AC4412(1) BROMLEY BRO 42 BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1946 INCLUDING ANNUAL REPORT ON THE SCHOOL MEDICAL SERVICES Printed by Bromley Office Supplies & Printing Co. Ltd. 46 East Street, Bromley, Kent BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1946 INCLUDING ANNUAL REPORT ON THE SCHOOL MEDICAL SERVICES 3 CONTENTS. Page Members of the Health and Maternity and Child Welfare Committees 6 Staff 6 Prefatory Letter 9 Section A. Statistics and Social Conditions. Vital Statistics 12 Population Births 13 Stillbirths 15 Deaths 16 Infantile Mortality 16 Maternal Mortality 17 Meteorological Conditions 17 Open Air Recreational Amenities 18 Section B. General Provision of Health Services of the Area Civil Ambulance Service 19 Laboratory Services 19 Nursing in the Homes 20 Treatment Centres, Clinics and Centres 21 Tuberculosis Dispensary 25 Venereal Disease Treatment 25 Hospitals, Public and Voluntary 25 Bromley and District Hospital 25 Nursing Homes 26 Section C. Maternity and Child Welfare. Municipal Midwifery Service 26 Ante-Natal Clinic 27 Dental Scheme—Mothers 27 Domiciliary Medical Practitioner Service 28 Midwives Acts, 1902-1936, Administration 28 Analgesics. Administration of 29 Maternity Hospital Provision 29 Puerperal Pyrexia Notification 30 Ophthalmia Neonatorum Notification 30 Premature Infants, Care of 31 Home Helps 31 Post-Natal Services 32 Health Visiting 32 Welfare Centres 32 Child Life Protection 34 Clinic Treatments, under 5 years 36 Day Nurseries 36 Domestic Help Scheme 38 Section D. Sanitary Circumstances of the Area. Water 38 Drainage 40 Cesspools 40 Rivers, Streams and Lakes 40 Swimming Baths and Pools 41 Public Cleansing and Refuse Collection 41 Sanitary Inspection of the Area 41 Factory Act, 1937 42 Shops Acts, 1912-1936 42 Smoke Abatement 42 Verminous Conditions and Uncleanliness 42 Rodent Control 43 4 Section E. Housing. Page Inspections and Abatements 44 Rehousing 45 Section F. Inspection and Supervision of Foods. Food Utensil Bacteriology—Dr. R. I. Hutchinson .... 46 Milk, Ice Cream 49 Food and Drugs Act, sampling 50 Meat and Other Foods Surrendered 51 Other Foodstuffs, special enquiries 52 Section G. Prevalence of, and Control Over, Infectious Diseases Scarlet Fever 53 Diphtheria 53 Diphtheria Immunisation 53 Puerperal Pyrexia 53 Ophthalmia Neonatorum 54 Measles and Whooping Cough 54 Other Diseases " 54 Tuberculosis 54 Public Health (Prevention of Tuberculosis) Regulations. 1925 55 Public Health Act, 1936, Section 172 55 Tuberculosis Dispensary and Treatment 55 Section H. Other Services. Diseases of Animals Acts 55 Registries for Female Domestic Servants 55 Petroleum Acts 56 Retail Market 56 APPENDIX. Charts—No. 1. Birth Rate 58 „ 2. Death Rate 58 „ 3. Zymotic Death Rate 59 „ 4. Influenza Death Rate 59 „ 5. Death Rate Diarrhoea (under 2 years) 60 „ 6. Maternal Death Rate 60 „ 7. Stillbirth Rate 61 „ 8. Infantile Mortality 61 „ 9. Infant Mortality in Age Groups 62 „ 10. Age Groups of Infant Deaths 63 „ 11. Infectious Disease Incidence Rate 64 STATISTICAL TABLES. Vital and General Statistics. Table I. Summary of Tables, 1946 II. Birth Rates, Death Rates, Analysis of Mortality and Case Rates for Certain Infectious Diseases, 1946 67 „ III. Causes of Deaths, 1946 „ IV. Infant Mortality—Causes and Age Groups. 1946 „ V. Infant Mortality, Analysis of Causes, 1942-1946 71 VI. Infant Mortality and Maternal Mortality—Summary of Statistics, 1910-1946 71 Notifiable Disease. Table VII. Notifiable Diseases, Wards Distribution, Attack Rates, and Mortality Rates, 1946 72 „ VIII. Notifiable Diseases, Sex and Age Grouping. 1946 73 „ IX. Tuberculosis—New Cases and Mortality, 1946 74 „ X. Ophthalmia Neonatorum, 1946 74 5 Maternity and Child Welfare. Page Table XI. Health Visiting, 1946 75 XII. Welfare Centres and Ante-Natal Clinics, 1946 76 Housing and Sanitary Inspection. Table XIII. Housing Statistics, 1946 77 XIV. Factories, Outworkers, 1946 78 XIV. Work of Sanitary Inspectors, 1946 78 XV. Nuisances and Contraventions Abated, 1946 80 XVI. Factories, 1946 83 SCHOOL MEDICAL SERVICE. 1946. Members of the Welfare Committee 86 Officers of Committee 86 Introduction 86 Staff 88 Number of Children on School Rolls 89 Hygiene of Schools 89 Medical Inspection. Routine Inspection 89 Results of Routine Inspections 90 Tabulation of Defects Discovered—Routines 90 Tabulation of Nutrition of Children 92 Special Medical Inspections 92 Tabulation of Defects Discovered—Specials 93 Minor Ailment Treatment. Tabulation of Treatments 94 Special Clinics. Eye Clinic 95 Tabulation of Eye Defects, Treatments, &c 95 Eye Specialist's Report 95 Orthoptic Clinic 96 Ear, Nose and Throat Clinic 96 Tabulation of Throat Treatments 96 Orthopaedic Clinic 97 Orthopaedic Surgeon's Report 97 Tabulation of Orthopaedic Defects 98 Handicapped Children. Tabulation 98 Dental Services. Tabulation of Dental Returns 99 Dental Surgeon's Report 100 Uncleanliness 101 Milk in Schools 101 Meals, Provision of 102 Nursery Schools 102 Employment of Children 103 Juvenile Delinquency 103 Physical Education. Infant Schools and Nursery Classes 103 Primary Schools 104 Modern Secondary Schools 104 Organised Games 104 Swimming Instruction 105 Teachers, Training of 105 Physical Recreation, Course for Men Leaders 106 Recreative Evening Classes 106 Youth Service 106 Boot Club 108 Care Committee 108 6 MEMBERS OF THE HEALTH AND MATERNITY AND CHILD WELFARE COMMITTEES. Health Committee. Councillor J. S. Marriott (Chairman), Alderman M. Stafford Smith, M.B.E., BA. (Vice-Chairman), The Worshipful the Mayor (Alderman W. R. L. Trickett, O.B.E., MA., M.L., J.P.), Alderman W. F. Skilton, Councillor H. M. V. Green, Councillor D. V. H. Hartley, Councillor A. L. Hill, Councillor L. L. Irwin, MA., LL.B., Councillor S. Lane, and Councillor Major-General C. W. Norman, C.B.E., BA. Maternity and Child Welfare Committee. Councillor H. M. V. Green (Chairman), The Worshipful the Mayor (Alderman W. R. L. Trickett, O.B.E., M.A., M.L., J.P.), Alderman W. F. Skilton, Alderman M. Stafford Smith M.B.E., B.A., Councillor D. V. Hartley, Councillor A. L. Hill, Councillor L. L. Irwin, M.A., LL.B., Councillor S. Lane, Councillor J. S. Marriott and Councillor Major-General C. W. Norman. C.B.E., B.A. Co-opted Members: Mrs. A. M. Howe, J.P (ViceChairman), Mrs. K. P. Jensen, Mrs. M. Packe, Mrs. M. Pearce and Miss V. Vincent. STAFF OF THE PUBLIC HEALTH DEPARTMENT as at 31st December, 1946. Medical Officer of Health K. E. Tapper, o.b.e., g.m., m.b., ch.b., d.p.h. Assistant Medical Officers of Health j Miss G. H. Stinson, m.R.c.s., and School Medical Officers l.r.c.p. j P. A. CuRRIE, M.R.c.s., l.R.c.P. jk A. Orgler, m.d. Specialists (Part-time): Orthopaedic Surgeon j J. A. Cholmeley, f.r.c.s. Eye Specialist j Eric Lyle, m.a., m.d., ch.b., D.o.m.s. Ear, Nose and Throat Surgeon (Service in abeyance.) Consulting Gynaecologist Alistair L. Gunn, m.d., f.r.c.s. 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). 7 Sanitary Inspectors: Chief Sanitary Inspector, Chief edcba G. H. Woods, m.s.i.a., Sampling Officer, and Inspector a.r.san.i. under the Petroleum Acts, the Diseases of Animals Acts and the Shops Acts District Sanitary Inspectors and cba T. C. Towersey, m.s.i.a. Sampling Officers cba H. Archer, m.s.i.a., a.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. Crowe, s.r.n. hgf Miss F. L. Gray, s.r.n. hgf Mrs. N. M. Taylor, s.r.n. hgf Miss W. G. Hemmings, s.r.n. hgf Miss H. Hogger, 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 (deceased 10/1/1947.) gf Miss E. V. Robathan, s.r.n. gf Mrs. M. A. Gregory, s.r.n. gf Miss L. M. Needham, s.r.n. 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. J. Stapleton. k Miss I. Legg. k Miss M. J. Kelly. k Miss B. B. Burrows. k Mrs. J. L. Flanders. Dental Clinic Assistants j Mrs. W. Carrie. j Miss F. E. Rolfe. j Miss M. Ellen (part-time). Other Appointments: Assistant Rodent Officers ek J. C. Dunn. J. L. Gough. Orthopaedic Nurse and Masseuse j Miss M. Dodge, c.s.m.m.g. (part-time). Orthoptist j Miss J. Pinnick (part-time). 8 Outdoor Staff: Disinfector and Drain Tester J. W. Seager. Market Superintendent F. J. Ephgrave (part-time). Home Helps (four). Domestic Helps (two). Rodent Operatives (three). The letters denote:— a Certificate of the 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). j General Trained (S.R.N.). g State Certificate Midwife. h Royal Sanitary Institute Health Visitors' Certificate. i Royal Sanitary Institute in Sanitary Science as applied to Building and Public Works. j County Officers. k Unestablished or Temoorarv Staff. WAR-TIME NURSERIES at 31st December, 1946. Elmfield Nursery. Matron 4 Miss K. Minchin. Deputy Matron 3 Miss E. Scaggs. Nursery Nurse 5 Miss L. Grugeon. Warden 3. Miss Jeffcoat. Student Nurses (four), Cook (one) and Cleaners (two). Draycott Nursery. Matron 21 Miss M. E. Davey. Deputy Matron 21 Miss M. E. Thompson. Nursery Nurses 21 Mrs. E. M. Benge. 3 Miss N. Boughen. 3 Miss J. Nicholls. Nursery Assistants (four), Student Nurses (five), Cook (one) and Cleaners (five). Numbers denote:— 1 State Registered Nurse. 4 Registered Sick Childrens 2 State Certified Midwife. Nurse. 3 Nat. Soc. of Children's Nurseries 5 College Trained Nurse. Diploma. 9 PREFATORY LETTER. To The Mayor, Aldermen and Councillors. Mr. Mayor, Mesdames and Gentlemen, I have the honour to submit my 22nd Annual Report on the Health Services of the Borough of Bromley for the year 1946, and 1 do so at a time when the country as a whole, and Bromley as a part, is suffering the consequences of many restrictions and the atter-strain of six years of war. The year 1946 again showed that the Bromley housewife who withstood the war years with such courage and stamina has had further problems added to her burdens. What effect will this have upon the health of the nation in the years ahead? The housing problem, which remains a vital problem in the rearing of a family, and queueing in quest of food and coal, and the shortage of clothing, cannot continue without danger of loss of health and faith. 11 the mother fails the family fails also, and with it the social security of the nation. But courage remains and no word of mine can express adequately the admiration we must all feel for the housewife. So far as the Health Department is concerned, more than ever have we endeavoured to give priority to preventive medicine over the practice of medicine, and to be a help to the Public in relieving some of the many problems with which they are in daily contact. As it would appear in the contemplated changes in Local Government, that the control of medical services will pass to the County Council in the near future, I am submitting as an Appendix a serious of charts, showing the effect of the services mostly since I was appointed as your Medical Officer of Health. The charts are:— 1. Birth Rate. 9. Infantile Death Rate in ages 2. Death Rate. under 1 week, 1 week to 4 3. Zymotic Death Rate. weeks and 4 weeks to 1 year. 4. Influenza Death Rate. 10. Age Groups of Infant Death 5. Death Rate Diarrhoea (under since 1926. two years of age). 11. Infectious Disease Incidence 6. Maternal Death Rate. Rate (Scarlet Fever,' Diphtheria 7. Stillbirth Rate. and Tuberculosis). 8. Infantile Death Rate. A study of the charts will show where we have succeeded and where we have failed, and will indicate the field in which intensive work of prevention is still needed. Taking for example chart 9, the increase of death in babies under one week 10 against a marked decrease in the groups one to four weeks and four weeks to one year, must indicate a closer attention to the cause of premature babies, causes which lie in the ante-natal and natal periods. Again for similar reasons tnere has been no improvement in the stillbirth rate (chart 7). The marked saving in maternal death (chart 6) speaks well for the improvement in the maternity services. The ageing population, in spite of the increase in the birth rate for 1946 must affect the death rate which remains comparatively stationary. We have not had any severe epidemics during recent years nor has the type of the common infections been as severe as in years past. With the increased practice of communal feeding, the establishment of civic restaurants, school meals and works canteens, a closer attention to hygiene in the kitchens and the handling of food becomes more than ever essential. An investigation carried out in Bromley by Dr. R. I. Hutchinson, of the Ministry of Health Emergency Pathological Laboratory, Downe, and by Mr. G. R. Woods, Chief Sanitary Inspector, into the dish washing at canteens and restaurants has demonstrated bacteriologically the dangers that exist from inadequate attention to the hygiene in the washing and drying of utensils used at these communal feeding establishments. This valuable report has been published in the medical Press and with the kind permission of the Editor of the British Medical Journal I am permitted to reprint the Report later in the Annual Report, under the heading Supervision of Food section. The uncertainty of the future of Government of the Health Services has made it impracticable to develop or submit a programme for the future services in the prevention of disease, so the report for the year 1946 is mostly a submission of details of routine carried out by the Department and of its almost universal appeal to the public. As is well known, the services have been so organised as to bring them to the public and not the public to the services. Thus we have the two ad hoc clinics, one at the North and the other at the South, the daily use of school premises at Hayes and Burnt Ash for minor ailment treatment and inspection, and the use of district halls for the holding of nine welfare sessions. This is decentralisation in practice, and it is on this principle that the future Health Services and Health Centres under the new Health legislation should function, bringing into the existing health services the medical care service. 11 it is also of paramount importance if initiative in development is to be maintained that essential delegation to local administration be granted. Whether or not we are to incorporate the social functions, such as Community Centres, into the Health Centres, is a matter for careful consideration. It is pleasing to note that during past years the public are making an increasing use of the Public Health Services. At the same time it must be recorded that there is a tendency to place upon the Local Authority responsibility for many small matters which might well have been corrected by a little more self-help, or made less evident had the neighbourly spirit so strongly exercised during the war years been carried forward into the years of so called peace. Your sanitary inspectors, in spite of shortage of staff, have carried out their duties with increasing skill and activity. The statistics submitted by Mr. G. R. Woods, Chief Sanitary Inspector, are worthy of close study, if one is to obtain a full knowledge of the importancs and extensive and skilled nature of their work. The most acute problem, whether taken from the social or from t e health aspect, is the housing problem. I have reported on this matter in my previous reports and there is nothing I can usefully add I can but repeat that in spite of 318 prefabricated houses and 28 permanent houses erected during the year, only the fringe of the problem has been touched; the living conditions of a very large section of the public are deplorable, and unless corrected within the near future, will have a very serious effect on the welfare and health of the People. One house, one family must be the aim of all those interested in the rehousing of the people for it is upon the establishment of the home, in its real sense, that security of happiness and health is dependent. I would thank the Committees for their help and their encouragement and to the staff and colleagues I extend my Personal appreciation of their loyalty and application to their work, and not the least to Mr. H. E. Lawley, the Chief Clerk, who through his long years of service and experience has played an essential part in the compilation of these yearly reports. I am. Your obedient servant, K. E. TAPPER, Medical Officer of Health. 12 SECTION A. STATISTICS AND SOCIAL CONDITIONS. Area (in acres) 6,519 Registrar General's estimate of population mid-year, 1946 No. of inhabited houses and flats according to the rate books 60,540 at the close of the financial year 1945-1946 16,850 No. of valuation assessments of habitable premises at that date 17,376 (a) Bromley (old Borough area) (b) Hayes & Keston Houses and flats 13,827 3,123 Shops and dwellings 334 42 Hotels and licensed premises (Excluding 1,412 sundry rateable hereditaments.) 43 7 14,204 3,172 17,376 Rateable Value at 31st March, 1947 £711.270 Product of a Penny Rate for the year ended 31st March, 1948 £2,910 Vital Statistics. Live Births: Total Male Female Legitimate 1119 566 553 Birth Rate 19.4 per 1,000 Illegitimate 57. 29 28 population. 1176 595 581 Stillbirths: Total Male Female Legitimate 32 13 19 Stillbirth Rate 27.28 per Illegitimate 1 — 1 1,000 (live & still) births. 33 13 20 Deaths: Total Male Female 656 298 358 Death Rate 10.8 per 1,000 population. Deaths from Puerperal Causes: Puerperal Sepsis – Maternal Mortality Rate 0.82 per Other Puerperal causes 1 1,000 {live and still) births. Deaths of Infants under I year of age. Legitimate 31 16 15 Infantile Mortality Illegitimate – – – 26.3 per 1 000 live birtns. 31 16 15 13 Death Rates of Infants under 1 year of age: All infants per 1,000 live births 26.3 Legitimate infants per 1,000 legitimate live births 27.7 Illegitimate infants per 1,000 illegitimate live births – Deaths from: Cancer (all ages) 112 Measles (all ages) – Whooping Cough (all ages) 1 Diarrhoea (under 2 years of age) 1 POPULATION. The Registrar General's estimate of population for mid-1946 is 60,540. Based on the voters' register and other local data the following tabulation gives, in the absence of a census return since 1931, a local estimate of population and density of persons per acre at the present time:— Wards Acreage Density No. of persons per acre Estimated Population Bickley 1074 7.92 8510 Bromley Common 747 14.51 10842 Keston & Hayes 2646 4.35 11516 Martins Hill 347 20.44 7095 Plaistow 377 23.35 8804 Sundridge 1029 8.00 8238 Town 299 22.25 6654 Total 6519 9.4 61659 There has, for various reasons, been no census since 1931, and much valuable information is therefore missing: the age grouping, the true figure of the number of persons per room and overcrowding, and other factors upon which so many reports and opinions are to be based. BIRTHS. The Birth Rate for 1946 is 19.4 per 1,000 population. Comparative rates during the past ten years are as follows— Year Bromley England & Wales 1937 13.2 14.9 1938 13.1 '5.1 1939 13.9 15.0 1940 13.2 14.6 1941 13.3 14.2 1942 17.2 15.8 1943 17.5 16.5 1944 16.5 17.6 1945 16.6 16.1 1946 19.4 19.1 14 Registered births for 1946 after transferable adjustments had been made were as follows:— Live Births Stillbirths Total 1176 33 1209 These are the official figures used for rate calculations. The number of births occurring in the Borough which were notified to the Medical Officer of Health under the provisions of the Public Health Act, 1936, Section 203, were as follows:— Domiciliary Confinements Institutional Confinements Total Live births 272 1175 1447 Stillbirths 5 30 35 Totals 277 1205 1482 By mid-February these figures had been modified ferable births as follows:— by trans- Outward transfers (Minus) Inward transfers (Plus) Net Total 1447 live births 550 309 1206 35 stillbirths 12 3 26 1482 notifications 562 312 1232 It should be noted that the net figure of 1232 would not remain static, as the inward transfer figure is progressive, notifications concerning the area being received for some time during the current year. The 1482 confinements occurring in the Borough during 1946 were attended professionally as follows:— Domiciliary. Municipal midwives attended: — (a) As midwives 220 (b) As maternity nurse (with a doctor) 55 Institutional. Practising midwives attended:— (a) As midwives 849 (b) As maternity nurse (with a doctor) 356 Others. Midwives' cases 2 1482 15 STILLBIRTHS. The number of stillbirths registered for the area during 946 is 33. The stillbirth rate per 1,000 (live and still) births for 946 is 27.28 and the rate per 1,000 population 0.54. The following tabulation gives the number of stillbirths, rates per 1,000 births and comparative rates per 1,000 population with England and Wales for the past ten years:— Year No. of Stillbirths Rate per 1,000 births Rate per Bromley 1,000 population England & Wales 1937 15 18.9 0.25 0.60 1938 30 36.9 0.50 0.60 1939 39 44.8 0.61 0.59 1940 26 32.2 0.45 0.55 1941 20 28.1 0.39 0.51 1942 26 28.9 0.51 0.54 1943 22 23.8 0.42 0.52 1944 20 23.8 0.40 0.50 1945 15 16.9 0.28 0.46 1946 33 27.2 0.54 0.53 The low estimate of civilian population allocated to the area during the war years 1940-1944 must be taken into consideration when examining the above rates for this period. During the year under review 35 stillbirths were notified to the Medical Officer of Health as occurring in the area, and of this figure 30 occurred in hospital and 5 were home confinements. A classification of the causes of the 30 hospital cases gives the following results:— No. of cases Post-mortem examinations Long labour, primary inertia 3 No P.M. made Long labour 1 No P.M. made Maternal toxaemia 3 No P.M. made Prematurity, maternal toxaemia 3 No P.M. made Prematurity, pre-eclampsia 1 No P.M. made Prematurity 1 No P.M. made Placenta praevia 1 No P.M. made Placenta praevia, prematurity 1 No P.M. made Breech labour 2 No P.M. made Prolapse of cord 1 No P.M. made Cord twice tightly around neck 1 No P.M. made Hyd-ocephalus, exomphalos 1 No P.M. made Hydrocephalus 2 No P.M. made Aneneephaly 3 No P.M. made Hydrops foetalis 1 No P.M. made Rhesus haemagglutination 1 No P.M. made Unknown, post mature 1 P.M. no lesions Torn tentorium cerebelli 1 P.M. confirmed Intra-cranial haemorrhage 1 P.M. confirmed 30 16 DEATHS. Death Rate for 1946 is 10.8 per 1,000 population. The number of deaths occurring were 298 males, 358 females, total 656. Comparative death rates for the past ten years is as follows:— Year Bromley Rates (crude) England & Wales Rates 1937 10.3 12.4 1938 9.8 11.6 1939 10.0 12.1 1940 12.9 14.3 1941 15.1 12.9 1942 11.4 11.6 1943 11.7 12.1 1944 13.3 11.6 1945 12.5 11.4 1946 10.8 11.5 Main causes of deaths are shown in the following table which gives comparative rates per 1,000 population for the past five years:— Rates per 1,000 population 1942 1943 1944 1945 1946 Respiratory disease 1.1 1.5 1.2 1.2 1.1 Heart disease 2.7 3.1 3.6 3.4 2.9 Cancer 2.2 1.8 2.4 2.0 1.8 Tuberculosis 0.6 0.5 0.4 0.7 0.3 Congenital causes, etc 0.5 0.4 0.6 0.5 0.5 Infectious disease 0.07 0.03 0.04 0.04 0.01 Influenza 0.01 0.2 0.06 0.06 0.1 INFANTILE MORTALITY. The Infant Mortality Rate for 1946 is 26.3 per 1,000 live births. The following details relate to infant deaths under one year of age during 1946:— Inward transfers of death—institutional 14 Local deaths—institutional 11 domiciliary 6 Died in the first week of life 28 Died between the first week and twelfth month 11 So much has been written about infant mortality in previous reports that to discuss the question further would be merely repetition. It is sufficient to stress that 1946 was a year when infantile mortality reached the second lowest rate to be recorded in Bromley; the record figure being 22.6 in 1940. It is upon infantile mortality results that the Public Health Service is judged. The Local Authority can well be pleased that their efforts have been successful and justified, especially at this time when government by the local people is regretfully being passed to authorities other than the Town Council. 17 reference to Charts 7, 8, 9 and 10 in the appendix are worthy of attention. The record, however, is marred by the continued high comparative rate in the newly born dying within one week of life. MATERNAL MORTALITY. 1946 breaks the previous sequence of three years without a maternal death in Bromley. In 1946 there was one maternal death giving a mortality rate of 0.82 per 1,000 births. The causes and rates of maternal mortality in the Borough are shown in 5-yearly periods since 1911 in the following table:— 5-yearly periods Puerperal Sepsis Other puerperal causes Rate per 1,000 births 1911-1915 4 5 2 1916-1920 9 9 6 1921-1925 6 7 4 1926-1930 4 6 3 1931-1935 6 9 4 1936-1940 4 9 3 1941-1945 2 3 1 Year: 1946 — 1 0.8 METEOROLOGICAL CONDITIONS. The Air Ministry's Report on the weather records of the country showed the year 1946 to be the wettest for two decades— sixth successive year with sunshine deficiency—and summer and autumn worst of the century. It was the wettest year since 1927 with more than six inches above the average; the sixth successive year with less sunshine than the average (1,288 hours altogether which is 178 less than the average); the worst summer and autumn of the century because of the combination of low temperature, frequent rain and no sun. The records kept by the Borough Engineer at the Climatological Station at Church House, Bromley, disclosed a total rainfall of 29.52 inches. August, usually a dry month, had 4.83 inches. May with 3.86 inches and November with 3.36 inches. October with 1.03 inches was the driest month. There were 167 wet days during the year. The average rainfall for the past 50 years is 25.61 so that the rainfall for 1946 was 3.91 inches above the average Recordings for Bromley during 1946 were as follows:— Total rainfall 29.52 inches Mean maximum daily temperature 57.5° F. Mean minimum daily temperature 43.0° F. Highest maximum temperature (2.7.1946) 85° F. Lowest minimum temperature (28.2.1946) 18° F. (23.12.1946) Lowest grass temperature (21.12.1946) 15° F. 18 The effect of the weather upon health is an important factor, especially when associated with overcrowding and fuel shortage. It will be interesting to note the effect that the unusual meteorological conditions of 1946 will have upon the future health of the children born in that year, and upon the ageing population who are less able to withstand the rigours of a cold and sunless year. OPEN AIR RECREATIONAL AMENITIES. Commons and Open Spaces. Acres Roods Poles Acres Roods Poles Elmstead Woods 61 1 36 Keston Common 55 1 24 Hayes Common (incl. Pickhurst Green) 213 1 32 Hollydale 6 1 0 New Street Hill 11 2 8 Southborough 1 0 0 Turpington 1 3 10 355 3 30 Public Recreation Grounds. Kings Meadow 9 1 0 Martins Hill 12 0 29 Oakley Road 2 0 0 Queens Mead 10 3 15 Widmore 3 1 28 Whitehall 17 1 6 Norman Park (reserved) 56 0 0 110 3 38 Public Gardens and Grounds. Church House Grounds 12 3 20 Hayes (Old) Rectory Grounds 2 0 25 Husseywell Crescent 2 1 30 Library Gardens 1 2 0 Queens Garden 2 1 4 The Knoll 4 1 39 25 2 38 492 2 26 Golf Course (Bromley & Bickley- -subject to lease) 103 1 0 Thus 595 acres of land have been secured or reserved for public recreational purposes within the Borough, representing 9 per cent. of the total acreage of the Borough. SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. CIVIL AMBULANCE SERVICE A Corporation Service, operated (by arrangement) from and by the Bromley and District Hospital. Mr. E. W. Hurst, House Governor of the Hospital, reports for the year 1946 as follows: " In the year under review there has been a considerable increase in the volume of work undertaken by the Ambulance Service, as will be readily appreciated by the figures given in the following statistical summary. The total mileage in 1946 was 16,488, as compared with 10,841 in 1945; an increase of 5,647. The total number of cases dealt with was 2,317 as against 1,708 in 1945, an increase of 609 cases. "On the 2nd October, 1946, a new Ford V8 Ambulance was put into service at the expense of the Hospital. The addition of this new ambulance now brings the number of ambulances available for service up to three, so that as well as being able to cope with more work, we are able to ensure that two ambulances are always available. "Despite the large increase in the volume of work carried out by the Ambulance Service the staff still remains at the same lumber of ten. The work of the Ambulance Superintendent and his assistants has been carried out throughout the year in a most efficient and satisfactory manner, and numerous reports have been received from patients and their relatives of the Promptness, courtesy and understanding with which the Personnel perform their duties." LABORATORY SERVICES. The Kent County Council provide a Laboratory Service for the whole of the County through their Laboratory at Maidstone. The distance from Bromley and the delay caused by postal despatch militates against efficiency for material of an urgent nature being speedily examined and reported on. We have during recent years used the facilities of the Ministry of Health Emergency Laboratory at Downe, and the co-operation we have received from Dr. R. I. Hutchinson has been excellent and of great value to our services. It is regrettable that this Laboratory closed down early in 1947 and we shall, indeed, miss the help that has at all times been freely given. Emergency diphtheria swabs are sent to the West Kent Isolation Hospital and the liaison here has got us out of many difficulties. This service will continue. 19 20 The following statement gives the number of swabs, specimens, etc., despatched for examination and report during 1946:— Haemolytic Streptococci 194 Diphtheria 45 R.L. Wassermann tests 175 Specimens in connection with food inspection, water sampling, etc. 203 Others 54 NURSING IN THE HOME. The Bromley and District Nursing Association and the Hayes and West Wickham Nursing Association provide skilled nursing for the sick in the home. They are affiliated bodies of the Kent County Nursing Association. The current annual reports for the associations give the following particulars of work done:— so. of Nurses employed Genera Total No. of Visits Casual Paid Total Cases Nursed Bromley & District Nursing Association 4 9341 672 10013 751 Hayes & West Wickham Nursing Association 2 4380 124 4505 402 Totals 6 13721 796 14518 1153 21 CLINICS AND WELFARE CENTRES OF THE LOCAL AUTHORITY WITH BRIEF DESCRIPTION OF SERVICES AVAILABLE. Description Situation No. of Sessions Per Week Professional Attendants Services Available Ante-Natal Clinic North Clinic, Station Road, Bromley. 3 (Mon. 2) (Thurs. 1) Monday Afternoon 1 Doctor 2 Midwives Monday Evening 2 Midwives Thursday Afternoon 2 Doctors 2 Midwives Medical Examinations. Blood Tests Rh. Ante-Natal Care. Chemical Foods, Drugs, etc. Masons Hill Welfare Centre William Morris Hall, Masons Hill, Bromley. 2 Monday and Thursday 2 Doctor and Health Visitor Medical Examinations. Mothercraft. Babies Weighed. Chemical Foods, Drugs, Cod Liver Oil, etc. on sale. Whitehall Welfare Centre Whitehall F.A. Post, Recreation Ground, Southlands Road, Bromley. 2 Wednesday and Friday 2 Doctor and Health Visitor Do. Bromley Common Welfare Centre South Clinic, Princes Plain, Bromley Common. 1 Tuesday Doctor and Health Visitor Do. Hayes Welfare Centre Hayes Village Hall, Hayes Street, Hayes. 2 Tuesday and Thursday 2 Doctor and Health Visitor Do. 22 Clinics and Welfare Centres of the Local Authority with Brief Description of Services Available (Continued). Description Situation No. of Sessions Per Week Professional Attendants Services Available Burnt Ash Welfare Centre Burnt Ash Lane Branch Library, Bromley. 1 Wednesday 1 Doctor and Health Visitor Medical Examinations. Mothercraft. Babies Weighed. Chemical Foods, Drugs, Cod Liver Oil, etc. on sale. Plaistow Welfare Centre North Clinic, Station Road, Bromley. 1 Wednesday 1 Doctor and Health Visitor Do. * North School Clinic North Clinic, 4 Doctor and Nurse Minor Ailment Treatment Clinic. Station Road, 1 Nurse ,, ,, ,, ,, Bromley. 2 Doctor and Nurse Immunisation Clinic. 1 Doctor and Nurse Infectious Disease Examinations. 2 Physiotherapist Ultra Violet Ray Treatment. 3 Physiotherapist Remedial Exercises. 6 Orthoptist Electrical Treatment. Massage. Eye Defect Treatment. 2 Eye Specialist Refractions and Other Eye Treatments. 1 Per Month 2 Orthopaedic Surgeons Consultative Service and Treatment. 22 3 Dental Surgeons Primary Scholars— 1.5 yrs. to 11 yrs. Age Groups— Routine Annual Inspection and Treatment. 2-11 yrs. to 14 yrs. Age Groups— Half-year Routine Inspection and Treatment. Secondary Scholars— Half-yearly Routine Inspection and Treatment. 23 Clinics and Welfare Centres of the Local Authority with Brief Description of Services Available (Continued). Description Situation No. of Sessions Per Week Professional Attendants Services Available Ancillary Service for all Children. 1. Orthodontics including consultant Service. (Mr. L. RussellMarsh of K.C.H. as consultant.) 2. X-Rays. 3. Prosthetics (Crowns, etc.) Maternity and Child Welfare. 1. Inspection and Treatment of Day Nurseries and Welfare Children. 2. Inspection and Treatment of all Ante-Natal Mothers. 3. Treatment of Welfare Mothers. 4. Denture Service for all Mothers. *South School Clinic South School Clinic, 5 Doctor and Nurse Minor Ailment Treatment Clinic. Princes Plain, 1 Doctor and Nurse Immunisation Clinic. Bromley. 1 Doctor and Nurse Infectious Disease examinations. 2 Nurse Ultra Violet Ray Treatment. 4 Dental Surgeon Service as shown under North School Clinic. * Burnt Ash Clinic Burnt Ash School, 3 Doctor and Nurse Minor Ailment Treatment Clinic. (auxiliary) Rangefield Road, 2 Nurse ,, ,, ,, ,, Downham. 1 Doctor and Nurse Immunisation Clinic. * Hayes Clinic Hayes School, 2 Doctor and Nurse Minor Ailment Treatment Clinic. (auxiliary) George Lane, 3 Nurse ,, ,, ,, ,, Hayes. 1 Doctor and Nurse Immunisation Clinic. 24 Clinics and Welfare Centres of the Local Authority with Brief Description of Services Available: (Continued). Description Situation No. of Sessions Per Week Professional Attendants Services Available *All Schools 5 Doctor and Nurse Routine Medical Inspection of Various Age Groups. 2 Dental Surgeon Routine Dental Inspection of Various Age Groups. At Office 1 Doctor Special Examinations of Handicapped Children by Appointment. * Transferred to County Council administration under the Education Act, 1944. Description Situation Accommodation Open On : Staff Services Available Elmfield Day Nursery Elmfield Road, Bromley. 40 Children under 5 yrs. Each day 8 a.m. to 6-30 p.m. (excluding Sundays) Matron Deputy Matron Nursery Nurse Warden 4 Student Nurses Cook 2 Cleaners Routine Medical Inspections. Baby Care and Mothercraft. Education Work. Student Training. Meals Provided. Cod Liver Oil, Orange Juice and Vitamins Daily. Draycott Day Nursery Southborough Lane, Bickley. 60 Children under 5 yrs. Do. Matron Deputy Matron 3 Nursery Nurses 5 Nursery Assistants 5 Student Nurses Cook 3 Cleaners Do. 25 HEALTH SERVICES UNDER COUNTY ADMINISTRATION. (a) Tuberculosis Dispensary. The County Council hold a clinic twice weekly at 2, Park Road, Bromley. These premises are grossly inadequate and unsuitable for their purpose and have on more than one occasion been the subject of adverse report. The staff liaison and co-operation has been all that we would wish. (b) Venereal Diseases Treatment. We are, because of the location of Bromley, dependent upon the London Hospitals for the treatment of venereal disease, but as this disease is not apparent in Bromley very few cases come to our knowledge. Those cases that do come to our notice readily receive the necessary treatment through London Hospitals which provide the specialist treatment. The County Council is the responsible Authority for the provision of treatment of venereal diseases. HOSPITALS, PUBLIC AND VOLUNTARY. Isolation and Treatment of Infectious Disease.—There is one Isolation Hospital for general infectious diseases and one for smallpox. These hospitals are provided and maintained by the West Kent Isolation Hospitals Board of which the Local Authority is one of the constituent authorities. BROMLEY AND DISTRICT HOSPITAL. This voluntary Hospital, situated at Cromwell Avenue, provides general hospital out-patient and in-patient services. There are two maternity units attached, one at 118, Widmore Road, and the other at 20, Masons Hill. Details of accommodation, staff and principal health services available:— Maternity Units General Hospital Section No. of Beds Widmore Road Unit Masons Hill Unit Nursing Staff Beds No. of Nursing Staff 22 38 25 144 50 General Services, Specialist and Medical Staffing. Administrative Department. Almoner's Office. X-Ray Department. Physiotherapy. Out-patients' Department, etc. 3 Resident Medical Officers. Honorary Specialists and Consultants for diseases of children, general surgery, orthopaedic, gynaecology, obstetrics, ophthalmology, aural, dermatology, neurology, radiology, etc. There are some 20 honorary medical officers, surgeons, anaesthetists, pathologist and dental surgeon. Details of maternity work are included under section Maternity Hospital Provision " later in this Report. 26 PUBLIC HEALTH ACT, 1936. Sections 187/194 Nursing Homes.—There are eight registered nursing homes which come under periodic inspection from the Health Department. Details of these homes at the 31st December, 1946, were as follows:— Address No. of Beds Patients Received Nursing Staff Surgical Medical Qualified Others 42, Cambridge Road 12 — 13 2 4 24. Elmfield Road 10 — 1 2 2 67, Hayes Road 3 — 1 1 1 58. Heathfield Rd. Keston 10 (Registered in Dec. 1946) 1 5 18, Blyth Road 13 — 33 1 5 48, London Lane 10 — 13 1 6 32, Orchard Road 12 — 25 5 — 47, & 51, Park Avenue 25 — 30 2 4 95 — 116 15 27 SECTION C. MATERNITY AND CHILD WELFARE. MUNICIPAL MIDWIFERY SERVICE. The municipal midwives employed by the Corporation now carry out the entire domiciliary midwifery practice of the Borough. The amount of independent midwifery practised within the area is negligible. Routine work of the municipal midwives is shown in the following figures for 1946:— Total number of bookings 537 Confinements attended 275 Hospital cases (ante-natally and post-natally supervised by the midwives) 240 Visits—Ante-natal 2973 Post-natal 4306 Difficulty in keeping the staff of midwives up to the complement of six was experienced during the year, but having regard to the dire shortage of midwives throughout the country we were fortunate in having the continuous service of five efficient midwives throughout the year. It is with sincere regret that I have to record the death of Miss A. M. Winter on 10th January, 1947, due to an accident in which her car was involved and whilst she was on duty. Miss Winter had given exemplary service since the inception of the Council's midwifery service, and her untimely decease brought to an end a greatly appreciated worker amongst the mothers of Bromley. 27 ANTE-NATAL CLINIC. The Ante-Natal Clinic is held at the North Clinic, Station Road, with sessions as follows:— Mondays at 2 p.m. with Doctor and Midwife. Mondays at 4.30 p.m. with Midwife. Thursdays at 2 p.m. with Doctor and Midwife. At the Thursday sessions there are additional medical attendances for taking blood tests regarding investigations into the Rh factor in an endeavour to combat the high infantile mortality prevalence among the under one week babies. Vitamin K. is also available for similar purposes. The activities of the Ante-Natal Clinic is indicated in the following figures for 1946:— No. of sessions—by the Doctor and midwife 97 No. of sessions—by midwives 49 New cases examined by the Doctor during 1946 489 Total of all medical examinations during 1946 753 Total of all midwives' examinations during 1946 501 No. of blood tests Rh Wasserman Blood grouping (commenced August, 1946) 175 DENTAL SCHEME FOR EXPECTANT MOTHERS AND NURSING MOTHERS. Patients needing dental attention are referred to Mr. J. H. Glen, Dental Officer. Statistical records of this work for the year, 1946 are as follows:— Attendances for—extractions 92 fillings 159 dentures 181 other operations 203 Total attendances 635 Discharged treatment completed 82 Dentures fitted 76 Fillings done 190 Extractions done 316 Gas administrations 53 No. of sessions held 1221/3 28 DOMICILIARY MEDICAL PRACTITIONER SERVICE (Midwifery). This service is at a low ebb at the present time mainly owing to the high proportion of confinements in hospital, shortage of doctors and stress on their services. Only 4 ante-natal and 4 post-natal examinations were made under the assisted scheme during the year 1946. The scheme was formulated within the municipal midwifery service in 1936 and the Local Authority pay the doctors a fee for each report on ante-natal and post-natal examinations. ADMINISTRATION OF MIDWIVES ACTS, 1902 1936. Delegation of powers to administer the provisions of this important legislation was made to the Borough of Bromley in 1930. Periodic inspection of midwives, their records and equipment is made by the Assistant Medical Officer (Dr. G. H. Stinson) as Inspector of Midwives for the area. No. of midwives practising in the area at the end of 1946, 41. (a) Municipal midwives .... 5 (b) Institutional midwives 36 The number of confinements attended by midwives reached record proportions for 1946:— Domiciliary Institutions Total (a) As midwives (without a doctor) 222 849 1071 (b) As maternity nurses (with a doctor) 55 356 411 277 1205 1482 No. of cases in which medical aid was summoned owing to special medical emergencies which are outside the scope of treatment by a midwife, and as laid down by the rules of the Central Midwives Board:— (a) domiciliary cases 52 (b) institutional cases 354 The following is a summary of reasons for summoning medical aid in the 52 domiciliary cases given above:— Mothers. Ruptured perineum 11 Delayed labour 10 Placenta adherent 2 Abnormal presentation 3 Haemorrhage 5 Rise of temperature 5 Other causes 5 29 Infants. Eye discharge 4 Feebleness 5 Other causes 2 52 The Local Supervising Authority is responsible for payment of the fee to the doctor called in, according to a fixed scale of fees under statute. These fees are recoverable either in whole or in part, or may be remitted in whole or in part according to the circumstances of the patient. ADMINISTRATION OF ANALGESICS. The Local Authority provides apparatus for administration of gas and air analgesia, which are held at the disposal of midwives qualified to administer. Training for qualifying in administration is provided by the Authority, the course occupying two weeks. Shortage of midwives present difficulty in release for training, but co-operation amongst the profession usually mitigates this drawback. Gas/air apparatus supplies at the present time would not allow us to furnish each so trained midwife in domiciliary practice with apparatus. Only 8 administrations were given in 1946 due mainly to scarcity of cylinders available. The difficulty of transporting the heavy apparatus is a factor militating against its more frequent use, except in the case where the midwife has transport by car. The number of midwives practising in the area qualified in analgesia administration is (a) domiciliary midwives 3, and (b) in institutions 18. MATERNITY HOSPITAL PROVISION. Under agreements with the County Hospital, Farnborough, 231 patients were admitted through the Local Authority's maternity service, and an additional arrangement with the Bromley and District Hospital commenced during the year and 9 cases were admitted up to the end of the year. Only environment and/or medical necessity qualifies applicants for hospital in-patient treatment so far as cases passing through the local service are concerned. Many beds in the Bromley and District Hospital, 30 which serves a wider area than Bromley, are occupied by cases not coming under either environmental or medical necessitous circumstances. The Bromley and District Hospital had a very full year in their two maternity hospital units, and I am indebted to the Medical Officer of the two units for the following interesting figures for 1946:— Widmore Rd.Unit Masons Hill Unit Total No. of beds 22 38 60 No. of maternity cases admitted 518 780 1298 No. of ante-natal in-patients admitted 33 45 78 No. of cases delivered by Midwives 383 466 849 Doctors 105 251 356 Medical aid sought by midwives in emergency 176 178 354 No. of Puerperal Pyrexia cases 7 10 17 No. of infants receiving complementary or supplementary feeding 50 80 130 No. of infants wholly breastfed on discharge 443 633 1076 No. of maternal death — 1 1 No. of stillbirths 11 19 30 No. of infant deaths within 10 days 5 10 15 PUERPERAL PYREXIA NOTIFICATION. Twenty-one cases were notified to the Medical Officer of Health during 1946. Three were domiciliary cases of whom one was subsequently hospital treated, and 18 concerned institutional confinements. The visiting officers of the Department followed-up with care and advice in 11 cases and the remaining cases returned home to addresses outside the area. OPHTHALMIA NEONATORUM NOTIFICATION. After an absence of cases since 1943 two cases were notified during 1946. Both received in-patient treatment and vision unimpaired was reported in each case. 31 CARE OF PREMATURE INFANTS. Special care and attention is paid by the health visitors and midw ives to these cases. Notifications of births are required to disclose prematurity of infants with a birth weight of 5½ lbs. or under. Information of births occurring in the Borough but normally resident outside the area is passed on to the authority concerned. Figures of premature births in Bromley during 1946:— No. notified— (a) Home births 13 (b) Institutional births 28 41 Details of non-residents transferred to other authorities 11 0/ the home birth cases:— (a) Nursed entirely at home 12 (b) Moved to hospital 1 — 13 (c) Died during the first 24 hours of life 2 (d) Survivors at the end of one month 11 Of the institutional birth cases:— — 13 (a) Died during first 24 hours of life 8 (b) Died in the first week 5 (c) Survivors at the end of one month 15 Weights of premature babies notified:— — 28 Under 2 lbs 4 2 lbs. and under 3 lbs 7 3 lbs. and under 4 lbs. ' 7 1 lbs. and not over 5½ lbs. 23 41 HOME HELPS. Four full-time helps are employed in the municipal midwifery service. Part-time service was given on 50 occasions by various approved persons. Home help assistance was arranged for mothers in 126 instances. The supply has not fully met the demands for this extremely necessary adjunct in present day domiciliary maternity service. I fear home helps will be scarce for a long time. The Domestic Help Scheme which unctions apart from the Home Help Scheme, and is reported later in this Report, is not entirely a comparable service. 32 POST-NATAL SERVICES. HEALTH VISITORS. Home Visiting. Table XI in the appendix gives health visiting statistics for 1946. 1089 primary visits to infants under one year were paid by the health visitors during 1946. A full total of 2,709 visits were made before these children attained one year of age. Children between one year and five years received a total of 2,863 visits. Thus 5572 welfare and babycraft visits were made during 1946 to children under five years. Details of all home visiting for 1946 is as follows:— Primary visits under one year 1089 Re-visits under one year 1620 Re-visits 1 to 5 years 2863 Expectant mothers—special visits 48 School children 153 Stillbirths—special enquiries 19 Infant deaths—special enquiries 11 Miscellaneous 276 6079 "Ineffectual" visits 1314 Total 7393 Visits classified in above figures:— Diphtheria Immunisation 291 Boarded-out children 27 Adopted children 130 WELFARE CENTRES. Table XII in the appendix gives full welfare centre statistics for 1946. Nine sessions are held weekly at the welfare centres. Details of place, day and times may be seen under the previous heading Section B. General Provision of Health Services. A health visitor attends each session and supervises the general routine and arrangements and is assisted by a band of voluntary helpers whose assistance is of inestimable value in coping with the volume of work each session provides. A doctor attends each session. Medical examinations of new entrants: periodic examinations until the child attains school age; advice on babycraft. 33 advice on mothercraft and post-natal matters, are the advantages to be gained by the mothers using the centres. The personal contact, so important a factor in local health services, is exercised to the full in the work of the welfare centres. Mothers using the centres may obtain certain chemical foods, cod liver oil, orange juice, etc., at a welfare price. Medical history cards are kept at the centres until school age; weights are taken, test feeds taken, and records are brought weekly to the general office for medical recording and to extract statistics for official and graph charting purposes. Welfare centres' statistics for 1946 are as follows:— 1. Nominal role of babies at end 1946 4748 2. New enrolments: (a) Under 1 year 908 (b) Over 1 year 193 1101 3. Total number of children attending at the centres during 1946 and who at the end of the year were: (a) Under I year 853 (b) Over 1 year 4. Total attendances of infants: 1545 2398 (a) Under 1 year 12328 (b) Over 1 year 7285 19613 5. Total number of welfare sessions held 416 6. Total number of medical consultations 3799 7. Total number of medical sessions held 288 8. Total number of weighings of babies 18747 9. Total attendances by mothers 17834 The nominal roll of 4,748 babies is a build-up of regular and occasional attenders and contains a fair proportion of children very near to school age. The roll undergoes annual revision by deletion of school entrants and removals to other districts. The figure 2,398 under (3) above is more representative of the active roll. Average attendance of infants per year were (a) under 1 year 15, and (b) over 1 year 5. After adjustment of inward and outward transfers at the close of the year there was a net figure of 1,206 births notified and against this figure 908 babies had attended the centres for the first time Wring the year—a percentage of 75. 34 CHILD LIFE PROTECTION. The welfare of these children has been much to the fore in recent times owing to a number of instances of gross negligence in the care and treatment of these children coming to light. Much can be done to help the mother and safeguard the child, but since all children need parental affection, security and shelter of a normal home, it is clear that a complete solution of the problem is difficult to find, but much successful work by voluntary agencies and welfare workers associated with diocesan and religious bodies, has been achieved. During 1946 the Curtis Report was issued as a result of the investigations of the Care of Children Committee set up by the Government to "inquire into existing methods of providing for children who from loss of parents or from any cause whatever are deprived of a normal home life with their own parents or relatives." I submitted a report to the Welfare Authority in December, 1946, and a very brief recapitulation of the main recommendations will serve to indicate the line of care and supervision envisaged to safeguard the future welfare of these children. 1. Public care and supervision should be extended from 9 years to 16 years of age. 2. Inclusion of those children who are in the care of fosterparents without reward. 3. Registration of all voluntary homes accepting children. 4. Centralisation of supervision under one department. 5. Responsible local authority to be the County or County Borough. 6. Appointment of an ad hoc committee of the local authority to deal with all such children. 7. Appointment of an ad hoc visitor with academical qualifications. 8. To provide the child with a home in order of preference (a) by adoption, (b) boarding-out, (c) residence in communities. 35 9. Medical examination of child before adoption and a health fitness certificate of the adopters. 10. Boarding-out should not function except through the appointed children's officer. There are many other recommendations affecting institutional and residential communities, approved schools, remand homes, handicapped children, emigration, etc., regarding which the Curtis Committee had some critical comments "... that in the majority of public assistance institutions the general care of children was of a poor standard." The "deprived child" comes under many categories, but this Welfare Authority's duties concern adoptions pending, and boarded-out children with foster-parents. For many years our policy has been that the child is placed with suitable fosterparents with the insistence on one child a foster-mother, unless related children were to be fostered. This checked the past evil of baby farming. In 1945 we attempted to secure uniformity of supervision of all deprived children through the deliberations of an informal committee of all agencies in the Borough, and thus to promote co-ordination of supervision. The effort did not, however, achieve complete voluntary co-ordination amongst the agencies concerned. The Curtis Report stresses the formation of a special committee with the appointment of a special officer possessing academic qualifications. I feel, in the light of past experience, that such appointments tend on visitation to single out the child from the family. The health visitor has all the attributes Qualifications and experience befitting her for child life protection duties, and through the functions of the Welfare Committer she would apply the principles of preventive medicine thus ensuring against the risk of tendencies to treat the deprived child otherwise than as a unit of family life. Any supervision which tends to stigmatise the deprived child during its years of nurture is to be guarded against, as much as its welfare is to be safeguarded. In Bromley, I believe, we have achieved this desirable result in a marked degree. At the end of 1946 our registers showed:— No. of foster-parents receiving children for reward 7 No. of foster-children under 9 years receiving care 8 No. of pending adoptions 9 36 At the end of the year the records showed 91 children placed for adoption or with foster-parents. These children having mostly passed the statutory registrable age of 9 years are, nevertheless, periodically contacted through routine health visiting or school nursing. CLINIC TREATMENT OF CHILDREN UNDER 5 YEARS. Treatments in 1946:— Eye Clinic, 118. Minor ailments, 79. Orthopaedic, 581. Ultra Violet Ray, 800. Tonsil and Adenoid operations, 4. Dental Clinic: Total attendances, 99. Number of extractions, 35. Number of fillings, 40. Number of gas administrations, 18. DAY NURSERIES. Since the cessation of war there has been much diversity of opinion expressed as to whether the day nursery is to stay in peace time, but the call to women to again enter industry owing to the serious economic crisis disposes of this controversy for a long time to come. In Bromley we have two day nurseries with accommodation as follows:— No. of approved places: (a) For children 0—2 years 39 (b) For children 2—5 years 61 — 100 No. of children on the registers at the end of 1946 (a) Children 0—2 years 31 (b) Children 2—5 years 63 94 37 Elmfield Road Nursery. The Matron reports for 1946 as follows: " The nursery has remained full throughout the year; at some periods there has been a strain on capacity. Attendances have been maintained at a high level. The general health of the children has been good. There were 6 cases of whooping cough, confined to the 0—2 years nursery; all were mild cases without complications. "The staff, with one exception, was unchanged during the year. Miss Thomson resigned on marriage and was succeeded by Miss Jeffcoat. Two students passed the examination of the National Society of Children's Nurseries, but reverted to private employment. Students now train under the National Nursery Board, the whole course occupying two years. "Many mothers still appear to be anxious to work; the reason advanced being chiefly that demobilised husbands are unable to obtain suitable employment and there is insufficiency of wages in the home. The call for increased production is likely to be a potent factor in the demand for nursery accommodation." Draycott Nursery. The Matron reports as follows: "The nursery was in full activity throughout the year 1946 and attendances were maintained to full capacity. Occasional fluctuation, in attendance occurred during inclement weather and at the beginning of the year some fall in attendance was due to 16 cases of whooping cough. There was no direct evidence of spread of infection due to attendance at the nursery itself as every possible precaution was taken with the co-operation of the mothers. "The average attendance throughout the year was 15 under two years and 32 over two years. Fifty mothers were in whole time employment and in the other case employment was casual, or there were specific reasons for the child's attendance at a nursery. "The nursery remains open from 8 a.m. to 6 p.m. being closed on Sundays. The response of the child to community life in the nursery as been excellent and the mothers on many occasions expressed verbally and in writing their appreciation of the mental and Physical progress of their children. The medical inspection of 38 the children has been periodic and regular and special cases referred to the Assistant Medical Officer, Dr. P. Currie "The training of the five students has progressed satisfactorily, the technical lectures being held at Sidcup Polytechnic. " The Maternity and Child Welfare Committee pay monthly visits for inspection and supervision. The year of work at the nursery has, I believe, been successful." DOMESTIC HELP SCHEME. The steady demand for home assistance in cases of sickness during 1946 has been met by this service, though not without difficulty haying regard to the shortage of workers, which is a difficulty not at all likely to be alleviated in the future. Figures of the service during 1946:— No. of helpers engaged during 1946: (a) Whole-time, 4. (b) Part-time, varying 4 to 10. Total number of cases assisted, 182. (a) Maternity, 58. (b) Sickness, 124. There is at the present time no limit to the amount of help that can be given to the distressed household, but we have, owing to shortage of staff, had to restrict the help available to the most needy and to those in a temporary emergency. There are many aged and decrepit people who should be under institutional care and for whom domestic help would be of assistance, but we have not been able to meet this need owing to the fact that such help would be of a permanent nature requiring a much larger staff than the labour market can provide. SECTION D. SANITARY CIRCUMSTANCES OF THE AREA WATER. The Director of Water Examination of the Metropolitan Water Board has kindly supplied the following information on water supply to the Borough for the year 1946:— "The supply to the Bromley district during 1946 has been adequate at all times. The higher level is supplied from Shortlands Wells and by Thames-derived filtered water; the lower level is supplied from West Wickham and Orpington Wells with additional Thames-derived filtered water during the summer months. 39 "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. The closest watch is kept for any form of contamination and immediate action is taken if the results of the analyses are not up to standard. Appended are the average results of the chemical and bacteriological analyses of the various supplies." Chemical and Bacteriological Examinations, 1946. Bacteriological. No. of Samples Colony Count on Agar at 37»C Bact. coli Test Percentage of Samples negative 100 ml Bact. coli per 100 ml. Shortlands 252 100.0 0.0 West Wickham 256 — 100.0 0.0 Orpington 431 — 100.0 0.0 Thames derived filtered water (Walton) 256 21.8 98.8 0.016 Chemical. Shortlands West Wickham Orpington Thames-derived filtered water (Walton) Samples 4 4 11 251 Ammoniacal Nitrogen 0.061 0.020 0.006 0.151 Albuminoid Nitrogen 0.048 0.025 0.018 0.106 Oxidised Nitrogen 3.3 3.1 4.7 3.2 Chlorides as C1 22.5 14.4 14.6 26.6 Oxygen abs. from Perman ganate 3 hrs. at 80° F. 0.51 0.10 0.12 1.67 Turbidity in terms of Silica — — — 1.1 Colour, m.m. brown, 2 ft. tube Burgess's Tintometer 6 0 0 25 Hardness (Total) 288 292 291 243 Hardness (permanent) 107 86 83 78 pH Value 7.2 7.2 7.1 7.7 Conductivity 500 400 450 450 40 DRAINAGE. The main drainage of the Borough links up with the undertaking of the West Kent Main Sewerage Board, whose purification works are at Dartford. The Borough Engineer reports that 586 yards of 9 in. diameter soil sewer, and 586 yards of 30 in. diameter storm water sewer were laid to connect the Coppice Estate to the main sewer and main water course respectively at Princes Plain. CESSPOOLS. No new premises were erected with cesspool drainage. The pre-war work of securing the abolition of cesspools in the added areas of Hayes and Keston of necessity received a check during the war years. Number of inhabited properties in the Borough which are not on the water carriage drainage system:— Hayes and Keston areas. Sewer not available, 30. Sewer available, 16. (Water carriage to cesspools or small purification plants.) Houses with pail closets: Sewer not available, 14. Sewer available, 3. (No water carriage system.) Other Borough areas. Drainage to cesspools where sewer not available 14 Premises with pail closets where sewer not available 1 RIVERS, STREAMS AND LAKES. The sanitary inspectors paid 37 visits of inspections, and 10 samples were taken for chemical and bacteriological tests as follows:— Chemical Tests. 2 samples of stream water. Results. Reasonably good quality for stream water, but slight sewage contamination reported. Bacteriological Tests. 2 samples of above stream water. 6 samples of lake and stream water. B. Coli contaminated. B. Coli contaminated. 41 SWIMMING BATHS AND POOLS. Samples were taken as follows:— (a) Corporation Open-Air Bath: — Two samples taken indicated good waters efficiently treated. (b) Privately owned Baths: — Bacteriological tests.—2 samples taken from one bath showed B.Coli (presumptive) present in 90 ccs, absent in 80ccs. Further tests showed no typical B.Coli and one sample B.Coli (presumptive) present in 10 ccs. absent in 1 cc. Further tests showed presence of typical B.Coli in 80 ccs. This sample indicated inefficient treatment. 4 samples from two other private baths were satisfactory. PUBLIC CLEANSING AND REFUSE COLLECTION. There are no noteworthy improvements, constructional work or extensions regarding refuse collection and disposal to report for 1946. SANITARY INSPECTION OF THE AREA. The following are aggregate totals of the Chief Sanitary Inspector's statistics for 1946. Tables XIII, XIV, XV and XVI in the appendix of statistical tables shows the figures in greater Total of Inspections and visits Total of Defects and Nuisances found Housing 6782 3888 Infectious disease inquiries 1284 — Food shops 1555 67 Factories 349 86 Sampling (visits) 425 — Trade premises (various) 4044 434 Miscellaneous 621 34 15070 4509 Interviews regarding the above work at office and on sites: 3189. Notices issued: Preliminary—Housing 2641 Other 602 3243 Statutory notices issued—housing: nil. Food Condemnation certificates issued: 867. The figure 1,284 for infectious disease inquiries is high, mainly concerning the daily surveillance for 16 days of smallpox contacts arriving from overseas. Housing defects located in 'he course of these inquiries are classified and included under the heading of Housing. Sampling visits of 406 do not include the number of samples taken, these appear under Food and Drugs Act. 42 FACTORIES ACT, 1937. Table XVI in the appendix gives the annual figures for this work. This Act came into force on 1st July, 1938. Its provisions are designed to secure betterment of hygiene and general welfare for the employees in factories and other workplaces. It is an enactment amending and consolidating earlier factory and worshop acts. With the intervention of the war there was little time to observe the effects of this legislation. There is thus an accumulation of outstanding work to be done in this branch of the service. SHOPS ACTS, 1912-1936. Here again is legislation designed to mitigate as far as possible any conditions detrimental to the health of shop assistants. The Bromley shopkeepers have readily co-operated with the Inspector under the Shops Act, Mr. G. R. Woods. Conditions during the war, bombing, rationing control and post-war conditions have all contributed their particular problems for the shopkeeper and his staff, and some little time must elapse before anything like normal conditions can be enjoined on traders. Inspections and results at end of 1946:— Shop Acts Inspections Absence of Statutory Forms Ventilation defects Sanitary conveniences unsatisfactory Washing facilities unsatisfactory Found 8 2 4 2 21 Remedied 6 2 4 1 SMOKE ABATEMENT. Twenty-nine inspections were made by the inspectors. Five instances of smoke nuisances were all remedied. VERMINOUS CONDITIONS AND UNCLEANLINESS. Seventy-eight visits to premises by the sanitary inspectors related to eradication of bugs, dirty conditions and disinfestations. Twenty premises were successfully cleaned up. The Property Manager reporting for the year on the Council's Housing Estates states that little bug disinfestation was carried out during 1946, and that the very minor troubles that were encountered were dealt with by removal of woodwork and spraying, with apparent success. Linked with the general action of the Department in dealing with verminous infestations is the work of the School Medical Service through routine vermin and cleanliness inspections by the school doctors and school nurses, a particular instance of 43 valuable co-ordinated effort which is effective through the administration of medical and environmental services functioning through one self-contained health department. Reference to this work appears under the heading Uncleanliness in the Report on the School Health Services which is bound with this Annual Report. Where neglect of personal hygiene prevails one often finds associated the common skin infections, as scabies and impetigo. and impetigo. The medical inspections and treatments by the school doctors during 1946 shows a decrease compared with the previous year, as follows:— Disease. Inspected and required treatment Treated at School Clinics Scabies 61 55 Impetigo 29 33 Other skin diseases 537 512 Totals 627 600 RODENT CONTROL. The assistant Rodent Officers and operators have been active, under the supervision of the Chief Sanitary Inspector, in carrying out remedial measures to control rodent infestation. To implement the rodent destruction campaign of the Ministry of Food a defined period for intensive investigation and baiting scheme for the whole area commenced towards the end of the year. Inclement weather conditions impeded the work and an extension of the drive to destroy rats to the middle of 1947 has been approved. Progress under the special schemes from the commencement in November, 1946, to the time of writing (midMarch, 1947) is shown in the following figures:— No. of premises inspected 6797 No. of premises showing evidence of rats and/or mice found (a) 509 rats, (b) 501 mice in the 934 premises 934 No. of premises treated 749 Estimated kill of rats only 4083 For the year ended 31st December, 1946, the routine work statistics are as follows:— On Complaint Routine ReInspections Total Infestation Found Abated Trade premises 41 16 708 765 52 42 Private premises 357 12 2605 2974 360 353 Totals 398 28 3313 3739 412 396 The foregoing tabulation of the year's work, includes the work of the sanitary inspectors regarding rat infestation. This work forms part of their normal duties which are supervisory as well as inspectorial. 44 SECTION E. HOUSING. Table XIII in the appendix gives housing statistics for the year, and treats exclusively of structural and all other defects to the fabric of houses. Tables XIV and XV includes (inter alia) full details of inspections and abatements of environmental housing defects, and the following tabulations summarise the housing figures of these tables. Inspections and Abatements. Housing Inspections On Complaint Routine Reinspections Totals Nuisances 3033 63 3034 6130 Overcrowding 6 — — 6 Verminous conditions 14 — 21 35 Dirty conditions 7 — 17 24 Water supply — 1 — 1 Disinfestation 11 4 4 19 Noxious accumulation 11 — 6 17 Re-housing enquiries 261 276 13 550 3343 344 3095 6782 Housing nuisances and defects found, 3,888. Housing nuisances and defects remedied, 2,418. On housing inspections alone the 'Chief Sanitary Inspector and district inspectors have had a heavy year of inspection. The total of housing inspections for 1946 exceeds the figure for 1945 by over 3,000. Defects found and remedied have increased. The gap between housing defects found (3,888) and defects remedied (2,418) must be attributed almost entirely to shortages of materials and labour which can only be sparingly devoted to repair work. The 2,418 defects abated, are classified as follows: Drainage 548 Dampness 519 Plastering 167 Cleansing walls and ceilings (rooms) 122 Floors 93 Windows 139 Cooking facilities improved 80 Water supply 355 Refuse bins 84 Other items 311 2418 It is noteworthy that during 1946 no less than 3,343 housing complaints have been lodged with the Department—an indication of the confidence with which the public make direct contact with the health officers regarding the difficulties affecting their environmental conditions. 45 Turning to Table XIII it will be noted that 2,886 houses were inspected for housing defects involving a total of 6,130 inspections. Of these houses 2,641 were found not in all respects fit for habitation, and as a result of informal action 1,327 houses were rendered fit by the end of the year. Action under statutory powers was not invoked during the year. The total number of inhabited houses and flats according to the rate books at the close of the financial year 1945/46: 16,850. New houses erected to end 1946: 28. In addition, houses rebuilt: 4. Pre-fabricated houses erected by 31st December, 1946: 318 (of which 52 were erected before 1st January 1946). An analysis of rateable hereditaments as at 31st March, 1946 as follows, shows very clearly that the predominating characteristic of the area is residential, houses and flats being 90 per cent. of the total rateable assessments:— Houses and flats 16950 Shops and dwellings 376 Industrial premises 259 Schools and Public Buildings 57 Public Entertainments 6 Banks and Offices 141 Miscellaneous 280 Advertising Stations 27 Hotels and Licensed Premises 50 Sports Grounds and Clubs 89 Garages and Petrol Stores 64 Lock-up Shops 439 18738 Rehousing. The problem of housing remains acute, but there can be no criticism of the great effort of the Local Authority in their endeavour to remedy the unhealthy and unsocial state in which so many families are living. I am indebted to the Housing Manager for the following tabulation of rehousing position as it existed at December 31st, 1946. 318 families (949 persons) had been " permanently " housed in prefabricated houses. 741 families had been rehoused in requisitioned premises (414 properties containing 2,799 persons). There were, on December 31st, 4,003 applicants remaining on the waiting list. Applicants for housing accommodation are allocated according to seven categories and within each category decided by Committee on a points system. 46 SECTION F. INSPECTION AND SUPERVISION OF FOODS. Safeguarding the food supply of the area is a work of primary importance. The unremitting zeal and expert knowledge brought to bear by the Chief Sanitary Inspector and staff of District Sanitary Inspectors in food inspection and supervision, maintains a high standard. Excellent co-operation has been established between inspector and trader and is an important factor in the good results obtained. During the year Dr. R. I. Hutchinson of the Ministry of Health Laboratory of Downe, and the Chief Sanitary Inspector, carried out an investigation into the bacteriology of food utensils and washing-up water at public restaurants, school canteens and other premises where communal feeding is provided. Her full report was published in the British Medical Journal and is indeed a valuable contribution to Public Health. A further investigation into food handling is being considered. The findings on the bacterial content of food utensils, knives, forks and spoons and the drying cloths showed the presence of pathological organisms and that these organisms were likely to spread among the users of the various articles. I am indebted to the British Medical Journal for permission to reprint the report as follows:— FOOD UTENSIL BACTERIOLOGY By R. Irene Hutchinson M.B.. D.P.H., D.T.M. Public Health Laboratory Service. Modern conditions compel many people to have meals in communal feeding-places, and much work has been dene on outbreaks of enteritis following the consumption of meals contaminated by infected " foodhandlers." Not so much attention has been given to the possibility of transfer of similar and other infections by food utensils. To 'ascertain the general hygienic condition of the "messing erjuipment" in daily use by the public a survey was made in 25 kitchens. These included A.A. and R.A.C. approved hotels, restaurants of multiple stores, works and school canteens, day nursery kitchens, teashops. snackbars, and a civic restaurant. Visits were made between 12.30 and 1 30 p.m.. so that conditions were observed at the peak hour when they were at their worst. The visits were not pre-announced, so that no special cleaning could be done. The kitchens were situated in a residential area of about 60,000 inhabitants—a London dormitory town where the food inspection was maintained at a very high level. Samples of washing-up water in actual use were taken and swabs of spoons, cups, forks, classes, and plates which had been used, washed, and were stacked ready for re-circulation. The swabs were moistened in nutrient broth, and for cups an area of 2 sq. in. (12.9 sq. cm.) to the left of the handle was rubbed over on the assumption that this area was most likely to contain organisms. For glasses the rims and inner and outer surfaces to a depth of J in. (1.25 cm.) were covered, and for forks the free ends of the prongs for a depth of 1 in. (2.5 cm.), 47 Organisms Isolated from Utensils. Spoons.—Out of 164 examined. 8 grew a coagulase-positive Staphylococcus aureus, 2 a Group B haemolytic streptococcus. 1 a Bact. iysenteriae sonnei, 1 a paracolon bacillus, 2 Bact. faecalis alkaligenes, and 27 yielded coliform bacilli. Cups.—Out of 121 examined 9 crew a coagulase-positive Staph, aureus, four haemolytic streptococci (2 Group C. 1 Group B. and 1 Group G), 2 paracolon bacilli, 2 Bact. faecalis alkaligenes, and 30 yielded coliform bacilli. :| Forks.—Out of 219 examined 8 yielded a coagulase-positive Staphaureus. 2 haemolytic streptococci (1 Group A, 1 Group G). 2 paracolon alkaligenes, 1 Proteus bacilli, 3 Pseudomonas oyocyanea, and 23 yielded coliform bacilli. Plates.—Out of 53 examined 6 grew a coagulase-positive Staph-aureus, 2 haemolytic streptococci (1 Group B and 1 Group G), 2 Bact. faecalis alkaligenes, 1 Proteus bacilli, 3 Pseudomonas oyocyanea, and 23 yielded coliform bacilli. Glasses.—Out of 58 examined 3 grew a coagulase-positive Staph, aureus. 4 haemolvtic streptococci (2 Group B and 2 Group G). 1 Bact. faecalis alkaligenes, 1 Morgan's bacilli, and 10 yielded coliform bacilli. All these organisms except the coliform bacilli are possible pathogens and have been cited as causes of disease. The widespread occurrence of coliform bacilli would suggest a real possibility of contamination by intestinal pathogens. No attempt was made to classify these coliform bacilli, as high counts of the dish-washing waters grown at 37° C. suggested that the majority we—5 of animal origin. Faecal streptococci. Streptococcus viridans, and Staph, albus were also grown from 588 of the utensils examined, only 27 yielded no growth of any kind. These organisms, although not pathogenic in themselves, are an indication of the degree of possibility of infection from mouth and bowel organisms. Dish-washing Waters. Thirty-eight samples of dish-washing water were examined: 19 had counts of more than 1,000.000 organisms per m. at 37° C. and 9 had counts of more than 1,000.000 organisms per ml. at 22° C. Twenty of the 38 had considerably more organisms growing at 37° C. than at 22° C.— the approximate proportion being 120: 1—suggesting the presence of a much higher number of organisms of animal than of soil or dust origin. As the average crude sewage in this country contains approximately 1.000,000 to 5.000.000 organisms per ml. at 37° C. (Topley and Walson. 1946), it is seen that the majority of the dishes are being washed in water that bacteriologically is equivalent to sewage. Twenty-three of the 38 waters had more than 1.800 coliform bacilli Present per 100 ml. The Ministry of Health standard for a potable water varies according to the origin, but is ideally no coliform bacilli in 100 ml., and waters are "satisfactory" only if they have not more than 2 coliform organisms per 100 ml. Hence, these waters used for washing utensils. most of which are to be placed in the mouth, would appear to be entirely unfit for such a purpose. Owing to the difficulty of obtaining soaps and soda 11 of the 38 waters contained no detergent. In others soda had been generally added, but in varying Proportions—a handful or so being thrown in at random, That the addition of soda is of value is shown by the following: With PH range 7—10 67% waters had bacterial counts greater than 1,000,000 organisms per ml. 43 Over pH 10 only 47% water had coliform bacilli greater than 1.800 per 1,000,000 per mi. With pH range 7—10 67% waters had coliform bacilli greater than 1,800 per 100 ml. Over pH 10 only 47% water had coliform bacilli greater than 1,800 per 100 ml. The temperatures of the waters were found to be exceptionally low: the average was 40' C.—the maximum being 50 C. and the minimum 30° C. These temperatures would, of course, be too low to have any destructive or inhibitory effect on any organisms. Among the organisms isolated from these waters were Streptococcus viridans, faecal streptococci, Staph, albus and aureus (coagulase-poitive), coliform bacilli, paracolon bacilli (8 times), Bact. faecalis alkaligenes (12 times), Proteus bacilli (once), Pseudomonas pyocyanea (8 times) and aerobic sporing bacilli (14 times). Drying Cloths. In most cases, owing to the shortage of towels and the impossibility of a quick laundry service, cloths were used till wet. and then dried and re-used. Many were washed at night and sent to the laundry weekly. Seventeen of the 36 examined yielded only faecal streptococci. Staph. albus. Str. viridans, and aerobic sporing bacilli. From the others one or more of the following were grown: coliform bacilli, paracolon bacilli, coagulase-positive Staph, aureus, and Bact. faecalis alkaligenes. On the whole the cloths did not seem too unsatisfactory. The cleanest utensils came from a multiple store where a washing machine, with soda, was used and where there was no hand-drying of cups, plates, and glasses. These were placed in a drying oven with a temperature of approximately 82° C., their length of stay varying from a few minutes to half an hour according to the demand for them. This temperature was high enough to kill many of the more delicate organisms, and indeed 10 out of the 20 swabs were sterile. This compares very favourably with the other 24 kitchens, where only 17 sterile results were obtained from among 595 swabs. Though this investigation was not concerned with the bacteriological examination of the " food-handlers" in the kitchens, advantage was taken of the visit to inspect the sanitary arrangements and washing facilities provided for them. In most cases these were unsatisfactory. In 14 places no washing facilities were available either within or immediately adjacent to the sanitary convenience and hands had to be washed, if indeed they were washed at all, in the same kitchen sink as the crockery and cutlery. This provides a sure path of infection by intestinal pathogens. Conclusion. It would seem from this brief survey that in communal feeding-centres the cleaning of eating utensils is very unsatisfactory, and that pathogenic organisms are likely to be spread among the users of different articles. The lack of modern equipment such as washing machines, the difficulty of obtaining soap and washing powders, and the scarcity of drying towels renders very difficult the important and necessary task of feeding people in a hygienic manner. The finding of dysentery bacilli on the cutlery in one out of only 25 kitchens is rather disquieting, and may suggest the origin of the sporadic case of "diarrhoea" and the finding of pathogenic streptococci 14 times and of pathogenic staphylococci 36 times may help to explain the high incidence of septic mout 49 lesions so common in the last few years. The prevalent method of washing and drying infected crockery and cutlery appears to do little in the way of destroying their pathogens. Very great interest was shown by the proprietors of the premises visited, and every help was given to facilitate that investigation. Results were keenly awaited, and they were eager to know what measures could be adopted to remedy defects. It would seem that public health propaganda for improvement in kitchen hygiene, together with suggestions as to the methods to be followed, would be welcomed, especially if accompanied by bacteriological evidence showing its necessity. My grateful thanks are due to the Medical Officer of Health for approval and permission to work in his district; to the Chief Sanitary Inspetor, without whose co-operation and active help this work could not have been done; and to my technicians, Mr. P. G. R. Browne, Mrs. R. Udall, and Mr. H. Gillies, for much willing help in the preparation of media. Reference.—Topley and Wilson (1946). Principles of Bacteriology and Immunology, 3rd. ed., p. 1584. The problem is one indicating the necessary provisions of modern washing and drying equipment, especially with the increase of communal feeding. The scarcity of drying towels and the lack of an efficient detergent are other factors. Much can be done under present methods and the work is being followed up by the Sanitary Inspectors with keen co-operation of those in charge of the catering establishments. There is a wide field of research still open in the hygiene of these premises and Dr. Hutchinson's pioneer work in above direction is worthy of close attention of all those interested in the hygiene of communal feeding. MILK, ICE CREAM. Inspections and sampling during 1946:— Dairy premises, inspections 36 Milk examined on highway 2 Milk sampling, visits 75 Ice cream premises, inspections 111 Samples submitted for testing:— Bacteriological—ordinary milk 10 graded milk 24 Tuberculin tests 5 Phosphatase test 17 Methylene Blue test 17 Churn tests 9 Ice cream tests 40 Two unsatisfactory milk results, and 22 unsatisfactory ice cream results, were notified to the suppliers concerned and improvement in supplies were achieved. Milk samples taken and submitted to the County Analyst for test are included under the heading of Food and Drugs Acts, 50 FOOD AND DRUGS ACT. The Sanitary Inspectors are authorised sampling officers under this Act. Samples taken during 1946 and results:— Articles Formal Samples Informal Sample Articles Formal Samples Informal Samples Aspirin — 2 Friquix — 1 Anti - Rheumatic Compound — 1 Flour — 3 Gelatine — 2 Arrowroot 1 — Ground ginger — 1 Beef Aspic Jelly — 1 Glycerine phosphates — 1 Bisurated magnesia — 1 Baking powder — 2 Golden raising powder — 1 Bicarbonate of Soda — 1 Barley, coarse cut — 1 Ice cream powder — 10 Bismuth, soda and magnesia — 1 Jam, blackcurrant — 1 Lemonade powder — 1 Black pepper (ground) — 2 Lemon wine essence — 1 Blood compound (herbal) — 1 Mustard — 3 Meat extract tablets — 1 Butter 2 1 Milk 13 23 Beef cubes — 1 Mixed spice — 2 Bread — 3 Malt vinegar — 1 Camphorated Oil — 1 Margarine 2 — Celery Salt — 1 Orange, Phosphorous & Iron Tonic — 1 Curry powder — 3 Cake, Bun & Pudding mixtures — 10 Pudding mixtures — 2 Semolina — 2 Cocoa — 4 Sponge pudding mixtures — 3 Coffee — 4 Chocolate spread — 1 Soup, desiccated — 1 Corned Beef 1 — Table dessert — 1 Dried milk powder — 2 Tonic phosphate — 1 Essence of rennet — 1 Wine flavouring — 1 Egg substitute powder — 1 Worcester sauce — 1 Yorkshire Pudding Mixtures — 2 Epsom Salts — 1 Flavouring essences — 6 Zinc ointment — 1 Fish paste — 1 Totals 19 122 Five adulterated samples amongst the follows:— above list were Article of Food. Informal Nature of adulteration or irregularity Observations Milk 1 30 per cent, deficient in fat Follow-up samples were genuine. Bread ... ... 2 Contained a few small glass fragments Follow-up samples were genuine. Dried milk powder 2 Unfit for food Old stock from a school 51 MEAT AND OTHER FOODS. The war-time control on meat slaughtering continues to operate. There are five registered and three licensed slaughterhouses on the register records of the Local Authority. Under the provisions of the Slaughter of Animals Act, 1933, the Local Authority continues to grant annual licenses to slaughtermen. The following articles of food were surrendered either as unfit for human food, for destruction, salvage for animal feeding, or utilised for any authorised process of re-conditioning. 867 Food Condemnation certificates were issued. Approx. Weight. Article of Food. Quantity. (in lbs.) Canned Meat 594 containers 17091/4 Canned Milk, milk powder 1803 containers 41493/4 Canned Fruit 322 containers 4843/4 Canned Fish 501 containers 671½ Canned Soup 79 containers 153/4 Canned Vegetables 822 containers 9833/4 Meat 1827½ Meat (cooked) 322 Fish 3253 Fruit, dried, etc 476½ Vegetables 221½ Fats (butter, margarine, lard, cheese) 69½ Eggs 621/4 Egg powder 13 containers 43/4 Fluor, flour mixtures 526 containers 4184 Bread, cake, biscuits 764 Cereals, pearl barley, oatmeal, rice 499½ Sugar and sweets 173 coffee, cocoa 15 containers 35 Jam, marmalade, syrup 249 containers 367 Miscellaneous 227 containers 1381/4 20,412½ (Total: 9 tons, 2 cwt., 1 qr., 0½ lbs.) It is a matter for regret that we must report annually that tons of food have been condemned or otherwise pronounced unfit for human consumption, especially in these days of shortage. So many factors are, however, responsible that it 52 renders attempts to control wastage difficult. Faulty and careless packing at source; exposure of food to contaminating influences either in store, whilst for sale, or in transit; unsuitable storage place (e.g., dampness and faulty temperature or lack of refrigeration), and controlled foodstuffs after lengthy storage unsold, probably due to the housewives' points having given out. If this latter factor prevails, the less popular products for sale might well be decontrolled before staleness or other decontaminating influences render food unsaleable. SPECIAL ENQUIRIES. Foodstuffs submitted for bacteriological tests:— Gelatine 1 Satisfactory. Grapefruit marmalade 1 Satisfactory. Swabs—W.C. 5 Satisfactory. Faeces 11 Satisfactory. Tap water and cistern 6 Satisfactory. Corned Beef (one sample) 3 Satisfactory. Corned Mutton 3 Unsatisfactory. Corned Mutton 1 Satisfactory. Flour 4 Unsatisfactory. Condensed Milk 1 Satisfactory. Dried Milk 9 Satisfactory. Flour 4 Satisfactory. Canned steak and kidney 1 Satisfactory. Salt Beef 1 Satisfactory. Sample of Brine 1 Satisfactory. Suet 1 Satisfactory. Dried Egg 2 Satisfactory. Bottled Sardelles 1 Unsatisfactory. Spice Herring fillets 1 Unsatisfactory. Tinned Pork Sausage 1 Unsatisfactory. Cheese 1 Unsatisfactory. The foregoing were submitted for bacteriological tests in pursuance of investigations into various cases of intestinal disturbances reported during the year. The unsatisfactory conditions found were not so bacterially contaminated as to give rise to serious food poisoning, but in most cases bacteriological contamination was the probable cause of illnesses. The Department is indebted to Dr. R. Hutchinson of the Ministry of Health Pathological Laboratory, Buckston Browne Farm, Downe, for her invaluable investigations and reports on these specimens. 53 SECTION G. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Tables VII, VIII, IX and X in the appendix give figures regarding notifiable diseases during 1946. SCARLET FEVER. Fifty-one cases were notified, giving an attack rate of 0.84 per 1,000 population. The cases were sporadic over the area, mild in type, and no mortality. Twenty-eight of the cases were isolated in hospital which is 55 per cent. of all notifications. One "return" case was responsible for a further case in the home. The type of infection continues to be mild and there were no serious complications in any of the cases. DIPHTHERIA. Twelve cases were notified, giving an attack rate of 0.19 per 1,000 population. The incidence was sporadic in the Borough, fortunately not virulent in type, and no mortality among the patients. We pin our faith to Diphtheria Immunisation as the only reliable means of protecting childhood against the menace of diphtheria. Every child has a natural right to the one safeguard against a disease which has been, and can be, so fatal to children. We ought not to be content in Bromley until the margin of security of children immunised against diphtheria has been raised at least to 90 per cent. The figures for 1946 show how far short we fall of this target. Diphtheria Immunisation. Approximate percentage of children under 15 years of age in Bromley who have been immunised: 45.31%*. No. of children completely immunised during 1946: (a) under 5,606; (b) over 5, 91. Total No. completely immunised up to 31st December, 1946: (a) under 5, 1,779; (b) over 5, 3,577. In addition to these figures are the cases immunised by private Practitioners and by authorities outside the County during the evacuation period. A " Gallup Poll" taken at three schools showed the Percentage of children immunised at one time or another to be 67 per cent. PUERPERAL PYREXIA. Twenty-one cases occurred with happily no mortality. Nineteen were institutionally treated and made good recovery. Routine investigations were made in the hospital cases and the advice rendered by Dr. R. I. Hutchinson in her bacteriological investigations proved of great value, especially in the majority of cases which occurred at the Bromley and District Hospital. 54 OPHTHALMIA NEONATORUM. Two cases were notified. One case was discovered by the Doctor at the welfare centre during medical inspections The case was referred to hospital for treatment and eventually cleared up with unimpaired vision. The other case also received hospital treatment and cleared up with vision unimpaired. All cases of inflammation of the eyes, or eye discharge, must be notified by midwives and thus early follow-up is assured and delay in treatment is avoided. MEASLES AND WHOOPING COUGH. 215 cases of measles and 92 cases of whooping cough during 1946 may be regarded as normal annual visitations of these infections. The distribution of cases occurring was fairly even throughout the Borough. The use of adult serum as protection is not in wide use. OTHER DISEASES Pneumonia 39; dysentery 2; erysipelas 16; acute poliomyelitis 1; typhoid 1; paratyphoid 1; cerebro-spinal fever 2, and malaria (contracted abroad) 1, complete the list of diseases notified (tuberculosis being dealt with separately) during a year fortunately free of any excessive sickness. TUBERCULOSIS. Table IX gives notifications of new cases and mortality during 1946:— Recordings in the register—1946. Respiratory Other Forms Total No. of cases M. F. M. F. On register at 1.1.46 266 243 80 98 687 New cases notified 1946 35 27 2 4 68 No. of cases coming to knowledge after death 3 1 1 1 6 Inward transfer 7 9 1 — 17 311 280 84 103 778 Deletions—deaths, removals, recovery, etc. 24 21 4 4 53 No. of cases on register at 31.12.1946 287 259 80 99 725 Six cases of unnotified tuberculosis out of a total of 23 tubercular deaths gives a ratio of 3.8 not notified previous to death. 55 Eighty-one cases were added to the register including 68 new notifications, 6 cases noted after death and 17 inward transfers to the area. Fifty-three cases were deleted from the register on account of death, removals, recoveries, etc., leaving a net figure on the register of 725, an increase of 38 over the total for 1945. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. These regulations concern persons suffering from pulmonary tuberculosis employed in the milk trade. No case arose in 1946. PUBLIC HEALTH ACT, 1936. SECTION 172. This section relates to compulsory removal to hospital of persons suffering from tuberculosis. No case arose in 1946. TUBERCULOSIS DISPENSARY AND TREATMENT. The administration of the Dispensary at 2 Park Road, Bronley, is the responsibility of the Kent County Tuberculosis Service, as is also the general provision of institutional treatment. The premises at 2, Park Road are grossly inadequate for the service and are becoming as the years pass a serious and urgent matter for correction. SECTION H. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. DISEASES OF ANIMALS ACTS. The Chief Sanitary Inspector is the authorised inspector under these acts for the Borough. Sixty routine visits and inquiries were made regarding movement licences, sheep dipping, suspected swine fever and suspected anthrax. The district came within the operation of an infected area Order for foot and mouth disease; licences being issued in respect of the movement of 85 pigs during operation of the Order. REGISTRIES FOR FEMALE DOMESTIC SERVANTS. There are no special comments to make under this heading, other than that a contravention was remedied. 56 PETROLEUM ACTS. The Chief Sanitary Inspector undertakes the duties of Inspector under the Petroleum Acts for the Borough. During the annual licencing period 95 licences were issued. 129 inspections of storage installations were made, during the course of which 4 contraventions were corrected. RETAIL MARKET. The Corporation owns the Retail Market under a Charter of Market Rights (granted 20th July, 1447). The Market is held on Thursday at the Car Park, Station Road. The administrative supervision is under the Health Committee and the Market is controlled by the Market Superintendent. There was a slight improvement in the business of the Market after a very lean war-time period but is still far below the business done in the pre-war years. Market tolls taken during 1946 compare with 1945 as follows:— 1946 1945 Monthly average takings £12 16 8 £5 15 2 Weekly average takings £2 19 3 £1 2 10 57 APPENDIX CHARTS AND STATISTICAL TABLES 1946 CHARTS—1946. Chart No. 1—BIRTH RATE. No. 2.—DEATH RATE. No. 3.—ZYMOTIC DEATH RATE. No. 4.—INFLUENZA DEATH RATE. No. 5.—DEATH RATE DIARRHOEA (under 2 years). No. 6.—MATERNAL DEATH RATE. No. 7.—STILLBIRTH RATE. No. 8.—INFANTILE MORTALITY. No. 9.—INFANT MORTALITY IN AGE GROUPS. No. 10.—AGE GROUPS OF INFANT DEATHS. No. 11.—INFECTIOUS DISEASE INCIDENCE RATE. 58 Chart No. 1 BIRTH RATE PER 1000 POPULATION YEARS 1901-1946 Chart No. 2 DEATH RATE PER 1000 POPULATION YEARS 1901-1946 59 Chart No. 3 ZYMOTIC DEATH RATE PER 1000 POPULATION Including: Typhoid, Measles, Scarlet Fever, Whooping Cough, Diphtheria Chart No. 4 INFLUENZA DEATH RATE PER 1000 POPULATION 60 Chart No. 5 DEATH RATE OF DIARRHŒA (Infants Under Two Years) PER 1000 BIRTHS Chart No. 6. MATERNAL DEATH RATE PER 1000 BIRTHS 61 Chart No. 7 STILLBIRTH RATE PER 1000 BIRTHS (Live and Still) Chart No. 8 INFANTILE MORTALITY PER 1000 BIRTHS Chart No. 9 INFANT MORTALITY Percentage of Deaths in Age Groups 62 63 Chart No. 10 AGE GROUPING OF 531 INFANT DEATHS OCCURRING DURING 1926 1945 64 Chart No. 11 INFECTIOUS DISEASE INCIDENCE RATE PER 1000 POPULATION STATISTICAL TABLES, 1946. Vital and General Statistics. TABLE I.— Summary of Statistics, 1946. TABLE II.— Birth Rates, Death Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases, 1946. TABLE III.— Causes of Deaths, 1946. TABLE IV.— Infant Mortality—Causes and Age-groups, 1946. TABLE V.— Infant Mortality—Analysis of Causes, 1942— 1946. TABLE VI.— Infant Mortality and Maternal Mortality— Summary of Statistics, 1910—1946. Notifiable Disease. TABLE VII.— Notifiable Diseases — Wards Distribution, Attack Rates, and Mortality Rates, 1946. TABLE VIII.— Notifiable Diseases—Sex and Age-grouping, 1946. TABLE IX.— Tuberculosis—New Cases and Mortality, 1946. TABLE X.— Ophthalmia Neonatorum, 1946. Maternity and Child Welfare. TABLE XI.— Health Visiting, 1946. TABLE XII.— Welfare Centres and Ante-Natal Clinics, 1946. Housing and Sanitary Inspection. TABLE XIII.— Housing Statistics, 1946. TABLE XIV.— Work of Sanitary Inspectors, 1946. TABLE XV.— Nuisances and Contraventions Abated, 1946. TABLE XVI.— Factories, Outwork, 1946. 65 66 TABLE I. SUMMARY OF STATISTICS, 1946. Population (mid-year 1946, Registrar General) 60,540 Birth Rate 19.4 Death Rate (Crude) 10.8 Infantile Mortality Rate 26.3 Number of Births (live) 1,176 Number of Stillbirths 33 Number of Deaths 656 Number of Infant Deaths (under 1 year) 31 Death Rate of Respiratory Diseases 1.1 „ „ „ Tuberculosis 0.3 „ „ „ Cancer 1.8 „ „ „ Zymotic Diseases 0.01 Notifications of Scarlet Fever 51 „ „ Diphtheria 12 „ „ Pneumonia 39 „ „ Tuberculosis 74 Number of Deaths from Measles — Number of Deaths from Scarlet Fever — „ „ „ „ Diarrhoea (under 2 years) 1 „ „ „ „ Child Birth 1 Number of visits by Sanitary Inspectors 15,070 „ „ „ „ Health Visitors 7,393 Number of Babies on the Nominal Rolls at the Welfare Centres, end December, 1946 4,748 67 TABLE II Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the Year 1946. (Provisional figures based on Weekly and Quarterly Returns.) Bromley England and Wales 126 C.Bs. and Great Towns including London 148 Smaller Towns Resident Pop. 25,000-50,000 at 1931 Census London Adm. County * Rates per 1,000 Civilian Population :— Live Births 19.4 19.1‡ 22.2 21.3 21.5 Still Births 0.54 0.53‡ 0.67 0.59 0.54 Deaths :— All Causes 10.8 11.5‡ 12.7 11..7 12.7 Typhoid and Paratyphoid — 0.00 0 .00 0.00 0.00 Scarlet Fever — 0.00 0.00 0.00 0.00 Whooping Cough 0.01 0.02 0.02 0.02 0.02 Diphtheria — 0.01 0.01 0.01 0.01 Influenza 0.13 0.15 0.13 0.14 0.12 Smallpox — 0.00 0.00 0 .00 — Measles 0.00 0.01 0.00 0.01 Rates per 1,000 Live Births :— Deaths under 1 year of age 26 43† 46 37 41 Deaths from Diarrhoea and Enteritis under 2 years of age 0.85 4.4 6.1 2.8 4.2 Rates per 1,000 Civilian Population :— Notifications:— Typhoid Fever 0.01 0.01 0.01 0.01 0.01 Paratyphoid Fever 0.01 0.02 0.02 0.01 0.01 Cerebro Spinal Fever 0 . 03 0.05 0 .05 0.04 0.06 Scarlet Fever 0.84 1.38 1.51 1.33 1.42 Whooping Cough 1.51 2.28 2.48 2.05 2.22 Diphtheria 0.19 0.28 0.32 0.31 0.24 Erysipelas 0.26 0.22 0.25 0.22 0.27 Smallpox — 0.00 0.00 0.00 0.00 Measles 3.55 3.92 4.73 3.70 7.35 Pneumonia 0.64 0.89 1.02 0.74 0.75 Rates per 1,000 Total Births (Live and Still) :— (a) Notifications :— Puerperal Fever 8.50 10.35 7.63 1.62 9.68 § Puerperal Pyrexia 17.36 (b) Maternal Mortality :— Puerperal Sepsis — 0.18 Not Available. Other Causes 0.82 1.06 * A dash ( — ) signifies that there were no deaths, † per 1,000 related births, † Rates per 1,000 total population. § Including Puerperal Fever* 68 TABLE HI Causes of Death, 1946. Male Female Total 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-Spinal Fever — — — 3. Scarlet Fever — — — 4. Whooping Cough — 1 1 5. Diphtheria — — — 6. Tuberculosis—Respiratory 13 7 20 7. „ Other forms 1 2 3 8. Syphilitic diseases 1 1 2 9. Influenza 2 6 8 10. Measles — — — 11. Acute Poliomyelitis, etc. — — — 12. Acute Infectious Encephalitis — — — 13. Cancer—Buccal Cavity etc. (M), Uterus (F) 1 7 8 14. Stomach, Duodenum 10 4 14 15. Breast — 17 17 16. Other sites 37 36 73 17. Diabetes 2 3 5 18. Intra-Cranial Vascular Lesions 32 42 74 19. Heart Disease 74 104 178 20. Other Dis. Circulatory System 2 14 16 21. Bronchitis 14 20 34 22. Pneumonia 12 7 19 23. Other Respiratory Disease 9 7 16 24. Ulcer of Stomach or Duodenum 6 2 8 25. Diarrhoea (under 2 years) 1 — 1 26. Appendicitis 1 1 2 27. Other Digestive Diseases 10 9 19 28. Nephritis 5 3 8 29. Puerperal Sepsis — — — 30. Other Maternal causes — 1 1 31. Premature Birth 7 7 14 32. Congenital Malformation etc. 8 6 11 33. Suicide 1 2 3 34. Road Traffic Accidents 6 4 10 35. Other Violent causes 6 6 12 36. All other causes 37 39 76 Totals 298 358 656 TABLE IV. INFANT MORTALITY, 1946. (Compiled from Local Returns.) CAUSES OF DEATH Under 1 Week 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Total under 4 Weeks 1 month and under 3 Months 3 months and under 6 Months 6 Months and under 9 Months | 9 Months and under 12 Months Total Deaths under 1 year Measles Whooping Cough — — — — — — — — 1 1 Tuberculosis — — — — — — — — — — Convulsions — — — — — — — — — — Bronchitis — — — — — — — — 1 1 Pneumonia 2 — — — 2 1 — — — 3 Diarrhœa — — — — — — — — — — Gastro-Enteritis — — — — — — — — — — Suffocation — — — — — — — — — — Injury at Birth — — — — — — — — — — Atelectasis 1 1 — — 2 — — — — 2 Malformation 2 — 1 — 3 — — — — 3 Premature Birth 14 — — — 14 — — — — 14 Marasmus, etc. — — — — — — — — — — Other Causes 1 1 — 1 3 — 1 — — 4 Syphilis — — — — — — — — Congenital Heart Disease — — — — — 1 — 2 — 3 Totals 20 2 1 1 24 2 1 2 2 31 69 70 TABLE V 1 Analysis of Causes of Infant Deaths, 1942-1946. 1942 1943 1944 1945 1946 Total No. of Births (live) 871 901 820 872 1,176 Infant Mortality Rate 33 27 39 28 26 Malformation 6 11 7 4 3 31 Premature Births 5 7 4 9 14 39 Respiratory Diseases 3 2 3 3 4 15 Marasmus and General Debility 3 — 1 1 — 5 Infectious Disease — 1 — — 1 2 Gastro Enteritis 1 1 3 2 — 7 Convulsions — — — — — — Other Causes 11 3 14 6 9 43 Totals 29 25 32 25 31 142 This Table shows that Premature Births, Congenital Debility and Malformation caused 53 per cent, of the total infant deaths during the past five years, and should be taken as an indication of the great need for ante-natal supervision. TABLE VI.— SUMMARY OF INFANT AND MATERNAL MORTALITY STATISTICS. Six quinquennial periods are shown with the year 1946. Years Total Births Infant Mortality Rate Total Infant Deaths Age at Death Maternal Deaths Deaths under 1 week Deaths 1 week to 4 weeks Deaths 4 weeks to 1 year Sepsis Other 1910—1914 3,186 68 220 61 41 118 3 6 1921—1925 2,832 62 177 64 26 87 6 7 1926—1930 3,014 44 134 51 14 69 4 6 1931—1935 3,284 28 124 54 10 60 6 9 1936—1940 3,945 37 146 69 18 59 4 9 1941—1945 4,086 31 129 76 10 43 2 3 1946 1,176 26 31 20 4 7 — 1 71 In these figures the following facts are shown :— 1. Reductions in Infantile Mortality Rates. The fall occurs chiefly in the period over one week of age. 2. Increase in the deaths of infants under one week of age. Rate 1910-1914, 28 per cent. 1936-1940, 46 per cent. Rate 1926-1930, 38 per cent. 1941-1945, 59 per cent. Rate 1931-1935, 43 per cent. 1946, 64 per cent. 3. Increase in Maternal Deaths. Rate 1910-1914, 2.7 per 1,000 births. Rate 1926-1930, 3.3 per 1,000 births. Rate 1931-1935, 4.5 per 1,000 births. Decrease in Maternal Deaths. Rate 1936-1940, 3.3 per 1,000 births. Rate 1941-1945, 1.2 per 1,000 births. Rate 1946, 0.82 per 1,000 births. TABLE VII. Notifiable Diseases, 1946. (Civilians.) Ward Distribution, Attack and Mortality Rates. Disease Total WARDS Cases removed to Hospital Attack Rate per 1,000 population No. of Deaths Death Rate Plaistow Martin's Hill Town Sundridge Bickley Bromley Common Keston and Hayes Scarlet Fever 51 7 10 5 9 10 8 2 28 0.84 Diphtheria 12 1 1 1 1 3 5 — 12 0.19 — — Pneumonia 39 7 1 4 10 2 12 3 17 0.64 19† 0.31 Puerperal Pyrexia 21 — 1 11 7 — 1 1 19 17.36* — — Dysentery 2 — 1 1 — — — — 1 0.03 — — Erysipelas 16 4 1 1 3 1 4 2 2 0.26 — — Ophthalmia Neonatorum 2 1 . — 1 — — — — 2 1.70* — — Acute Poliomyelitis 1 1 — — — — — — 1 0.01 — — Typhoid Fever 1 — — 1 — — — — 1 0.01 — — Paratyphoid Fever 1 — 1 — — — — — — 0.01 — — Cerebro Spinal Fever 2 — — 1 — — — 1 2 0.03 — — Malaria (Contracted Abroad) 1 — — 1 — — — — 1 0.01 — — Whooping Cough 92 20 1 7 15 12 31 6 1 1.51 1 001 Measles 215 30 23 16 22 40 26 58 2 3.55 — — Tuberculosis :— 0.33 Respiratory 82 22 11 6 10 7 18 8 — 1.35 20 Other Forms 9 2 1 — 1 1 1 3 — 0.15 3 0.05 Totals 547 95 52 56 78 76 106 84 89 9.03 43 0-71 t Includes Pneumonia (all forms) whereas notifiable types include only acute primary pneumonia and acute influenzal pneumonia. * These figures are based on the attack rate per 1,000 births, and not population. 72 73 TABLE VIII. Notifiable Diseases, 1946. (Civilians.) Sex and Age Grouping. Scarlet Fever Whooping Cough Acute Poliomyelitis Ac. Polioencephalitis Measles Diphtheria Ac. Pneumonia Dysentery Ages M. F. M. F. M. F. M. F. M. F. M. F. Ages M. F. M. F. 0- — — 3 6 — — — — 3 3 — — 0- 2 3 — 1 1- — 1 10 14 — — — — 16 18 — — 5- 2 4 — — 3 1 3 15 12 — _ — — 33 19 2 — 15- 5 6 — — 5 17 11 13 17 — — — 47 62 — 3 45- 5 5 — 1 10 6 6 — — — — — — 4 3 1 3 65 and over 3 4 — — 15 1 1 — — 1 — — — — 5 — 1 Age 25 and over 2 2 — 1 — — — — — 1 1 1 Unknown — — — — Age Unknown — — 1 — — — — — — 1 — — — — — — — Totals 27 24 42 50 1 — — — 103 112 4 8 Totals 17 22 — 2 Smallpox Ac. Encephalitis Lethargica Typhoid Fever Paratyphoid Fevers Erysipelas Cerebrospinal Fever Other Notifiable Diseases Ages M. F. M. F. M. F. M. F. M. F. M. F. M. F. 0- — — — — — — 1 — — — 1 — Puerperal Pyrexia — 21 5- — — — — — — — — — — — Ophthalmia Neonatorum 1 1 15 — — — — — 1 — — 3 1 — 1 Malaria (Contracted Abroad) 1 — 45 — — — — — — — — 1 6 — — 65 and over — — — — — — — — 2 3 — — Age Unknown — — — — — — — — — — — — Totals — — — — — 1 1 — 6 10 1 1 Totals 2 22 74 TABLE X Ophthalmia Neonatorum, 1946. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 2 - 2 2 — - - TABLE IX. Tuberculosis. New Cases and Mortality during the Year 1946. Age periods. New cases notified or otherwise revealed. (Not including Inward Transfers.)* Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 - - - - - - - - 1— 5 2 1 — 1 - — — 2 5—15 4 6 1 — - — — — 15—25 10 9 — 2 1 4 — — 25—35 9 4 — — 1 — — — 35—45 3 4 — — 2 2 — — 45—55 2 - 1 1 4 — — — 55—65 7 1 — 1 4 — — — 65 and over 1 3 1 - 1 1 1 - Totals 38 28 3 5 13 7 1 2 *Inward Transfers 7 9 1 - 75 TABLE XI. Health Visiting, 1946. Classification of Visits. Totals AREAS. 1 2 3 4 5 ] Primary Visits—Under 1 year 1,089 97 201 338 86 189 178 Re-Visits—Under 1 year 1,620 172 294 180 218 451 305 Re-Visits- 1 to 5 years 2,863 442 393 525 440 584 479 Expectant Mothers 48 - 1 1 10 30 — Still births—Special Enquiry Visits 19 - 4 8 - - 7 Infant Deaths—Special Enquiry Visits 11 — 1 6 — 1 3 School children 153 29 37 12 57 4 14 Miscellaneous 276 6 35 31 159 15 30 "Ineffectual" Visits 1,314 142 282 493 50 150 197 Aggregate Total of all Visits 7,393 888 1,248 1,594 1,020 1,430 1,213 Net Total of all Visits (after deducting "Ineffectual") 6,079 746 966 1,101 970 1,280 1,016 Other Visits— Also Classified and Included in Above Tabulation. Diphtheria Immunisation 291 38 - 34 160 - 59 Boarded-out Children 27 1 11 4 2 4 5 Adopted Children 130 14 3 31 - 22 60 76 TABLE XII. Welfare Centres and Ante-Natal Clinics, 1946. CENTRES. Nominal Roll of Babies 31/12/1946 New Enrolments Total Attendances Welfare Sessions held Medical Consultations No. of Weighings Under 1 year Over 1 year Under 1 year Over 1 year Mothers Medical Sessions held No. of Babies Examined Bromley Common 719 99 25 1,170 989 1,967 51 47 706 1,946 Burnt Ash 518 123 19 1,316 627 1,797 50 44 504 1,871 Hayes and Keston 986 138 20 1,692 1,449 2,851 102 45 383 3,009 Masons Hill 539 220 55 3,009 1,468 4,091 63 54 769 4,357 Plaistow 759 174 49 2,300 1,415 3,223 51 49 806 3,590 Whitehall 1,227 154 25 2,941 1,337 3,905 99 49 631 3,974 Totals 4,748 908 193 12,428 7,285 17,834 416 288 3,799 18,747 Ante-Natal Clinic, 1946. MEDICAL CONSULTATIONS CLINICS HELD BY MIDWIVES ONLY No. of Sessions held New Cases Examined Total Attendances for Medical Examinations Blood Tests Rh. Factor No. of Sessions Held Total Examinations by Midwives 97 489 753 175 49 501 77 TABLE XIII Housing Statistics for the Year 1946. Total number of inhabited houses, 1946 16,850 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) 2,886 (b) No. of inspections made for the purpose 6,130 (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) No. of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,641 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 1,327 78 TABLE XIV Work of Sanitary Inspectors for the Year 1946. HOUSING INSPECTION. On Complaint Routine Re Inspection Total Nuisances Found 1. Inspection of District Regulations - - - - - 2. For Nuisances 3,033 63 3,034 6,130 3,839 3. Over-Crowding 6 — — 6 6 4. Verminous Conditions 14 — 21 35 6 5. Dirty Conditions 7 — 17 24 10 6. Water Supply — 1 — 1 — 7. Cesspools — — — — — 8. Earth Closets — — — — — 9. Privy Pails — — — — — 10. Houses Let in Lodgings — — — — 11. Disinfestation 11 4 4 19 15 12. Noxious Accumulations 11 — 6 17 7 13. Housing Inquiries 261 276 13 550 5 Total 3,343 344 3,095 6,782 3,888 Infectious Diseases— 1. Inquiry Visits (Nuisances found recorded above) - 138 3 141 - 2. Disinfection Purposes - 76 — 76 — 3. Smallpox Inquiries—Contacts — 1,040 4 1,044 — 4. Aircraft Passengers — 23 — 23 — Total - 1,277 7 1,284 — Meat, Milk and Other Food Shops— 1. Butchers 6 488 13 507 13 2. Confectionery 16 — 16 2 3. Dairy premises 1 30 5 36 5 4. Fish 2 216 — 218 — 5. Fried Fish - 30 — 30 — 6. Food Hawkers - 15 — 15 — 7. Greengrocery, Fruiterers 1 60 1 62 1 8. Grocery 30 381 8 419 44 9. Ice Cream Shops, Vendors — 35 16 51 l 10. Meat Regulations (Spec. Visits) - - - — - 11. Milk Examined on Highway 1 1 - 2 — 12. Retail Market - 92 — 92 — 13. Slaughterhouses - 33 - 33 — 14. Horseflesh Shops - 74 — 74 1 Total 41 1,471 43 1,555 67 Factories, Outworkers. Etc. 1. Factories—Mechanical Power 15 31 19 65 39 —Non-Mechanical Power 4 14 9 27 7 2. Other Premises and Workplaces—Hotels, Restaurants, Etc. 9 119 6 133 19 3. Bakehouses—Mechanical Power ... 2 20 23 45 5 —Non-Mechanical Power - 34 3 37 9 4. Outworkers Premises - 12 - 12 — 5. Smoke Abatement 8 6 15 29 7 Total 38 236 75 349 86 79 TABLE XIV— (Cont.) SAMPLING, FOOD and DRUGS ACT, Etc. On Complaint Routine ReInspec tion Total Nuisances Found No. of Samples taken 1. Milk—Bact.: Ordinary 10 — 11 — 11 ,, Graded 24 — 16 — 16 Tuberc. Tests 5 — 6 — 6 Phosphatase Test 17 — 20 — 20 Methylene „ 17 — 22 — 22 Churns ,, 9 — 1 — 1 2. Food and Drugs—Sampling 141 2 16$ 28 199 —Registration — — 11 — 11 3. Ice Cream 40 — 51 9 60 4. Food poisoning and Special Food Investigations 52 8 18 1 27 5. Water (Drinking) Bact. Test 6 — 22 — 22 6. Restaurants, Hotels, Canteens— (Special Investigations) —Washing Water 436 25 25 —Utensils (Smears) 35 — — — — 7. Samples of Earth 4 — 5 — 5 Total 796 10 377 38 425 Trade Premises— Various. 1. Shops Acts 7 8 6 21 16 2. Petroleum Acts 1 47 81 129 3 3. Registry Offices — 2 — 2 — 4. Offices (P.H. Act, Sec. 46) 1 — — 1 1 5. Diseases of Animals Acts : —Movement Licences - 4 - 4 - —Sheep Dipping — 8 — 8 — —Swine Fever — 6 — 6 — —Anthrax — 3 2 5 — 6- Piggeries 2 15 3 20 1 7. Stables 1 2 2 5 1 8- Rodent Control—Trade Premises 41 16 708 765 52 Private 357 12 2,605 2,974 360 Sewer Treatment — 33 2 35 — »• Public Houses—Urinals — 65 4 69 — Total 410 221 3,413 4,044 434 Miscellaneous— 1. Animals, keeping of 9 - 5 14 5 2. Schools 6 11 17 34 11 3. Drain Tests—Smoke 1 11 - 12 2 Water 10 74 — 84 6 Colour 2 22 — 24 — 4.Tents, Vans and Sheds — 2 4 6 — 5.Billets and Camps — 3 1 4 — 6. Swimming Baths, Pools — 4 - 4 - 7. Air Raid Shelters - 49 - 49 - 8. Accumulations 8 10 13 31 9 9. Streams 1 57 5 63 1 10. Unclassified - 306 - 306 - Total 37 549 45 631 34 Grand Total 3,879 4,475 6,716 15,070 4,509 Interviews at Office and on Sites : 3,189 80 TABLE XV. Nuisances, Defects, Contraventions, Abated, 1946. HOUSING INSPECTION. Drainage— Premises Re-Drained and Connected to Sewer 16 Cesspools Abolished — Cesspools Emptied 1 Earth Closets, Privy Pails, Abolished — Drains Relaid or Repaired 59 Drains Unstopped 155 Inspection Chambers Provided 20 W.Cs. Provided (Additional or Separate) 5 „ Buildings Reconstructed 3 „ „ Repaired 3 ,, Pans Renewed 131 „ „ Cleansed 5 ,, Box Seats Removed 11 Soil, Vent, Pipes Renewed or Repaired 4 Sink, Bath, Waste Pipes Renewed or Repaired 48 Sinks Renewed 58 Lavatory Basins Renewed 28 Baths Renewed 1 Dampness— Roofs Repaired or Renewed 214 Rainwater Pipes, Guttering, Repaired or Renewed 152 Vertical Plinth Provided 8 Walls Rendered 16 Horizontal D.C. Provided 6 Solutioning — Earth Removed from Walls ... 6 Walls Repointed 18 Subfloor Ventilation Provided or Improved 45 Dry Areas Constructed 4 Brickwork Repaired 47 Under Floor Sites Concreted 3 General Items— Rooms Cleansed 100 W.C. Walls Cleansed 7 Entr. Hall and Staircase Cleansed 11 Bathroom Cleansed 4 Light and Ventilation Improved 25 Plastering Repaired or Renewed 167 Floors Renewed or Repaired 93 Windows, Frames, Renewed or Repaired 67 Sashcords Renewed or Repaired 42 Putty, Pointing Renewed or Repaired 30 Doors Renewed or Repaired 27 Stoves Renewed or Repaired 80 Coppers, Renewed or Repaired 25 81 TABLE XV.—(Cont.) Handrails, Renewed or Repaired 1 Stairtreads, Renewed or Repaired 7 Dustbins Provided 84 Dirty Conditions Remedied 3 Over-Crowding Abated 6 Chimneys Repaired 29 External Woodwork Repainted 49 Food Stores Provided 2 Food Stores Ventilated — Yard Paving Renewed 5 Houses Disinfested 11 Noxious Accumulations Removed 20 Domestic Boilers Renewed 6 Water Supply— Drinking Water Service Installed from Main 10 Fittings Renewed 236 Water Supply, Separate or Additional, Provided 3 Water Supply Re-Instated 19 Flushing Cisterns, Storage Tanks, Renewed Etc. 87 Miscellaneous Items—Housing 95 meat, Milk and other food shops— Butchers Confectionery Dairies Fish Grocery Yards, Floors, Repaired 1 — — — 2 3 Cleansing & Limewashing 2 2 — 3 — 7 Sinks Provided 3 — — — — 3 Manure, Refuse, Removed 1 — — — — 1 Refuse Bins Provided 1 — — — 3 4 Floors Cleansed 2 — — 1 — 3 Cold Storage, Improved 1 — — — 1 Miscellaneous 11 2 — 4 5 22 FACTORIES—Outworkers— Want of Cleanliness 9 Over-Crowding — Unreasonable Temperature — Inadequate Ventilation — Ineffective Drainage of Floors 1 Sanitary Insufficient 3 Conveniences Unsuitable or Defective 15 Not Separate for Sexes 5 Other Offences 46 Outworkers Premises — Smoke Abatement 5 82 TABLE XV.-(Cont.) TRADE PREMISES—Various— Shops Acts : Ventilation 2 Temperature — Sanitary Conveniences 4 Absence of Statutory Forms 6 Washing Facilities Unsatisfactory 1 Meals, Rest Interval — Seats for Female Workers — Other Offences — Petroleum Acts—Contraventions 4 Registry Offices 1 Offices (P.H. Act, 1936, Sec. 46) 3 Diseases of Animals Acts - Piggeries—Cleansed, Etc. 1 Stables „ 1 Rodent Control—Trade Premises 42 Private „ ... 353 MISCELLANEOUS— Animal Nuisances 2 Tents, Vans and Sheds - Billets and Camps - Accumulations 20 Stream Pollutions 1 Schools - Total 2,965 NOTICES ISSUED— Housing Others Preliminary 2,641 602 Statutory — - Totals 2,641 602 83 TABLE XVI. Factories, 1946. I Inspections for purposes as to provisions of health. Premises Number of Inspections Written Notices Occupiers Prosecuted Factories With Mechanical Power 139 27 - Factories Without Mechanical Power 64 10 — Other Premises 134 13 - Total 337 50 — II. Defects found. Particulars Number of Defects Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.l.) 11 9 - Over-Crowding (S.2.) — — — Unreasonable Temperature (S.3.) - - — Inadequate Ventilation (S.4.) — — — Ineffective Drainage of Floors (S.6.) 1 1 — Sanitary Conveniences (S.7.) Insufficient 3 3 - Unsuitable or Defective 17 15 — Not Separate for Sexes 5 5 — Other Offences 49 46 - Total 86 79 — III.Outwork. Nature of Work Inspections Nuisances Notices Served Wearing Apparel (Making) 12 - - BOROUGH OF BROMLEY COMMITTEE FOR EDUCATION ANNUAL REPORT on the SCHOOL HEALTH SERVICES for 1946 K. E. TAPPER, O.B.E., G.M., M.B., Ch.B., D.P.H. 17th February, 1947 Medical Officer of Health 86 Members of Welfare Committee: Alderman M. Stafford Smith (Chairman). Mrs. A. M. Howe, J.P. (Vice-Chairman). Alderman F. W. Isard. Councillor, H. Dorrett. Councillor H. L. Elphick. Councillor H. M. V. Green. Councillor A. L. Hill. Mrs. E. J. Munn. Officers of Committee: Borough Education Officer: H. W. C. Eisel, M.A., M.Litt., I.Ed. Assistant Borough Education Officer: A. C. Cleveland. Chief School Enquiry Officer: E. P. J. Wythe. Introduction. To the Chairman and members of the Welfare Committee. Ladies and Gentlemen, The year 1946 saw the beginnings of the working of the service under the Act of 1944, Bromley being an "excepted area " with limited self-government of the Health Services but sufficiently elastic to allow of local initiative. The statistics indicate the scope of the work performed during the year but are low for a normal year owing to the absence of medical staff for prolonged periods of sickness. During the latter part of the year medical inspections and treatment of the Grammar Schools was undertaken by the Bromley staff and it is hoped that the year 1947 will see an extension of medical supervision of the child at school. One looks forward with interest to a Complete and effective service. The year 1946 saw, too, an endeavour within the Health Department to associate the individual with the family as a unit and to link up the defect with the home environment. This 87 can only function if the staff of a health department work as a team—the doctor, the school nurse, the sanitary inspector, the teacher and the parent. If one is to get the full result of our efforts we must have uniformity of record and associate the physical and mental environment of the child with its medical history. In the early days school medical service was established mainly with the idea of controlling infection and cleanliness at school. Recent years saw the establishment of medical clinics and the treatment of minor and special ailments. The future must take under survey the whole physical and mental environment of the child at school and at home. The parent, teacher, doctor, nurse and sanitary inspector, and the physical training officer will function as a team working in the child's welfare and there must be no watertight compartments within the controlling local authority. 1946 was the first complete post-war year and it was with the hope of the approach to normal, that the special investigation could be made on the effects of war upon the child. Unhappily normality was not complete and all that could be noted was that the home environment with its overcrowding and housing shortage was having an unhappy psychological effect on the behaviour of many children. Dr. Orgler, assistant school medical officer, noted especially the prolongation of minor illness—probably aggravated by lack of sunshine. It is of interest to note that these children responded well to ultra violet ray treatment. The increase of intestinal disorders may have been due to food shortages, and the increase in the number of cases of stomatitis to a lack of sufficient vitamin C in the diet. It is of interest to note that a bacterial investigation of communal feeding places showed pathological organisms in the dish washing and food utensils in school kitchens. It may be that these factors are coincident but further investigation is necessary. The school health staff have worked at full pressure and with enthusiasm. The liaison with the County has been a happy one and with the Local Education Committee our relations all that one could desire. It is essential, however, that if The health services are to be fully effective local interest and control must be encouraged. 88 Staff. The services of Public Health, Maternity and Child Welfare, and School Welfare are joint services and officers perform the multiple duties. The staff is as follows:— Medical. Whole-time Officers: Proportion of time allocated to School Health Service Medical Officer of Health Dr. K. E. Tapper ¼ Assistant Medical Officers Dr. G. H. Stinson 5/8 Dr. A. E. Orgler 3/4 Dr. P. A. Currie 3/4 Part-time Officers: Orthopaedic Surgeon Mr. J. A. Cholmeley 2 sessions a month Ophthalmic Surgeon Dr. Eric Lyle 2 sessions a week Dental Officers. Whole-time Mr. J. H. Glen Whole-time Mr. B. S. Birkhahn 7/10 Part-time: Mr. Fairman J. Ordish 4 sessions a week Clinic Assistants Mrs. W. Carrie 1 7/10 Miss F. E. Rolfe 1 7/10 Miss M. Ellen 1/6 (part-time) Nursing Staff. Whole-time Miss L. A. Briggs ½ Miss E. B. Crowe ½ Miss F. L. Gray ½ Mrs. N. M. Taylor ½ Miss C. Hemmings ½ Miss H. Hogger ½ Part-time: Masseuse Miss M. Dodge 5 sessions a week Orthoptist Miss J. Pinnick 6 sessions a week Clerical Staff. 1 Chief Clerk Mr. H. E. Lawley 3/8 1 Senior Clerk Mr. S. F. Judd 3/8 3 Grade I Clerks Mrs. D. Cox 3/4 Miss R. Brock — Miss J. Woodrow — 8 Grade II Clerks Miss S. Potterton 3/4 Miss M. Kelly 3/4 Miss S. Rumph 3/8 Miss I. Legg — Miss B. Booth — Miss B. Burrows - Mrs. I. Stapleton — Miss M. Croxson — 89 Number of Children on School Rolls. Primary and Secondary Modern 5117 Secondary Grammar—Boys 723 Girls 643 - 1366 Technical 279 School of Art 205 Total 6967 Hygiene of Schools. There have been no noteworthy improvements carried out in 1646. The main reasons for this have been:— (1) The great lee-way to be made up in the exterior decoration of school premises; and (2) The general shortage of materials and labour. MEDICAL INSPECTION. This includes the routine medical inspection of the various age groups at school, and the special examination of children with defects at the various school clinic sessions. Routine Inspection. Five sessions a week are held at the schools, and, in order to make this examination as complete and thorough as possible, not more than 15 children are called for each session. The parent of the child is informed of this inspection and some 80/90 per cent. of parents accept the opportunity to attend. The medical record of the child is continuous with the Maternity and Child Welfare record of the child; all records being kept at the Health Department. A beginning has been made to associate this medical card with the family record card and home environment. In the case of the primary and modern schools, a school nurse attends with the doctor, and here We get an immediate association of the home visitor with the doctor examining the child. In the case of the grammar schools, however, the school nurse does not attend and the preparation of the child for examination is given by one of the teaching staff, usually the teacher responsible for the physical training. In all cases of defect the head teacher is informed. There is, however, a need for greater liaison between the teacher, the Parent, the doctor and the child. It would be of advantage to the doctor carrying out the examination if he had before him a record of the child's behaviour and intelligence at school, its habits and behaviour at home, and a report of the home environment by the school nurse and the sanitary inspector. Until this is done the value of the medical inspections at school cannot be fully functionable. 90 The statistical records of Routine Inspection for 1946 are as follows:— Entrants to school life 549 2nd Age Group 8-9 years 540 3rd Age Group 13 years plus 481 Other Routine Inspections 202 Total 1772 It is to be noted that the examinations of the grammar school pupils were not undertaken by the local staff until the end of the year, and during the greater part of the year only two doctors were functioning owing to illness in the medical staff. Results of Routine Inspections. The following table indicates individual children found with defects requiring treatment (excluding defect of nutrition, uncleanliness and dental defect). Group Defective Vision Other Defect Total Entrants 3 30 33 2nd Age Group 44 41 85 3rd Age Group 80 101 181 Other Routine 5 10 15 Total 132 182 314 The following is a tabulation of the defects discovered and classified for observation or for treatment. Defect or Disease Routine Inspections No. of Defects Requiring Treatment Requiring Observation Skin. 1. Ringworm—Scalp — — 2. Ringworm—Body — — 3. Scabies 2 — 4. Impetigo 6 — 5. Other Diseases (non-tuberculous) 19 • Total (Heads 1 to 5) 27 — Eye. - - 6. Blepharitis — — 7. Conjunctivitis 5 — 8. Keratitis — — 9. Corneal opacities — — 10. Other conditions (excluding defective vision and squint) 10 2 Total (Heads 6 to 10) 15 2 11. Defective Vision (excluding squint) 132 39 12. Squint 5 1 91 Ear. 13. Defective Hearing 1 — 14. Otitis Media 1 — 15. Other Ear Diseases 3 1 Nose and Throat. 16. Chronic Tonsilitis only 21 68 f 17. Adenoids only 2 5 18. Chronic Tonsilitis and Adenoids 23 2 19. Other Conditions 15 1 . 20. Enlarged cervical glands (non-tuberculous) 1 7 21. Defective speech 1 — Heart and Circulation. Heart Disease: — 22. Organic 2 1 23. Functional 2 17 24. Anaemia 3 — Lungs. U 25. Bronchitis 4 — 26. Other Non-Tuberculous Diseases 4 2 Tube culosis. Pulmonary: — 27. Definite — — 23. Suspected 1 1 Nou-Pulmonary: — 29. Glands — — 30. Bones and Joints — — 31. Skin — — , 32. Other Forms 4 5 Total (Heads 29 to 32) 4 5 Nervous System. 3J Epilepsy — — 34 Chorea 1 — 35. Other Conditions — — Deformities. 36 Rickets 1 1 37. Spinal Curvature 7 — 38. Other Forms 73 9 Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Disease) 29 16 Totals 378 178 The figure of 378 requiring treatment is not to be compared w'th the figure 314 given in the previous table as there are some children with more than one defect. The nutritional state of children classified at routine ®spections at school is indicated in the following classification. This return is not to be taken too literally as there are so many 92 factors which make for incorrect findings. It is more an indication of physical condition of the child examined and not necessarily the child's nutritional state. The factor of familiar likeness may make for a child of subnormal physique, whereas its nutritional state may be quite normal. The height and weight factor is not taken into consideration in this classification. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups—1946. Age Groups No. of Children Inspected A. (Excellent) B. (Normal) C. (Slightly Sub-normal) D. (Bad) No. Per Cent. No. Per Cent. No. Per Cent. No. Per Cent Entrants 549 30 5.46 459 83.61 60 10.93 — Second Age-Group 540 19 3.52 482 89.26 38 7.04 1 0.18 Third Age-Group 481 16 3.33 415 86.28 48 9.98 2 0.41 Total 1570 65 4.14 1356 86.37 146 9.30 3 0.19 Other Routine Inspections 202 8 3.96 173 85.64 19 9.41 2 0.99 Grand Total 1772 73 4.12 1529 86.29 165 9.31 5 0.28 In my previous reports I have indicated a more careful survey of the child during the war years in comparison with the child of the pre-war years. Special Medical Inspections. These include cases referred to the clinics from routine inspections at school, or referred by teacher, attendance officers, and also those cases brought to the clinic by the parent for one reason or another. During the year some 6,386 medical examinations were carried out. The chinics are held on 15 occasions a week and are run in conjunction with minor ailment treatment clinics. These clinics are held at. North Clinic, 5 sessions a week; South Clinic, 5 sessions a week; Hayes School, 2 sessions a week; Burnt Ash School, 3 sessions a week. A special session at the Municipal Offices is held on Saturday mornings for handicapped children and on other occasions when circumstances demand it. It is at this session that selected cases are referred for consultation. Excluding the handicapped children, the following table gives an indication of the defects found at these special inspections. 93 Defect or Disease Special Inspections No. of Defects Requiring Treatment Requiring Observation Skin. 1. Ringworm—Scalp 7 — 2. Ringworm—Body 9 1 3. Scabies 59 3 4. Impetigo 23 2 5. Other Diseases (non-tuberculous) 518 — Total (Heads 1 to 5) 616 6 Eye. 6. Blepharitis 14 1 7. Conjunctivitis 79 1 8. Keratitis — — 9. Corneal opacities — — 10. Other conditions (excluding defective vision and squint) 111 3 Total (Heads 6 to 10) 204 5 . 11. Defective vision (excluding squint) 72 3 12. Squint 9 — Ear. 13. Defective Hearing 6 — 14. Otitis Media 52 — 15. Other Ear Diseases 61 7 Nose and Throat. 16. Chronic Tonsilitis only 15 62 17. Adenoids only 4 9 18. Chronic Tonsilitis and Adenoids 74 9 19. Other Conditions 386 14 20. Enlarged cervical glands (non-tuberculous) 4 5 21. Defective speech 6 — Heart and Circulation. Heart Disease: — 22. Organic — — 23. Functional 3 7 24. Anaemia 4 — Lungs. 25. Bronchitis 3 - 26. Other Non-Tuberculous Diseases 24 7 Tuberculosis. Pulmonary: — 27. Definite - - 28. Suspected — 4 Non-Pulmonary: — 29. Glands 1 1 30. Bones and Joints 31. Skin - - 32. Other Forms. — 5 Total (Heads 29 to 32) 1 6 94 Nervous System. 33. Epilepsy — — 34. Chorea — 1 35. Other Conditions 85 1 Deformities. 36. Rickets — 2 37. Spinal Curvature — — 38. Other Forms 3 4 39. Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Disease) 565 68 Totals 2197 220 It is from the special inspections, as well as from routine inspections, that children with special defects are referred to the special clinics by appointment. MINOR AILMENT TREATMENTS. Minor ailment treatments are carried out by the school nurses under the direction and advice of the medical officers. Sessions are held in conjunction with the special medical inspection clinics. The treatments are available also to children under school age. The following is a statistical record of the treatments carried out by the nurses during the year. Defect or Disease Number of Defects Treated, or under Treatment during the year 1946 Skin. Ringworm—Scalp: — Under the Authority's Scheme Otherwise Total i. X-Ray Treatment — ii. Other - — — Ringworm—Body 9 — 9 Scabies 55 — 55 Impetigo 33 — 33 Other Skin Disease 501 11 512 Minor Eye Defects 180 54 234 Minor Ear Defects 109 7 116 Miscellaneous (e.g., Minor injuries, bruises, sores, chilblains, etc.) 438 162 600 Total 1325 234 1559 In addition to the above, 234 children were referred to own doctor or hospital and 638 for treatment at home under the supervision of the school nurse. 95 The table is self-explanatory and indicates the type of cases requiring clinic treatment. There is no doubt in my mind, and the foregoing figures indicate, that the parents of the school child make extensive use of the clinic facilities in Bromley. There were 13,876 attendances for treatments during 1946. Special Clinics and Treatments. Special Clinics are held for Eye and Orthopaedic conditions. Eye Clinic. This clinic is held at the North Clinic on two sessions a week, Dr. Eric Lyle, the Ophthalmic Surgeon, being in attendance Attendances are made by appointment only. The following stastistical table is a record of the work for the year 1946. No. of Defects dealt with No. of Children for whom Spectacles were (a) Prescribed (b) Obtained Uuder the Authority's Scheme Otherwise Under the Authority's Scheme Otherwise Under the Authority's Scheme Otherwise Errors of Refraction (including squint) 794* 284 199 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 33 Totals 827 — 284 — 1991 — *Including 596 re-mspections. † Owing to opticians' supplies being in short supply, delay in obtaining spectacles promptly is unavoidable at present time. Other Figures. Clinics held, 82. Higher Education pupils (included in table above), 143. New cases awaiting inspection at end 1946, 83. Number awaiting re-inspection, 198. On this work Dr. Lyle reports:— "During the past year the work of the Eye Clinic las increased considerably over and above the pre-war days. On this account extra clinics have been held. The attendance has been good and the co-operation of parents over matters of treatment has been excellent. I have particularly noticed this in comparison with the pre-1939 days. "The work of the Orthoptic (Squint) Department has been “going strong." The department has more than doubled itself. it is doing really first class work and deserves every encouragement. I have been able to admit to the Bromley and District Hospital every case where hospital treatment was necessary, This has included at least 25 cases of strabismus and a dozen or more other types of case. 96 "As regards statistics, the following gives a guide to the type of work being done and treatment given:— No. of Clinics held in 1946 82 New cases for refraction 198 New cases for other defects 33 Re-inspection cases 596 Total spectacles prescribed 284 Total attendances 827 "Finally, I should like to express my genuine appreciation for the co-operative spirit of the clerical staff who deal with the Eye Department, and to offer my sincere thanks to them all. With these I should like to mention the help from time to time of the voluntary worker, Miss Clifton." Orthoptic Clinic. This is an adjunct to the Eye Clinic and to which cases are referred by the Eye Specialist. This is held on six sessions a week under Miss Pinnick. The treatment of squint is a patient and prolonged matter but the results are good, and this clinic is fulfilling a great need. No. of cases on treatment 70 No. of treatments given 1302 No. of new cases during year 43 No. found unsuitable 9 No. ceased to attend 13 Number cured 11 with S.B.V., 7; cosmetic, 4; with operation, 4; without operation, 7. EAR, NOSE AND THROAT CLINIC. This clinic has been in abeyance since the outbreak of war and cases are now referred for specialist treatment at Farn borough Hospital or Bromley and District Hospital. No ear nose and throat case is referred without first keeping observation on the child at special medical inspection clinics, and only selected cases are referred for operation for tonsils and adenoids. The statistical record for 1946 is as follows:— NUMBER OF DEFECTS. Received Operative Treatment By Private Under the Practitioner, Authority's or Hospital Scheme, in apart from Clinic or Authority's Hospital Scheme Total Received other forms of treatment Total number treated 126 tonsils & adenoids — 126 218 344 97 ORTHOPAEDIC CLINIC. This special clinic is held on two sessions a month, but owing to the difficulty of transport and other reasons, and to the large number of cases referred, it was found convenient to hold one session a month at the North Clinic with two specialists in attendance. Associated with the specialist, and on his advice, cases are referred to the massage and remedial clinic which is held at the North Clinic under Miss M. Dodge on five sessions a week. The clinic is not limited to school children but provides also for children under school age. It is obviously important to remedy defects as early as possible. The clinic is held in co-operation with the Royal National Orthopaedic Hospital to which are referred all cases for in-patient treatment. Statistics: — New cases seen, 155. Total attendance, 452. Attendances for massage, etc., 2,025. Attendances for U.V.R., 2,325. Or this work Mr. Cholmeley reports:— ''It is perhaps interesting, at least from the statistical and administrative points of view, to note that the figures for 1945 and 1946 of new cases examined are almost identical, although there has been an increase in the total attendances at surgeons sessions; possibly this increase is due to the fact that during the latter part of 1946 I was able to bring an assistant with me so that there is now no appreciable waiting list of new cases to be seen. "In the 1944 and 1945 statistics your office sub-divided certain of the headings so that, for example, it was easy to determine how many of the congenital defects were of major importance; this was not done for 1946. The total figures for congenital defects is almost identical during the past three years, and I think it is more than likely that, as before, the majority of them have been quite minor—such as crooked toes; with regard to other points in the table of new cases there is the usual number of non-rachitic bow legs and knees, most of which will be cases of knock knee, occurring in children of 3 to 4 years of age, but, which arise in the normal course of development, and usually clear up completely within the first few years of school life. 98 "The postural defects of the spine still remain rather high being about 15% of the total, but I do consider that this number will gradually be reduced as better facilities are now available for physical training in the schools by teachers who have had gymnastic training. I am of the opinion that it is quite as important, if not more so, to have such teachers available in the primary schools as in the secondary schools; after all it is easier to correct bad habit early rather than to wait until the condition has become established for some years. "Flat feet still take up a great deal of our time at the orthopaedic clinics and about 30% of the new cases come under this category. Most of these are symptomless and quite a number of them only need suitable shoes, unfortunately children's shoes are bad at the present time; in the case of children with long narrow feet it is very often necessary for the mother to get a medical certificate before the retailer will supply proper shoes. "Whilst most of the cases are classified as deformities the aim of the Orthopaedic Clinic is wherever possible to prevent deformities." Orthopaedic and Postural Defects. No. of children treated Residential treatment with Education Residential treatment withoi Education Non-residential treatment it at an Orthopaedic Clinic Under the Authority's Scheme 16 — 279 Otherwise — — — Additional Statistics. Surgeons' clinics (2 surgeons) 11 New cases seen 155 Total attendances to see surgeons 452 Atendances for massage exercises, etc 2025 Attendances for U.V.R. 2325 EXCEPTIONAL CHILDREN: HANDICAPPED CHILDREN. All exceptional children including those to be certified as handicapped children are referred to a special clinic held at the Municipal Offices on Saturday mornings and on other occasions as circumstances demand. At the year's end we had records of 176 children classified as " exceptional " of whom 88 have been certified as handicapped and not suitable for education in ordinary schools. Twenty-five 99 of these handicapped children were certified in 1946 and referred to the County Council for special education. Handicapped Certified Double Defect Blind—3 3 1 Partially blind—1 1 1 Deaf—5 5 — Partially deaf—5 — — Delicate—25 8 — Diabetic—1 — — Mentally sub-normal—63 49 18 Epileptic—12 11 9 Maladjusted—33 12 — (referred to child guidance) Physically defective—18 11 3 Speech defect—10 7 1 (referred to speech clinic) At the end of 1946, the number of children in special day or residential schools were:— Residential Schools Special Day Schools Mental deficiency 5 4 Blind 1 — Deaf and dumb 2 — Epileptic 2 — Physically defective 10 — Maladjustment 1 — DENTAL SERVICES. There are two whole-time dentists and one part-time dentist giving four sessions a week. Four dental sessions are held daily at the North Clinic and four sessions a week at the South Clinic. Children at all schools are inspected at least once a year and the following statistics give details of the year's excellent work, in comparison with the previous year. The services apply also to children under five years and to expectant mothers under the Municipal Midwifery Services. Mr. J. H. Glen also carries out orthodontic work to an advanced stage of efficiency. 100 Dental Returns relating to Pupils attending Maintained Primary and Secondary Schools. 1946 1945 Total Inspections 7783 4394 Specials 694 Primary and Modern 3515 Grammar Schools 3574 No. found to require treatment 5328 2779 Primary 2785 Grammar Schools 2543 Total treated 2785 2266 Total attendances 6832 4075 Total attendances for gas 1352 951 Orthodontic attendances 646 340 Fillings—Permanent 2046 1255 Temporary 974 883 Extractions—Permanent 897 434 Temporary 2274 2259 Other operations—Permanent 2672 899 Temporary 164 96 Maternity and Child Welfare Dental Returns. Mothers. 1946 1945 Attendances—Extractions 92 97 Attendances—Fillings 159 134 Attendances—Dentures 181 144 Attendances—Other operations 203 30 Total 635 405 No. of Dentures fitted 76 51 No. of Fillings 190 134 No. of Extractions 316 510 No. of Gas Administrations 53 67 Children. Total attendance 99 61 No. of Extractions 35 32 No. of Fillings 40 46 No. of Gas Administrations 18 14 No. of Sessions employed 122½ 84 5/6 On this work Mr. Glen reports:— "I have much pleasure in submitting the statistical returns for the work done in the Dental Clinics during 1946. "The figures show a substantial increase over these for 1945, and where these increased figures relate to the actual work done, e.g., fillings, orthodontics, etc., this is a welcome sign of the public demand for treatment. However, there is the almost phenomenal rise in the number of "other operations" an increase out of all proportion to the total attendance. It would appear that the work in this section is almost completely 101 accounted for by the amount of temporary work done in an eftort to save the teeth of those children who must remain deprived of a full service until such time as the essential elementary items of equipment have been supplied. It will be remembered that one surgery has now been out of full action for two years—not a very satisfactory state of affairs in an essential service, and one which does not allow us to look forward with any confidence to the business of tackling the increased demands which will arise with the inauguration of the new Health Act." UNCLEANLINESS. School Nurses carry out at least one visit a term to each school for vermin and cleanliness inspection. The standard of cleanliness throughout the schools is excellent—of the 13,954 inspections made only 115 children were found to be so infested as to be excluded. An additional 245 children showed minor evidence of uncleanliness. All children excluded are referred to attend minor ailment clinics for reinspection, and, if still verminous, are reported to committee for action under the Education Act. No such cases were reported in 1946. Parents are advised on the best methods of treatment for verminous conditions and their response to advice has been, in practically all cases, excellent. (i) Average number of visits per school made during the year by the school nurses 3.25 (ii) Total number of examinations of pupils in the schools by school nurses 13954 (iii) Number of individual pupils found unclean 115 It is to be noted that the statistics above refer to individual children (iii), but more often than not the same child is found to be verminous at each inspection. Special attention and advice is given to these parents, and a home inspection shows other members of the family to be similarly infected. MILK IN SCHOOLS. Up to August, 1946, children were permitted to order ⅓ or 2/3 Pint milk per day, the charge being ½d. for ⅓ pint and the figures shown represent those taken in a survey made on a day in February, 1946. (These figures include Primary and Modern) Children taking 1/3 pt. milk. Children taking 2/3 pt. milk. FREE PAYMENT OR PART PAYMENT FREE PAYMENT OR PART PAYMENT 30 1450 178 2856 102 Free milk was introduced at all schools at commencement of Christmas term September 10th, 1946, and after this date children were only permitted pint of milk per day. All schools are now receiving their milk supply in ⅓ pint bottles with straws. The tables below shows the difference in the percentage of children receiving milk since free milk was introduced. Percentage of children receiving milk in February, 1946, before free milk was introduced Percentage of children receiving milk in October, 1946, after free milk was introduced 64.77% 91.3% PROVISION OF MEALS AT SCHOOLS. The kitchen at Plaistow St. Mary's C. of E. School was opened on October 1st, 1947, and about 80 children now dine at this school daily. The numbers of meals served in all school canteens have increased steadily during 1946 increasing from a daily average of 2,786 in January, 1946, to 3,445 in December, 1946. The total number of meals served to children in 1946 in Primary and Modern Schools was 601,871. This means that 73% of the children attending now dine at school. The increasing use made of the school meal is an important factor in the better nutrition of the school child. The standard1 meal provided is a good one and well balanced. Care is also taken in the cleanliness of preparation of the meal, but it is of interest to note that a recent bacteriological investigation into the bacterial content of the washing-up water, the drying cloths and the dried utensils showed evidence of pathological organisms. The importance of the alkalinity of the water, the heat of the water, proper use of a fat detergent, and the importance of heat drying after washing are factors that must be closely watched in all cases of community feeding. The importance, too, of personal cleanliness of those preparing the meal cannot be too greatly stressed. NURSERY SCHOOLS. The extended War-Time Nursery Class at Burnt Ash County Primary School reverted to the status of an ordinary Nursery Class for thirty children under Ministry of Education Regulations with effect on and from 10th September, 1946. As a result of this there are now two Nursery Classes forming part of Primary Schools in the Borough at (1) Burnt Ash County Primary School; and (2) Valley County Primary School. 103 EMPLOYMENT OF CHILDREN. 177 children were examined by the School Medical Officers during 1946 as follows:— No. employed Certs. issued (a) Boys 151 151 (b) Girls 26 26 177 177 JUVENILE DELINQUENCY. During the year 78 juveniles appeared before the Court compared with 88 for the previous year. The prevailing offence for which they were charged was larceny. STATEMENT ON PHYSICAL EDUCATION. In our statement for last year's Report we referred at some length to the broad principles and aims of Physical Education and to the disastrous effects of the recent war conditions on their realisation and development. It is our intention on this occasion to limit our observations to a brief review of the progress which has been made during the past year and to draw attention to some of the difficulties which are still providing a handicap to the subject's general recovery. Physical Training. (a) Infant Schools and Nursery Classes. One of the most difficult problems for the teacher of very young children is that of securing a satisfactory balance between formal exercise and informal activity. While the latter should be regarded as the keynote of all infant work, the teacher should not lose sight of the value of those fundamental skills which, while requiring a certain formality of approach, provide an important foundation for the child's further development. The wider use of small aparatus—small and large balls, hoops, skipping ropes, and small mats, etc., has been more in evidence, and has done much to improve the general spirit of the lessons and the dexterity of the children. For nursery classes there is a need for improved facilities Particularly playrooms, small gardens, hygienically maintained sand-pits and simple climbing apparatus. 104 (b) Primary Schools. Efforts have been made during the past year to direct the attention of teachers to the need for correcting and improving the posture of children which had tended to deteriorate during the war years. To do this it has been necessary to lay stress on those parts of the physical training lesson which aim to improve the strength and suppleness of the spine and to emphasise the importance of correct performance in all formal exercises. Shortage of plimsolls, especially in the smaller sizes, continues to detract from the general values of physical training in primary schools but the position in regard to the supply of games equipment has considerably improved. It would greatly facilitate the further development of our work in these schools if they could now be supplied with some of the special types of climbing and hanging apparatus which have recently been tested and adopted for use by a number of education authorities. (c) Modern Secondary Schools. The main task of our specialist teachers of physical training in our Modern Schools has been to continue the process of recovering lost standards. While there is still much more to be done before these standards can again be raised to their pre-war level, the fact that teachers are fully alive to this problem is a hopeful sign. It must be stated quite emphatically, however, that until such time as all our modern secondary schools can be provided with well-equipped gymnasia, staffed by qualified experts, and until every pupil can be provided with suitable clothing and footwear for their physical training lessons, the true potentialities of this branch of physical education will never be achieved. Organised Games. (a) On Playing Fields. Arrangements for weekly visits to the Education Committees playing fields have been continued for all pupils over 11 years of age, transport being provided for one school where the distance would otherwise have made these visits impracticable. Lack of suitable footwear has continued to restrict the use of playing fields to dry periods and has consequently proved a handicap to the development of such games as football and hockey. The general condition of the playing fields has been maintained at its usual high level by an efficient and helpful ground stall. 105 When time and opportunity permits it is hoped that consideration may be given to the question of adding to the existing amenities of the playing fields by the provision of suitable changing accommodation, showers and offices. (b) In School Playgrounds. Until such time as it may be possible to extend the facilities of playing fields to all children under 11, a provision which would involve a considerable increase in transport arrangements, several of our primary schools will be compelled to restrict their organised games to the limitations of the school playgrounds. Unfortunately, many of our playgrounds are not only in a poor stats of repair, but their full use continues to be obstructed by air-raid shelters and their surrounding barriers. In spite of these difficulties, however, the majority of teachers, now used to the work of improvisation and adaptation have shown considerable skill both in the selection of games and in their coaching. Swimming Instruction. We are pleased to be able to state that facilities for swimming instruction have again been restored for the following schools:— At the Municipal Open Air Bath. Classes Aylesbury C. Modern Girls' School 9 Valley C. Primary Senior Girls' School 1 Keston C. Primary Senior Girls' School 1 Parish C. Primary Boys' School 3 Raglan Road C. Modern Senior Boys' School 4 Keston C. Primary Senior Boys' School 1 (2) At the Downham L.C.C. Swimming Bath. Burnt Agh C. Primary Senior Girls' School 6 Burnt Ash C. Primary Senior Boys' School 5 The arrangements provided for the weekly instruction, in school time, of approximately 900 children, over 50 per cent. of whom were able to swim by the end of their course. The Further Training of Teachers. Thee following courses of instruction for men and women teachers were held during the year:— men. (1) An Introductory Course of 8 evening sessions in the Principles and Practice of Physical Education for candidates of Emergency Training College Courses. (2) A Course of Swimming Instruction for Teachers of boys of 11—14 years of age. women. (1) a Course in Modern Dance for teachers in Primary Schools. (2) A Supplementary Course of Swimming Instruction for teachers desiring to improve their personal performance. 106 Course for Men Leaders of Physical Recreation. This course was arranged for the purpose of training Leaders for service in Evening Institutes and Youth Clubs. The syllabus included advanced gymnastics, boxing and preparatory field athletics. Note.—All the above Courses were organised and conducted by the Committee's Organisers of Physical Education. Recreative Evening Classes. The following classes for adolescents and young people were held under the Local Education Authority's arrangements for further education:— (a) Girls and Women. 6 classes in Recreative P.T., Gymnasticselementary and advanced, and Folk Dancing. (b) Boys and Men. 10 classes in Elementary and Advanced Gymnastics, Boxing, etc. Youth Service. The Education Committee's Organisers of Physical Education have continued to give advice and assistance to local youth organisations both in the planning of their recreative programmes and in the development of inter-club activities. Assistance has included:— (1) Talks to youth clubs on various aspects of recreation and on local facilities for their development. (2) The organisation of an inter-club Boxing Tournament. (3) The training and supply of leaders, games coaches and referees. (4) Liaison between youth clubs and the District Education Committee in the allocation of games pitches for football and cricket and tennis, etc. (5) The organisation of instructional classes in swimming. (4 classes were arranged for girls and women at the Convent Open Air Bath by the kind permission of the Revd. Mother Superior.) (6) Co-operation with the Central Council of Physical Recreation, in the organisation of a Netball Rally. Our local youth organisations are indebted to the Committee for Education for the following facilities for outdoor games:Playing Field Games Regular Use Occasional Use Gadsden Tennis 5 Youth Clubs Charity Fetes 2 Girls Pre-Serv. Trg. Units including Sports Items. 2 Church Y. Clubs 1 O.S.A. 1 Technical School Football 2 Youth Clubs Squash Court 2 Youth Clubs Cricket 1 Youth Club 1 Ch. Fellowship 107 Playing Field Games Regular Use Occasional Use Oakley Hockey 2 Ch. Youth Clubs Football 3 Youth Clubs Inter-School League games. 1 Boys' Pre¬Serv. Trg. Unit 5 youth Clubs. 3 Pre-Serv. Trg. Units 1 Scout Troop 1 Commercial College Club Prince's Plain Netball 1 G.F.S. Club Sunday School 1 Life Brigade Club Sports 1 Youth Club Pixfield Football Cricket 1 Wolf Cub Troop Girl Guide Rally Rounders Netball 1 Pre-Serv. Trg. unit Children's Sports 1 Pre-Serv. Trg. Unit 1 Church Fellow. 1 Pre-Serve. Trg. Unit Hayes Netball 1 Youth Club Hayes Annual Sports Football 1 Jnr. Football Club Southborough Hockey 1 Board of Trade Office Club Children's Annual Sports Cricket Ex-Service Cricket Club C.Grammar Girl's Youth Clubs Netball Rally School Netball Meetings of Kent Gymnasts Field Games and Tennis Conclusion. In the new and wider sphere of modern educational development and reform, physical education will be required to play an increasingly important part, not only in the production of higher standards of health and physical development among our child and adolescent population, but in educating I the young in the social habits of fellowship and good-sportsmanship. The high standard of provision laid down for this purpose by the Education Act of 1944 provides the opportunity for new and interesting developments, and will be a source of stimulation and hope to all concerned in the physical welfare of the child. GEO. H. ATKINSON. F. H. BENTLEY. Organisers of Physical Education. 108 BROMLEY SCHOOLS BOOT CLUB. The Chairman reports as follows:— "The work of the Bromley Schools Boot Club Committee has progressed satisfactorily during the year ended 31st December, 1946, and without particular incident. Contributions received from members during the past year amount to £408 5s. 7d. as against £427 18s. 8d. in 1945, whilst purchases of footwear amounted to £427 17s. 8d. nett during 1946 compared with £387 2s. 7d. nett during 1945. "Efforts have been made during the past year to increase the number of firms willing to participate in the scheme, but only one additional firm has been willing to do so. As stated in the last report, two firms have reduced their discount to 5% instead of 10%. These firms have as yet been unable to restore the higher rate and as the bonus granted to contributors stands at 10% a deficit amounting to £10 19s. 7½d. has been contracted during the year 1946. As a result of this it may be necessary to reduce the bonus granted to contributors until such time as the higher rate of discount is restored. "You will be aware that the Committee lost the services of its Hon. Secretary in March and of his successor in September but in spite of this dislocation the work of the Committee has continued uninterrupted. You will, I am sure, wish to express our appreciation of the work of the Hon. Secretary, Hon. Treasurer and Hon. Auditor and also of the work of Head Teachers who operate the scheme in bur schools." BROMLEY CHILDREN'S CARE COMMITTEE Again I record the very helpful co¬operation of Miss M. A. Isard, Honorary Secretary, who rendered valued assistance in 15 cases referred for assistance.