily work the scheme in the interests of the children. There were over £600 purchases for the year 1943 in comparison with £520 for the previous year. Many necessitous cases have been submitted to the Bromley Children's Care Committee for consideration for the provision of free footwear and 71 pairs of boots and shoes were provided at a cost of £40 through the assistance of the Bromley Benevolent Association. A tribute is due to the seven firms co-operating in the scheme on a discount basis, of 10 per cent. in some cases, and 5 per cent. in others, having regard to war-time difficulties of supply shortage in children's footwear and increased working costs. Bromley Children's Care Committee. Miss M. A. Isard, Honorary Secretary, in addition to assistance given to the Boot Club, has been most helpful in all the cases referred through the School Medical Service. SECTION F. Appendix of Statistical Tables. The pre-war statistical tables required by the Board of Education have been compiled and are available for reference but are not re-produced here. Extracts from these statistics are referred to under the various appropriate headings of this Report.