AC 4412(1) BROMLEY BRO 40 Borough of Bromley 1944 ANNUAL REPORT MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER FOR OFFICAL USE ONLY BROMLEY, KENT. Promley Office Supplies & Printing Co., Ltd., 46, East Street. 2 PUBLIC HEALTH STAFF, 1944. The more important staff changes during 1944 are as fol lows:— Health Visitor Miss F. L. Gray (Appointed 6.12.44) Unestablished or temporary staff. Assistant Rodent Officer Mr. J. C. Dunn (Appointed 5.6.44) Midwife Mrs. B. E. Foster (Appointed 5.2.44) WAR-TIME NURSERIES. Elmfield Road Nursery. No Change. " Draycott" Nursery. Deputy Matron Miss I. Rogers (Appointed 6.10.44 on the resignation of Mrs. E. M. Hood) Nursery Nurse Miss P. Cramer (Appointed 6.10.44 on the resignstion of Miss I. Rogers) 3 INTRODUCTION. This is my 20th Annual Report to you as your Medical Crticer of Health and School Medical Officer, and the sixth report during the war years. In comparing this report with previous years, and especially the statistics, due consideration must be given to the fact that 1944 was in Bromley a year of intensive enemy activity, causing Bromley to evacuate officially some 3,000 of its children. In spite of this, the clinics and centres, the midwifery service, the child welfare service and public health activity continued their everyday functions, and the general public continued to use the department at the pre-war level. This is a pleasing indication, not only of the value and trust the public place upon these services, but also of the stoicism of the people of Bromley who, for six long years, played their great part in the victory which is ours to-day. From the departmental viewpoint, with the tar-time changes and shortage of staff, and the extra duties Placed upon the department in its war activities, the task has indeed been heavy, and one that could not have been successfully accomplished but for the application and untiring effort of the professional and clerical staffs. All praise is due to them, and I take this opportunity to bring it to your notice. While I have no absolute figures of sickness among the public during these tiring years, one has the belief that, in spite °f war-time environment, the sickness rate has not been unduly increased. We have the statistical fact that in the case of school children the physique has actually improved. The infectious diseases rates have continued below the average, the Birth rate has increased and the Death rate remained low. Within the report I have enlarged upon infant death rates, indicating that much research and valuable work remains to be done, especially '"that period of the beginning of life. There is a need within 'he deoartment of a skilled statistician, not only in the correlation of facts but in the sorting of essential and non-essential research into the causation of these early deaths. For the past 20 years we have concentrated upon the improvement of the health and environment of the individual, with. I believe, some success, but with changing thought more and more important comes the need to treat the family as the unit, for it is upon the inter-reactions within the family that the welfare of the individual depends. The building up of a family record has become of prime importance within the Health Apartment, and a start has been made in this direction. I 4 believe that any change in administration that would split the school medical service from the Maternity and Child Welfare service and each or both from the service known as environmental hygiene, can but lead to non-efficient work. One can visualise in this cleavage the break-up of twenty years successful effort in co-ordinating all three services. There is to-day an ever growing tendency to plan and control other people's lives and their social activities, yet history has shown us that progressive evolution depends very largely on the effort of the individual to give of his or her utmost endeavour to self-help. There exists, even in Bromley, families who, either through low mental quotient or through wilful negligence, do not respond to advice or teaching, but run counter to all tenets of health or fail lamentably in self-help Perhaps we shall have such problem families always with us: if so, the juvenile courts will have much work still ahead of them, and any progress in fulfilling the purpose of our people will be frustrated. This problem family is just one of our tasks The immediate future is clamant for results in one direction only, and unless fulfilled, all other activities will be fruitless. This problem is housing—the ultimate answer of a home for each family, a home where the newly-married can begin to establish the family of the future. It is well to talk and consider community centres, guidance councils, nursery schools and day nurseries, and many other essential social activities. But the first task to-day is a house for each family, a task which requires the whole energy and thought of every committee and every sound citizen. Only when this problem is solved can we apply our attention to the planning of future local government and future social services, or expect any lasting good from our present day efforts towards Health. Finally, I can but tender thanks to the various committees for the trust and help given me throughout these years, and to the staff who have given long and faithful service in their endeavour to promote the wellbeing of the children of Bromley I am, Your obedient servant, K. E. TAPPER. July, 1945, Medical Officer of Health 5 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA, 1944. Statistics. Area (in acres) Registrar General's estimate of resident population mid-year 1944 No. of inhabited houses according to the rate books at the close of the year 1944 No. of valuation assessments of habitable premises at the close of the year 1944 : (a) Bromley (old (b) Hayes & Bromley area) Keston Houses 12,513 2,663 Flats 1,426 74 Farmhouses 13 1 Public Houses 33 5 13,985 Rateable Value (31.3.1945) 2,743 6,519 49,730 16,325 16,728 £694,810 Product of a Penny Rate (Year ending (31.3.46) £2,760 Vital Statistics. Live Births: Legitimate Illegitimate Total Male Female 755 354 401 65 30 35 820 384 436 Birth rate per 1,000 of the estimated resident population : 16.5 Stillbirths: Legitimate "legitimate Total Male Female 19 10 9 1 1 — 20 11 9 Stillbirth Rate per 1,000 (live and still) births : 23.8 6 Deaths: Total Male Female From all causes 661 326 335 Rate per 1,000 estimated resident civilian population: 13.3 Deaths from Puerperal Causes : Puerperal Sepsis—NIL. Other Puerperal Causes—NIL. Deaths of Infants under 1 year of age: Total Male Female Legitimate 24 10 14 Illegitimate 8 4 4 32 14 18 Rate per 1,000 livebirths : 39.02 Death Rate of Infants under 1 year of age : All infants per 1,000 live births 39.02 Legitimate infants per 1,000 legitimate births 31.78 Illegitimate infants per 1,000 illegitimate live births 123.07 Deaths from: Cancer (all ages) .122 Measles (all ages) Whooping Cough (all ages) 1 Diarrhoea (under 21 years of age) 5 Meteorology. The Borough Engineer has kindly supplied the following details from the records of his Department:— Annual rainfall 21.17 inches Mean maximum daily temperature 58° F. Mean minimum daily temperature 43° F. Highest maximum temperature 900 F. on 6.3.44 Lowest minimum temperature 23° F. on 6.3.44 and 25.12.44 Lowest grass temperature recorded 190 F. on 15.3.44 7 Population. The Registrar General gives 49,730 as the estimated resident civilian population for mid-year 1944, which gives us the basis for calculating vital and disease rates in this Report. One must take into consideration the dispersal of population for national service and evacuation when comparing this much depleted figure with previous years. I would suggest that the population under normal conditions would be approximately 62,000. Taking the average number of persons per house, as ascertained in our housing survey of ten years ago, in conjunction with the number of assessment of habitable houses, or the excess of births over deaths since the outbreak of war, each method is productive of an approximate Population figure of 62,000. Births. The Birth Rate for 1944 is 16.5 per 1,000 per population, compared with 17.5 for 1943. The Registrar General's figure for 1944 is 820 live births and 20 stillbirths, after adjustment by transferable registrations. Many confinements took place during 1944 in safer areas, either under the Government Evacuation Scheme for expectant mothers or through private arrangements made by mothers themselves. This dispersal occasioned some difficulty in arriving at a figure for the year. At the end of January, 1945, we were able to calculate for official annual return after adjustment by inward and outward transferable notifications a total of 843 notified births, of which 826 were live and 17 stillbirths, but it is doubtful if the interchange of information between ties warding transferable births pursued a consistent routine, as it may remarked that subsequently further inward transferble births which filtered through to us through various nannels of information, increased the total to 879 (861 live and 18 still births). 8 We must, however, take the Registrar General's total of 820 births as the stabilised total for statistical calculations. Comparative birth rates based on the civilian population:— Bromley England & Great Towns (incl. Smaller Towns London Wales London) 25,000-50,000 pop. County Live Births : 16.5 17.6 20.3 20 9 ' 15.0 Stillbirths : 0.40 0.50 0.64 0.61 0.42 Deaths. The Death Rate for 1944 is 13.3 per 1,000 population compared with 11.7 for 1943. But when one considers the evacuation of some 3,000 of the young population, the calculation of the rate in the higher aged population left in the district will give a higher figure than usual. The total of deaths for 1944 is 661 compared with 604 for 1943. Bromley's Death Rate, based on 49,730 population, given in comparison with the rest of the country :— Bromley England & Great Towns (incl. Smaller Towns London Wales London) 25,000-50,000 pop. County 13.3 11.6 13.7 12.4 15.7 Main death causes in Bromley during 1944 compare with the preceding four years as follows :— 1944 1943 1942 1941 1940 Heart disease 182 161 139 170 207 Cancer 122 93 113 123 97 Respiratory (non-tuberculosis) 60 77 57 93 85 Tuberculosis 21 30 33 34 2 Infantile Mortality. Of the 32 infants' deaths that occurred in 1944, 11 died locally and 21 were inward transfers. Twenty-four of t ese cases died in institutions. Of these 32 deaths, 18 died in the first week of life and 14 between the first week and 12 months The continued low rate, in spite of yearly variation, infantile mortality, not only in Bromley but in the country a 9 a whole, is a pleasing statistical fact to all those active in the field of preventive medicine. In the last twenty years in Bromley the infant mortality rate from a five yearly average has fallen from 44 per 1,000 live births to 28. In my first annual report to you, when the infant mortality rate was 57 per 1,000 births, I stated that " no less than 50 per cent, of the baby deaths occurring were during the first month of life, 26 per cent, of baby deaths were under one week of age, and if we are to save a needless waste of life, intensive ante-natal work is essential." "We know that an infantile mortality rate of 30 is not an unachievable objective." Let us take, after twenty years, these two statements and compare with conditions as they exist today. Taking the last first, the objective has been attained, and in fact has been in some years surpassed : but the first remains much as it was, and this in spite of intensive ante-natal work and efficient midwifery service. The rate of deaths under one week of age has remained very much the same, while there has been an actual increase in the percentage dying in the first month of life It means that the present saving of life operates after the second week of life—a period of the life of a baby when it comes into active association with the child welfare services. These are statistical facts applicable not only to Bromley but to the whole country. Is there anything the matter with the maternity services, the care of the mother during pregnancy, the care of the mother and baby during confinement? The reduction in maternal mortality is proof that the midwifery service has improved and the provision for her care during the critical period at least adequate and complete. It follows, therefore, that it is mainly during the pregnancy that we fail. Is the mother adequately nourished, or what is it that devitalizes the unborn baby or interferes with a natural function of child bearing? Under our present state of knowledge there is no direct panacea to our troubles. Everything is done for the mother who shows evidence of abnormality during pregnancy, and until we know the actual causes of the accidents of pregnancy, or prematurity and of stillbirths, we shall not be able to reduce the stillbirth rate, or baby mortality in the first week of life. A post-mortem on all such deaths might bring to light something unknown to us at present. 10 The present system of recording infantile mortality rates is based on live births, whereas a truer state would be given if based on pregnancy, and it is on this basis that I record the following statistics. It is not possible, however, to include all pregnancies, as no true record of miscarriages or abortions exists. 1926- 1931- 1936- 1930 1935 1940 1941 1942 1943 1944 Confinements 3090 3383 4072 691 897 923 840 Stillbirths 76 99 127 20 26 22 20 Died—1st week 51 56 69 7 19 15 18 Died between 1st week and 1 year 83 70 77 11 10 10 14 Survivors at year's end 2880 3158 3779 653 842 876 788 Based on these figures, the true infantile mortality rate per 1,000 pregnancies (excluding miscarriages and abortions) and compared with the official infantile mortality rate based on 1,000 live births is as follows :— 1926- 1931- 1936- 1930 1935 1940 1941 1942 1943 1944 Per 1,000 pregnancies 68 66 67 55 61 51 62 Per 1,000 live births 44 38 37 28 33 27 39 Rate per 1,000 pregnancies : Stillbirth 25 2 9 31 29 29 24 24 Died in 1st week 16 16 17 10 21 16 21.5 Died 1st week to 1 year 27 21 19 16 11 11 I65 Based on these figures the true infantile mortality rate per 1,000 pregnancies (excluding miscarriages and abortions) com pared with the official infantile mortality rate based on 1,000 live births, is shown in the graph on opposite page. Maternal Mortality. Again it is pleasing to report that for the second year running we have no maternal deaths in Bromley mothers, immediate previous years gave a maternal mortality rate of 3.3 per 1,000 live mothers, 12 SECTION B (I). GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA (a) Civil Ambulance Service. A brief summary of the work of the Civil Ambulant Service during 1944 is as follows:— Total No. of cases conveyed : 1188 (a) Private 902 (b) Police 286 Total mileage travelled : 8346 (a) Private 7171 (b) Police 1175 Petrol consumption : Gals. No. 1 Ambulance 479 No. 2 Ambulance 283 762 There are no changes or important developments to record in the following services during 1944 (b) Laboratory Service. (c) Nursing in the Home. (d) Treatment Centres and Clinics providcc by the Lora Authority. (e) Tuberculosis Dispensary. (f) Venereal Diseases and Treatment Centres. (g) Hospitals, Public and Voluntary. For reports on the above, reference should be made to previous reports. PUBLIC HEALTH ACT, 1936. SECTIONS 187/195. Nursing Homes. There were 7 nursing homes on the register at the end of the year 1944. These homes provide a total of 95 beds, (a) 40 for maternity patients, and (b) 55 for other types of cases. 11 routine inspections were made during the year by Dr. G, H, Stinson, Assistant Medical Officer of Health. i3 SECTION B (II). MATERNITY AND CHILD WELFARE. NATAL SERVICES. Municipal Midwifery Service. Throughout the war it was the proud achievement of the municipal midwives that no mother at her confinement lacked their prompt attention at any hour of the day or night, no matter that danger had to be faced, and attendance at confinements n shelters also operated. During the second half of 1944, owing to fly bomb activity, mothers were evacuated under the Government scheme to quieter areas for confinements, and many others went away from the district for the lying-in period during this disquieting time. The local Maternity Hospital moved to Yorkshire during this time, and we were able to loan the services of one midwife the Hospital for six months. The normal routine work of the midwives was thus somewhat disturbed, but the following comparative table of statistics shows little cesation in the work of the year :— Year Total of bookings Confinements Hospital Visiting 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 1944 598 242 284 2784 3572 Domiciliary Medical Practitioner Service. No. of Medical examinations :— Ante-natal 25 Post-natal 20 An increase in this service is not to be expected until more doctors are released from National Service. Ante-natal Clinic. (a) No. of sessions, Doctor in attendance 58 (b) New cases seen by Doctor 376 (c) Total of all Medical Examinations cluding (a)] 835 14 (d) No. of sessions, midwives in attendance 52 (e) New eases seen by midwife . 151 (f) Total of all midwives' examinations cluding (e)] 483 All cases seen by midwives at the Ante-Natal Clinics have either been examined by the doctor or referred to the doctor at least once. Dental Scheme for Nursing and Expectant Mothers. The following figures are reprinted from the Senior Dental Officer's annual report for 1944 :— Mothers. Appointments kept 378 Number discharged, treatment complete 46 Attendances for gas extractions 65 Attendances for local extractions 28 Extractions 319 Fillings Dentures fitted 49 Attendances for denture work 141 No. of sessions held 78,5/6 Administration of Midwives' Acts, 1902-1936. No. of midwives practising in the area at the end of 1944 20 No. of confinements attended :— Domiciliary Institutional Tota. (a) As midwives 201 247 448 (b) As maternity nurses 41 311 352 242 558 800 Number of cases in which medical aid was summoned during the year under Sec. 14 (1) Midwives Act, 1918, by a midwife (a) For domiciliary cases 37 (b) For cases in institutions — Note.—Cases in the Maternity Hospital are medically super vised, and are not included under (b). 15 Maternity Hospital Provision. 284 were admitted through the Municipal Midwifery Service to the County Hospital, Farnborough, during 1944. Shortage of housing accommodation and home help attention are both factors in this large increase in hospital admissions, which is the highest figure recorded since the inception of the Midwifery Service. There would appear to be no immediate prospect of the demand for hospitalisation diminishing during the next few years ; in fact, the public, having acquired by custom the practice of hospital treatment, may tend to become more and more institutionally-minded, so that domiciliary confinements may well find less favour. The Bromley and Chislehurst Maternity Hospital admitted 249 cases for confinement, of whom 202 were delivered by midwives and 47 y doctors. In addition, 19 women were admitted for treatment in the ante-natal period. Three cases of puerperal Pyrexia were notified from the Hospital; six stillbirths were notified, and one infant death occurred within ten days of birth. Puerperal Pyi xia. Six cases were notified within the area during 1944, and no deaths occurred. fare of Prem. ure Infants. The Advisory Committee on the Welfare of Mothers and Young Children set up by the Minister of Health was requested to examine the question of the care of the premature infant in view of its importance in the matter of neo-mortality. The recommendations of the Committee were brought to the notice of welfare authorities, and, as far as practicable under Present conditions, steps have been taken in the area to implemet the Minister's wishes. Information as to weight at birth of 5½ lbs. or less is notified and immediate visit of inquiry is .made by the health visitor, such cases importance is attached to a separate bedroom for mother and infant; the provision of adequate and suitable equipment in the home; a supply of expressed breast milk where necessary; the services of a paediatrician ; the particular attention to the infants by midwives and health visitors, and home help service where needed. Institutional care is available through the County Hospital, and suitable transport for conveyance of these infants is available through the Civil Ambulance Service. 16 POST-NATAL SERVICES. Health Visitors: Home Visiting. 6,316 visits were made during 1944, a decrease of 1,200 compared with the previous year, due to vacancies on the health visiting staff, and evacuation of children during the fly bomb attacks. 73 per cent, of births received a primary visit within three weeks of birth, and an average of three visits to infants under one year of age was accomplished during 1944. All visits in 1944 are tabulated as follows Primary visits under one year of age 606 Revisits under one year 1,251 Revisits one to five years 2,613 Expectant mothers (special) School children 300 Infant deaths (special enquiries) 2 Immunisation 221 Miscellaneous 240 5,257 " Ineffectual" visits 1,059 6,316 Visits to Boarded-out children (included above 38 Special visits to children for adoption (included above) 36 16.3 per cent. of visits were classified as "ineffectual," which is precisely the same figure as recorded for 1943. It is now opportune to place on record an appreciation of the unremitting devotion to duty displayed by the health visitors during the many dangers of the past six years. Their normal duties were carried out regardless of danger, and in addition their skilled work for casualties at the first aid posts was of inestimable value. 17 Welfare Centres. At the end of 1944 six welfare centres sessions were in operation ; the weekly session at Southborough was merged with the Widmore Centre at Whitehall First Aid Post owing to war damage to Ray's Hall, Southborough. With the enthusiastic and valuable help of the voluntary workers, the essential work of the centres was carried on, but attendances suffered owing to evacuation. Figures for 1944, in comparison with those of the past five years, are as follows :— 1944 1943 1942 1941 1940 1939 Total No. of babies on register 3199 3080 2521 3885 3671 3389 Total attendances of babies 14550 21665 20071 15989 20433 25993 Total of Medical examinations 3175 4451 4247 2793 3085 3535 Total No. of weighings 13324 19695 17974 14583 18353 22899 The returns were lowest during 1941 and 1944 when, it will be remembered, enemy air activity reached intensive phases. Child Life Protection. 38 routine visits were made to boarded-out children during 1944. Further contacts are made with the children at the Welfare Centres where those under 5 years attend, and those at School are seen from time to time at the school clinics. At the end of 1944 there were 20 individual foster mothers °n the register, and 25 children under 9 years registered as boarded-out. The question of the Welfare Authority guaranteeing payment of a foster mother has not yet arisen for con- sideration in any case. There is need for the closest possible co-ordination between the various authorities responsible for the boarding-out and adoption of young children, the Juvenile Court, the Public Assistance, the Education Authority and the Maternity and Child Welfare Authority. 18 Care of Illegitimate Infants. The care of illegitimate child and the mother falls into three categories: (a) Ante-natal care; (b) lying-in period; and (c) Post-natal welfare. We are able in this area to provide adequately for (a) and (b) through existing maternity and child welfare services, which maintain a close liaison with the Voluntary Society working for the care of these infants and mothers. The Welfare Authority contributes towards the maintenance of cases in the Society's Homes, but not to the maintenance cost of the Homes. The post-natal care presents most difficulties, because it concerns the rehabilitation of the mother with her child towards normal conditions of citizenship. The after-care of the child is exercised satisfactorily under the following methods of disposal, viz.:— 1. The child remaining with the mother or relatives. 2. The mother, with child, being received into residential employment. 3. The mother engaging in daily employment and the child being cared for in a day nursery. 4. The child being admitted to a residential nursery. 5. Boarding-out with a foster mother, or at a " Foster home with mother. 6. Adoption of child. Under (1) and (2) the Health Visitor supervises; (3) provides a day-time supervision ; and (4), of course, continuous supervision operates. The Kent County Council make provision for residential nursery, and Bromley children may be accepted who would be paid for on a weekly basis. Under (5) the selection and approval of foster mothers functions under the Health Visitor, with the guarantee of payment to the foster mother. The establishment of the projected " Foster " home in Bromley will be a provision of the utmost value in after care of these children. Under (6) adoption is regulated by statute, and is linked with the services of Maternity and Child Welfare. Viewing the supervision of the boarded-out child and adopted child as a whole, it would appear as if the time were 19 ripe for consolidation and clarification of the various acts and regulations governing these children, and the present age limit of 9 years under the Child Life Protection provision of the Public Health Act, 1936, could, I believe, with advantage, be advanced to school leaving age in order to maintain sequence of supervision. Adoption of Children. During the year under review three persons gave notice of the placing of three children under 9 years of age for the ultimate purpose of adoption. There were at the end of the year five such children under our direct supervision. There we thirty children legally adopted during 1944, which were under the supervision of the Education Authority. Clinic Treatment of Children under 5 years. Treatments in 1944 :— Eye Clinic 42 Minor Ailments 74 Orthopaedic Clinic 92 Dental Clinic. Appointments kept 55 Fillings completed 32 Discharged — treatment Extractions completed 18 complete 14 Dressings completed 10 Extractions under gas 18 The importance of an adequate dental service for the under five years is becoming more than ever evident. War-Time Nurseries. Elmfield Road Nursery.—The Matron reports as follows :— The Nursery year has been very successful, notwithstanding the difficulties arising through enemy air activities. The beginning of the year was marked by good attendances in both sections of the nursery. With the first flying bombs the attendances popped, but not so drastically as would have been expected. From 15th June to the 5th September twenty-three were evacuated under the Government scheme, mostly with their mothers, but some went with organised parties. Of these children 10 returned at various times. The places of the rest were filled by children from the long waiting list. Between the 20 foregoing dates, when enemy activity was at its height, there were only three days, exclusive of Saturdays, when the attendance was under 20 children. It was 17 and 19 for those days. The enjoyment of the children during the summer was considerably curtailed by the frequent necessity of going into the shelter and sleeping them there. They lost many hours fresh air and sunlight, but this lack did not result in ill-health during the winter as might have been expected. During the summer and autumn the nursery had a few cases of whooping cough. They were spread over a long period, beginning in June and ending mid-November. This was the only infectious disease of the year. At the present time the Nursery is running to capacity with a growing waiting list which dates from September, consisting of 7 children under 2 years and 11 over 2 years. Draycott Nursery.—The Matron reports as follows:—At the beginning of the year 1944 there were 45 children on the books, and by the end of March numbers had increased to full capacity—60. Apart from absences due to colds and influenza during the winter months, attendances were good until the beginning of June when we had epidemics of measles, German measles and whooping cough. The fly-bomb campaign began mid-June, and two-thirds of our children were evacuated with their mothers. Until the end of August, Nursery routine was carried on in the shelters with brief intervals between the sirens when the children were able to play in the garden. They quickly learnt their air-raid drill and were never frightened at any time. It was found that a gramophone playing records of nursery rhymes drowned the less pleasant sounds outside. In August one of the students took her Nursery Nurses Diploma, obtaining distinctions, and another student was successful in November. The sand-pit was constructed during the autumn, to the great delight of the children, and will be a popular feature during the coming season. The Deputv Matron, Mrs. E. M. Hood, resigned in October to take a further course of study, and she was succeeded bv Miss I. Rogers, one of our Nursery Nurses. In spite of t e interruptions in our normal routine throughout the summer, the work in the Nursery made good progress. The children have made good all-round progress, physically, mentally an socially. 21 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. Iam indebted to the Director of Water Examination of the Metropoiitan Water Board for the following information regarding the supply of water to the Borough during 1944 :— "The main supply to Bromley is a mixture of water from Shortlands Well and filtered Thames water. Occasionally part of the supply is derived from Eynsford and Bexley, West Wickham and Orpington Wells. All the water is chlorinated as it leaves the works. "Bacteriological analyses are made five times per week of all supplies at the works, and consistently satisfactory results have been obtained. In the case of the river derived supply, the water is tested bacteriologically at all stages of purification, but with regard to the well waters, owing to the conditions of treatment, only Bexley water can be tested before chlorination. All new and repaired mains are chlorinated before being restored to use, and samples of water from them are tested wteriologically. "None of the supplies is plumbo-solvent. We have no information with regard to the proportion of the total number of dwelling houses in Bromley which are supplied by the Board, but of these all are supplied direct and not by means of standpipes. "Appended are the average results of the chemical and bacterolgical analyses of the various supplies." Bacteriological Results—January-December, 1944. No. of Bact. coli Colonies on agar Samples. neg in 100 ml. 24 hrs. at 37° C. per 100 ml. Shortlands 251 100% 0 Eynsford 306 100 0 Bexley 157 100 0 West Wickham 185 100 0 Orpington 252 100 0 Thames filtered Water 248 99.6% 0.01 (Walton Works) 22 Results of the Chemical Examination of 1944, January-December. Parts per million (unless otherwise stated). Shortlands Eynsford Bexley West OrpWickham ington Thames filtered water (Walton Works) Samples 3 3 3 6 2 Ammoniacal Nitrogen .006 .015 .012 .019 .018 .161 Albuminoid Nitrogen .017 .017 .017 .014 .018 .112 Oxidised Nitrogen 5.0 3.5 4.7 5.0 6.1 3.7 Chlorides as CI. 20.3 15.1 17.2 14.1 16.0 31.7 Oxygen abs. from Permanganate 5 mins. at 80° F .13 .03 .06 .08 .14 1.31 Turbidity, in terms of Silica 0.6 Colour, m.m. brown, 2ft. tube Burgess's Tintometer 2 0 0 0 0 21 Hardness (Total) 261 252 283 257 268 205 Hardness (Permanent) 94 59 69 57 62 62 7.4 pH Value 7.1 7.3 7.2 7.1 7.2 Cond. 475 433 467 429 475 450 Cesspools. Refuse Collection and Disposal. Drainage. Rivers and Streams. There are no special comments to make under the foui headings above. SANITARY INSPECTION OF THE AREA. Work carried out by the Sanitary Inspectors during 1944 is indicated in the following figures :— No. of Inspections Nuisances and Defects Type of Inspection On Complaint Routine Re Visits Total No. of Inspections Found Remedied Housing 704 170 1816 2690 861 873 Infectious Disease — 175 11 186 — – Disinfections — 61 4 65 — – Food Shops 2 2177 10 2189 34 32 Factories 7 176 121 304 101 101 Sampling 1 234 21 256 — — Trade premises (various) 129 263 857 1249 290 302 Miscellaneous 14 1571 37 1622 11 10 Total 857 4827 2877 8561 1297 1318 The excess of defects remedied over defects found is accounted for by the carry-over of outstanding defects from the previous year. i 3 Notices Issued. Preliminary—Housing 504 Others 385 889 Statutory Nil Food Condemnation Certificates issued, 825 Factories. Written Factory Premises. Inspections. Notices. (a) With mechanical power 85 17 (b) Without mechanical power 24 4 (c) Other premises 195 16 304 37 Number of defects found 101, and subsequently remedied. Shops Acts, 1912/1936. Some 2,189 visits of inspection were made to all types of shops during the year, not specifically for the purposes of the Shops Acts, but covering a variety of routine inspection work including the provisions of the Shops Acts. Few contraventions were encountered, but in 3 instances there was absence of statutory forms, and in one instance the temperature did not meet the requirements of the Shops Acts. Smoke Abatement. No special action to record. Swimming Baths and Pools. No special action to record. Verminous Houses. 101 visits were made by the inspectors in connection with verminous conditions and disinfestation arrangements. Regarding the Council's Housing Estates, the Property Manager states that there has been little cause for disinfestation during 1944, and action taken has been along the lines indicated in last year's Report. Uncleanliness and Scabies. The routine of instruction, inspection and treatment for uncleanliness has received the closest attention during the year, It was found that a considerable number of children returned from reception areas after evacuation with verminous heads, scabies and impetigo. Of 2,914 children examined before evacuation, less than 1% showed evidence of uncleanliness, but energetic measures to restore cleanly conditions were pursued thrugh the school clinics, and once again we are very free of skin troubles. 24 Under the School Medical Service the school nurses during 1944 made 9,554 examinations of children for verminous conditions, and of this number 135 individual children were discovered unclean on 144 occasions, some cases being recurrent during the year. Of this number 83 were classified as highly verminous and excluded from school attendance and 61 slightly verminous. No legal action became necessary to deal with recalcitrant cases under the School Attendance Byelaws. Suitable combs and preparations for dealing with verminous heads are available at the School Clinics. Scabies and Impetigo. Scabies is not notifiable in Bromley. Medical inspections by the School Medical Officers and treatments given are shown in the following figures during 1944 Inspectioils. Total No. of Treatments. Requiring Treatment. Requiring Observation. At School Clinics. Home, or own Doctor. Scabies 83 3 63 20 Impetigo 51 1 57 — Other skin trouble 272 7 225 47 The excess of treatments of impetigo over inspections is a carry-over of treatments from the previous year. The health visitors exercise continuous supervision of infected cases, not only at clinics and welfare centres, but also in the homes, and so ensure success of the treatment given. Badly infected cases and patients not yielding to treatment are admitted to the County Hospital, Farnborough. Rats and Mice Destruction. An Assistant Rodent Officer was appointed in June, 1944. in order that the Department might better cope with the measures of rodent destruction under the provisions of the Infestation Order. 1.943. The following is a brief summary of visits made by the Sanitary Inspectors and the Assistant Rodent Officer during 1944 :— Total No. of Visits. Infestations located, during 1944. Infestations abated. Trade Premises 755 91 98 Private Premises 2266 194 204 3021 285 302 The abatements include a carry-over of outstanding cases of infestations from previous year. Legal Proceedings. No Court proceedings were instituted under the foregoing headings of this Section of the Report. 25 . SECTION D. HOUSING. Housing Statistics for the Year 1914. Total number of inhabited houses at end 1944 (according to the rate books) 16325 Number of houses erected during 1944 : (a) by Private Enterprise — (b) by Local Authorities — 1. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 830 (b) No. of inspections made for the purpose . 2559 (2) (a) No. of dwelling houses (included under sub head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 — (b) No. of inspections made for the purpose (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub head) found not to be in all respects fit for human habitation 797 2. Remedy of defects during the year without Service of Formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by the Local 3. Authority or their Officers 504 Action under Statutory Powers during the year. The foregoing figures are amplified in the following tion:- Total Nuisances and Defects Complaint. Routine. Reinspections. Inspections. Found. Remedied. 704 170 1816 2690 861 873 Of 874 inspected, 687 were for general housing defects, (33 were not confirmed), 1 for overcrowding (not confirmed), 28 for verminous conditions (12 not confirmed), 5 for dirty conditions, 1 for cesspool nuisance, 6 for disinfestation, 3 for noxious accumulations, and 143 for special environmental inspections, 861 defects were recorded as a result of these inspections. and 873 were abated during the year, which includes outstanding from previous year. Of defects abated 188 concerned drainage, 145 dampness, 52 water supply, 51 rooms cleansed, 23 light and ventilation improved, 69 plastering repaired or renewed, 76 floors repaired, 69 windows repaired, 80 dustbins provided, and 120 miscellaneous items. 26 SECTION E. Inspection and Supervision of Foods. Milk Supply. 100 inspections of registered dairy premises were made in 1944, and 6 instances of unsatisfactory conditions were remedied Licences have been issued for graded milks under the Milk (Special Designations) Regulations, 1936-1943, as follows:— Pasteurisers' Licence 1 Licences. Dealers Supplementary "Pasteurised" 12 4 "Tuberculin Tested" 6 4 18 8 samples taken by the Sanitary Inspectors and submitted for examination:— Ordinary milk, bacteriological test 6 Graded „ „ „ 27 Phosphatase test 16 Tuberculin 5 Methylene Blue 4 Milk bottles tested 3 Samples of milk taken under the Food and Drugs Act: appear in the following tabulation Food and Drug's Act. Samples taken during 1944, and results, are shown in the following table:— Formal. Informal. Adulterated or Irregularity. Apple Juice – 1 – Aspirin – 1 – Baking Powder – 4 – Boric Ointment – 2 – Butter 2 1 – Beef Aspic Jelly – 1 – Bicarbonate of Soda – 1 – Bunflower – 1 – Barlova – 1 – Biscuit Mixture – 2 – Bismuthated Magnesia – 1 – Castor Oil – 3 – Cough and Cold Mixtures – 4 – Cinnamon – 2 – Coffee – 1 – Cocoa – 5 – Curry Paste – 1 – 27  Formal. Informal. Adulterated or Irregularity. Cod Liver Oil in Chocolate – 1 – Chocolate Powder – 1 – Chocolate Pudding Powder – 1 – Compound Glycerine of Thymol – 1 – Cake & Pudding Mixture – 3 – Cod Liver Oil – 1 – Creamola Pudding – 1 – Dried Egg – 1 – Emulsified Essences – 3 – Epsom Salts – 1 – Far Fol (cereal) – 1 – Food Colouring – 1 – Fruit Sauce – 1 – Green Ginger Wine Essence – 1 – Ginger Wine Essence – 1 – Ground Ginger – 1 4 Gelatine 3 6 1 Gin 1 8 – Glycerine Thymol – 1 – Gravy Powder – 1 – Golden Raising Powder – 1 – Glaubers Salt – 1 – Haricot Beans – 1 – Horseradish Cream – 1 – Jelly – 1 – Junket Powder – 1 – Liquid Paraffin – 1 – Lemon Essence – 1 – Won Linctus – 1 – Lemon Flavour – 1 – Milk 29 1 – Margarine 2 – – Mixed Spice – 1 – Malted Boya Cream – 1 – Nerve Tonic – 1 – Nutmeg – 1 – Orange Quinine Tonic Powder – 1 – Onion, Essence of – 1 – Orange Juice – 1 – Pure Fluid Magnesia – 1 – Pepper – 1 – 28  Formal. Informal. Adulterated or Irregularity. Paste – 1 – Rolled Oats – 2 – Saccharin Tablets – 2 – Sage and Onion Stuffing – 1 – Swiss Roll – 4 – Sauce – 1 – Semolina and Semolina Pudding – 3 – Smoked Herring Butter – 1 – Soup – 1 – Sauces and Pickles – 6 – Soya Flour – 1 – Stuffing – 1 – Tonics 1 2 2 Tincture of Iodine – 2 – Vinegar – 5 – Whisky – 4 – Zinc Ointment – 1 – Total 38 126 7 The following tabulation gives particulars of adulteration or irregularities, and action taken:– Article. Formal. Informal. Adulteration or Irregularity. Action Taken. Powdered Gelatine. Formal. Contained 150 parts of Zinc per million. See subsequent samples taken as follows. „ Informal. Contained 190 parts of Zinc per million. Do. „ „ Contained 400 parts of Zinc per million. Formal sample unobtainable as supply all sold. „ Formal. Contained 165 parts of Zinc per million. No action taken. Remaining stocks had been w i t h d r awn from sale. Gin. Informal. 48.01 degrees under proof. Contained 20% of excess water. Formal sample taken subsequently was. found to be genuine. Malted Tonic. Informal. Contained only 25% of Syrup FerriPhosph. Co. See formal sample below. „ Formal. Contained less than ½ of the amount of Syrup Ferri Phosph. Co. that it was stated to contain. Fined £10 and £3 3s. costs. 29 the County Analyst makes comment as follows: "Different impurities still occur in Gelatine sold as food. Throughout the country many prosecutions have taken place, but although we have determined the amount of the metallic impurities in the samples we have received during the year, we have not had occasion to prosecute any vendor for the sale of gelatine containing excessive amounts of metallic impurities. The presence of excessive quantities of preservative has also received the attention of the laboratory, but this year excessive amounts of preservatives have not been found in gelatines." Meat and Other Foods. The following tabulation gives results of food surrendered as unfit for human food which was directed to be either destroyed, salvaged for animal food, or used for soap making. Certain commodities were recommended to be rendered fit by treatment for human consumDtion 825 Food Condemnation Certificates were issued in connection with the disposal of these foods. Article of Food. Quantity. Approx. weight (in lbs.) Canned meat 495 containers 846 Canned milk, milk powder, raw milk 1254 „ 16284¼ Canned fruit 50 „ 99 Canned fish 889 „ 8094¼ Canned vegetables 1383 „ 1392 Fish 2331 Meat . 6813½ Meat (cooked) 2554 Fats (margarine, butter, lard) 1857¾ Poultry 3244 Rabbits 699 Vegetables 18026¾ Fruit 5467 Flour, flour mixtures 11226 Bread, cake 1898½ Cereals, pearl barley, oatmeal rice 13525¾ Biscuits 330¾ Sugar 2743½ Coffee, tea, cocoa . 1061 containers 522½ Jams, Marmalade, Syrup 929 „ 1162¼ Eggs 168 „ 17 (Total: 33 tons, 5 cwts., 0 qrs., 9½ lbs.) 74489½ 30 This total is greatly in excess of previous years, but abnormal conditions prevailed; enemy aerial activity caused damage to foodstuffs, and there was deterioration of food in many eases through unsatisfactory storage centres for distribution in emergency. That the arrangements for feeding the population throughout the country worked extremely well, few would deny, and in the worst blitzed areas the lack of a meal for anyone within a few hours was a rare occurrence. SECTION F. Prevalence of and Control Over Infectious Disease and Other Diseases. Fortunately there was no excessive causes of sickness or invalidity in the Borough during 1944, and the cases of infectious disease notified involve no special comment. A new form of quarterly return to the Registrar General came into operation in 1944, which provides for the correction of erroneous notifications and subdivides corrected notifications into sex and age groups. The following is a tabulation, based on the new form of return, of infectious disease notifications for 1944, on opposite page. 31 Infectious Disease. Sex and Agre Grouping:. (Civil Papulation Only) Scarlet Fever Diphtheria Whooping Cough Measles Ac???te Poliomyelitis Acute Polioencephalitis Ages M. F. M. F. M. F. M. F. M. F. M. F. 0– – – – – 1 4 2 1 – – – – 1– 2 1 – – 9 9 13 12 – – – – 3– 8 5 – – 11 11 15 16 – – – – 5– 35 30 – 1 17 13 18 26 1 – – – 10– 8 13 2 1 – – 1 5 – – – – 15– 2 6 1 4 – 2 2 3 – – – – 25 & over 1 6 – 1 2 1 1 2 – – – – Age unknown – – – – – 1 – – – – – – Totals 56 61 3 7 40 41 52 65 1 – – – Enteric or Typhoid Fever Para-typhoid Fevers Acute Pneumonia Dysentery Cerebrospinal Fever Acute encephalitis Lethargica Ages M. F. M. F. M. F. M. F. M. F. M. F. 0– – – – – – 2 1 – 1 1 – – 5– – – – – 5 – 1 5 – – – – 15– – – – – 3 – 1 4 – – – – 45– 1 – – – 7 4 – 2 – – – – 65 and over – – – – 5 2 – – – – – – Totals 1 – – – 20 8 3 11 1 1 – – Erysipelas. Small Pox. Other Notifiable Diseases. M. F. M. F. M. F. 0 – – – – Puerperal Pyrexia – 6 5 – – – – Ophthalmia Neonatorum – – 15 – 2 – – 45 2 2 – – 65 plus 1 – – – Totals 3 4 – – Totals – 6 The following tabulation shows infectious disease attack and mortality rates per 1,000 population during the war years 19391944. Scarlet fever has prevailed throughout with a tendency to increase, but mortality is fortunately, except for 1940, absent. Diphtheria lessened in incidence, but the insidious mortality tendencies of this disease does not lessen. The general incidence in intestinal infections, Enteric and Dysentry, has been sporadic. Cerebro Spinal fever reared up in 1940-1941, but has, fortunately, lessened in the successive years. Encephalitis Lethargica, except for 1942 has been absent in the area, but for 1944 we have the anomaly of two deaths occurring from this disease, but no notifications of the disease within the area ; this is accounted for by the cases being Bromley residents contracting the infection and dying outside the district. Acute Poliomyelitis (infantile Paralysis) has shown up sporadically during the period. Whooping Cough and Measles have given us epidemic visitations, and single cases of mortality from the former in 1939. 1943 and 1944. with one death from Measles in 1941 out of 1,563 cases notified during the six years under review. Ophthalmia Neonatorum rates, based on 1,000 live births, have been low in incidence, and all cases during the six years have made good recover; Puerperal infections, calculated per 1,000 live and stillbirths, have decreased in incidence since 1939, and with the exception of the years 1940 and 1941, mortality among patients has lessened. 32 INFECTIOUS DISEASE–WARTIME, 1939-1944 (CIVILIAN ONLY). Attack Rates and Mortality Rates Per 1,000 Population (Registrar General). Estimated Population (Civilian) 60,000 56,580 50,430 50,480 51,300 49,730 Year 1939. 1940. 1941. 1942. 1943. 1944. Attack and Mortality Rates Attack Rate Mortality Rate Attack Rate Mortality Rate Attack Rate Mortality Rate Attack Rate Mortality Rate Attack Rate Mortality Rate Attack Rate Mortality Rate Scarlet Fever 0.83 – 0.86 0.01 2.35 – 2.06 – 3.97 – 2.35 – Diphtheria 0.38 – 0.19 0.01 0.61 0.05 0.29 0.01 0.06 – 0.20 – Enteric 0.01 – 0.08 0.01 0.02 – – – – – 0.02 – Erysipelas 0.13 – 0.30 – 0.25 – 0.33 – 0.31 – 0.14 – Dysentery 0.01 – 0.10 – 0.09 – – – 0.03 – 0.28 – Cerebro-spinal Fever – – 0.22 0.03 0.09 – 0.05 0.04 0.01 – 0.04 – Encephalitis Lethargica – – – – – – 0.01 – – – – 0.04 Acute Poliomyelitis 0.05 – – – 0.05 0.02 – – 0.09 – 0.02 – Whooping Cough 0.05* 0.01 2.48 – 3.15 – 1.08 – 1.83 0.01 1.62 0.02 Measles 0.03* – 0.03 – 12.71 0.02 2.39 – 10.46 – 2.35 – Total comparative rates 1.50 0.01 4.31 0.05 19.45 0.09 6.24 0.05 16.93 0.01 7.03 0.08 Attack Rates and Mortality Rates per 1,000 Births. Ophthalmia Neonatorum 2.4 – 3.7 – 1.49 – – – 3.33 – – – Puerperal Pyrexia 25.3 – 2.58 1.28 10.13 4.68 7.80 – 6.50 – 7.14 – * Made notifiable in the area, November, 1939. 34 Tuberculosis. Recordings in the register during 1944 were as follows:— Respiratory Other . forms. Total No. of cases. M. F. M. F. On register, 1.1.1944 243 215 80 95 633 New cases notified 31 30 3 6 70 Cases re-entered on register – – – – – No. of cases coming to knowledge after death 3 1 – 2 6 Inward Transfers 2 5 – – 7 279 251 83 103 716 Deletions — deaths, removals and recovery 23 17 2 6 48 On register, 31.12.1944 256 234 81 97 668 There has been a net increase of 35 cases in 1944 over the figure for 1943. The total number of cases gives a case rate of 13.4 per 1,000 population. The six cases diagnosed after death as Tubercluosis give a ratio of 1 in 12.6 cases notified. New Cases and Mortality, 1944. New cases notified or otherwise revealed. Deaths. Age. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. Periods M. F. M. F. M. F. M. F. Under 1 – – – – – – – – 1—5 – – 1 1 – – – – 5—15 2 3 1 2 – – – – 15—25 7 14 1 1 2 2 – – 25—35 6 6 – 1 1 1 – 1 35—45 12 6 – 1 1 1 – 45—55 3 2 – – 3 1 2 – 55—65 3 – – 1 2 1 – 2 65 & over 1 – – 1 – – – 1 Totals 34 31 3 8 8 6 3 4 Inward Transfers (not included in above table): Respiratory, M. 2 F. 5 Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health Act, 1936, Section 172. No action required under these enactments during 1944. 35 SECTION G. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. Diseases of Animals. Routine inspections were made as follows: Movement licences, 11; Swine Fever, 16; and interviews, 56. No serious outbreak occurred within the area. Registries for Female Domestic Servants. One complaint was investigated, and the contravention was remedied; otherwise there is no special comments under this heading. Retail Market. During 1944 the monthly average takings was £5 and the weekly £1 2s. 10d., compared with 1938 pre-war, monthly £55, and weekly £12 12s. 0d. Naturally difficulties of transport, operation of rationing and bombing are prime factors in proving these meagre war-time results. As controls relax contons will improve, and in the first six months of 1945 the Monthly average is £6 2s. 0d. and weekly £1 9s. 0d. Petroleum Acts. Total number of licences issued:— (a) for Petroleum Spirit 87 (b) for Carbide of Calcium 1 37 BOROUGH OF BROMLEY ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR 1944 38 INTRODUCTION—SCHOOL MEDICAL SERVICE. This is my 20th Annual Report as your School Medical Officer, and it is again pleasing to note that, in spite of the war years and all the inconvenience caused by the enemy, we have been able to maintain the services to the child at its pre-war level. 1944 was not without its difficulties, not the least of which was the impending changes indicated in the Education Act of that year. It was during 1944 that Bromley became an evacuation area, and the loss of school population is reflected in the statistics for the year ; but, nevertheless, no less than 64% of the children passed through the clinic service provided by the Local Authority, an indirect indication of the value of the services and of trust placed in the School Medical Services by the parents. These facts are pleasing, and reflect much credit to the Committee who have given so much time and thought to the development of the Medical Services throughout the past 20 years. The services were not limited to the elementary school child, but were made available and were used by the child under 5 years and to the necessitous children of the county secondary schools. The development of Dental Treatment during the year is indicated in the text of the School Dental Officer's report, which follows in Section B. 51% of children received meals in School, and 81% milk. Except for the operative treatment at Tonsils and Adenoids Clinic, which was suspended during the war, the appointment of a Consultant Psychologist, which, owing to shortage of medical personnel, has had to be postponed, and the establishment of a special speech clinic, the services for the school child are comprehensive and complete. What has been provided for the school child has been provided for the child of pre-school years. Dr. Orgler has carried his investigation in nutrition of the war years to the intermediate group. This shows that, so far as the boys intermediate group is concerned, there is a progres sive increase in weight and height as compared with the immediate pre-war years. In the case of the girls, their position is stationary, and no deterioration. Finally, should it become necessary under the Education Act for me to pass on the administration of School Medical 39 Service in the future, this may be my last report to you as a School Medical Officer, and in doing so, I would like to take this opportunity of expressing to you the pleasure I have had in the trust placed upon me in the development of the Service during the past 20 years, and to the staff who have given such loyal service. I believe it to have been a good and complete service, and therein lies my consolation. SUMMARY OF STATISTICS. Number of children on the School Roll, excluding children evacuated 3,674 Normal Roll, including evacuated children 4,989 Number of individual children who attended the Medical Clinics:— (a) North Clinic 1,249 (b) South Clinic 1,094 2,343 Number of children medically examined prior to evacuation 2,914 Number of individual children routine medically examined at School in the prescribed age groups 1,269 JNumber of other routine medical examinations Number of special medical examinations and re-inspections at the Clinics:— (a) North Clinic 1,307* (b) South Clinic 3,089 (c) Specialist Clinics 861 5,257 Number of attendances made by children for treatment by School Nurses:— (a) North Clinic 5,821* (b) South Clinic 4,781 10,602 Including figures for the Auxiliary Clinics held at Hayes and Burnt Ash. Number of attendances for treatment at Dental Clinics:— (a) Elementary School Children 2,937 (b) Higher Education Children 1,539 (c) Other Dental Schemes 433 Number of attendances at the Eye Clinic 547 Number of spectacles prescribed 169 Number of attendances at the Orthoptic Clinic 385 40 Number of attendances at the Orthopaedic Clinic:— (a) For Surgeon's consultations 313 (b) For treatments, massage and exercises 1,756 2,069 Number of attendances for Ultra Violet Ray Clinics:— (a) North Clinic 1,365 (b) South Clinic 668 2,033 Staff. Particulars of staff are given at the beginning of this joint report. Co-ordination. The School Medical Service of the Local Education Authority is an integral part of the Public Health and Maternity and Child Welfare Service of the Borough. This policy has been pursued during the past twenty years to the mutual benefit both of the services as a whole and the public who use them. If there is any cleavage in these co-ordinated services resulting from the New Education Act, there will result retrogression in the New Health Services. It cannot be too often stressed that you will not obtain full functioning health unless the medical and mental treatment of the child is associated with improved environment in which the child lives, works and plays. Hygiene of Schools. Owing to the restricted conditions governing labour and materials, it has not been possible to make any major improvements during the year. In the case of one temporary church school, action was taken to raise the existing standard, and a decided improvement has been noted. The principle of a hygienic school environment which we have urged so long as a "sine qua non" of the perfect School Medical Service, bids fair to attain complete fulfilment under the reconstructive proposals envisaged in the new education legislation. In the past 20 years Bromley Education Committee have done much in the establishment of modern school buildings, so that we now have Burnt Ash, Princes Plain, Southborough, Hayes and Aylesbury Road Schools with modern ideas of what school buildings really should be. The remaining old schools in the Borough will be supplanted, let us hope, in the near future. 41 SECTION A. MEDICAL INSPECTIONS. We had hoped to step-up our routine Medical Inspections considerably in 1944, and, in spite of enemy activity during the year, we were still able to improve on the figures for 1943, with a total of 1,404 for 1944, as against 1,241 for 1943. The following statistics reflect a very full year of activity, having regard to the difficult circumstances. Special Medical Inspections and re-inspections totalled 5,257 for 1944, and this figure does not include 2,914 children medically examined prior to evacuation. A large number of these children are still in reception areas, and are, or should be, receiving the normal health attention in those areas. The figures of inspections for 1944 are as follows:— TABLE A. (1) Entrants 785 (2) Second Age Group (intermediates) 207 (3) Third Age Group (leavers) 277 (4) Other Routine Inspections 135 1,404 (5) Special Inspections and re-inspections 4,396 (6) Specialist Inspections 861 (7) Evacuation Inspections 2,914 9,575 Findings at Medical Inspections. Of the 1,269 routine examinations in the three age groups, 237 individual children (18.6 per cent.) were found to require treatment excluding defects of nutrition, uncleanliness and dental diseases) 274 defects were noted for treatment in these children, and in addition 123 suspected defects were marked for further observation. The examining doctors have reported that there is a slight increase in "nervy children," which may be ascribed to the general effect of the war. the following figures enumerate the number of individual children found at Routine Medical Inspections to require treatment:– 42 TABLE B. Age Group. Number Inspected. Defective Vision (excluding squint). Other Conditions. Total Entrants 785 20 114 134 2nd Age Group 207 19 26 45 3rd Age Group 277 14 44 58 Total 1,269 53 184 237 The following table summarises the defects found at routine and special Medical Inspections during 1944:— TABLE C. Defect or Disease. Routine Inspections requiring Special Inspections requiring Treatment. Observation. Treatment. Observation. Skin 15 1 396 10 Eyes 77 16 187 11 Ears 4 2 105 2 Nose & Throat 45 70 302 52 Defective – 1 – – Heart & Circulation 3 13 7 2 Lungs (non-T.B.) – – 54 – Tuberc. Pulmonary Definite – – 1 – Tuberc. Pulmonary Suspected – – 2 – Tuberc., Non-Pulm. – 4 15 – Nervous System 3 4 17 2 Deformities 52 4 15 – Miscellaneous 75 8 844 69 274 123 1945 148 Nutrition Standard. This table gives the nutritional standard discovered among the 1,404 routine medical inspections during 1944:— TABLE D. Classification of Nutrition. Age Groups. No. Inspected. Excellent. per cent. Normal. per cent. Sub-normal. per cent. Bad per cent. Entrants 785 3.44 90.45 5.75 0.38 Second Age Group 207 2.90 85.50 10.63 0.97 Third Age Group 277 8.30 81.95 9.75 – Other 135 4.45 88.15 7.40 – 1404 4.42 87.82 7.41 0.35 43 TABLE E. Comparative Nutrition Standard: Pre-War and War-time. 1944. % 1943. % 1942. % 1941. % 1940. % 1939. % 1938. % Excellent 4.42 6.11 6.68 7.63 8.36 9.38 8.32 Normal 87.82 84.81 84.06 84.25 83.75 78.47 80.81 Sub-normal 7.41 8.33 9.19 8.03 7.76 10.03 10.01 Bad 0.35 0.74 0.07 0.08 0.13 2.12 0.84 This table is to be read with Dr. Orgler's report in his height and weight research, which appears under the following heading. Malnutrition and Cleanliness. The Assistant School Medical Officers, Dr. G. H. Stinson and Dr. Arnold Orgler, both report on their findings at inspections that, generally, nutrition of the school children is good. Dr. Stinson observes that many children, hitherto difficult over meals at home, will take their meals with other children at School, and Dr. Orgler comments that parents have become more "food-conscious." Dr. Stinson found that a considerable number of children returned from reception areas with verminous heads, scabies and impetigo, but since cleaning up these cases we have been very free of skin troubles. Dr. Orgler notes that from amongst the children coming under his inspection there has been a definite decline in scabies and impetigo, and, regarding pediculosis, conditions are very much the same as in the previous year. The School Nurses made 9,554 examinations of children for verminous conditions during 1944, and of this number 135 Vidual children were found unclean. Following up his investigation, published in the 1943 Report into heights and weights of school children averaging 13 years, Dr. Arnold Orgler has pursued his research regarding nutrition of choildren in war-time, and in the following report he has sought to discover whether nutrition at the present time is contributing to reasonable normal growth and affording as far as possible a physical build up in the children to protect them against disease. i am indebted to Dr. Orgler for the interest he has taken in this field of research His conclusions are a valuable contribution towards the study of the Nutritional Standards. 44 OBSERVATIONS ON SCHOOL CHILDREN IN THE YEARS 1943 AND 1944. BY A. ORGLER, Temporary Assistant Medical Officer of Health. Any nutrition of children, to be sufficient, has to fulfil two conditions—first, to guarantee a normal growth, and second, as far as possible, to protect children against diseases. The aim of the following observations was to find out whether the nutrition of school children in Bromley in wartime fulfils both these conditions. The findings are based on the measurements of weight and height of these school children at routine inspection and on my clinical observations at the School Clinic. I have already reported (see Annual Report, 1943) my investigations concerning those school children averaging 13 years in 1943, while the following new observations include the school children of 13 years examined in 1944 (the "leavers"), as well as the school children averaging 8 years (the "intermediates") examined in 1943 and 1944, the latter, that is the "intermediates," 1943-44, being compared with the "intermediates "examined in 1938 and 1939. I have obtained 2,450 measurements, of height as well as of weight, belonging to about 1,900 children, the difference in the figures being due to the "intermediates" examined in 1938 and 1939 I being again examined as "leavers" in 1943 and 1944. TABLE I. The Intermediates. BOYS. GIRLS. 1938 1939 1943/44 1938 1939 1943/44 Number of Records Investigated 261 278 253 215 234 243 Average Age 7.10/12 8 7.10/12 7.6/12 8 7.10/12 Average Height (ins.) 48¾ 48½ 49½ 48¼ 49½ 48¾ Average Weight (lbs.) 54 551/8 55½ 52 55 54¼ It is to be noted that when giving consideration to the intermediate age group, the average rate of increase in weight may be taken as ½ lb. per month. This should be taken into account when comparing the above figures owing to slight difference in ages. 45 Just as in my former report, we can form three percentage 'groups" of children affecting height and weight:— A. A small lower group. B. A medium group, comprising most of the children. C. A small higher group. TABLE II. Intermediate Boys. Height in Inches. Inches 1938 1939 1943-44 A. 40 — 46 6.9% 11.9% 10.7% B. 46¼ — 52 88.1% 80.2% 81.0% C. Over 52¼ 5.0% 7.9% 8.3% Weight in Lbs. Lbs. 1938 1939 1943-44 A. 34 — 46 8.4% 9.4% 3.2% B. 46¼ — 62 83.9% 75.5% 81.4% C. Over 62¼ 7.7% 15.1% 15.4% TABLE III. Intermediate Girls. Height in Inches. Inches 1938 1939 1943-44 A. 40 — 46 18.3% 7.7% 13.9% B. 46¼ — 52 78.0% 84.1% 79.9% C. Over 521 3.7% 8.1% 6.2% Weight in Lbs. Lbs. 1938 1939 1943-44 A. 38 — 46 18.8% 7.3% 12.8% B. 46¼ — 62 73.4% 79.9% 75.3% C. Over 62¼ 7.8% 12.8% 11.9 comments. When we study the Table I of the boys, we see that the boys examined in 1943 and 1944 are taller and heavier than the boys examined in the years 1938 and 1939. This is especially evident when we compare the boys examined in 1938 with the boys examined in 1943-44, being of the same monthly age. the girls 1943-44 show lower weight and height compared with the girls examined in 1939. These differences are caused by the difference of the age and disappear completely when we put into account the age factor, thus:— children between 7 and 8 years should gain in the average about half a monthly according to the figures of London's school children. The intermediate girls examined in 1943-44 46 are 2 months younger than the girls examined in 1939. Thus we have to deduct from the weight of the 1939 girls, 2 months' weight, i.e., one pound. Their true weight is 54 lbs. compared with 54¼ lbs. of the girls in 1943-44. A confirmation that I am justified in deducting half a pound for each month is supported by the following fact. The intermediate girls examined in 1938 are 6 months younger than those in 1939. Therefore they weigh 3 lbs. less (6 times half a pound). Thus, a true comparison of the girls in 1939 with the girls in 1938 and in 1943-44, is only possible by considering the age factor. The difference in age is also the cause for the higher proportion in the lower group of the girls, Table II examined in 1943-44. Although we should expect, owing to the difference in age of 2 months, less intermediate children over-weight, i.e., more than 66 lbs. in 1943-44, the number of these cases is about the same as in the pre-war year. (See Table IV.) TABLE IV. Weight in lbs. 1939 1943-44 1939 1943-44 66 – 70 12 boys 12 boys 66 — 70 7 girls 9 girls 70 — 74 5 boys 7 boys 70 — 80 7 girls 7 girls 74 — 79 3 boys 5 boys 80 — 90 2 girls 3 girls 90 — 94 — 1 girl THE LEAVERS, 1944. TABLE V. BOYS. girls. Number of Records 1939 1943 1944 1939 1943 1944 Investigated 193 147 164 228 166 165 Average Age 12.7/12 12.10/12 12.9/12 12.7/12 13 12.10/12 Avg. Height (ins.) 57¾ 58½ 58½ 59.1/12 59¾ 59.1/6 Av. Weight (lbs.) 85 84½ 87 884 92 90½ TABLE VI. Distribution. Height in Inches. BOYS. Inches 1939 1943 1944 49 — 55 17.1% 8.2% 12.8% 55¼ — 61 73.0% 78.2% 70.1% 61¼ — 69 9.8% 13.6% 17.1% Weight in Lbs. Lbs. 1939 1943 1944 55¼ — 75 21.2% 17.0% 16.4% 75¼ — 95 60.6% 70.7% 62.2% 95¼ — 120 and more, 18.2% 12.2% 21.4% 47 Height in Inches. GIRLS. Inches 1939 1943 1944 49 — 55 12.6% 8.4% 6.7% 55¼ — 63 78.5% 78.9% 85.4% 63¼ — 71 8.9% 12.6% 7.9% Weight in Lbs. Lbs. 1939 1943 1944 50 - 75 22.3% 16.8% 10.3% 75¼ - 100 59.2% 55.0% 69.1% 100¼ — 120 and more. 18.4% 28.2% 20.6% Comments. In surveying these tables, we can see that, in accordance with my former report, the boys are taller as well as heavier than the boys examined in 1939. The girls, too, show a better height and weight, especially when we survey the. table with the distribution. It is likely, however, that these differences are for the greater part due to age differences of those examined in 1939. if we take an optimistic view regarding the boys, we could consider these results as an improvement \ if we take a realistic or pessimistic view, only as an annual fluctuation. The girls, "however, have the same standard as those examined in 1939. Children Over-Weight. In the following table (VII), I have put together the children ,with a weight above 120 lbs. As with the intermediates, I have found little difference between 1939 and 1943-44. TABLE VII. [BOYS. 1939 1943 1944 Lbs. 120 — 125 1 4 – 125 — 130 1 – – 130 – 135 – – 1 135 — 140 – 1 – 140 — 145 – – 1 191½ – – 1 GIRLS. 1939 1943 1944 120 — 125 – 4 3 125¼– 130 5 1 1 130¼ — 140 3 3 4 140¼ — 150 1 1 155 – 1 – 48 I was, however, able to follow up the development of seventeen of these children, examined 1943-44. Eight children (four boys and four girls) have doubled, or more than doubled, their weight in the five years since the examination as intermediates. Besides these, there are other children who gained 100 per cent, or more without reaching 120 lbs. in this space of time, e.g. BOYS. Name: Intermediate Leaver. P.S. 50 lbs. 117 lbs. R.H. 48 lbs. 96 lbs. A.T. 51¼ lbs. 111½ lbs. J.F. 46 lbs. 93¾ lbs. GIRLS. Name: Intermediate Leaver. H.B. 42½ lbs. 85 lbs. F.J. 50 lbs. 103¼ lbs. R.D. 44¾ lbs. 95 lbs. F.L. 54 lbs. 112 lbs. Children Under-Weight. I was interested to find out if the under-weight of these children was caused by war nutrition. By surveying their weight at entrance to school and their weight as intermediates, I found that most of them have been under-weight from the start—that means, under-weight in pre-war time. Thus, we cannot expect these children to reach the same weight of the average leaver. We have to find out by other means if these children show a normal development. The average child as an intermediate has an average weight of 50 lbs. and gains in the 5 years to leaver age about 25 lbs.; in other words, it puts on about 50 per cent, of his weight as intermediate in this space of time. Thus, any child that as a leaver has gained 50 per cent of his weight as an intermediate has at any rate a normal development. Using this standard, we can now ascertain how manv under-weight children have shown a normal development I found out the following figures: from 52 under-weight boys I was able to trace the development of 43 boys, and from 45 under-weight girls the development of 38 girls, from intermediate to leavers. 32 boys = 74 6% and 32 girls = 84.2ro reached the standard mentioned above, as sample:— A. BOYS. Intermediate Weight. Leavers. Difference. R.Ch. 37½ lbs. 57 lbs. 19½ lbs. = 52% R.G. 38½ lbs. 62½ lbs. 24 lbs. = 62% B GIRLS. M.B. 38 lbs. 59½ lbs. 21½ lbs. = 57% J D 34 lbs. 58½ lbs. 24½ lbs. = 73% I found that most of these under average weight children came from families of small stature. Investigation of the re- maining children yielded many other causes for their under 49 weight, as prematurity, delayed development, diseases, such as recurrent bronchitis, asthma, etc. Even if we assume that all under-weight children, whose development I was not able to trace, belong to the group of children who failed to gain 50 per cent. of their weight as intermediates, we should have left only 33 children who did not show a normal development. Thus, we can state that at least 95 per cent, of the leavers have fulfilled the first condition of sufficient nutrition to guarantee a normal development. In comparing the school children of Bromley with those of London's Elementary Schools, the intermediates as well as the leavers in Bromley are taller and heavier than those of London in the same age group. It is more difficult to prove that the second condition is fulfilled, namely, to give the children the best protection against diseases. So far as I could judge from my observations in the School Medical Examinations and at the School Clinics, I could not detect any deterioration in the resistance towards diseases caused by lack of one or the other foodstuff. Surely there have always been children who need a bigger amount of a certain foodstuff, especially of one or another vitamin, than the average. But I have not found any increase of diseases which we now attribute to a lack in the nutrition. Conclusion. I was able to prove that the intermediates as well as the lavers in the past two years 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 the last two years than in 1939. These good results are partly due to the provision of school meals and milk, and also to the fact that the mothers have become more food-conscious. SECTION B TREATMENT. The number of treatments for minor ailments under the local Authority's scheme during 1944 compared with those for 1943:– 1944. 1943. Skin Diseases 349 732 Minor Eye Defects 87 214 Minor Ear Defects 123 155 Miscellaneous 757 794 1,316 1,895 1944. 1943. Total attendances of children at the School Clinic for treatments 10,602 14,357 50 Eye Clinic. Statistics for the year 1944:— Number of sessions during 1944 68 Number of children dealt with for errors of refractions 461 Number of other defects or diseases of the eye treated 87 Number of spectacles prescribed and obtained 169 Total attendances of children for treatment 47 Mr. Rushton's Comments. During 1944 I have continued to hold the Eye Clinic, acting in place of my colleague, Major Eric Lyle. Most of the children dealt with have errors of refraction, whose annual incidence is fairly constant. These defects are mostly congenital and are alleviated by spectacles. Preventive measures are, however applicable in myopia; it can be minimised by attention to conditions under which close work is done lighting, posture, quality of printing and me spent reading are factors which are controlled satisfactorily under school conditions, but the regulation of a myopic child's private reading is notoriously difficult. Continual attempt- have been made to enlist the co-operation of parents with varying success. The treatment of squint is more effective. Many cases are corrected by glasses, with or without orthoptic exercises. The latter are ably carried out by our orthoptist, Miss Binstead. Those cases requiring operation are normally admitted under my care at the Bromley and District Hospital, but as these operations are seldom urgent, they have been postponed during the past year owing to war conditions. The incidence of diseases of the eyes has been lower than usual this year, and this is very satisfactory after these years of war. I should like to thank the staff of the School Clinic for their efficient help, and also the staff of the Bromley and District hospital. (Signed) R. H. RUSHTON. Ear, Nose and Throat Clinic. Specialist Consultative Service and operative treatment for tonsils and adenoids at the School Clinic remains in abeyance Twelve cases were referred for operative treatment to hospital in the early part of the year, but hospitals under emergency needs were unable to take any tonsil and adenoid cases in the latter half of the year. 197 cases received other forms of treament at the School Clinic. It is very debatable as to whether full benefit is obtained of the routine tonsil and adenoid operative treatment: there are cases that benefit, but there is a tendancy to operate merely because of tonsil enlargement. 51 Orthopaedic Clinic. The work of this Clinic, with its ancillary services of massage, remedial exercises and ultra violet ray, etc., treatments, during 1944 is shown in the following figures :— Number of Clinics held by the Consultant 11 Number of children treated at the Clinic 136 Number of attendances for Consultations 313 Number of attendances for massage and exercises, etc 1756 Number of attendances for Ultra Violet Ray and Infra Red treatments :— (a) North Clinic 1365 (b) South Clinic 668 Tabulation of new cases by the Orthopaedic Surgeon, 1944 :— 1. (a) Congenital Defects: — Club Foot 2 Dislocation of Hips 1 Other conditions 18 (b) Hammer Toes 2 2. Birth Injuries: — Torticollis 5 Other conditions 3 3. Rickets Deformities:— Bow Legs — 4. (a) Bow Legs (non-rickety) 2 (b) Knock Knees (non- rickety) 5 5. Postural Defects of Spine 28 6. Structural Curvature of Spine — 7. Flat Feet 23 8. Infantile Paralysis 1 9. Sequelae of Acute Fevers — 10. Fracture 2 11. Tuberculosis—Joints — 12. Other Bone Diseases (non - tubercular) 3 13. Osteomyelitis — 14. Not Classified 5 15. Non-orthopaedic 1 16. No Active Disease 15 116 Orthopædic Clinic Report for 1944. During 944 there has been a fall in the number attending the Clinic, but this is not at all surprising when one remembers the Flying Bomb period from June to September. It is noticeable that there has been a steady decline in recent years of the number of cases of rachitic deformities referred to the Orthopaedic Clinic, evidence of the good done at the Infant Welfare Centres, particularly during these war years. On the other hand, the number of children suffering from postural defects of the spine and from foot defects has remained almost unchanged, if anything, increasing slightly. As far as foot defects are concerned, this state of affairs is due Partly to the poor types and quality of shoes available for children at the present time. For these foot defects and for many other conditions, electric treatment is often very beneficial and the recent decision of the Committee, at my suggestion, Purchase a combined electric table will enable the masseuse, Miss Dodge, to treat a larger number of patients more efficiently (Signed) J. H. CHOLMELEY, F.R.C.S. 52 DENTAL SERVICES. Mr. James H. Glen, School Dental Surgeon, reports as follows for 1944:— After a very good start in the first few months of 1944, when we exceeded the estimated number of 150 sessions which were expected to cover the requirements of the Higher Education Scholars for the whole year, the Evacuation put an end to this early promise of success, and although we continued " in residence " at the Clinic, the small attendance produced a very small output of work, which was, however, completed without mishap ; although we were lucky that the dental chair was empty when the bomb fell in Wharton Road and shattered our windows. It is unfortunate that the first full year of the enlarged dental scheme should coincide with the first year that Bromley has been made an evacuation area. 2,914 children and 55 mothers were examined for evacuation, out of a total school population of 5,200. In consequence, the output of work for each surgeon employed has been proportionately small. However, the lower attendance has resulted in a greater amount of work per child at each session, and, except for the necessitous excursions to shelter, more time could be spent in consultation with the parent. I do not think the low attendance of the welfare children is entirely due to the evacuation. The steady decline in the figures during the war years is more certainly due to an increased intake of advice and vitamins provided at the Welfare Centres, together with a fortunate shortage of cheap paste sweets. An examination of the records of pre-war years shows that each welfare child attending the Dental Clinic required 3.9 unsaveable temporary teeth extracted. The average for the last three war years is 1.9 unsaveable temporary teeth extracted per child. When it is remembered that the crowns of the temporary teeth are formed before birth, it is possible that this improvement in the dentition is due to the simpler diet both for the antenatal mother and the welfare child provided by war-time fare There is, however, a rapid deterioration of the dentition in the 6 years to 8 years age groups, and it would seem that the failure to continue the supply of vitamin foods to these children may be one of the causes of the deterioration. Perhaps the proposed supply of Orange Jelly to school canteens will help to improve the dentition of these children. I am indebted to the Clinic staff and voluntary helpers who have assisted them during this unhappy year. (Signed) J. H. GLEN, L.D.S. 53 STATISTICAL REPORT OF THE VARIOUS DENTAL SCHEMES. Grand Total (all schemes). 1943. 1944. Total attendances 5964 4909 Number discharged 2856 3016 Attendances for Gas Extractions 1492 1029 Attendances for Local Extractions 246 111 Attendances for Denture Work 200 141 Attendances for Orthodontics 414 102 Attendances for Other Operations 804 919 Number of Fillings done 3143 2826 Number of Extractions done 4322 2427 Number of Dentures fitted 57 49 Number of Sessions employed 664 979, 5/6 Number of Children inspected 4471 3737 Scaling and Gum treatment 360 Referred for X-ray 26 Referred to Consultant Orthodontist 7 (a) Elementary Children — See Board of Education table. (b) Report of the Maternity and Child Welfare Dental Schemes. Mothers. Appointments kept 409 378 Number discharged 105 46 Attendances for Gas Extractions 93 65 Attendances for Local Extractions 23 28 Number of Extractions done 600 319 Number of Fillings 92 173 Number of Dentures fitted 54 49 Attendances for Denture work 197 141 Number of Sessions devoted to treatment 65 78, 5/6 (c) Welfare Children. Appointments kept 94 55 1943. 1944. Number discharged 90 14 Attendances for Gas Extractions 73 18 Attendances for Local Extractions 4 — Number of Fillings done 12 32 Number of Extractions 160 18 Number of Dressings 4 10 (d) Higher Education Schools. Appointments kept 693 1539 Number discharged 387 1113 Attendances for Gas Extractions 83 195 Attendant's for Local Extractions 20 10 Number of Fillings done 613 988 Number , Extractions 197 228. Orthodonic attendances 62 49 Scaning and Gum treatment attendances 107 53 Root treatments 14 16 Referred for X-ray 16 14 Number inspected at School 930 684 Number requiring treatment 328 404 Half-days devoted to treatment 22 192, 3/8 Half-days devoted to inspection 8 54 REPORT FOR THE BOARD OF EDUCATION, 1944. 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 91 263 271 303 281 282 280 364 377 254 Total ... 2766 1943. 1944. (b) Special cases 297 287 (c) Total number of children inspected (Routine and Special) 3561 3053 2. Number of children found to require treatment 2327 1941 3. Number of children actually treated 1621 1843 4. Total attendances for treatment 4770 2937 5. Half-days devoted to— (a) Inspections 13 16 (b) Treatment 565 692 Total 578 708 6. Number of Fillings completed in— (a) Permanent Teeth 1798 1108 (b) Temporary Teeth 628 525 Total 2426 1633 7. Number of Extractions— (a) Permanent Teeth 1171 377 (b) Temporary Teeth 2194 1485 Total 3365 1862 7943. 1944 8. Administration of general anaesthetics 1223 751 9. Other operations—individual cases treated, including (a) Orthodontic cases—attendances 414 53 (b) Crowns and Inlays 16 9 (c) Space retaining appliances 3 1 (d) Scaling and Gum treatment 308 307 (e) Temporary Teeth—dressings 340 357 (f) Root treatment 54 48 (g) Referred for X-ray 46 12 Total 1181 787 Infectious Disease. SECTION C. The figures of absentees during 1944 in the elemental} schools on account of infectious diseases are as follows NOTIFIABLE INFECTIOUS DISEASES: Cases. Contacts. Scarlet Fever 60 42 Diphtheria 2 7 Measles 55 Contacts not excluded. Whooping Cough 32 ,, 55 NON-NOTIFIABLE INFECTIOUS DISEASES: Extracted from returns made by Head Teachers:— German Measles 34 Chicken pox 171 N.B.— I learn that owing to a misunderstanding, the teachers ceased sending in these returns of non-notifiable infection after May; therefore the above figures are really valueless, or at least not complete. Open Air Education. During the year six children were sent to residential schools for special courses of open air treatment for exceptional defects. Much is being done for the children of the area under the direction of the Physical Training Organisers, Mr. G. H. Atkinson and Miss F. M. Bentley, to whom I am indebted for the following report on Physical Education for the year 1944 :— STATEMENT ON PHYSICAL EDUCATION FOR THE YEAR 1944. General. Physical education, like any other branch of the school curriculum, depends for its results upon regular and systematic teaching progressively adapted to the changing development of the individual pupil. Any break in the continuity of this process leaves a gap which, especially in the case of Physical education, cannot easily be closed at a later stage of the child's growth. It is, therefore, a matter of some concern that during the totter half of the year under review the enemy's flying bombs and rocket weapons created such conditions of disorganisation in our schools that normal progress in this subject became impossible. With the evacuation of a large proportion of our schoolchildren to safer areas it was necessary to regroup the remnant classes and to replan schemes of work. This involved, in many cases, the amalgamation of children of different agegroups under teachers unfamiliar with the standards of work Previously attained by their pupils. Added to these difficulties. the children who remained behind suffered further disadvantages from frequent stoppages of school work during danger Periods, am. from lack of proper sleep, which left many of them tired and lis less, and consequently unable to derive full benefit from their lessons. It is not surprising, therefore, that in all our schools there is evidence general lowering of the standards of work in all branches of physical education, and it is anticipated that considerable time and effort will be required to restore these standards wards to a satisfactory level. 56 Physical Education in Elementary Schools (a) Physical Exercises. The fact that every normal child finds enjoyment in the P.T. lesson has been an important factor in preventing what would otherwise have been a much more serious decline in the standard of this work. Whilst it is obvious that much detail and precision has been lost, and that the posture and carriage of the children seems to have suffered, the recreative values of the work have been well maintained, and, in consequence, the daily P.T. lesson has done much to counteract those influences which have tended to depress the spirits of the children during the dangerous and difficult period. (b) Organised Games. Regular visits to the Education Committee's playing fields were possible only during the Spring and early part of the Summer terms, after which period all arrangements were cancelled owing to the general disturbance of war conditions. (c) Children's Holiday Games Centre. Owing to the outstanding success of the experiment sponsored by the " Holidays at Home" Committee, under which school children of all ages were offered facilities for games and recreation under expert leadership during school holidays, it was decided to repeat these arrangements during 1944. Two Games Centres were opened during the period 30th May—9th June, and the following attendant returns are sufficient to indicate that the scheme has again proved highly successful:— Average Total Centre. Daily Attendance. Attendance. 1. Hayes School P. Fld 132 1123 2. Southborough School P. Fld 168 1513 (d) Swimming. It is greatly to be deplored that the vast majority of the children in this Borough roach school leaving age without having been taught to swim. Until such time as facilities for instruction in a closed and heated swimming bath are made available to the children, this important branch of physical education must continue to be neglected. Clothing for Games and Physical Training. The Education Committee have continued to take advantag of the Board of Trade arrangements under which supplies of plimsols for games and P.T. can be purchased for the use of schools. 57 These supplies are strictly limited, however, and are by no means adequate to meet the requirements of all pupils. The fact that the majority of parents are reluctant to use clothing coupons for their children's P.T. shorts and vests, etc., has meant that an increasing number of children are unable to provide a change of garments for these activities. The wearing or ordinary clothes during exercise is not only unhygienic, but the wear and tear on heavy garments is a source of annoyance to many parents. It is hoped that as it is now possible for Education Authorities to provide these garments for loan to pupils and coupon free, the position may soon be remedied. Youth Service. The demand for recreative physical training classes and boxing, etc., among voluntary youth clubs and pre-service organisations, although high during the first few months of the year, showed a rapid decline during the early summer months, and became almost negligible during the flying bomb period. In the Organisers' efforts to develop the more recreative side of youth work, they have been greatly assisted by the setting up of leaders' and sports officers' Committees, through which they have been able to keep in close touch with local requirements and to give assistance in the organisation of interclub games and competitions in football, tennis, athletics, swimming, etc. future Developments. Under the wide provisions of the new Education Act of 1944 every normal child and adolescent will utimately receive regular and systematic physical education from 4—18 years of age and possibly beyond. We look forward to the time when, under an adequate supply of young, athletic and well-trained teachers, the subject will be offered its long-awaited chance to demonstrate its true potentialities in the wide new field of adolescent education. (Signed) GEO. H. ATKINSON. F. M. BENTLEY. District Organisers of Physical Education. Vision of Meals. the midday meal at home for many children is now almost a thing of the past. Hitherto the child, as is well known, in fair weather or foul, would return home from midday dinner— some very naturally, prone to tarry by the wayside—and having 58 partaken of a hasty meal, heavy or sparse, according to the family circumstances, would then make either a hastier return to school or tarry again, according to his mental outlook on punctuality. Nowadays, the child can have his meal under conditions of regularity and correct dietary, with a consequent minimising of digestion ailments arising from that hitherto continual factor of haste and anxiety. The Assistant Medical Officers are more and more noticing the beneficial results showing in the nutritional standards of the children obviously resulting from the provision of milk and meals, and Dr. G. H. Stinson specially mentions that many children hitherto reluctant to eat a dinner at home will do so with other children at school. Owing to enemy action and evacuation during 1944, it was impossible to make any substantial progress with the extension of the School Meals Service, although the Ministry's approval of most of the Committee's projects was received during the course of the year. Some work, however, was carried out, and the kitchen at Valley Council School was slightly enlarged, a separate larder constructed, and extra cooking equipment and a refrigerator provided. A new kitchen was constructed at Princes Plain Council School and fitted with up-to-date equipment; but, unfortunately, shortly after completion of the work, the kitchen suffered severe damage and was rendered unusable when the school was partially destroyed by enemy action. The number of children receiving meals in school is still on the increase, and for the year ended 31st March, 1944, the total number of meals served to children was 423,727, an increase of over 66,000 for the corresponding period last year. Towards the end of the year a further 25 per cent, was added to the family allowances in the Committee's Income Scale for assessing applications for free or half-rate meals and milk thus making a total increase of 50 per cent, on the original allowances given when the Scale first came into operation. Milk in Schools. A slight falling off in the number of children receiving milk is shown in a return made to the Ministry of Education in October, 1944, when the percentage of children receiving milk based on the actual number in school was 66.59%. This reduction may be partly due to evacuation, which commenced in july and partly to the fact that as more children take advantage of the midday meal there is less demand for milk. 59 The return submitted to the Ministry showed the following figures Number of children receiving Milk. 1/3 pt. 2/3 pt. (1) For full payment 438 1194 (2) At half-rate 1 22 (3) Free of charge 17 42 (The charge for 1/3 pint remains unchanged at ½d.) SECTION D. Exceptional Children in the Area at the 31st December, 1944 :— Residential Schools. Special Day Schools. Elementary Schools. Not in School. Blind 2 — — — Partially sighted — — — — Deaf and Dumb 2 — — — Partially Deaf — — — — Mentally Defective 13 2 — — Epileptic 1 — — — Physically Defective 7 — — — Malajusted 1 — — — Backward — — — — Secondary Schools. The School Health Services have been at the disposal of higher education Scholars under agreed arrangements with the County Council. The School Dental Officer, in his annual report for1944, states that 684 pupils were inspected, of whom 404 reded treatment. Details of treatment are as follows :— Attendances 1539 Discharged, treatment complete 1113 No. of Fillings 988 No. of Extractions 228 Gas Anaesthesia 195 Other operations 382 No. of sessions employed 192 3/8 Mr. R. H. Rushton, Eye Specialist, examined 70 children for elective vision, and Mr. Cholmeley, Orthopaedic Surgeon, examined 36, all of whom received appropriate treatment through the services. health Education. parent's Payments. Special Enquiries. There are no noteworthy remarks to make under these headings, except to direct attention to the special enquiry into height and weight of children in relation to nutrition made by Dr. A. Orgler and included in Section A. of this Report. 60 Nursery Classes. During the year 1944 the Extended Nursery Class at the Burnt Ash Infants' Council School was opened, and as an extension of the original class for 24 children, it provided for the admission of a further 15 children ; but on account of evacuation the numbers of children in attendance have not made it necessary to operate the extended class. Also on account of evacuation, the Play Centre at Raglan Road Council School was closed on 31st July, 1944, with the approval of the Ministry of Labour. There are no play centres now open in the Borough, and the nursery school provision is as follows:— Valley Infants' Council School Nursery Class : Accommodation 25, number in attendance, average 22 Burnt Ash Infants' Council School Nursery Class ; Accommodation 40, number in attendance, average 18 SECTION E. Occupation Centre for the Mentally Defective. No activity during the war. Employment of Children and Young Persons. The School Medical Officers examined 157 children as to their fitness for employment out of School hours, as follows:- No. Examined. Fit Certificates Issued (a) Boys 135 135 (b) Girls 22 22 157 157 61 Boot Club. That children should be properly shod with correctly fitting and weather-proof footwear is a health matter of some importance to the child, and it is fitting that mention should be made in this Report of the meritorious voluntary activities of all concerned in the working of the Schools' Boot Club. The following is the Chairman's Report for 1944:— BROMLEY ELEMENTARY SCHOOLS' BOOT CLUB COMMITTEE. Chairman's Report to the Members of the Committee. During the year ended 31st December, 1944, the Boot Club has continued to function most satisfactorily, although, owing to the evacuation of scholars from this area, there has been a decrease in the number of contributors and number of vouchers issued. There were 642 vouchers for footwear issued during the year, and the total purchase of footwear amounted to £495 15s 3d., compared with £649 2s. 9d. for the previous year. Necessitous cases brought to the notice of the Committee during the year have been recommended to the Bromley Benevolent Association, and I am informed that thirty-five pairs of boots and shoes have been supplied free of charge to scholars in Bromley at a cost to the Bromley Benevolent Association of £31 0s, 0d. No doubt it is your wish that the Committee should record their appreciation of the valuable work of the teachers who continue to carry out the collection of scholars' contributions and Suing of vouchers to tradesmen. I think we may be assured that the scheme is serving a very useful purpose not only in encouraging thrift, but also to obtain good footwear at reduced prices. In this connection, you will note from the Hon. Secretary's statement that the sum of approximately £40 0s. 0d. has been earned in discount during the year. As you are no doubt aware, the Education Act, 1944, in section 51, makes provision for assistance being given by the Education Authority in the matter of clothing (which includes Footwear) in cases of financial necessity ; but this, as far as one can tell, should not in any way affect our Thrift Scheme, which will we hope, continue to give the satisfactory service it has don for so long past. I must once again record my appreciation of the work of the Hon. Secretary, Treasurer and Auditor. F. R. GODDEN, Chairman. 62 Cash Statement—Year Ended 31st December, 1944. RECEIPTS. £ s. d. Cash Balance Brought Forward 400 4 6 Payments Made to Bank by Contributory Schools 428 13 6 Martins Bank Ltd.—Interest Earned 2 6 1 £831 4 1 PAYMENTS. Purchases of Footwear: £ s. d. £ s. d Gross 534 8 3 Less Discount 39 13 0 494 15 3 Bromley Benevolent Association Grant re Necessitous Cases 20 0 0 Miscellaneous—Cash Refunds 2 10 0 Martins Bank Ltd.— Cheque Book 5 0 Cash Balance Carried Forward 313 13 10 £831 4 1 Hon. Treasurer: Mr. G. P. L. SYMS, Chief Education Officer, Bromley, Kent. Hon. Secretary : Mr. E. A. A. GOOCH, Education Department, Bromley, Kent. 63 Bromley Children's Care Committee. The School Medical Service has continued to receive the very helpful services of Miss M. A. Isard, Honorary Secretary, in necessitous cases referred for assistance in obtaining convalescent home treatment, fares to hospital, clothing and Medicine. SECTION F. The pre-war statistical tables required by the Ministry of Education have been compiled and are available for reference, but are not reproduced here. Extracts from these statistics figure in the body of this Report. Printed by Bromley Office Supplies and Printing Co., Ltd., 46, East Street, Bromley, Kent.