Borough of Bromley 1945 ANNUAL REPORT medical officer of health AND school medical officer Printed by Bromley Office Supplies & Printing Co., Ltd., 46, East Street, Bromley, Kent. 3 CONTENTS. Members of the Health and Maternity and Child Welfare Page Committees 5 Staf 5 Prefatory Letter 8 Section A. Statistics and Social Conditions. Vital Statistics 10 Meteorology 11 Population 11 Births 11 Deaths 12 Infantile Mortality 13 Section B. (I) General Provision of Health Services. Ambulance Service 15 Laboratory Service 15 Nursing in the Homes 15 Treatment Centres, Clinics and Centres 15 Tuberculosis Dispensary 15 Veneral Disease Treatment 15 Hospitals, Public and Voluntary 15 Nursing Homes 16 Section B. (II) Maternity and Child Welfare. Midwifery, Ante-natal 16 Practitioner Service, Domiciliary 17 Dental Scheme, Mothers 17 Midwives Acts, Administration 17 Analgesics, Administration 18 Maternity Hospital Provision 18 Puerperal Pyrexia 18 Premature Infants 19 Home Helps 19 Post-Natal Services:— Health Visiting 19 Welfare Centres 20 Child Life Protection 20 Illegitimate Children 20 Adoption of Children 21 Clinic Treatments under 5 years 21 Day Nurseries 21 Domestic Help Scheme 22 Section C. Sanitary Circumstances of the Area. Water 22 Cesspools 24 Refuse Collection 24 Drainage 24 Rivers and Streams 24 Sanitary Inspection 24 Factories 24 Shops Acts 25 Smoke Abatement 25 Swimming Baths 25 Verminous Conditions and Uncleanliness 25 Scabies and Impetigo 25 Rats and Mice Destruction 26 Legal Proceedings 26 4 Section D. Housing Statistics. Page Inspections and Abatements 26 Section E. Inspection and Supervision of Foods. Milk, bacteriological tests 28 Food and Drugs Acts, sampling 28 Meat and Other Foods Surrendered 31 Section F. Prevalence of, and control over, Infectious Diseases. Tabulation, Sex and Age Groupings 32 Diphtheria, Immunisation 34 Tabulation, Attack and Mortality Rates 35 Tuberculosis 36 Section G. Diseases of Animals 37 Registries, Domestic Servants 37 Retail Market 37 Petroleum Acts 37 SCHOOL MEDICAL SERVICE. Members of Education Committee 40 Introduction 40 Summary of Statistics 41 Staff 42 Co-ordination 42 Hygiene of Schools 42 Section A. Medical Inspections. Findings at Medical Inspections 43 Nutritional Standards 45 Malnutrition 45 Cleanliness 46 Section B. Treatment 46 Eye Clinic 47 Orthoptic Clinic 47 Ear, Nose and Throat Clinic 48 Orthopaedic Clinic 48 Dental Services 49 Section C. Infectious Disease 52 Physical Education 52 Provision of Meals and Milk 57 Section D. Handicapped Children 59 Child Guidance 59 Juvenile Delinquency 60 County Grammar Schools 60 Nursery Classes 60 Section E. Employment of Children 60 Boot Club 61 Care Committee 63 Section F. re Statistical Tables 63 5 MEMBERS OF THE HEALTH AND MATERNITY AND CHILD WELFARE COMMITTEES at 31st December, 1945. Health Committee. Councillor F. L. Harris (Chairman), Councillor J. S. Marriott (Vice-Chairman), The Worshipful The Mayor (Councillor Hilda M. Vincent, J.P.), Aldermen W. J. Guthrie, J.P., W. F. Skilton and M. Stafford Smith, M.B.E., B.A., Councillors H. M. V. Green, C. G. Griffin, P. Jones and H. Lynch-Watson. Maternity and Child Welfare Committee. Councillor H. M. V. Green (Chairman), The Worshipful The Mayor (Hilda M. Vincent, JP.), Aldermen W. J. Guthrie, JP., W.F. Skilton and M. Stafford Smith, M.B.E., B.A., Councillors C.G. Griffin, F. L. Harris, P. Jones, H. Lynch-Watson and J. S. Marriott. Co-opted Members : Mrs. A. M. Howe, J.P. (ViceChairman), Mrs. K. P. Jensen, Mrs. M. Packe, Mrs. M. Pearce and Miss V. Vincent. PUBLIC HEALTH DEPARTMENT STAFF as at 1st April, 1946. Medical Officer of Health and School Medical Officer Assistant Medical Officer of Health and School Medical Officers Specialists (part-time) : Orthopaedic Surgeon Eye Specialist Ear, Nose and Throat Surgeon Consulting Gynaecologist K. E. Tapper, o.b.e., g.m., m.b., ch.b., d.p.h. j Miss G. H. Stinson, m.r.c.s., l.r.c.p. j A. Thomson, m.b.; ch.b., d.p.h. (H.M. Forces). jk A. Orgler, m.d. j J. A. Cholmeley, f.r.c.s. j Eric Lyle, m.a., m.d., ch.b., d.o.m.s. (Service in abeyance). Alistair L. Gunn, m.d., f.r.c.s, 6 Dental Surgeons: j J. H. Glen, l.d.s., r.c.s. j B. S. Birkhahn, l.d.s., r.c.s. j Fairman J. Ordish, l.d.s., R.c.s. (part-time). Sanitary Inspectors : Chief Sanitary Inspector, Inspector under Petroleum Acts & Diseases of Animals Acts, and Chief Sampling Officer edcba G. R. Woods., m.s.l.a., ar.san.I. District Sanitary Inspectors and Sampling Officers cba T. C. Towersey, m.s.la. icba E. R. Hodge, m.s.i.a., m.r. san.i. ka H. Cooper, a.r.san.i. (one vacancy). Health Visitors and School Nurses : hgf Miss L. A. Briggs, s.r.n. hgf Miss E. B. Crowe, s.r.n. hgf Miss E. Rhodes, s.r.n. hgf Miss F. S. Leader, s.r.n. hgf Miss F. L. Gray, s.r.n. hgf Mrs. N. M. Taylor, s.r.n. Municipal Midwives: gf Miss S. A. Garner, s.r.n. gf Miss E. Smith, s.r.n. g Miss A. M. Winter, gf Miss E. Robathan, s.r.n. kgf Miss M. a. Gregory, s.r.n. (one vacancy). General Clerical Staff: Chief Clerk H. E. Lawley. Senior Clerk S. F. Judd. Grade I Clerks E. H. Andrews (H.M. Forces). Miss R. Brock. k Mrs. D. Cox. k Miss J. Woodrow. Grade II Clerks k Miss B. Booth. k Miss S. Potterton. k Miss S. Rumph. k Mrs. I. Stapleton. k Mrs. P. M. Warner. (two vacancies). Dental Clinic Assistants: j Mrs. W. Carrie. j Miss F. E. Rolfe. j Miss M. Ellen (part time) 7 Other Appointments: Assistant Rodent Officer ek J. C. Dunn. Orthopaedic Nurse and Masseuse j Miss M. Dodge, c.s.m.m g. (part time). Orthoptist j Miss J. Pinnick (part time). Outdoor Staff: Disinfector and Drain Tester J. W. Seager. Market Superintendent F. J. Ephgrave (part time). Shelter Superintendent k R. H. Mitchell. Home Helps (two). Domestic Helps (two). The letters denote: — a Certificate Royal Sanitary Institute and Sanitary Inspectors' Joint Examination Board. b Royal Sanitary Institute Certificate for Meat and Other Foods. c Royal Sanitary Institute Smoke Certificate. d Certificate of Examination Board of The Sanitary Inspectors' Association. e Diploma of Institute of Hygiene (London). f General Trained (S.R.N.) g State Certified Midwife. h Royal Sanitary Institute Health Visitors Certificate. i Royal Sanitary Institute in Sanitary Science as applied to Building and Public Works. j County Council. k Temporary appointments. WAR-TIME NURSERIES. Elmfield Nursery : Matron 4 Miss K. Minchin. Deputy Matron 3 Miss E. Scaggs. Nursery Nurse 5 Miss L. Grugeon. Warden 3 Miss A. Thomson. Student Nurses (four), Cook (one), and Cleaners (two). Draycott Nursery : Matron 21 Miss M. E. Davey. Deputy Matron 21 Mrs. M. E. Thompson. Nursery Nurses 21 Mrs. E. M. Benge. 3 Miss B. Hammond. 3 Miss J. Nicholls. Nursery Assistants (five), Student Nurses (two), Cook (one), and Cleaners (three). Numbers denote: — 1. State Registered Nurse. 4. Registered Sick Children's 2. State Certified Midwife. Nurse. 3. Nat. Soc. of Children's Nurseries 5. College Trained Nurse. Diploma, 8 Madam, Mayor, Ladies and Gentlemen, I have the honour to present my 21st Annual Report on the Health Services of the Borough during 1945, the year of Victory. The Report is an interim report, as suggested by the Minister of Health, and is confined to essentials until the time is opportune to present a more comprehensive survey of public health activities. In portraying in broad outline only the main activities of the Health Department, one is conscious that the absence of much important detail does not allow one to do full justice either to the results accruing from the comprehensive services or to the efforts of the officials of the Department who so efficiently dispense these varied services for the common good. I believe I am correct in my view that had it not been for the organisation of the Public Health Service in all its many activities, built up so successfully in the years of peace, the strain of the war years could not have been surmounted, nor would I be able to submit such satisfactory statistical returns as are embodied in the reports of the last few years It may well be, however, that the expenditure of effort by each member of the Public of Bromley during these years of stress has depleted the stock of resistance to disease and to fatigue of mind and body. Time alone will answer. The statistics for 1945 are generally satisfactory. The mid1945 figure of population given by the Registrar General is 52,310. I believe the figure to be in the region of 62,000. The vital statistics are good, the Birth Rate is 16.6, the Death Rate 12.5, the Infant Mortality Rate 28.6, and no maternal deaths. The year saw the commencement of the Domestic Help Service by the Local Authority on behalf of the Ministry of Health, a service invaluable in selected cases, and one that will be, in my opinion, a continuous need. The increasing demand for maternity bed hospital accommodation has placed a great strain upon the Department, especially arising during the serious housing shortage for the young married people and the great difficulty of obtaining adequate nursing staff. The housing problem remains acute in spite of intense activity by the Local Authority. Until this problem is solved efforts to promote health and happiness of our people will be merely palliative, 9 A family without a house is a family without a home, and, however one may look at this very vexed question, whether from the viewpoint of health or from the social happiness and security of our people, the consequences are serious. The Sanitary Inspectors investigated in 1945 the living conditions of 494 families. 92 families of 244 persons were living in one room each family ; 264 families of 761 persons were living in two rooms each family ; of the balance of 138 families 35 families were living more than two persons per room, and these figures are not complete. The year saw, too, the coming into operation of the Education Act, 1944, whereby Bromley undertook Divisional Administration as defined by the Minister of Education. The staff have continued to give efficient and loyal service, and it is to them that I am indebted for any success obtained. I am, Your obedient servant, K. E. TAPPER, Medical Officer of Health. 10 SECTION A.—STATISTICS AND SOCIAL CONDITIONS. Statistics. Area (in acres) 6,519 Registrar General's estimate of resident population mid-year 1945 52,310 No. of inhabited houses according to the rate book: at the close of the year 1945 16,719 No. of valuation assessments of habitable premises at the close of the year 1945 : (a) Bromley (old Bromley Area) (b) Hayes & Keston Houses 12,531 2,669 Flats 1,445 74 Farmhouses 13 1 Public Houses 31 5 14,020 2,749 16,769 Rateable Value (31.3.1946) £703,787 Product of a Penny Rate (year ending 31.3.47) £2,820 net Vital Statistics. Live Births: Total Male Female Legitimate 807 419 388 Birth rate per 1.000 of the estimated civilian resident population: 16.6 Illegitimate 65 28 37 872 447 425 Stillbirths: Total Male Female Legitimate 14 12 2 Stillbirth rate per 1,000 (live and still) births. 16.9 Illegitimate 1 1 — 15 13 2 Deaths: Total Male Female 657 319 338 Death rate per 1,000 estimated resident civilian population: 12.5 11 Deaths from Puerperal Causes : Puerperal Sepsis—NIL. Other Puerperal Causes—NIL. Deaths of Infants under I year of age: Total Male Female Legitimate 23 17 6 Infantile mortality rate per 1,000 live births: 28.6 Illegitimate 2 2 — 25 19 6 Death Rate of Infants under 1 year of age : All infants per 1,000 live births 28.6 Legitimate infants per 1,000 legitimate live births 28.5 Illegitimate infants per 1,000 illegitimate live births 30.7 Deaths from : Cancer (all ages) 106 Measles (all ages) 1 Whooping Cough (all ages) — Diarrhoea (under 2 years of age) 1 Meteorology : I am indebted to the Borough Engineer for the following details of climatic conditions recorded by his staff in 1945:— Total rainfall 21.14 inches Mean maximum daily temperature 54.00° F. Mean minimum daily temperature 42.01° F. Highest maximum temperature 85° F. 8.4.45 Lowest minimum temperature 15° F. 29.1.45 Population. 52,310 is the Registrar General's estimate of resident civilian Population for mid-1945. I am content to leave for the present my last year's estimate of 62,000 as a likely figure of population when something like normal conditions are restored. The influx of families and persons into every type of accommodation available at the present time renders population calculation on the basis of persons per dwellings too transient a factor for even approximate estimating. Births. The Birth Rate for 1945 is 16.6 per 1,000 population compared with 16.5 for 1944. 12 According to the Registrar General's returns for 1945, there were 872 live births and 15 stillbirths after transferable adjustments had been made. Comparative birth rates per 1,000 population are as follows: Bromley England & Wales Great Towns (incl. London) London County Live Births : 16.6 16.1 19.1 15.7 Stillbirths : 0.28 0.46 0.58 0.40 The total number of births occurring in the area notified to the Medical Officer of Health (after making adjustments by transferable births), was 903, of which 884 were live births and 19 still births. Actual number of confinements in the Borough area was 781, of which 225 were home cases and 556 institutional cases. In addition, 320 cases were referred for hospital confinement to the County Hospital. Thus, 1,101 known confinements concerned the Borough, which gives some indication of the stress of work placed upon the Maternity services. There will always be some disparity between the Registrar General's figure and the actual cases dealt with, mainly because births notified to the Medical Officer are notified within 36 hours of birth, whereas registration is permitted within six weeks of birth. Deaths. The Death Rate for 1945 is 12.5 per 1,000 population compared with 13.3 for 1944. The total number of deaths for the area in 1945 is 657. For 1944 it was 661. Comparative Death Rates per 1,000 population are as follows :— Bromley England & Wales Great Towns (incl. London) London County 12.5 11.4 13.5 13.8 Main causes of deaths in Bromley during the past five years:— 1945 1944 1943 1942 1947 ] Heart Disease 176 182 161 139 170 Cancer 106 122 93 113 123 Respiratory (non-T.B.) 61 60 77 57 93 Tuberculosis 36 21 30 33 34 13 Infantile Mortality. The Infant Mortality Rate of infants under 1 year of age for 1945 is 28.6 per 1,000 live births. This is a substantial reduction on the figure for 1944, when it was 39. 25 infants under 1 year of age died in 1945 ; of these we may note the following particulars :— 15 were inward transfers, died in hospitals. 10 died locally, 4 in hospital and 6 at home. 17 of the total died in the first week of life, and 8 between the first week and 12 months of life. 14 deaths (56 per cent.) were due to prematurity, malformation and congenital debility, indicating the great need for complete ante-natal supervision. In an endeavour to reduce the high mortality in infants under one week of age, every expectant mother has an investigation into the Rh factor ; Vitamin K is also provided. An attempt is made in the following figures to show the state of infant mortality based on pregnancies (not including the unknown factors of miscarriages and abortions) These figures bring up-to-date on a five-yearly basis the findings in my previous report of 1944. 19261930 19311935 19361940 19411945 Confinements 3090 3383 4072 4238 Stillbirtns 76 99 127 103 Died—1st week 51 56 69 76 Died—between 1st week and 1 year 83 70 77 53 Survivors at year's end 2880 3158 3779 4006 Based on these figures, a truer infantile mortality rate per 1,000 pre nancies (excluding miscarriages and abortions) is compared with the official infantile mortality rate based on 1,000 live births, as follows :— 19261930 19311935 19361940 19411945 Per 1,000 pregnancies 68 66 67 55 Per 1,000 live births 44 38 37 31 Rate per 1,000 pregnancies :— Stillbirth 25 29 31 24 Died in 1st week 16 16 17 18 Died 1st week to 1 year 27 21 19 13 14 In the following graph, based on these figures, one can present a truer picture of infantile mortality rate per 1,000 pregnancies when compared with the official rates based on 1,000 live births. Maternal Mortality. For the third year in succession we have no maternal deaths to record in Bromley. 15 SECTION B (I). GENERAL PROVISION OF HEALTH SERVICES OF THE AREA. Under this heading I have in the pre-war years referred in more detail to the activities of the following services. Whilst there has been no exceptional changes or important developments to record of these services in recent years, except as regards development of the Bromley and District Hospital, to which I shall here specially refer, space at the present time forbids my referring to all their work in detail. It must not be forgotten, however, that all are important factors in the general health services available to the Borough, and all have been carrying out their work to the fullest extent during the war and since. (a) Civil Ambulance Service. A Corporation service, operated from and by the Bromley and District Hospital by arrangement. The work of this service is increasing. Total No. of cases conveyed: (a) Private 1391 (b) Police 317 1708 Mileage : (a) Private 9602 (b) Police 1239 10841 Petrol consumption : 1009 galls. (b) Laboratory Services available : (a) Ministry of Health Emergency Laboratories at Downe. (b) Kent County Laboratories at Maidstone. (c) Isolation Hospital—Swabs chiefly. (c) Nursing in the Home. A service principally maintained by the Bromley District Nursing Service. (d) Treatment Centres, Clinics and Welfare Centres provided by the Corporation. No noteworthy changes. (e) Tuberculosis Dispensary provided by the Kent County Council. No noteworthy changes. (f) Venereal Diseases Treatment Scheme provided by the K.C.C. (g) Hospitals, Public and Voluntary : (1) Isolation Hospitals of the West Kent Isolation Hospitals Board. (2) Bromley and District Hospital and its Maternity unit—a voluntary organisation, 16 Bromley and District Hospital. This hospital has adopted a progressive policy to make available to the Borough a general hospital service of inestimable value to the townspeople. Co-operation with the services of the Local Authority is always readily extended by the hospital, and especially so to the Borough's Casualty Services during the war, when so many civilian casualties were treated and cared for at the Hospital. An extract from their Annual Report reads :— " During the year arrangements have been made with the Bromley Borough Council whereby the Hospital now administers the Ambulance Service on their behalf. An arrangement has also been made with the Council to accept Maternity cases for whom they are responsible, and for treating School Children on behalf of the Education Committee. "With the anticipated nationalisation of the Hospitals, the position of this hospital in the future cannot be foreseen with any certainty, but whilst we are a Voluntary Hospital the Board will continue to give the sick population and the mothers of Bromley the same standard of efficiency of which the Hospital has always been proud ; and the Board will also press forward with progressive schemes with a view to establishing a comprehensive Hospital Service at Bromley for the use of the Bromley people." PUBLIC HEALTH ACT, 1936. SECTIONS 187/194. Nursing Homes. Eight nursing homes on the register at the end of the year 1945. These homes provide a total of 85 beds for surgical and medical cases. The homes were inspected on 18 occasions during the year. SECTION B (II). MATERNITY AND CHILD WELFARE. Municipal Midwifery Service. Domiciliary midwifery of the Borough is entirely operated by the Municipal Midwives. There are no independent midwives practising in the area. Routine work of the midwives is indicated in the following figures for 1945 :— Total No. of bookings 510 Confinements attended 225 Hospital cases 320 Visiting—Ante-natal 2771 Post-natal 3671 The midwives attend the Ante-natal Clinics twice weekly, details of which follow. They carry out the ante-natal and posnatal routine examinations of all hospital cases. 17 Ante-natal Clinic. The figures of work done during 1945 are as follows:— No. of sessions—By Doctor 95 By Midwives 49 New cases seen by the Doctor 487 Total No. of all medical examinations 696 Total No. of all midwives' examinations 628 Domiciliary Medical Practitioner Service. Twelve expectant mothers were ante-natally examined by private practitioners on behalf of the Local Authority, and 12 were post-natally examined. This service will not increase until more doctors are released from National Service. The predominance of hospital confinements. reduces the use of the private doctors' participation in this scheme. ' Dental Scheme for Nursing and Expectant Mothers. Mr J. H. Glen reports for 1945 as follows :— Appointments kept 405 No. discharged, treatment completed 47 Attendances—Gas extractions 67 Local extractions 30 Extractions 510 Fillings 134 Dentures fitted 51 Attendances for denture work 144 No. of sessions held 84, 5/6 Administration of Midwives' Acts, 1902-1936. No. of midwives practising in the area at the end of 1945—31. (a) Municipal Midwives 6 (b) Midwives in institutions 25 No. of confinements attended:— Domiciliary Institutional Total (a) As Midwives 194 236 430 (b) As maternity nurses 31 320 351 No. of cases in which medical aid was summoned during the year by a midwife :— (a) Domiciliary cases 53 (b) For cases in Institution — Note.—Cases in the Maternity Hospital being medically supervised are not included under (b). 18 Administration of Analgesics. Number of midwives in practice in the area qualified to administer analgesics :— (a) Domiciliary 5 (b) In Institution 13 18 Facilities are provided by the Local Authority for midwives practising in the area to attend courses of instruction in the administration of analgesics, and apparatus for administrations are supplied for the use of midwives in domiciliary cases. Only 9 administrations in domiciliary cases were given during 1945, mainly due to the fact that cylinders were not available and the difficulty of transporting equipment except by car. Maternity Hospital Provision. Our agreement with the County Hospital, Farnborough, has operated with complete success and with the closest operation. The Hospital refer to us all cases of Bromley mothers making direct application to them in order that we may select the environmentally and medically necessitous patient Only these types of cases are admitted. During the year 320 cases were financially assisted. On 1st June, 1945, the Bromley and District Hospital amalgamated with the Bromley, Chislehurst and District Maternity Hospital, and the immediate result was to increase maternity bed accommodation in Bromley from 22 to 60. I am indebted to the Medical Officer of the Maternity Hospital for the following extract of figures of work done in 1945:— No. of cases admitted 551 Ante-natal in-patient treatments 30 Cases delivered by—Midwives 370 Doctors 151 Cases of Puerperal pyrexia 9 Stillbirths 6 Infant deaths 5 Puerperal Pyrexia. Eleven cases were notified within the area during 1945, and no deaths occurred. Nine cases were institutional, and two were domiciliary. 19 Care of Premature Infants. No. of babies notified during 1945 weighing 5½ lbs. or less at birth was 23. These cases come under the special care and visitation by the health visitors, and all made satisfactory progress, with the exception of one case which died at six months of age. Home Helps. Three whole-time Home Helps are employed in the Municipal Midwifery Service, and also some 50 persons were available during the year for casual employment. Home Help was provided for 107 Domiciliary cases in 1945. (The Home Help Service is not to be confused with the Domestic Help Service reported on later herein.) POST-NATAL SERVICES. Health Visitors : Home Visiting. 748 first visits were made to babies under one year of age, representing 84 per cent. of infants notified in 1945 within three weeks of birth. Total number of visits to babies in the first year of age was 2,282, making approximately 3 visits per child. The following is a tabulation of all visits during 1945 :— Primary visits under 1 year 748 Revisits under 1 year 1534 Revisits 1 to 5 years 3158 Expectant mothers (special visits) 43 School Children 315 Infant deaths (special inquiries) 11 Stillbirth (special inquiries) 2 Immunisation 109 Miscellaneous 272 6192 " Ineffectual " visits 1676 7868 Visits to Boarded-out Children (included above) 43 Visits to Adopted Children (included above) 27 21 per cent. of visits were classed as " ineffectual," which is 5 Per cent. higher than usual. 20 Welfare Centres. At the end of the year six welfare sessions were in operation weekly. Much valuable help continues to be given freely by the voluntary workers at the Centres. Figures for 1945 are as follows Total No. of babies on registers 4096 Total attendances of babies :— Under 1 year, 9816 Over 1 year 7216 17032 Total medical examinations 3252 Total weighings 16260 These figures show a general increase over the previous year's figures. 776 infants under one year attended at the Centres for the first time during the year, and 210 first attendances over one year of age were made. At the end of the year there were 892 under one year of age and 1,181 over one year of age who had attended at the centres during the year. The 4,096 babies on the centres' registers is a gross total figure of enrolments up to school entrant age, made up of regular attenders, irregular attenders and children who when on the verge of attending school rarely attend centres. The figure is subject to fluctuation from time to time when revised at school commencing age, changes of address and other reasons. We may claim that of the full roll 50 per cent. are regular in attendance. There were 776 new enrolments of the under one year babies, which is a good proportion (87 per cent.) of the 884 notified live births for the year. There were in addition 210 babies over one year of age newly enrolled during the year. Child Life Protection. Only five individual foster mothers were on the register at the end of 1945, having the care of five children under nine years of age. 43 visits of inspection were made during the year by the child Protection Visitors. There was no cause for complaint in the care given. Care of Illegitimate Children. In last year's Report I summarised the provisions made by the Council for the care of these children, and no change arrangements have been made. Five mothers were sent to the home where special care during the ante-natal and lying-in periods is available. 21 Adoption of Children. Notices were received during 1945 in respect of 32 children. Clinic Treatment of Children under 5 Years. Treatment in 1945 :— Eye Clinic 77 Minor Ailments 100 Orthopaedic Clinic 600 Dental Clinic. Appointments kept 61 Discharged — treatment complete 61 Extractions under gas 14 Extractions, local anaesthetic 5 Fillings 46 Extractions 32 Dressings 15 War-Time Nurseries. Elmfield Road Nursery.—The Matron reports as follows :— "During the past year the nursery continued to run to capacity. It is very popular with the mothers, and there is rarely a day without an enquiry for a vacancy. The waiting list at the end of the year was 36 children over two years and 12 under two years of age. The attendance is remarkably good and consistent. We were unfortunate enough to have twelve cases of mumps in May followed by 25 cases of measles, and the latter continued over a period of three months. Both infections were mild in nature, and there were no complications. The majority of these cases contracted the infection outside the Nursery. There was one case of chicken pox and one of scarlet fever. Apart from these infectious diseases the health of the children has been good, and 'hey look exceedingly healthy and happy. Medical examinations have been carried out as a routine. The Staff of the nursery has not changed during the past twelve months. The students have worked well, and two entered for the November examination of the National Society of Children's Nurseries and obtained their Diploma." Draycott Nursery.—The Matron reports as follows :— " During the year 1945 there were several changes on the Staff of the Nursery. Miss Gunyon, Matron, resigned after two years' service to take further training. She was succeeded in july by Mrs. Brockwell, who resigned the position in December, 1945. Amongst other resignations were those of the Deputy Matron. Miss Rogers, who also left to take a further training, and Miss Wright, Nursery Warden. 22 Three students took the National Society of Children Nurseries' Examination in May, 1945. All passed the examination. The attendance of children at the Nursery was on the whole rather low during the first part of the year owing to evacuation, weather conditions and illness, but gradually increased during the summer months. In April there was a considerable outbreak of measles and mumps amongst the children, and in November and December the numbers were very much reduced owing to an outbreak of whooping cough which spread through the Nursery. There was a considerable waiting list at the beginning of the year, but this was reduced to about ten by the end of the year. Domestic Help Scheme. This Service commenced in January, 1945, and has flourished since with considerable success. Throughout the year there was a steady and increasing demand for domestic help, which we were able to satisfy in spite of many difficulties. Home visitation was found to be necessary to ensure not only that the case came within the category of help, but also that proper use was made of the help given. The following figures give some indication of the work involved :— Total No. of helpers engaged during 1945 : Whole-time 2 Part-time 61 Total No. of cases assisted 213 Types of cases assisted : *Maternity 61 Sickness 152 213 * Not being cases of Home Helps within the Municipal Midwifery Service. SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. I am indebted to the Director of Water Examination of the Metropolitan Water Board for the following information regarding the supply of water to the Borough during 1945 " The supply to the Bromley district is a mixture of water from Orpington, West Wickham and Shortlands Wells, and 23 Thames-derived filtered water. All the water is chlorinated as it leaves the works. " Bacteriological analyses are made five times per week of all supplies, 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. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically. "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 bacteriological analyses of the various supplies." Chemical and Bacteriological Examinations, 1945. Bacteriological. No. of samples Colony Count on Agar at 37° C. Bact. coli Test Percentage Bact. coli of samples per 100 ml. negative 100 ml. Orpington 246 – 100.0 0.0 West Wickham 244 – 100.0 0.0 Shortlands 247 – 100.0 0.0 Thames derived filtered water (Walton) 252 12.3 100.0 0.0 Chemical. Orpington West Wickham Thames-derived filtered water Shortlands (Walton) Samples 5 5 6 245 Ammoniacal Nitrogen 0.006 0.003 0.027 0.155 Albuminoid Nitrogen 0.017 0.023 0.041 0.098 Oxidised Nitrogen 5.1 4.3 3.5 2.9 Chlorides as C1 14.7 13.8 22.7 28.4 Oxygen abs. from Permanganate 3 hrs at 80° F. 0.10 0.12 0.41 1.31 Turbidity in terms of Silica — — — 1.0 colour, m.m. brown, 2 ft. tube Burgess's Tintometer 0 0 2 22 Hardness (Total) 302 279 287 227 Harness (permanent) 82 71 107 65 PH Value 7.1 7.1 7.2 7.7 Conductivity 475 425 475 450 24 Cesspools. Refuse Collection and Disposal. Drainage. Rivers and Streams. There are no special comments to make under the foregoing headings. SANITARY INSPECTION OF THE AREA. Sanitary Inspectors' statistics for 1945 :— Type of Inspection On Complaint Routine inspns. Total No. of Inspection? Defects Found Housing 1148 95 2517 3760 1410 Infectious Disease Inquiries 113 116 9 238 Food Shops 75 1364 22 1461 77 Factories 47 152 121 320 88 Sampling 1 357 3 361 — Trade Premises Various 22 240 81 343 30 Rat Infestation 423 40 2553 3016 221 Miscellaneous 33 677 65 775 59 Totals 1862 3041 5371 10274 1885 Interviews at office and on sites, 1,453. Notices Issued. Preliminary—Housing 819 Others 474 1293 Statutory 1 Food Condemnation Certificates issued, 796. Factories. Factory Premises Inspections Written Notices (a) With mechanical power 102 20 (b) Without mechanical power 30 5 (c) Other premises 188 15 Total 320 40 Number of defects found 88, and subsequently remedied. 25 Shops Acts, 1912/1936. 19 special visits of inspection were made to shops during the year. Six contraventions of provisions of the Shop Acts were remedied without resort to legal proceedings. Smoke Abatement. 15 visits to premises were made in connection with a nuisance from smoke, which was abated. Swimming Baths, Pools and Water Sampling. Three samples of lake water submitted for analysis were not found to be materially polluted. A sample of boiled water from a copper pan used for tea making disclosed 4.6 parts of zinc per million, which is somewhat excessive for potable purposes. A subsequent sample from the same source proved satisfactory. Verminous Conditions and Uncleanliness. The Sanitary Inspectors made 209 inspections in connection with eradication of bugs and dirty conditions. 26 infestations and 25 dirty conditions were successtully abated. The Property Manager had no reports of serious infestation on the Council's Housing Estates, and records a negative return for 1945. Particular attention was given to the routine of instruction, inspection and treatment regarding uncleanliness among children returning home after evacuation. The School Nurses made 11,835 inspections of children for head vermin during 1945, and of this number 184 children were found unclean in a minor degree. Scabies and Impetigo. Associated with uncleanly and verminous conditions are the common skin infections, as scabies and impetigo. Where crowding exists and personal hygiene is neglected prevalence of these infections will become widespread. Generally, there was a lessening of cases coming under notice of the services ouring 1945. Medical inspections and treatments by the School Medical Officers for 1945 are recorded as follows:— Inspections. Total No. of At School Clinics. Treatments. Home, or own Doctor. Requiring Treatment. Requiring Observation. Scabies 61 – 42 9 Impetigo 35 — 31 — Other Skin Disease 657 3 594 26 26 Rats and Mice Destruction. Figures of inspections during 1945:— On Complaint Routine Re-inspections Total Trade Premises 49 31 370 450 Private Premises 374 9 2183 2566 Totals 423 40 2553 3016 No. of baits laid 2,691 Legal Proceedings. No Court proceedings were instituted under the foregoing headings of this section of the Report. SECTION D. HOUSING. Housing Statistics for the year 1945. Total number of inhabited houses at the end 1945 (according to the rate books) 16719 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) (b) No. of inspections for the purpose 3379 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 (b) Number of inspections 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 872 27 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 Authority or their Officers 819 3. Action under Statutory Powers. Proceedings under the Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 1 (2) Number of dwelling houses in which defects were remedied after service of formal notices (a) By owners 1 (b) By Local Authority in default of owners — Inspections and Abatements. The foregoing figures are amplified in the following tabulation which gives total figures relative to housing visits of all kinds including figures not falling under the preceding headings. Housing Inspections. On Complaint. I ioutine Re-Inspections Total. 1. Inspection of District Regulations - - - - 2. For Nuisances 1001 49 2315 3365 3. Overcrowding 9 1 13 23 4. Verminous Conditions 19 1 47 67 5. Dirty Conditions 17 — 56 73 6. Water Supply 6 — 8 14 7. Cesspools — 2 — 2 8. Earthclosets 1 — 1 2 9. Inadequately housed surveys - 23 1 24 10. Special housing inquiries 66 13 3 82 11. Disinfestation 19 2 48 69 Noxious accumulation 10 4 25 39 Totals 1148 95 2517 3760 Nuisances and defects found: 1,410. ' Nuisances and defects remedied: 1,140. Of the 1,140 defects abated 233 concerned drainage, 221 dampness, 58 plastering renewed or repaired, 93 floors renewed or repaired, 46 windows repaired, 109 dustbins provided, 86 water supply fittings, renewals, etc., and 294 miscellaneous items. 28 SECTION E. Inspection and Supervision of Foods. The vigilance exercised by the Sanitary Inspectors in the important work of safeguarding the Borough's food supply will be readily appreciated from the details of food supervision recorded in this section. Milk Supply. 89 inspections of registered dairy premises were made during 1945. Satisfactory conditions were generally reported except in 4 instances of minor defective conditions which have been remedied. Licenses have been issued for graded milks under the Milk (Special Designations), Regulations as follows:— Pasteuriser's License 1 Dealers' Licenses. Supplementary Licenses. " Pasteurised " 13 3 "Tuberculin Tested" 7 3 Samples taken by the Sanitary Inspectors and submitted for examination :— Ordinary Milk, bacteriological test 17 Graded Milk, bacteriological test 40 Phosphatase test 25 Tuberculin test 16 Methylene Blue test 36 Souring test 13 Food and Drugs Act. Samples taken by the Sanitary Inspectors during 1945, and results:— Formal. Informal. Adulteration or Irregularity. Ale 3 — - Ammoniated Quinine — 1 - Aspirin — 1 Beer 3 — - Baking Powder — 12 - Bicarbonate of Soda — 2 ' Blood Mixture — 1 - Batter Flour - 1 - Biscuit Mixture — 2 - 29  Formal. Informal. Adulteration or Irregularity Carrageen Moss — 1 — Coffee — 3 - Coffee Essence — 1 - Cocktail Tonic — 1 - Curry Powder — 5 - Cocoa — 3 - Corned Beef Roll — 1 - Cake Flour — 1 - Chocolate Cup — 1 - Carmine — 1 Creamola Pudding — 1 - Compound Zinc Starch and Boracic Powder - 1 — Cake, Bun and Pudding Mixtures - 10 — Castor Oil — 2 - Children's Cough Mixture — 1 - Cinnamon, Ground — 1 - Forcemeat — 2 - Flavouring Essence — 1 - Golden Raising Powder — 3 - Glycerine — 1 - Gelatine — 1 - Glycerine, Lemon and Honey Balsam 1 —- Ginger Wine Essence — 1 - Jam — 1 - Lactic Barley Malt — 1 - Medicinal Paraffin — 1 - Mixed Veg. Soup — 2 - Milk 41 9 2 Mustard . — 1 1 Milk, Evaporated .— 2 - Mustard Sauce — 3 - Pudding Mixture . — 4 - Peppermint, Essence of . — 1 - Peanut Butter — 1 - Phosphate Compound .. — 1 - Raising Flour .. — 1 - Saccharin Tablets .. — 1 - Sausages, Sausage Meat 1 8 - Self Raising Flour — 4 - Sauce — 3 - Semolina - 3 - 30  Formal. Informal Adulteration or Irregularity. Salad Dressing Powder — 1 Syrup of Figs — 1 Spice Pickling — 1 - Tincture Iodine - 1 Vinegar 3 6 Walnut Ketchup - 1 - Yeast Tablets - 1 Zinc & Castor Oil Ointment - 1 Zinc Ointment - 1 — Total 51 125 3 Particulars of adulteration or irregularity in above samples: Article Formal Informal Adulteration or Irregularity Ground Mustard Milk Informal Formal Contained only 0.06% of allyl isothiocyanate 24.6% deficient in fat Milk Informal 18.0% deficient in fat Legal proceedings were not instituted in these cases, but cautions were given to the vendors concerned. The County Analyst makes comments as follows: " That during the year considerable attention had been given to mustards offered for sale in the County. There are two mustard flours of importance, a brown mustard being the one which has the characteristic taste and is required as a condiment mustard. White mustard is sometimes offered for sale as mustard, and this has been the cause of complaints, as white mustard is of little or no value as a condiment. In order to limit the amount of white mustard flour which may. occur in mustard offered as a condiment, the Minister has fixed a standard so that mustard on sale must contain a minimum quantity of an active principle, namely, allyl isothiocyanate," 31 Meat and Other Foods. Food surrendered as unfit for human food is either destroyed, salvaged for animal feeding, or utilised for soap making. Certain commodities may be recommended to be rendered fit by treatment for human consumption. 796 food condemnation certificates were issued by the Sanitary Inspectors during 1945 in connection with the disposal of the following articles of food surrendered as unfit. Article of Food Quantity Approx. weight (in lbs.) Canned Meat 1066 containers 1442 Canned Milk, milk powder 1199 containers 1071¼ Canned Fruit 12 containers 16½ Canned Fish 2126 containers 1507¼ Canned Soup 444 containers 359 Canned Vegetables 1291 containers 1408¾ Meat 2740¼ Meat (cooked) 137¼ Fish 32184 fruit, dried, etc. 2460½ Vegetables . 2782 Fats (butter, margarine, lard, cheese) 687¾ Poultry, game 55½ Eggs, egg powder 87¾ Flour, flour mixtures 453 containers 1700 Bread, cake, biscuits 1137 Cereals, pearl barley, oatmeal, rice 1614¼ Sugar 772 Tea, coffee, cocoa 238 containers 134¾ Jam, marmalade, syrup 860 containers 1239¾ Salt 507 Miscellaneous 6901 25768¾ (Total: 11 tons, 10 cwts., 0 qrs., 8¾ lbs.) 32 The following foodstuffs were submitted for bacteriological examinations:— Ice Cream Produced in district 5 4 satisfactory 1 unsatisfactory Ice Cream Produced outside district 5 5 satisfactory Ice Cream Powder 1 satisfactory Tins of Pilchards 2 satisfactory Evaporated Milk 5 4 satisfactory 1 unsatisfactory Yorkshire Pudding Mixture 1 unsatisfactory Dried Egg 7 6 satisfactory 1 unsatisfactory Powdered whole milk 2 unsatisfactory Tin Sardines 5 3 satisfactory 2 unsatisfactory Corned Beef Roll 3 satisfactory Special Enquiries. Negative 1. Re Sonnes Dysentery. Water samples 5 Milk (certified) 2 Fowl Faeces 1 2. Re Threadworms in a family. Water 3 Negative Garden Soil 1 Positive (doubtful) 3. Food Poisoning Case. Tins Stewed Steak 2 negative Stewed Steak (the Meal) 2 positive CI. Butyricum Special enquiry was made regarding a large number of blown tins in a large consignment of Full Cream Condensed Milk, of which eight were submitted for test and were all unsatisfactory. The examination showed a fault in manufacture, and all consignments of this pack were withdrawn from sale. SECTION F. Prevalence of and Control Over Infectious Disease and Other Diseases. There were no abnormal causes of sickness or invalidity m the Borough during 1945. The following table gives the infectious diseases notified during 1945, 33 Infectious Disease. Sex and Age Grouping:. (Civil Population only) Scarlet Fever Diphtheria Whooping Cough Measles Acute Poliomyelitis Acute Polioencephalitis Enteric or Typhoid Fever Paratyphoid Fevers Ages M. F. M. F. M. F. M. F. M. F. M. F. Ages M. F. M. F. 0 - 2 7 2 _ - 0- - - - - 1 - 3 2 — — 6 4 33 24 - - - - 5- - - - - 3 - 2 5 1 — 7 4 26 25 — - — — 15 - - 5 - 12 11 3 — . 3 — 60 64 — — — - 45 - — — - 10 - 2 7 — — 2 — 9 13 — — — 65 & - - - - 15 - 2 4 1 1 — — 3 6 — over - - 25 & over 1 2 — 1 - 2 — 7 — — — — Age unknown — — - - Age unknown — — — — — 1 1 3 — — — — Totals 22 31 5 2 20 11 139 144 - - - — - — — — Acute Pneumonia Dysentery Cerebrospinal Fever Acute Encephalitis Lethargica Erysipelas Small Pox Other Notifiable Diseases Ages M. F. M. F. M. F. M. F. M. F. M. F. M. F. 0 - 1 Puerperal Pyrexia 12 5 - 1 3 1 - - - - - - - - 15 - - 4 2 - - 2 - _ Ophthalmia Neonatorum 2 - 45 - 11 6 - — — - 1 — 5 2 — — 65 & over Age 2 4 - - - - - - 2 - - - Malaria (contracted abroad) 2 12 unknown - - - - - - - - 1 1 — — Totals 15 17 2 1 — 2 1 8 3 — Totals 2 12 34 The foregoing table shows that apart from measles the Borough had a low infectious disease incidence during 1945. There was one death from measles, one from acute encephalitis and 32 from pneumonia. The encephalitis death was an inward transfer of a case which had contracted the disease and died outside the area. The 32 pneumonia deaths must not be set against the 32 cases notified, as deaths include all forms of pneumonia whereas notified cases are confined to the acute types of pneumonia. Diphtheria Immunisation. Number of children completely immunised during 1945:— Under 5 520 Over 5 39 Total number of children completely immunised up to 31st December, 1945:— Under 5 1557 Over 5 3374 The following tabulation gives notifiable disease attack and mortality rates per 1,000 population during the years 1940-1945. 35 INFECTIOUS DISEASE-1940-1945 (CIVILIAN ONLY). Attack Rates and Mortality Kates per 1,000 Population (Registrar General). Estimated Population (Civilian) 56,580 50 430 50,480 51,300 49,730 52,310 Year 1940. 1941 1942. 1943. 1944. 1945. 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 0.86 0.01 2.35 2.06 — 3.97 _ 2.35 - 1.01 - Diphtheria 0.19 0.01 0.61 0.05 0.29 0.01 0.06 — 0.20 0.13 Enteric 0.08 0.01 0.02 - — — — 0.02 Erysipelas 0.30 — 0.25 — 0.33 — 0.31 — 0.14 — 0.21 Dysentery 0.10 — 0.09 — — — 0.03 — 0.28 0.05 Cerebro Spinal Fever 0.22 0.03 0.09 — 0.05 0.04 0.01 — 0.04 0.03 . Encephalitis Lethargica — — — — 0.01 — — - — 0.04 0.02 0.02 Acute Poliomyelitis — — 0.05 0.02 — — 0.09 — 0.02 — - Whooping Cough 2.48 — 3.15 — 1.08 — 1.83 0.01 1.62 0.02 0.59 Measles 0.03 — 12.71 0.02 2.39 — 10.46 — 2.35 — 5.41 0.02 Total comparative rates 4.31 0.05 19.45 0.09 6.24 0.05 16.93 0.01 7.03 0.08 7.49 0.04 N.B.—Pneumonia and Malaria (contracted abroad) are not included in the above figures. Attack Rates and Mortality Rates per 1,000 Births. Ophthalmia Neonatorum 3.7 — 1.49 — — — 3.33 — — — — — Puerperal Pyrexia 2.58 1.28 10.13 4.68 7.80 — 6.50 — 7.14 — 13.52 — 36 Tuberculosis. Recordings in the register during 1945 were as follows:— Respiratory Other Forms Tot. No. of Cases M. F. M. F. On register, 1.1.1945 256 234 81 97 668 New cases notified 22 28 4 5 59 No. of cases coming to knowledge after death 4 5 - 1 10 Inward Transfers 2 1 — — 3 284 268 85 103 740 Deletions—deaths, removals and recovery 18 25 5 5 53 On register, 31.12.45 266 243 80 98 687 There has been a net increase of 19 cases in 1945 over the figure for 1944. The total number of cases gives an incidence rate of 13.1 per 1,000 population for the year 1945. There were 10 un-notified cases amongst the 36 deaths from tuberculosis, giving a ratio of 1 in 3.6. I do not regard this result as meaning that inefficiency of notification exists. Seven of these cases were elderly people between 55 and 60 years who died outside the area, and little could be discovered regarding their previous case history. New Cases and Mortality, 1945. New cases notified or otherwise revealed Deaths Age Groups Respiratory NonRespiratory Respiratory NonRespirator M. F. M. F. M. F. M. F. Under 1 1 — — — — — 1—5 — 1 1 1 — — 1 — 5—15 — 2 1 3 — — — 1 15—25 9 10 — 1 4 — — — 25—35 3 5 1 — 2 4 — — 35—45 4 6 — — 2 4 1 — 45—55 4 3 — 1 3 2 — 1 55—65 5 3 1 — 4 2 1 — 65 & over. — 3 — — 1 3 - - Totals 26 33 4 6 16 15 3 2 Inward transfers (not included in above table): Respiratory M.2 F1 37 Public Health (Prevention of Tuberculosis) Regulations, 1925 Public Health Act, 1936, Section 172. No action required under these enactments during 1945. SECTION G. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. Diseases of Animals. The Chief Sanitary Inspector is Inspector under the Diseases of Animals Acts. Routine inspections were as follows : Movement licences 25, Swine Fever 12, and interviews 45. Notices were served for Swine Fever 3, and Foot and Mouth Disease 1, in connection with infected area orders. No serious outbreak occurred within the Borough. Registries for Female Domestic Servants. There are no noteworthy comments to make under this heading. Retail Market. The monthly average takings during 1945 were £5 15s. 2d., and the weekly £1 6s. 7d., compared with £5 0s. 0d. and £1 2s. l0d. respectively for 1944. Until there is relaxation of controls in food and other goods, there is not likely to be much ment to record. Petroleum Acts. The Chief Sanitary Inspector undertakes the duties of Inspector under the Petroleum Acts. 167 inspections were made during 1945, and three matters of contraventions were remedied. Total number of licenses issued :— (a) For Petroleum Spirit 86 (b) For Carbide of Calcium 1 39 BOROUGH OF BROMLEY ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR 1945 40 EDUCATION COMMITTEE at 31st December, 1945. Alderman F. W. Isard (Chairman). Councillor L. L. Irwin, M.A., LL.B. (Vice-Chairman). Alderman M. Stafford Smith, M.B.E., B.A. Councillors H. Dorrett, H. L. Elphick, B. J. Finnie. M.C., H.M.V. Green, C. G. Griffin, F. G. Hamilton-Spratt, H. LynchWatson, F. Sutcliffe, F.R.I.B.A., and H. M. Vincent (Mayor). Co-opted Members: The Rev. F. W. Armstrong, M.A., Mr. G. J. Gully, J.P., Lt.-Col. E. J. Heilbron, Mrs. A. M. Howe, J.P., Mr. H. J. Lester, Mr. L. Harvey Lowe, Mrs. E. J. Munn, and the Rev. Q. G. Whitfield, M.A. Officers (at 1st April, 1946):— Borough Education Officer: H. W. C. Eisel, M.A., M.Litt., M.Ed. Assistant Borough Education Officer : A. C. Cleveland. Chief School Enquiry Officer: .E. P. J. Wythe. Introduction. In this my 21st Annual Report on the School Medical Services as applicable to Bromley, and as suggested by the Minister of Education, I present only a brief report on the health and well-being of pupils during 1945. As the figures for 1945 will show, the services were fully occupied ministering to the health needs of pupils, and a great deal of work was accomplished. It was not a year in which it was easy to pursue an ordered routine. The new Education legislation commenced to introduce administrative changes which have not yet completed their transitional phase, and the form in which medical and dantal records shall be kept in future is under consideration by the Ministry of Education. Thus, administratively, we might well be described as being in a state of suspended animation; but I am satisfied that the School Medical Services as built up in past years will prove flexible enough to meet and absorb whatever new policies and extensions are demanded of them. With the return of evacuated children during 1945, the school roll was increased to 5,000 by the end of the year. Many needed our special attention, and upwards of 72 per cent. of 41 scholars were seen at routine medical and special clinic inspections. Total attendances for inspections and re-inspections at all clinics, including specialist clinics were 5,862. Treatment attendances for minor ailments, massage, exercises, artificial sunlight, etc., totalled 17,544. In addition, the Dental Service dealt with a total attendance of 5,899. In broad outline these figures indicate to some extent how the Authority's services are used. These demands will, I believe, increase considerably in the near future. Nutritional standards came out statistically very well for 1945 as will be seen by reference to the sections dealing with this subject. Uncleanliness was not a matter for great concern in 1945, except as regards returning evacuees, who needed special attention. SUMMARY OF STATISTICS. School Roll 4,990 Number of individual children who attended the Medical Clinics:— (a) North Clinic 1,164 (b) South Clinic 1,103 2,267 Number of individual children routine medically examined at school in the prescribed age groups 1,372 Number of special medical examinations and re-inspections at the Clinics:— (a) North Clinic 1,783 (b) South Clinic 2,976 (c) Specialist Clinics 1,103 5,862 Number of attendances made by children for treatment by School Nurses:— (a) North Clinic 8,437* (b) South Clinic 5,226 13,663 dincluding figures for the auxiliary Clinics held at Hayes and Burnt Ash. 42 Number of attendances for treatment at Dental Clinics:— (a) Elementary School Children 4,075 (b) Higher Education Children 1,358 (c) Other Dental Schemes 466 Number of attendances at the Eye Clinic 691 Number of spectacles prescribed 258 Number of attendances at Orthoptic Clinic 401 Number of attendances at the Orthopaedic Clinic:— (a) For Surgeon's consultations 412 (b) For treatments, massage and exercises 2,003 2,415 Number of attendances at Ultra Violet Ray Clinics:— (a) North Clinic 1,211 (b) South Clinic 667 1,878 Staff. Particulars of staff appear at the beginning of this joint report. Co-ordination. The School Medical Service remains at the present time linked with the Maternity and Child Welfare and general Public Health services of the Borough, and an attempt is being made to complete within a single record all that affects the family as the unit in Public Health. How far this policy can be maintained in the future will be determined by the pending organisation of the National Health Services. Hygiene of Schools. No noteworthy changes or improvements could be undertaken during 1945. 43 SECTION A. MEDICAL INSPECTIONS. Routine medical inspections were confined to the usual prescribed age groups. During 1945 children returned home to Bromley from evacuation areas and we found that many needed our special attention chiefly in regard to uncleanliness. The effect of school population movement during the war has been to disturb the maintenance of routine inspections. In the following tabulation the figures for 1945 show little change compared with the average figures for the five-year war period 1940-44. In comparison with the five-year pre-war period 1934-1938 there is some leeway to make up, but in spite of enemy activities and the stress and strain of war it is to me remarkable that we were able to maintain and provide such a high level of service. Period Routine Medical Inspection Total Special Inspections and reinspections Inspections by Specialists Entrants 2nd Age Group 3rd Age Group Other Routine Pre - war years 1934-38 3092 2645 2670 293 8700 35941 7543 5 years' average 618 529 534 58 1740 7188 1508 War years 19401944 2923 1653 1918 402 6896 23322 4615* 5 years' average 585 331 383 80 1379 4664 923* 1945 555 432 385 — 1372 4759 1105* *Nose and Throat Specialist's Clinic in abeyance since 1940—all urgent cases being referred to Hospital. Findings at Medical Inspections. Of the 1,372 inspections in three age groups, 268 individual children (19.5%) were found in need of treatment (excluding defects of nutrition, uncleanliness and dental disease). 291 defects were recorded for treatment in these children and 228 suspected defects were noted for further observation. The Assistant Medical Officers commenting on their inspections during. 1945, were satisfied that there had been no deterioration in physique and well-being of the school children. Their general opinion supported the view that there had been an increase in the catarrhal conditions and apparently some loss of resistance in combating the skin infections, and that minor skin complaints were more liable to infection and much more resistant to treatment. 44 The following table shows the number of individual children found at routine medical inspections to require treatment (excluding defects of nutrition, uncleanliness and dental disease) in 1945. TABLE B. Age Group Defective vision Total No. inspected (excluding squint) Other Conditions Entrants 555 22 89 111 2nd Age group 432 19 65 84 3rd Age group 385 13 60 73 Totals 1372 54 214 268 This table summarises the defects found at routine and special medical inspections during 1945:— TABLE C. Defect or Disease Routine Inspections requiring Special Inspections requiring Treatment Observation Treatment Observation Skin 12 1 751 2 Eyes 61 48 220 17 Ears 3 2 99 11 Nose and Throat 45 133 395 86 Heart & Circulation 2 17 9 6 Lungs (non-T.B.) — 2 29 6 Tuberc., Pulmonary Definite - - - — Tuberc., Pulmonary suspected - - 1 2 Tuberc., non-Pulm. — 1 4 5 Nervous system 1 3 15 9 Deformities 44 4 61 4 Miscellaneous 123 17 605 48 Totals 291 228 2189 196 45 TABLE D. Nutritional Standard. This tabulation gives an indication of the nutritional standard of the 1,372 routine medical examinations at schools during 1945 Age Groups No. Inspected Classification of Nutrition Excellent Per Cent. Normal Per Cent. Sub-normal Per Cent. Bad Per Cent. Entrants 555 3.45 90.96 5.59 2nd Age Group 432 3.93 90.05 5.79 0.23 3rd Age Group 385 3.11 90.45 5.72 0.52 Total 1372 3.50 90.60 5.68 0.22 TABLE E. Comparative tabulation of Nutritional Standards of Pre-war and War-Time periods with 1945. Standard Year 1945 War Years 1940-1944 Pre-War years 1935-1939 Per Cent. average per cent. average per cent. Excellent 3.50 6.64 7.65 Normal 90.60 84.93 80.57 Sub-normal 5.68 8.14 10.89 Bad 0.22 0.27 0.87 Malnutrition. What may we deduce from the foregoing tabulations, which indicate that out of some 1,400 children medically examined only about 6 per cent. fell below a normal standard of nutrition? believe we should take the results shown in this table with some reserve. I have previously stated there are varieties of opinion as to what constitutes normal physique, and as there is no physiological standard of what constitutes the normal, the tables are merely an indication of the physical fitness of the 46 child as it appears to the medical examiner. When conditions become stabilised in the future, we shall be better able to judge whether tnere was an element of fallacy or freakishness to be associated with the results of 1945. On the other hand, we should not overlook the results of special investigations made during 1943 and 1944, which showed that nutritional standards had risen amongst the children. The provision of school meals and milk have played a large part in improving nutritional standards, but there exists none the less the opinion that there are deficiencies which are believed to be contributory causes of loss of resistance to certain ailments. Cleanliness. Lack of cleanliness amongst the children was not a serious problem in 1945, though quite a number of returning children from evacuation areas needed our attention regarding verminous heads. The school nurses made 11,835 examinations of children for verminous heads during 1945. The number found unclean was 184, an increase of 49 over the figure for 1944. Treatment for skin troubles, mostly associated with uncleanly conditions, numbered 674 for the year. SECTION B.—Treatment. Treatments under the Authority's scheme in 1945, compared with 1944, were as follows :— 1945 1944 Skin Diseases 674 349 Minor Eye defects 191 87 Minor Ear defects 87 123 Miscellaneous 611 757 1563 1316 Total attendance of children for treatments 13,663 10,602 In addition to the 1,563 treatments, there were 344 referred for treatment elsewhere than at the Authority's clinics. 47 Eye Clinic. Statistics for the year 1945:— Number of sessions during 1945 73 Number of children dealt with for errors of refraction: New cases 210 Old cases 447 657 Number of other defects or diseases of the eye treated 34 Number of spectacles prescribed 258 Total attendances of children treated 691 Mr. R. H. Kushton's Report. As usual the attendances at the School Eye Clinic during I the past year were principally on account of errors of refraction, and included many cases of squint. Other defects of the eyes were comparatively uncommon. Reviewing the war years as a whole, I find that children's eyes, in common with those of adults, did not suffer seriously from the physical standpoint by the difficult conditions—shelter life, with poor lighting, blackout, etc. On the other hand, more children with small refractive errors complained of headaches and tired eyes than would have done otherwise. The frequency of physical defects is very constant from year to year. This will be my last Annual Report. During the war years I have been acting as locum tenens at the Clinic for my colleague, Dr. Eric Lyle. Now we are happy to welcome him back after his eventful war service. (Signed) R. H. RUSHTON. Orthoptic Clinic. The Orthoptist held two sessions a week, but this has now, owing to the large waiting list of 24 patients, been increased to four sessions a week. The treatment of "squint'' means prolonged treatment and frequent attendance. The 17 patients treated during the year made 390 attendances—four of these had been cured by the years end, three with S.B.V., and one osmetic" cure. An additional 20 patients have had postponement for further treatment or observation. Six patients refused further treatment or ceased to attend. This is a very valuable clinic, and is doing good work. 48 Ear, Nose and Throat Clinic. The Specialist Consultative Service and operative treatment for tonsils and adenoids at the School Clinic remains in abeyance. Under the Authority's scheme 206 nose and throat minor treatments were carried out at the School Clinics, and 96 cases were referred to hospital out-patients or private doctor. Figures relating to cases sent to the District Hospital for operative treatment during 1945 were as folio s Operations for— (a) Tonsils only 2 (b) Tonsils and adenoids 26 Orthopaedic Clinic. This Clinic, with its associated services of massage, remedial exercises, and ultra violet ray, etc., had a very full year of activity during 1945, as shown by the following figures No. of Clinics held by the Orthopaedic Surgeon 12 No. of children treated at the Clinic 236 No. of attendances for Consultations 412 No. of attendances for massage, exercises, etc 2003 No. of attendances for U.V.R. and Infra Red Ray treatment 1878 Tabulation of new cases seen by the Surgeon, 1941 1. (a) Congenital Defects: — 6. Structural Curvature of Club Foot 3 spine 4 Dislocation of hips 3 7. Flat Feet 41 Other conditions 22 8. Infantile Paralysis - (b) Hammer toes — 9. Sequelae of Acute Fevers - 2. Birth Injuries: — 10. Fractures 5 Torticollis 5 11. Tuberculosis—Joints - Other conditions 3 12. Other Bone Diseases (non-T.B.) 1 3. Rickets Deformities:— Bow Legs 1 13. Osteomyelitis - 4. (a) Bow Legs rickety) 6 14. Not classified 13 15. Non-orthopaedic 2 (b) Knock knees (nonrickety) 16 16. No active disease 12 Total 156 5. Postural Defects of spine 19 49 Orthopaedic Surgeon's Report for 1945. I do not think there are any special comments to be made. The Clinic is gradually increasing in size, there being a very considerable increase in the number of new cases seen, the number of cases attending for examination, and in the numbers attending for treatment. In the tabulation of new cases above there is nothing outstanding apart from the increase in the number of non-rachitic knock knees, which I do not consider is probably of any particular importance; but there is almost 100 per cent. increase in the number of cases of flat feet which were seen. As I have said elsewhere, I consider the increase in feet defects in children is very considerably due to the inferior footwear which is available for them. (Signed) J. A. CHOLMELEY, F.R.C.S. Dental Services. Since the end of the war the returns of the Dental Department have shown a welcome over-all increase, but not quite so much as I had hoped. No doubt this slow recovery has been due as much to the lack of equipment, which has kept one surgery almost completely out of action since last Easter, as to the unrest and extra holidays caused by the Elections. The only remarkable happening has been the growth of the Orthodontic Scheme. Many parents now attend to seek advice, and there seems to be an increasing knowledge of the advantages of a healthy mouth with teeth in good occlusion. Indeed, it is not going too far to say that it is in this field that we will find our strongest weapon in the struggle to control the incidence of dental decay in young adults. (Signed) JAMES H. GLEN, L.D.S. 50 Statistical Report of the various Dental Schemes. Grand Total (all schemes). 1944 1945 Total attendances 4909 5899 Number discharged 3016 2878 Attendances for Gas Extractions 1029 1132 Attendances for Local Extractions 111 50 Attendances for Denture Work 141 144 Attendances for Orthodontics 102 340 Attendances for Other Operations 919 1397 Number of Fillings done 2826 3370 Number of Extractions done 2427 3465 Number of Dentures fitted 49 51 Number of Sessions employed 979 5/6 991 Number of Children inspected 3737 6474 Scaling and Gum treatment 360 423 Referred for X-Ray 26 115 Referred to Consultant Orthodontist 7 6 Mothers. 1944 1945 Appointments kept 378 405 Number discharged 46 47 Attendances for Gas Extractions 65 67 Attendances for Local Extractions 28 30 Number of Extractions done 319 510 Number of Fillings 173 134 Number of Dentures fitted 49 51 Attendances for Denture work 141 144 Number of Sessions devoted to treatment 78 5/6 84 5/6 Welfare Children. Appointments kept 55 61 Number discharged 14 61 Attendances for Gas Extractions 18 14 Attendances for Local Extractions — 5 Number of fillings done 32 46 Number of Extractions 18 32 Number of Dressings 10 15 County Grammar Schools. Appointments kept 1539 1358 Number discharged 1113 504 Attendances for Gas Extractions 195 100 Attendances for Local Extractions 10 15 Number of Fillings done 988 1052 Number of Extractions 228 230 Orthodontic attendances 49 124 Scaling and Gum treatment attendances 53 63 Root treatment 16 24 Referred for X-Ray 14 35 Number inspected at School 684 2080 Number requiring treatment 404 1365 Half-days devoted to treatment 192 3/8 193¾ Half-days devoted to inspection - 18 51 REPORT FOR THE MINISTRY OF EDUCATION 1945. 1. Number of children inspected ^>y the School Dental Officer. (a) Routine Age Groups inspected: — Age 5 6 7 8 9 10 11 12 13 14 Number inspected 250 498 466 470 451 494 358 350' 382 230 Total 3949 1944 1945 (b) Special cases 287 445 (c) Total number of children inspected (Routine and Special) 3053 4394 2. Number of children found to require treatment 1941 2779 3. Number of children actually treated 1843 2266 4. Total attendances for treatment 2937 4075 5. Half-days devoted to— (a) Inspections 16 20 (b) Treatment 692 692 5/12 Total 708 712 5/12 6 Number of Fillings completed in— <a) Permanent Teeth 1108 1255 (b) Temporary Teeth 525 883 Total 1633 2138 7 Number of Extractions— (a) Permanent Teeth 377 434 (b) Temporary Teeth 1485 2259 Total 1862 2693 8. Administration of general anaesthetics 751 951 9. Other operations—individual cases treated, including: — (a)Orthodontic cases—attendances 53 216 (b) Crowns and Inlays 9 — (c) retaining appliances 1 5 (d)Scaling and Gum treatment 307 360 (e)Temporary Teeth—dressings 357 204 (f)Root treatment 48 10 (g) Referred for X-Ray 12 80 (h) Consultations and advice — 120 Total 787 995 52 SECTION C. Infectious Disease. The figures of absentees during 1945 affecting school attendance owing to infectious disease are as follows:— NOTIFIABLE DISEASES. Cases Contacts Scarlet Fever 29 28 Diphtheria 3 5 Cerebro Spinal Fever 1 — Measles 171 Contacts are not excluded Whooping Cough 10 „ NON-NOTIFIABLE INFECTIOUS DISEASE. Extracted from returns made by Head Teachers Mumps 106 Chickenpox 100 STATEMENT ON PHYSICAL EDUCATION, 1945. General. In estimating the effects of the recent war conditions on the physical development of school children, most observers have limited their investigations to body measurements only From data supplied by these observers, we are assured that, weight for weight, and height for height, our children to-day, contrary to expectations, are every bit as good as their fellows of pre-war years. It should be noted, however, that while statistics of this kind may be taken as evidence of correct or incorrect feeding, they are no criteria of an individual's state of health or physical efficiency : thus, from our own observations of the reactions of school children to their physical training and games lessons, we would say, quite emphatically, that, compared with their predecessors of 1939, our children to-day are less active, more easily fatigued by physical exertion, and certainly far less skilful in bodily control and management. Among the higher age-groups in our County Modern Schools, are many boys who, because of these war-time restrictions had, until the spring of 1945, never handled a cricket bat or played a game of football on a grass pitch; boys whose physical education throughout five and a half years of war had 53 been limited to irregular physical training lessons taken under the most adverse conditions of unsuitable clothing and footwear, lack of equipment, and, in many cases, under teachers unfamiliar with the work.. In spite of all these difficulties, however, the general standard of physical training in our schools at the end of local hostilities was far higher than might have been expected, and since April, 1945, with the return of more normal conditions for school work and attendance, considerable progress has been made towards this subject's recovery. In this our first post-war report it may be considered fitting that we should restate some of the aims of Physical Education, the wider appreciation of which did so much to enhance the subject's development in our schools during the latter years preceding the war. Recently summarised by our professional colleagues these aims may be stated as follows:— (a) To secure and maintain high standards of bodily health, physique and vigour; (b) to develop qualities of character, high social ideals and the team spirit, e.g., hardihood, courage, perseverance, fair play and friendliness ; (c) to foster an appreciation of the joy of physical fitness ; (d) to cultivate quick and accurate co-ordination of thought and action ; (e) to develop easy, graceful bodily movement and poise; (f) to develop general motor skill and specialised recreational and occupational skills ; (g) to help to correct bodily distortions, due either to heredity or environment; (h) to provide opportunities for self-expression and self- testing ; (i) to ncourage the pursuit of wholesome leisure-time activities. The extent to which these aims may be realised varies in every school according to the training and qualifications of its teaching staff and the facilities available for the development Physical education in its several branches : Physical Training, Gymnastics, Swimming, Games, Dancing, etc. In both of these essentials there is scope for considerable improvement in all our schools. 54 Physical Exercises and Gymnastics. (a) County Modern Schools. After five and a half years of school and curriculum disorganisations, handicapped by inadequate equipment and acute staffing problems, the standard of Physical Training and Gymnastics in our County Modern Schools in the spring of 1945 left much to be desired. By the end of the year, however, many of our specialist P.T. teachers had returned from the Forces, deficiencies of P.T. and games equipment were being rapidly made up, and increased supplies of plimsolls were being made available by the Local Authority for the use of children unable to provide their own. With these improved facilities, it has been possible to effect not only a general improvement in standard of physical exercises, but a reinstatement of our local advanced schemes for senior classes in which gymnastics form an important part. The temporary closure, pending war damage repairs, of one of our County Modern Girls' Schools, involving the transfer of its pupils and the loss of use of its excellent gymnasium, has been a severe handicap to the development of physical training not only in this school but also in that affected by the transfer. Thus, with two schools sharing the facilities of one gymnasium, neither has been able to secure the accommodation necessary for the normal requirements of this subject. (b) County Primary Juniors' Schools. Owing to the general restriction of supplies of plimsolls, particularly in those sizes required for use by the younger children, the rate of progress in the recovery of physical training standards in our County Primary Schools has been somewhat slower than in our Modern Schools. The wearing of boots or heavy shoes for physical exercises imposes a far greater handicap on the younger child than on the older, stronger child, limiting and restricting his movements to a far greater extent, and consequently preventing him from acquiring such skill and agility as the wearing of plimsolls would make possible. Lack of small games equipment and simple gymnastic apparatus has necessitated the postponement of a number ot interesting experiments which, before the war, were being conducted with a view to supplementing the then existing officia schemes of work for these younger children. 65 (c) County Primary (Infants') Schools. In our Infants' Schools useful progress towards the recovery of physical training standards has been noticeable during the year. While in certain cases it has been necessary to advise teachers against over- * formality and rigidity in their approach to this work, these cases have been rare, and development as a whole has been achieved without loss of fun and enjoyment by the pupils. The inclusion of Natural Movement Dancing in the general scheme of Infants' Classes has been a popular and valuable feature. Where facilities have permitted—a clean, smooth floor in a hall in which the temperature can be maintained at a suitable level—children have been encouraged to do this work barefooted. In the opinion of most experts, this practice is of considerable value in securing the correct development of the intrinsic muscles of the foot and thereby reducing the child's susceptibility to structural foot defects. Where parents have objected to this practice, it has usually been possible to convince therrt that not only is it entirely without risk to the child's health, but actually beneficial both to its health and physical development. Organised Games. Lack of suitable footwear for winter games has been the chief factor in preventing what would oth«rwise have proved a highly successful year for the development of organised games on the Committee's playing fields. Under present conditions restricting purchase of football and hockey boots by parents, most children in our County Modern Schools have had to play these games in unsuitable footwear, usually of such an inferior quality that, for reasons of health and out of consideration for parents, it has been necessary to cancel maany visits to the playing fields on occasions when the grass has been damp. It is obvious that until such time as the present restrictions the manufacture and supply of these articles can be removed, progress in the development of this important branch of physical education will continue to be seriously handicapped. Dancing. The wider introduction of Modern Dance, i.e., Natural Movemen Dancing, into the general scheme of Physical Education in our Modern Girls' Schools is achieving an interesting and valuable result. 56 Under an arrangement approved by the Local Education Authority, teachers with special qualifications in this subject may now obtain the assistance of part-time pianists additional to the normal school staff; this policy has done much to enhance the scope and value of this work and already more than justified its adoption. Swimming. Lack of facilities for the transport of children to and from the Swimming Bath has made it impossible to restore arrangements for organised swimming instruction during school hours. Voluntary evening classes were, however, arranged for a limited number of older girls at .the Convent Bath, Plaistow Lane. While the response to this arrangement was generally good, it will be understood that it has been a very poor substitute for a scheme which would ensure the teaching of swimming to all children as part of their general physical education. The Further Training of Teachers. A successful Course in Modern Dance for specialist teachers in County Modern, Grammar and Technical Schools in this area was held weekly for two terms. Attendances were well maintained, and arrangements have been made for the extension of this Course at a later date. During the Summer Term an Experimental Course in Swimming Instruction for local teachers was held at the Beckenham Public Swimming Baths. The aim of the Course, which was continued for a period of ten weeks, was to assist students towards a better understanding of the basic swimming strokes and simple diving, and to acquaint them with up-to-date methods of teaching and coaching. With improving conditions of staffing in our schools, it should soon be possible to restore normal arrangements for regular training courses in other branches of physical education. Youth Service. While every encouragement has been given to local Youth Organisations in planning and arranging suitable programmes of physical recreation, it has been disappointing to find so little permanent return for so much outlay of effort. Assistance has been given in organising and arranging facilities for a wide variety of activities, including Recreative Physical Training and Keep Fit Classes, Gymnastics, Athletics, Ballroom Dancing. Swimming, Field Games, Tennis and the organisation of Athletic Sports Meetings and Football and Netball Leagues, etc. 57 Training Courses for Club Leaders in (a) Camping and Open Air Activities, (b) Ballroom Dancing, (c) Recreational Gymnastics, have been held during the year, the popularity of which has been sufficient to justify a continuation of this provision. It appears to be typical of the attitude of youth to-day that they seem unable to appreciate the importance of regular and punctual attendance either at classes of instruction or even at voluntary team games. This failure to recognise these elementary social obligations to their class or team companions has been a source of continued disappointment both to their club leaders and others concerned in their welfare. Conclusion. The Education Act of 1944, in setting a new and higher standard of provision for the health and physical welfare of children and young people, will do much to alleviate those conditions which for many years have restricted the full and complete development of physical education in our schools. With conditions already slowly but definitely improving, we may look forward to a future in which this subject may at last assume its rightful place in the general trend of educational advance. (Signed) GEO. H. ATKINSON. F. M. BENTLEY. Provision of Meals. Unfortunately, little progress was made during 1945 towards 'implementing the Committee's proposals for extension of the School Meals Service, due to the delay in obtaining the Ministry's approval in consequence of the operation of the Education Act, 1944. In September the Committee reviewed the proposals made for the erection of kitchen and dining huts at schools, and in certain cases alterations were agreed to to increase the facility in the light of existing requirements. For the year ended 31st March, 1945, the total number of ®eals served to children attending Primary and Secondary Modern Schools was 307,383. This figure shows a falling off in numbers due to the fact that evacuation was in force for the heater part of the year. A truer indication of the trend of the service of meals to children is seen from a return made to the Ministry of Education, which showed that on one day in October 2,752 children attending Primary and Secondary Modern Schools had a midday meal at school, being 61.12 per cent, of the total attendance, 58 Milk in Schools. A return made to the Ministry of Education in October showed the percentage of children in attendance at Primary and Secondary Modern Schools receiving milk as being 72.72 per cent., a slight increase on the percentage for the corresponding period last year. Number of children in attendance at Primary and Modern Schools receiving milk :— l/3rd pt. 2/3rd pt. (a) For full payment (including part payment) 682 2419 (b) Free of charge 34 138 (The charge for l/3rd pint remains unchanged at id.) so SECTION D. Handicapped Children. The following table shows the number and classification of handicapped children in the records. At Residential Schools At Special Day Schools At Ordinary Day Schools Private Schools At no School or Institution Total (a) Blind 2 — — 1 3 (b) Partially sightec — — 1 — 1 2 (c) Deaf 2 — 1 — — 3 (d) Partially Deaf . — — 1 — — 1 (e) Delicate 3 — 30 — — 33 (f) Diabetic — — — — — — (g) Educationally sub normal 11 5 31 2 11 60 (h) Epileptic 2 1 4 — 5 12 (i) Maladjusted 1 — 35 — — 36 (j) Physically defective 6 1 12 — 2 21 (k) Speech defects — — 7 — — 7 Totals 27 7 122 2 20 178 Tuberculosis. Notified cases of children between the ages of 5 and 15 years. Respiratory 17 Non-respiratory 27 Child Guidance. The " problem child " we shall have with us always; but there is a tendency to make this child solely the province of the psychiatrist. There is much loose physchology in the public mind, and whilst we can all obtain guidance from the skilled Psychiatrist, we must not lose the wider view that the casual fault is not in the child, but in the environmental home life of the family, and that until we can remedy the disastrous housing Problem of to-day, we shall make no real progress. This is fundamental, . 60 Juvenile Delinquency. During the year there were 88 cases before the Court, of which 55 were for theft, 11 breaking into premises, 4 beyond parental control and 18 were for various other offences. County Grammar Schools. The Dental Department devoted considerable attention to the higher education scholars during 1945, as indicated in the following figures :— Half-days devoted to treatment 1933 Half-days devoted to inspection No. inspected at schools 2080 No. requiring treatment 136 Appointments kept 1358 No. discharged 504 Attendances—Gas Extractions Local Extractions Fillings done 1052 Extractions 230 Orthodontic attendances 124 Scaling and Gum treatments 63 Root treatments 24 Referred for X-Ray 35 Other Services extended to County Grammar Schools. Orthopaedic Clinic 74 Eye Clinic 77 Orthoptic Clinic 72 Nursery Classes. There has been no notable change since my previous report SECTION E. Employment of Children and Young Persons. The School Medical Officers examined 92 children regarding fitness for employment out of school hours, as follows No. Examined Fit Certificates (a) Boys 79 78 (b) Girls 13 13 92 61 Boot Club. The work of the Boot Club is a praiseworthy voluntary effort made towards securing suitable footwear for the school child. The Orthopaedic Surgeon has already commented on inferior footwear, which he believes is largely responsible for considerable increase in flat feet among children. War-time expediency is doubtless responsible for deterioration in materials used. One hopes for speedy improvement in this connection, especially if physical defects are arising through faulty footwear. BROMLEY SCHOOLS BOOT CLUB COMMITTEE. Chairman's Report. During the year ended 31st December, 1945, the Boot Club has continued to function satisfactorily. Although there has been a decrease in the number of vouchers issued, the contributions received were only 15s. Od. less than during the previous year. 591 vouchers for purchases accounting to £387 2s. 7d. net were issued during the year compared with 642 valued at £495 15s. 3d. in 1944. In some schools membership is decreasing, possibly due to the continued difficulty of obtaining the footwear required from the seven firms participating in the scheme. Efforts are being made from time to time to enlarge the list to give contributors a wider selection. Two firms have reduced their discount to 5 Per cent, instead of 10 per cent., but have stated that they will . restore the higher rate as soon as possible. This reduction means there is a deficit when comparing discount given by traders with bonuses granted to contributors, amounting to £5 10s. Od. in the year 1945. Necessitous cases have been recommended to the Bromley benevolent Association, and seventeen pairs of footwear have been supplied by the Association free of charge to scholars in womley. I ani sure you would wish to record our appreciation of the valuable work of the Hon. Secretary. I would also again record my appreciation of the work of the Hon. Treasurer and the Hon. Auditor. 62 Cash Statement—Year ended 31.12.1945. RECEIPTS. £ s. d. Cash Balance Brought Forward 313 13 10 Payments Made by Contributory Schools 427 8 8 Bank Interest Earned 1 14 8 £742 17 2 PAYMENTS. Purchases of Footwear: £ s. d. £ s. d. Gross 419 13 11 Less Discount 32 11 4 387 2 7 Bromley Benevolent Association—Grants 10 0 0 Martins Bank Ltd.—Cheque Book 10 0 Cash Balances—Current A/c 95 4 7 Deposit A/c 250 0 0 345 4 7 £742 17 2 Hon. Treasurer: Mr. A. C. Cleveland, Acting Divisional Education Officer. Hon. Secretary: Mr. E. A. A. Gooch, Education Department, Bromley. Certified: F. Yelland, Hon. Auditor. 63 Bromley Children's Care Committee. This Committee, through the very helpful co-operation of Miss M. A. Isard, Honorary Secretary, has rendered valued assistance in necessitous cases needing convalescent home treatment, fares to hospital, clothing and medicine. SECTION F. The pre-war statistical tables required by the Ministry of Education have been completed and retained in the records for reference, but are not reproduced in this Report.