AC 44124 BROMLEY BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1947 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 1947 INCLUDING ANNUAL REPORT ON THE SCHOOL MEDICAL SERVICES 3 CONTENTS. Page Members of the Health and Maternity and Child Welfare Committees 7 Staff 7 Prefatory Letter 10 Section A. Vital and Other Statistics and Social Conditions. Vital Statistics 14 Population 15 Births 15 Premature Births 16 Stillbirths 17 Infantile Mortality 18 Maternal Mortality 18 Deaths 19 Meteorological Conditions 19 Open Air Recreational Amenities 20 Section B. General Provision of Health Services for the Area. Ambulance Service 22 Laboratory Services 23 Supply of Insulin 23 Nursing in the Home 23 Old People's Homes 24 Clinics and Welfare Centres 26 Domestic Help Scheme 30 Hospitals—Voluntary and Isolation 30 Nursing Homes 31 Health Services administered by Kent C.C. 31 Section C. Maternity and Child Welfare. Ante-Natal Clinics 34 Administration of the Midwives Acts, 1902-1936 34 Municipal Midwifery Service 35 Domiciliary Medical Practitioner Service (Midwifery) 36 Analgesics, Administration of 36 Supply of Sheets to Expectant Mothers 37 Home Helps Scheme 37 Maternity Hospital Provision 37 Dental Treatment (Expectant and Nursing Mothers) 38 Care of Premature Infants 39 Puerperal Pyrexia 39 Ophthalmia Neonatorum 39 Pemphigus Neonatorum 39 Welfare Centres 40 Clinic Treatment of Children under 5 years 41 Home Visiting by Health Visitors 41 Child Life Protection 42 Adoption of Children 43 Care of Illegitimate Children 43 Day Nurseries 43 4 Section D. Sanitary Circumstances of the Area. Page Water 46 Drainage and Sewerage 47 Cesspools 47 Rivers, Streams and Lakes 47 Swimming Baths and Pools 47 Public Cleansing and Refuse Collection 48 Sanitary Inspection of the Area 48 Factories Act, 1937 49 Shops Acts, 1912-1936 49 Smoke Abatement 49 Verminous Conditions and Uncleanliness 49 Rodent Control 50 Section E. Housing. Housing Inspections 52 Nuisances and Defects Abated 52 Rehousing 53 Section F. Inspection and Supervision of Foods. Food Sampling 56 Food and Drugs Act, 1938 56 Bacteriological Examinations 58 Special Enquiries 59 Meat and Other Foods 60 Slaughterhouses 6() Inspection of Food Premises 60 Milk (Special Designations) Regulations, 1936-46 60 Unsound Food 60 Section G Prevalence of, and Control Over, Infectious and Other Diseases. Scarlet Fever 64 Diphtheria 64 Diphtheria Immunisation 64 Poliomyelitis and Polioencephalitis 65 Puerperal Pyrexia 65 Ophthalmia Neonatorum 65 Measles 66 Whooping Cough 66 Tuberculosis 66 Public Health (Prevention of Tuberculosis) Regulations, 1925 67 Public Health Act, 1936, Section 172 67 Treatment of Tuberculosis 67 Other Infectious Diseases 67 Section H. Other Services Supervised by the Health Department. Diseases of Animals Acts 70 Registries for Female Domestic Servants 70 Petroleum Acts 70 Retail Market 70 5 APPENDIX—STATISTICAL TABLES. Vital and General Statistics. Page Table I.—Summary of Statistics 73 „ II.—Birth and Death Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for Certain Infectious Diseases 74 „ III.—Causes of Deaths 75 „ IV.—Infant Mortality—Causes and Age Groups 76 „ V.—Infant Mortality—Analyses of Causes 77 „ VI.—Infant and Maternal Mortality—Summary of Statistics, 1910-1947 78 Maternity and Child Welfare. Table VII.—Health Visiting 79 „ VIII.—Ante-Natal Clinics and Welfare Centres 80 Housing and Sanitary Inspection. Table IX.—Housing Statistics 81 „ X.—Summary of the Work of the Sanitary Inspectors 82 „ XI.—Nuisances, Defects and Contraventions Abated 85 „ XII. —Factories Acts, 1937 88 Notifiable Diseases. Table XIII.—Ward Distributions, Attack and Mortality Rates 89 „ XIV.—Age and Sex Grouping 90 „ XV.—Tuberculosis—New Cases and Mortality 91 SCHOOL MEDICAL SERVICE, 1947. Members of the Welfare Committee 94 Officers of the Committee 94 Staff 94 Introduction 95 General Information 95 School Hygiene 96 Co-ordination 96 Medical Inspections at Schools 96 Special Inspections 97 Dental Inspection 98 Vermin and Uncleanliness Inspection 99 Treatment 99 Orthopaedic Clinic 99 Ophthalmic Clinic 100 Orthoptic Clinic 101 Ear, Nose and Throat Clinic 102 Speech Clinic 102 Exceptional and Handicapped Children 103 Child Guidance 103 Milk in Schools 103 School Meals 103 6 Page Nursery Schools 104 Employment of Children and Young Persons 104 Juvenile Delinquency 104 Physical Training— General 104 Infant and Junior Primary Departments 105 Senior Modern Departments 106 Physical Training Clothing and Shoes 106 Playgrounds and Playing Fields 107 Swimming 107 Training Courses for Teachers 108 Modern Dance 109 Training of Part-Time Leaders of Youth Clubs 109 Recreative Evening Classes 109 Outdoor Activities for Youth Associations 110 Conclusion 110 Boot Club 111 Nutritional Survey 111 Infectious Diseases in School 114 Acknowledgements 114 STATISTICAL TABLES. Table I.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools 116 „ II.—A. Return of Defects found by Medical Inspection B. Classification of the General Condition of Pupils Inspected during the year, in the Age Groups 117 „ III.—Group I. Minor Ailments 118 Group II. Defective Vision and Squint 118 Group III. Treatment of Defects of Nose and Throat 118 Group IV. Orthopaedic and Postural Defects 119 Group V. Child Guidance and Speech Therapy 119 „ IV.—A. Dental Inspection and Treatment 119 B. Orthodontic Clinic 120 „ V.—Infestation with Vermin 120 „ VI.—Orthoptic Clinic 120 „ VII.—Speech Clinic 121 ., VIII.—Handicapped Children 121 7 MEMBERS OF THE HEALTH AND MATERNITY AND CHILD WELFARE COMMITTEES. Health Committee. Councillor J. S. Marriott (Chairman), Alderman M. Stafford Smith B.A. (Vice-Chairman), The Worshipful the Mayor (Alderman F. W. Isard, J.P.), Alderman W. F. Skilton, Councillor H. M. V. Green, Councillor A. L. Hill, Councillor L. L. Irwin, M A., LL.B., Councillor S. Lane, Councillor Major-General C. W. Norman, C.B.E., B.A. Maternity and Child Welfare Committee. Councillor H. M. V. Green (Chairman), The Worshipful the Mayor (Alderman F. W. Isard, J.P.), Alderman W.F. Skilton, Alderman M. Stafford Smith, M.B.E., B.A., Councillor A. L. Hill, Councillor L. L. Irwin, M.A., LL.B., Councillor S. Lane, Councillor J. S. Marriott, Councillor Major-General C. W. Norman, C.B.E., B.A. Co-opted Members.—Mrs. A. M. Howe, J.P. (Vice-Chairman), Mrs. K. P. Jensen, Mrs. M. Packe, Mrs. M. Pearce, Miss V. Vincent. STAFF OF THE PUBLIC HEALTH DEPARTMENT as at 31st December, 1947. Medical Officers. 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 K. F. Hulbert, f.r.c.s. Eye Specialist j Eric Lyle, m.a., m.d., ch.b., d.o.m.s. Consulting Gynaecologist Alistair L. Gunn, m.d., f.r.c.s. Ear, Nose and Throat Surgeon (Service in abeyance.) Dental Surgeons: j b. s. birkhahn, l.d.s., r.c.s. j Fairman J. Ordish, l.d.s., r.c.s. (part-time). j I. W. Ross, l.d.s., r.c.s. (parttime). 8 Sanitary Inspectors: Chief Sanitary Inspector, Chief abcde G. R. 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 abc T. C. Towersey, m.s.i.a. Sampling Officers abi H. Archer, m.s.i.a., m.r.san.i a be P. R. Light, m.s.i.a., a.r.san.i ak H. Cooper, a.r.san.i. Health Visitors and School Nurses: fgh Miss L. A. Briggs, s.r.n. fgh Miss E. Crowe, s.r.n. fgh Miss F. L. Gray, s.r.n. fgh Mrs. N. M. Taylor, s.r.n. fgh Miss W. G. Hemmings, s.r.n fgh Miss H. Hogger, s.r.n. Municipal Midwives: fg Miss S. A. Garner, s.r.n. fg Miss E. Smith, s.r.n. fg Miss E. V. Robathan, s.r.n. fg Mrs. M. A. Gregory, s.r.n. fg Miss M. D. Peck, s.r.n. fg Miss F. D. Russell, s.r.n. Clerical Staff. Chief Clerk S. F. Judd. Senior Clerk (Vacant.) Grade I Clerks Miss R. Brock. k Mrs. D. Cox. k Miss J. Woodrow. (One Vacancy.) Grade II Clerks k Miss B. Booth. k Miss S. potterton. k Miss S. Rumph. k Mrs. I. J. Stapleton. k Miss M. J. Kelly. k Miss B. B. Burrows. k Miss M. N. Croxson. k Miss E. W. Lepper. k Miss I. Legg (shorthand-typist). Dental Clinic Assistants j Mrs. W. Carrie. j Miss F. E. Rolfe. j Miss M. Ellen (part-time). Other Appointments: Physiotherapist j Miss P. A. Williams, m.c.s.P. (part-time). Orthoptist j Miss P. A. Cope, d.b.o. (part" time). Assistant Rodent Officers ek J. C. Dunn. J. L. Gough. 9 Outdoor Staff: Disinfector and Drain Tester J. W. Seager. Market Superintendent F. j. Ephgrave (part-time). Home Helps (four). Domestic Helps (four). Rodent Operative (one). DAY NURSERIES. Elmfield Nursery. Matron m Miss K. Minchin. Deputy Matron I Miss E. Scaggs. Nursery Nurse n Miss L. Grugeon. Warden l Miss J. Jeffcoat. Nursery Assistants (two), Student Nurses (four), Cook (one), Cleaners (three). Draycott Nursery. Matron fg Miss M. E. Davey. Deputy Matron fg Mrs. E. M. Benge. Nursery Nurses l Miss J. Nicholls. l Miss N. Boughen. l Miss D. Cooney. Nursery Assistants (three), Student Nurses (nine), Cook (one), Cleaners (five). The letters denote: — a Certificate of the Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board, b Royal Sanitary Institute Certificate for Meat and Other Foods, c Royal Sanitary Institute Smoke Certificate. d Certificate of Examination Board of the Sanitary Inspectors' Association. e Diploma of Institute of Hygiene (London). f State Registered Nurse. g State Certified Midwife. h Health Visitor's Certificate of the Royal Sanitary Institute. i Certificate in Combustion Engineering, L.C.C. School of Engineering. j County Officers. k Unestablished or Temporary Staff. l Diploma of the National Society of Children's Nurseries. m Registered Sick Children's Nurse. n College Trained Nurse. 10 To the Mayor, Aldermen and Councillors of the Borough of Bromley Mr. Mayor, Ladies and Gentlemen, In submitting my 23rd Annual Report to you covering the year 1947, I do so at a time when the Health Service as administered by the Local Authority during those 23 years is in the process of administrative change. The Local Authority of Bromley will no longer administer the services for the care of Mother and Child which, on the appointed day, will, with other Part III Services of the National Health Act, 1946, be passed to the County Authority. Bromley will thus lose the keystone of their Health Services, and will be left with the administration of Enviromental Service and the Health of the School Child. That our services have been successful is not to be gainsaid, for this final year of the Maternity and Child Welfare Service administered locally gives us a remarkably low infant mortality rate of 19.11, as compared with a rate of 58.0 in 1924, and a maternal mortality rate of 0.74 per 1,000 births, as compared with 4.9 in 1924. No service to the health of the public can be successful if it does not receive the approval and support of the public, and it is this support which we have gained over the years. It would be quite unfair if I did not take this occasion of paying tribute to the Committee, the voluntary workers, and to the doctors, health visitors, and clerical staff, who have been unstinting in their enthusiasm to make Bromley the healthy town it is. The Report follows the usual lines, and is, in the main, a collation of statistical facts affecting the many branches of the Department's work: with it is a report made to the Education Committee which must be taken into consideration with the Report as a whole, for no Health Service can be successful unless all factors affecting the health of the individual are moulded into one united effort. The health of the school child is dependent on the circumstances of the child during its first five years of life. Likewise, the health of the under five is dependent on its life before birth, the health of its father and mother, and even its forebears. The whole is dependent on the environment of the family at home, at school, and at work. Unless one takes all these circumstances 11 into consideration when dealing with the individual, and so moulds the service to this end, successful effort cannot be obtained. Treatment of the individual for illness, whether mild or grave in nature, plays only a small part in the promotion of health. The raising of the socio-economic state of the family is of far greater importance. This is fundamental. So we come to the housing state of today. No less than 21% of babies born in 1947 were born into families who were living in houses sharing the use of the kitchen, the lavatory, the bath, and other essentials of a good home life, and yet we wonder why so many marriages break down, and why there is an increase in the anxiety state in families. Apart from these basic factors, there are matters of somewhat minor problems to report. The need to extend our activities to all those principles that make for the prevention of disease. The need to bring the standard of all community feeding places, hotels, public houses, restaurants, catering establishments, to a standard of hygiene that will eliminate the danger of mass food poisoning, or spread of intestinal disease. The danger lies not only in the quality of food, but in the handling and preparation of food and the utensils used in preparation and feeding. This hygiene is not a matter of expensive equipment or elaborate premises, but one that requires intelligent personal appreciation, both by the employer and employed. There is a vast scope of work in this direction and an ever increasing need for action owing to the increasing practice of feeding communally. There is also the need for greater laboratory field work, available not only for routine investigations, but also for concentrated work in an emergency. More than ever will there be a need for closer co-operation between the services of the County under Part III of the Act, and the environmental services of the Local Authority: a link that must be both at officer and Committee level. The valuable work of the Sanitary Inspectors as submitted by Mr. Woods, the Chief Sanitary Inspector, in the body of the Report under the sections on Housing and Food is worthy of attention. In the body of the Report, I have submitted particulars of the residential homes established by voluntary agencies for the care of the aged and infirm, a valuable work which is helping to fulfil a great need of the present day. 12 From the statistical angle, the Report shows a record low infant mortality and maternal mortality rate, a death rate of 11.7 and a birth rate of 20.9 per 1,000 population. A record number of babies (1,612) were born in Bromley, 81% of these being born in institutions. Mainly owing to the housing difficulty, more and more mothers are attending hospitals for their confinements, thus requiring, until such time as each family has a home, provision of additional and ever increasing maternity hospital facilities. During the year we lost two valued members of the Staff. Mr. Lawley who, for nearly 25 years had been Chief Clerk in the Health Department, and to whom I have been indebted for many years of faithful and constructive work in the development of the Department, died after a long illness during 1947. Miss Winter, who had been a much loved practising midwife in Bromley since the time Bromley became a Supervising Authority, died as a result of a street accident whilst on duty. I have been privileged indeed to have had the loyal service of all members of the Department, and it is with regret that professional staff, midwives and health visitors should now be passing out of my direct supervision. I am, Your obedient servant, K. E. TAPPER, Medical Officer of Health. SECTION A VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA 14 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) Registrar General's estimate of population (mid-year), 1947 No. of inhabited houses and flats, according to the rate books at the close of the year No. of valuation assessments of habitable premises at the close of the year 6,519 62,640 17,172 17,208 (a) Bromley (old Bromley area) (b) Hayes & Keston Total Houses 12,675 2,844 15,519 Flats 1,557 83 1,640 Farmhouses 12 1 13 Public Houses 31 5 36 14,275 2,933 17,208 Rateable Value (31st March, 1948) Product of a Penny Rate for the year ending 31st March, 1949 £718,439 £2,870 Vital Statistics. Live Births. Total Male Female Birth Rate 20.9 per 1,000 population. Legitimate 1252 623 629 Illegitimate 56 27 29 1308 650 658 Stillbirths. Total Male Female Stillbirth Rate 25.33 per 1,000 (live and still) births. Legitimate 31 19 12 Illegitimate 3 1 2 34 20 14 Deaths. Total Male Female Death Rate 11.7 per 1,000 population. 731 346 385 Deaths from Puerperal Causes. Puerperal Sepsis — Maternal Mortality Rate 0.74 per 1,000 (live and still) births. Other Puerperal causes 1 1 Deaths of Infants under 1 year of age. Total Male Female Infant Mortality Rate 19.11 per 1,000 live births. Legitimate 24 15 9 Illegitimate 1 1 — 25 16 9 15 Death Rates of Infants under 1 year of age. All infants per 1,000 live births 19.11 Legitimate infants per 1,000 legitimate live births 19.17 Illegitimate infants per 1,000 illegitimate live births 17.86 POPULATION. The Registrar General's estimate of the population (mid1947) is 62,640, an increase of 2,100 on the corresponding figure for 1946. The natural increase (excess of live births over deaths) accounts for 577 of this figure, and the fact that the present estimated population of the Borough is the highest yet recorded, shows, in addition to the trend of movement of the population of London to its outer suburbs, the urgency of the need for increased housing facilities. BIRTHS. The birth rate for 1947 is 20.9 per 1,000 population. The comparative rates between Bromley and England and Wales during the past ten years are as follows:— Year Bromley England & Wales 1938 13.1 15.1 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 1947 20.9 20.5 The Registrar General's returns for the year showed the following registered births, after transferable adjustments had been made:— Live Births Stillbirths Total 1308 34 1342 All rate calculations are based on these official figures. The total number of births occurring in the Borough which were notified to the Medical Officer of Health in accordance with the provisions of Section 203, Public Health Act, 1936, were as follows:— Live Births Stillbirths Total 1575 37 1612 16 After adjustment by the inclusion of transferable births, the above figures have been modified as follows:— Subtract Outward Transfers. Add Inward Transfers. Net Total. 1575 live births 590 326 1311 37 stillbirths 15 5 27 1612 notifications 605 331 1338 The number of maternity cases in the Borough during the year who were attended by midwives is as follows:— Domiciliary Confinements. Municipal midwives attended: — (a) As midwives 230 283 (b) As maternity nurses (with a doctor) 53 Institutional Confinements. Practising midwives attended: — (a) As midwives 974 (b) As maternity nurses (with a doctor) 328 1302 1585 PREMATURE BIRTHS. All notifications of birth reported to the Medical Officer of Health are required to disclose prematurity of infants with a birth weight of 5½ lbs. or less, and particulars of the births of children occurring in the Borough whose parents are normally resident outside the area are transferred to the local authority concerned. Details of premature births which occurred in Bromley during 1947 are as follows:— (a) Domiciliary births 13 (b) Institutional births 49 Total 62 No. of non-residents whose particulars were transferred to other authorities 26 No. of premature babies born out of the area whose mothers normally reside in the Borough 4 Total number of premature babies notified during year whose mothers normally reside in the Borough 40 17 STILLBIRTHS. The Registrar General's returns for the year show that the number of stillbirths registered for the area was 34 (after adjustment for inward and outward transfers), which represents a stillbirth rate of 25.33 per 1,000 (live and still) births, and 0.54 per 1,000 population. The number of stillbirths, rates per 1,000 births, and rates per 1,000 population for the past ten years, with comparative rates per 1,000 population for England and Wales, are shown in the following table:— Year No. of Stillbirths Bromley Rate per 1,000 births England & Wales Rate per 1,000 population 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 1947 34 25.3 0.54 0.50 Thirty-seven stillbirths were notified to the Medical Officer of Health as occurring in the Borough during the year, of which 35 occur-red in hospital and 2 were home confinements. Post mortem examinations were made in 6 of the hospital cases, and details of the 35 notified stillbirths which occurred in tiosDital are as follows:— Cases. Post Mortem Examinations. Cord tightly round neck 4 No P.M. exam. made. Hydrops foetalis 4 One case confirmed by P.M. Anencephaly 3 No P.M. exam. made. Right-sided cardiac failure 2 One case confirmed by P.M. Hydrocephaly 2 No P.M. exam. made. Meningocele 1 No P.M. exam. made. Breech Labour 3 No P.M. exam. made. Intracranial Haemorrhage 2 One case confirmed by P.M. Atelectasis 1 Confirmed by P.M. Haemagglutination 1 No P.M. exam. made. Prolapsed Cord 2 No P.M. exam. made. Born before arrival—cord round neck 1 No P.M. exam. made. Oligohydramnios 1 Confirmed by P.M. Maternal toxaemia, Prematurity 1 No P.M. exam. made. Accidental A.P.H. (34 weeks) 1 No P.M. exam. made. Intra-uterine asphyxia 1 Confirmed by P.M. Long Labour 1 No P.M. exam. made. Cause obscure (? erythroblastosis) 1 No P.M. exam. made. Cause obscure or not known 3 No P.M. exam. made. 35 18 INFANTILE MORTALITY. The Infant Mortality Rate for the year is 19.11 per 1,000 live births. 25 infants died during 1947 before reaching their first birthday, and the following particulars relate to these cases:— Local deaths in hospital 10 Inward transfers (died in hospital) 10 Died at home 5 25 Died in the first week of life 15 Died within first week and twelfth month 10 25 It is gratifying to note that the Infant Mortality Rate for 1947 is the lowest ever recorded in Bromley, and may be reasonably accepted as the fulminating result of 40 years of Maternity and Child Welfare work carried out in Bromley, in the beginning by the Bromley Health Society, and since 1918 by the Local Authority. In 1908 the Infant Mortality Rate was 62, and there has been progressive reduction to the present low and encouraging rate of 19. MATERNAL MORTALITY. There was one maternal death in 1947; a mortality rate of 0.74 per 1,000 total births. The following table shows the causes and rates of maternal mortality in five-yearly periods since 1911:— 5-yearly periods Puerperal Sepsis Other puerperal Rate per causes 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 1946 — 1 0.8 1947 — 1 0.74 19 DEATHS. The Death Rate for 1947 is 11.7 per 1,000 population. The total number of deaths was 731, of which 346 were males, and 385 females. Comparative Death Rates per 1,000 population for the past ten years are as follows:— Year Bromley Rates (crude) England & Wales Rates 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 1947 11.7 12.0 The main causes of death in Bromley, with comparative rates per 1,000 population are shown in the following table:— Rates per 1,000 population 1947 1946 1945 1944 1943 Heart Disease 3.5 2.9 3.4 3.6 3.1 Cancer 1.9 1.8 2.0 2.4 1.8 Respiratory disease (non-T.B.) 1.0 1.1 1.2 1.2 1.5 Tuberculosis 0.4 0.3 0.7 0.4 0.5 Congenital causes 0.2 0.5 0.5 0.6 0.4 Infectious disease 0.03 0.01 0.04 0.04 0.03 Influenza 0.03 0.1 0.06 0.06 0.2 METEOROLOGICAL CONDITIONS. I am indebted to the Borough Engineer for the following information, which has been extracted from the records at the Climatological Station at Church House Grounds. Total rainfall: 20.96 inches. Highest maximum temperature: 92o (on 3rd June). Lowest maximum temperature: 29o (on 29th January, 12th, 17th and 22nd February). Mean maximum daily temperature: 57.2°. Mean minimum daily temperature: 43.8°. Lowest minimum temperature: 8° (on 30th January and 24th February). Lowest grass temperature recorded: 10" (on 25th February). 20 OPEN AIR RECREATIONAL AMENITIES. Approximately 9% of the total acreage of the Borough (595 acres) have been secured or reserved for public recreational purposes, as shown in the following table:— 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 Garden 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 SECTION B GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA 22 SECTION B. GENERAL PROVISIONS OF HEALTH SERVICES FOR THE AREA. AMBULANCE SERVICE. Arrangements have been made whereby a Corporation service is operated from and by the Bromley and District Hospital. The following report on the service for the year 1947 has been received from Mr. E. H. Hurst, the House Governor of the Hospital:— During 1947 there has been a further increase in the volume of work undertaken by the Ambulance Service. The total mileage in 1947 was 20,643 miles as compared with 16,488 in 1946 and 10,481 in 1945. The total number of cases dealt with was 2,747, as against 2,317 for 1946 and 1,708 for 1945. On the 4th June, 1947, a seven-seater Ford V.8 sitting car was attached to the Ambulance Service, and up to the end of the year 1,739 cases were dealt with by this addition to the Ambulance Service. Due to the increased work and due to the addition of the sitting car, the number of staff has been increased to twelve. The reciprocal arrangements with Beckenham, Orpington, Chislehurst and Sidcup during the year worked quite satisfactorily. The work of the Ambulance Superintendent and his assistants continues to be carried out in a most efficient and satisfactory manner. A monthly statistical summary follows:— Month No. of Private Cases Miles on Private Cases Miles on Police Cases January 218 1723 168 February 217 1523 70 March 197 1728 189 April 198 1532 147 May 172 1436 268 June 171 1418 148 July 175 1420 139 August 192 1598 144 September 154 1418 77 October 229 1890 121 November 179 1399 117 December 231 1856 114 Total 2333 18941 1702 23 LABORATORY SERVICES. The Kent County Council Laboratory at Maidstone provides a Laboratory Service for the whole of the work of the County. Unfortunately, the distance of the laboratory from Bromley frequently causes a delay in the speedy examination and reporting upon of materials of an urgent nature, but this has, to a small extent, been overcome by specimens being sent by passenger train and collected by a member of the laboratory staff on their arrival at Maidstone Station. This arrangement does not, however, completely cover the question of obtaining early reports on urgent specimens. It is to be regretted that the Ministry of Health Emergency Laboratory at Downe was closed at the end of February, 1947, as the valuable co-operation and help which have been freely given at all times by Dr. R. I. Hutchinson and her laboratory staff will be very much missed. The examination of emergency diphtheria swabs is carried out at the West Kent Isolation Hospital, and the service afforded has, at all times, been most satisfactory. The following swabs, specimens, etc., were sent for tion and report during the year:— Haemolytic Streptococci 241 Diphtheria 54 Specimens of blood (for Rhesus factor, Wassermann and Kahn, and Haemoglobin) 323 Food samples. Water Samples, etc. 373 Miscellaneous 12 SUPPLY OF INSULIN. During the year, financial assistance was given to seven necessitous diabetic patients, by the free or part-cost provision of insulin. NURSING IN THE HOME. The services of the Bromley and District Nursing Association and the Hayes and West Wickham Nursing Association, both of which are affiliated to the Kent County Nursing Association, are available for the provision of nursing facilities for the sick 24 in the home. The following figures give an indication of the volume of work carried out:— No. of Nurses Employed Total No. of Visils Paid General Casual Total Bromley & Dist. Nursing Ass 4 8360 693 9053 Hayes & West Wickham Nursing Ass 2 5013 36 5049 Totals 6 13373 729 14102 OLD PEOPLE S HOMES. There are five homes within the Borough which are run by Voluntary Associations and public authorities for the care of old people. Details of these homes and their activities are as follows:— "The Vane," 12, Denbridge Road, Bickley. This Home is provided by the London County Council for bombed-out aged Londoners and returning evacuees, repatriated aged British subjects, and a few cases maintained under Poor Law Acts and Orders. There are 29 beds (4 for men, 25 for women), and on 1st January, 1947, there were 22 residents. There were 24 admissions and 19 discharges during the year. The London County Council or the Ministry of Health accept liability for the cost of maintenance of residents. "Armstrong House," 1, Southlands Grove, Bickley. This Home is part of the activities of the Save Our Souls Society of 24, Ashburn Place, S.W.7, and accommodates old age pensioners who are in receipt of either partial or whole supplementary pensions. There are 30 beds, all of which were occupied at the end of the year, and residents are admitted from Assistance Boards, Welfare Associations, or by direct application to the Matron. Residents contribute 32s. per week from their total pension of 37s. towards the cost of their full board, lodging and maintenance. " Merevale," Bickley Park Road, Bickley. The North-West Kent Housing Society opened this Home, which accommodates 30 residents, in December, 1947, and there were 6 residents at the end of the year. Applicants are admitted by the decision of the House Committee, and must be aged persons capable of taking care of themselves. 25 "Southwood," Oldfield Road, Bickley. The Residential Club for Elderly People is run by the Women's Voluntary Services, and has accommodation for 40. There were 36 residents at the end of December, 1947. 15 old age pensioners are accepted, and the remainder are selected from needy aged persons with incomes less than £200 per annum. Payment is made according to income. Applicants must have a clean bill of health, but short illnesses are nursed at the Club by the staff with the assistance of members of the British Red Cross Society. Cases of chronic illness are expected to be removed to a nursing home by relatives, but if this is not possible, the Women's Voluntary Services have two nursing homes to which they can be transferred. "Dunoran," Park Farm Road, Bickley. Dunoran Home, which has accommodation for 29 residents, is under the control of the Brook Lane Medical Mission. 28 patients were admitted during 1947, and the majority of cases are those in the last stages of illness, with the exception of a few chronic incurables. Patients are admitted direct from hospitals, or from their own homes if they are unable to be nursed there. Fees for maintenance are paid by the patients or relatives, according to income, but in some cases grants are received from public funds. CLINICS AND WELFARE CENTRES PROVIDED BY THE LOCAL AUTHORITY, WITH BRIEF DETAILS OF THE 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 Medical Examinations. Blood Tests Rh. Monday Evening 2 Midwives A rite-Natal Care. Chemical Foods, Drugs, etc. Thursday Afternoon 2 Doctors 2 Midwives Masons Hill Welfare Centre William Morris Hall, Masons Hill, Bromley. 2 Monday and Thursday Doctor and Health Visitor Medical Examinations. Mothercraft. Weighing of Babies Chemical Foods, Drugs, Cod Liver Oil, etc. Whitehall Welfare Centre Whitehall F.A. Post, Recreation Ground, Southlands Road, Bromley. 2 Wednesday and Friday 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. 1 Tuesday Doctor and Health Visitor Do. Keston Welfare Centre Village Hall, Keston 1 Thursday Doctor and Health Visitor Do. Immunisation Clinic. 26 CLINICS AND WELFARE CENTRES PROVIDED BY THE LOCAL AUTHORITY, WITH BRIEF DETAILS OF THE SERVICES AVAILABLE — (Continued) Description Situation No. of Sessions Per Week Professional Attendants Services Available Plaistow Welfare Centre North Clinic, Station Road, Bromley. 1 Wednesday Doctor and Health Visitor Medical Examinations. Mothercraft. Weighing of Babies. Chemical Foods, Drugs, Cod Liver Oil, etc. Burnt Ash Welfare Centre Burnt Ash Lane Branch Library, Bromley. 1 Wednesday Doctor and Health Visitor Do. Immunisation Clinic. *North School Clinic North Clinic, Station Road, Bromley. 4 Doctor and Nurse Minor Ailment Treatment Clinic. 1 Nurse ,, ,, ,, ,, 2 Doctor and Nurse Immunisation Clinic. 1 Doctor and Nurse Infectious Disease Examinations. 2 Physiotherapist Ultra Violet Ray Treatment. 3 Physiotherapist Remedial Exercises. Electrical Treatment. Massage. 6 Orthoptist Eye Defect Treatment. 2 Eye Specialist Refractions and Other Eye ments. 2 Per Month 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. 27 CLINICS AND WELFARE CENTRES PROVIDED BY THE LOCAL AUTHORITY, WITH BRIEF DETAILS OF THE SERVICES AVAILABLE — (Continued) Description Situation No. of Sessions Per Week Professional Attendants Services Available Ancillary Service for all Children. 1. Orthodontics including consultant Service. 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, Princes Plain, Bromley, 5 Doctor and Nurse Minor Ailment Treatment Clinic. 1 Doctor and Nurse Immunisation Clinic. 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 (auxiliary) Burnt Ash School, Rangefield Road, Downham. 3 Doctor and Nurse Minor Ailment Treatment Clinic. 2 Nurse ,, ,, ,, ,, 1 Doctor and Nurse Immunisation Clinic. *Hayes Clinic (auxiliary) Hayes School, George Lane, Hayes. 2 Doctor and Nurse Minor Ailment Treatment Clinic. 3 Nurse ,, ,, ,, ,, 1 Doctor and Nurse Immunisation Clinic. 28 CLINICS AND WELFARE CENTRES PROVIDED BY THE LOCAL AUTHORITY, WITH BRIEF DETAILS OF THE 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. Municipal Offices 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 Routine Medical Inspections. Deputy Matron Baby Care and Mothercraft. Nursery Nurse Education Work. Warden Student Training. 4 Student Nurses Meals Provided. Cook Cod Liver Oil, Orange Juice 2 Cleaners and Vitamins Daily. Draycott Day Nursery Southborough Lane, Bickley. 60 Children under 5 yrs. Do. Matron Do. Deputy Matron 3 Nursery Nurses 5 Nursery Assistants 5 Student Nurses Cook 3 Cleaners 29 30 DOMESTIC HELP SCHEME. A continued and steady demand for this service, which provides domestic assistance mainly in cases of sickness, was evident throughout the year. Every effort was made to respond to all appeals for assistance, but owing to the difficulty of obtaining sufficient domestic help staff, prior consideration had, of necessity, to be given to the most needy cases and to those in an emergency. A number of cases where patients are suffering from heart disease, asthma, etc., who require domestic assistance over a long and continuous period have, however, been assisted, until such time as the applicants have been able to obtain help from the Ministry of Labour. Assistance has also been provided to expectant and nursing mothers under this Scheme, in addition to that provided to mothers during their confinements under the Home Help Scheme. A separate report on this latter scheme is given in Section C—Maternity and Child Welfare. The following table gives details of assistance given under the Domestic Help Scheme during 1947:— Average number of helpers employed continuously during 1947: — (a) Whole-time 4 (b) Part-time 10 Total number of cases assisted:— (a) Maternity 73 (b) Sickness 97 170 HOSPITALS—VOLUNTARY AND ISOLATION. (a) Bromley and District Hospital. This voluntary hospital, situated in Cromwell Avenue, continues to provide a first-class general hospital service. In addition to general out-patient and in-patient departments, there are two maternity units at 118, Widmore Road and 20, Masons Hill,- and details of the work carried out at these units are given under " Maternity Hospital Provision " in this Report. The hospital is also responsible for the provision of the Ambulance Service on behalf of the Local Authority, and details of this activity are also included in this Report. (b) Isolation and Treatment of Infectious Disease. Provision for the isolation and treatment of infectious disease is made by the two hospitals in Lennard Road, one for general infectious 31 diseases and the other for smallpox. The responsibility for the maintenance of these hospitals lies with the West Kent Isolation Hospital Board, of which this Local Authority is a constituent authority. NURSING HOMES. (Public Health Act, 1936. Sections 187-194) At 31st December, 1947, there were five nursing homes which had been registered in accordance with Section 187 of the Public Health Act, 1936. 19 visits of inspection were carried out during the year by Dr. G. H. Stinson, Assistant Medical Officer of Health. The details of the registered nursing homes are shown in the following table:— Address No. of Beds Patients Received during 1947 Nursing Staff Surgical . Medical Qualified S.R.N. S.E.A.N. Other 42, Cambridge Road 13 — 13 2 — 6 47 & 51, Park Avenue 25 — 25 1 2 5 18, Blyth Road 17 — 14 3 — 4 67, Hayes Road 3 — 3 1 — 1 24, Elmfield Road 10 — 1 1 2 1 HEALTH SERVICES ADMINISTERED BY KENT COUNTY COUNCIL. (a) Tuberculosis Dispensary. This dispensary is situated in inadequate premises at 2, Park Road, and the County Council hold a clinic twice weekly. The co-operation and liaison which is received from the County Council staff has continued to be eminently satisfactory. (b) Venereal Diseases. Although there is no centre within the Borough for the treatment of venereal diseases, the close proximity to London affords ample and convenient facilities through the various hospitals which are equipped to provide the necessary treatment. The Kent County Council is the responsible authority for the provision of treatment facilities and has established centres throughout the County. Details of facilities available, both at London Hospitals and within the County, are displayed at the appropriate establishments which are under the control of this Local Authority, and also in the lavatories on the railway stations within the Borough. SECTION C MATERNITY AND CHILD WELFARE 34 SECTION C. MATERNITY AND CHILD WELFARE ANTE-NATAL CLINIC. Ante-natal clinic sessions are held at the North Clinic, Station Road as follows:— Mondays at 2 p.m. (Doctor and two Midwives in attendance). Mondays at 4.30 p.m. (two Midwives in attendance). Thursdays at 2 p.m. (two Doctors and two Midwives in attendance). The following tables give an indication of the activities of this Clinic during 1947:— No. of new cases (medically examined) 404 Total number of medical examinations 772 Total number of examinations by midwives 305 No. of examinations of blood samples (for Rhesus factor, Wassermann and Kahn and Haemoglobin) 323 No. of sessions (with Doctor and Midwives) 102 No. of sessions (Midwives only) 50 An additional doctor attends at the Clinic on the Thursday afternoon session for the purpose of taking specimens of blood for examination. In addition to the normal Wassermann, Kahn and Haemoglobin tests, an investigation into the Rhesus factor is made in an endeavour to combat and reduce the prevalence of infant mortality in babies under one week old. Details of the results of the 323 specimens submitted for examination during the year are given in the following table:— Rhesus Factor. Positive Negative — no anti-Rh agglutinations present. Negative - anti-Rh agglutinations present. Total 261 62 — 323 Wassermann and Kahn Tests. Positive Negative Total 2 321 323 Haemoglobin. 70% and below 71%—80% 81%—90% 91%—100% Total 35 114 140 34 323 ADMINISTRATION OF THE MIDWIVES ACTS, 1902 1936. The periodic inspection of midwives, their records and equipment by Dr. G. H. Stinson, Assistant Medical Officer of Health, who is the appointed Inspector of Midwives for the area, continued throughout the year. The number of midwives who gave notice of their intention to practice within the area during the year was 37, six of whom were Municipal Midwives and 31 Institutional. No notices were 35 received in respect of midwives intending to practice in an independent capacity. The number of confinements attended by midwives during the year was 1,585, an increase of 103 on the figure for 1946. Domiciliary Institutional Total As midwives (without medical assistance) 230 974 1204 As maternity nurses (with a doctor) 53 328 381 283 1302 1585 Medical aid in an emergency was sought by midwives on 698 occasions, of which 52 were in respect of domiciliary confinements and 646 institutional. The occasions in which medical aid was sought in the institutional cases included those for the repair of episiotomy and lacerated perineum. The details of cases in which medical assistance was requested in respect of the domiciliary confinements are as follows:— Mother Ruptured perineum 15 Delayed labour 8 Haemorrhage 1 Retained placenta 3 Tear of old perineal scar 1 Puerperal Pyrexia 1 Other causes 7 — 36 Baby. Spina bifida 2 Cyanosis 2 Prematurity 2 Discharging Eyes 2 Shock 1 Severe Vomiting 1 Other causes 6 — 16 52 MUNICIPAL MIDWIFERY SERVICE. All domiciliary midwifery practice within the Borough is tarried out by the Corporation's municipal midwives. There are no known midwives in independent practice. Despite the general shortage of midwives, it was possible to Maintain the number of municipal midwives at six for the 36 greater part of the year, and the following figures give details of the routine work carried out by them:— Total number of bookings 411 Total confinements attended 283 No. of hospital cases supervised ante-natally and post- natally 134 No. of visits: — Ante-natal 2593 Post-natal 4813 Arrangements have been made for all municipal midwives to be supplied with cars, and, at the end of 1947, two had already been delivered and taken into use. DOMICILIARY MEDICAL PRACTITIONER SERVICE (MIDWIFERY). It was not found necessary to utilise this service during the year, and this fact is due, mainly, to the high proportion of confinements which took place in hospitals, which have their own routine ante-natal and post-natal medical examination services. In addition, all women who were confined at home were required to attend for the necessary medical examinations at the Council's ante-natal clinic, and were, in addition, adequately supervised both ante- and post-natally by the municipal midwives. ADMINISTRATION OF ANALGESICS. All midwives (both municipal and institutional) practising in the Borough are qualified in the administration of gas and air analgesia. The Local Authority provides training facilities, when necessary, in order that midwives may qualify, and two municipal midwives attended the two weeks' course during 1947. Two sets of gas | air apparatus are provided by this Authority for use by midwives at domiciliary confinements, but difficulties of supply at the present time have not made it possible to provide each municipal midwife with her own apparatus. The difficulty of transport of the equipment has, to some extent, been met by allowing midwives, who have not yet been provided with a car, to use taxis. There were 10 administrations of gas and air analgesia at domiciliary confinements during the year. 37 SUPPLY OF SHEETS TO EXPECTANT MOTHERS. The scheme operated by the Board of Trade in conjunction with the Ministry of Health whereby priority dockets or equivalent certificates may be issued to expectant mothers who are confined in their own homes and who are genuinely in need of additional sheets for the confinement, continued to be operated satisfactorily during the year. The priority docket scheme was discontinued by the Ministry of Health on March 1st, 1947, on which date sheets were rationed, and coupon equivalent certificates were substituted. Genuinely necessitous applicants are permitted to receive certificates enabling them to purchase not more than three sheets. During 1947, 120 priority dockets and 458 coupon equivalent certificates were issued. HOME HELPS SCHEME. The provision of assistance in the home for women at the time of their confinement was maintained during the year by the employment of 4 whole-time and 37 part-time Home Helps. The duties of Home Helps include the ordinary domestic work usually undertaken by the mother, such as cleaning, cooking, washing, care of children, mending, shopping, etc. Despite the shortage of Home Helps, it was not found necessary to refuse any applicant during 1947, and 100 cases were assisted. Arrangements were made in several cases for suitable neighbours to be accepted as Home Helps, when assistance was required at a time when the regular Home Helps were already engaged. This Scheme is in addition to the Domestic Help Scheme, a report on which will be found in Section B—General Provision of Health Services. MATERNITY HOSPITAL PROVISION. The arrangement between the Local Authority and the County Hospital, Farnborough, for the admission of cases to that hospital where it is inadvisable on medical or environmental grounds for the confinements to take place at home, continued to operate satisfactorily during the year. The hospital service includes ante-natal and post-natal supervision, and a maternity ambulance service. A similar arrangement exists, on a smaller scale, with the Bromley and District Hospital. 195 patients were referred to the County Hospital, Farnborough, and 10 to the Bromley and District Hospital during the year. 38 The Bromley and District Hospital, which serves a wider area than the Borough, has two maternity units, and patients are admitted by the hospital, in addition to those referred by this Authority on medical or environmental grounds. 1947 was a record year, and the following figures, for which I am indebted to Mr. Alistair Gunn, F.R.C.S., give an indication of the volume of work undertaken at the maternity units during the year:— Number of beds 60 „ of beds reserved for expectant mothers in need of hospital treatment 12 „ of maternity cases admitted 1434 „ of ante-natal in-patients admitted 161 „ of patients delivered by: — (a) Midwives 974 (b) Doctors 328 „ of cases in which medical aid was sought by mid- wives in an emergency 646 „ of cases admitted after delivery 7 „ of cases of puerperal pyrexia 28 of infants who received supplementary or complementary feeding in hospital 103 , of infants wholly breast-fed on discharge 1160 of maternal deaths 1 „ of stillbirths 35 of infants who died within 10 days of birth 12 DENTAL TREATMENT (EXPECTANT AND NURSING MOTHERS). The loss of the services of Mr. J. Glen, who left in the autumn of 1947 to take up an academic post, threw a considerable strain on the Maternity and Child Welfare Dental Service, but. despite this, the facilities available to expectant and nursing mothers were undiminished, and it will be seen from the following figures that there is little, if any, reduction, compared with 1946:— 1947 1946 Attendances for extractions 119 92 Attendances for fillings 145 159 Attendances for dentures 181 181 Attendances for other operations 168 203 613 635 No. of patients discharged—treatment complete 85 82 No. of dentures fitted 64 70 No. of fillings 193 190 No. of extractions 310 316 No. of gas administrations 51 53 No. of sessions held 130 1221/3 I feel that these satisfactory results reflect to the credit of the Dental Clinic staff in their endeavours to provide as high a standard of service as possible in very difficult circumstances 39 CARE OF PREMATURE INFANTS. The Health Visitors and Municipal Midwives continued to give particular care and attention to premature infants during 1947. The births of 62 premature infants in the Borough were notified, of which 13 occurred at home, and 49 took place in institutions. Of the home birth cases: — (a) 12 were nursed entirely at home. (b) 1 was removed to hospital. 13 (c) 1 died during the first 24 hours of life. 12 survived at the end of one month. 13 Of the premature infants born in institutions:— 7 died during the first 24 hours of life. 4 died within 1 week of birth. 38 survived at the end of one month. 49 PUERPERAL PYREXIA. 31 cases of puerperal pyrexia were notified during the year, of which three were in respect of domiciliary and 28 in respect of institutional confinements. 19 of the cases were visited by the Council's Health Visitors, and the remainder returned to home addresses outside the area after recovery. OPHTHALMIA NEONATORUM. No cases of ophthalmia neonatorum were notified during the year. PEMPHIGUS NEONATORUM. No reports were received of the occurrence of cases of Pemphigus neonatorum during 1947. 40 POST NATAL SERVICES. WELFARE CENTRES. The following table, which shows details of attendances, etc., at the Welfare Centres, gives an indication of the extent to which these Centres are used, and also the confidence which mothers in the Borough have in the services provided:— 1947 1946 Nominal roll of babies at 31st December 5168 4748 Number of new enrolments during year: — (a) Under 1 year 1103 908 (b) Over 1 year 248 193 1351 1101 Total number of children attending the Centres during the year and who, at 31st December, were: — (a) Under 1 year 900 853 (b) Over 1 year 1662 1545 2562 2398 Total number of Welfare Sessions held 455 416 Total attendances of infants: — (a) Under 1 year 16262 12328 (b) Over 1 year 8392 7285 24654 19613 Total number of mcdical sessions held 388 288 Total number of medical consultations 4956 3799 Total number of weighings of babies 23132 18747 Total attendances by mothers 22221 17834 Whilst it is agreed that the number of children born in 1947 is higher than that for 1946, and that the under-5 population is higher, the following figures show that an increased use is being made of the services provided at the Welfare Centres:— Average number of attendances per session:— 1947 1946 (a) Mothers 48.8 42.8 (b) Children under 1 year 35.9 29.5 (c) Children over 1 year 18.4 17.5 Of the total number of children attending the Centres during the year, the average number of attendances per year were:— 1947 1946 (a) Children under 1 year 18.0 14.5 (b) Children over 1 year 5.0 4.7 It is clear, therefore, that, despite the difficulties with which the mothers of today have to contend, which take up so much 41 of their time, they consider that regular attendance at the Welfare Centres is vitally important to the health of their children. The fact that a child has been brought to the Welfare Centres regularly during its early life, is of particular importance when it reaches the age when it starts school, as we then have a continuous record of its progress from birth. The very necessary integration of the Maternity and Child Welfare Service and the School Medical Service is thus established. Full statistical details of the Welfare Centres for 1947 will be found in Table VIII. CLINIC TREATMENT OF CHILDREN UNDER 5 YEARS. The importance of regular attendance at the Welfare Centres is also shown in the following table which gives details of the treatments received by children under the age of 5 years at the various remedial school clinics. It will be appreciated that the early diagnosis and treatment of physical defects is most desirable and does much towards the prevention of these defects undermining the development and wellbeing of the child, particularly in its early years when healthy development is of such importance. Eye Clinic 159 Sunlight Clinic 469 Orthopaedic Clinic 352 Minor Ailments Clinic 147 Dental Clinic: — Total attendances 192 No. of extractions 74 No. of fillings 154 No. of gas administrations 42 In addition, 15 children were referred for tonsil and|or adenoid treatment. HOME VISITING BY HEALTH VISITORS. The increase in the number of births in 1947 (1,308 live births) compared with 1946 (1,176 live births) has meant that an increased responsibility has been placed on the Health Visitors. The following table, which gives comparative figures for the two years, shows that, despite the additional amount of work which has been carried out by them, both at the Welfare Centres, and also insofar as the School Medical Services are concerned, every effort has been made to maintain the level of home visiting as high as possible. This personal contact at home is most important, both from the point of view of the mothers seeking advice, and from that 42 of the Health Visitor. She is thus able to know the home conditions (a very necessary factor in these days of acute housing difficulties) under which children are living. The manner in which this work is carried out calls for the utmost skill and consideration in dealing with the harassed, and often perplexed, mothers, and it is gratifying to note, from letters which have been received, that the help and attention given has been much appreciated. 1947 1946 Primary visits to children under 1 year 1189 1089 Revisits to children under 1 year 2183 1620 Revisits to children aged 1 to 5 years 3448 2863 Special visits to expectant mothers 57 48 Home visits to school children 312 153 Special enquiries—stillbirths 34 19 Special enquiries—infant deaths 13 11 Miscellaneous 256 276 7492 6079 "Ineffectual" visits 1308 1314 8800 7393 Classified visits (included in above): — Diphtheria Immunisation 257 291 Boarded-out children 40 27 Adopted children 64 130 CHILD LIFE PROTECTION. The work carried out by the Health Visitors in the supervision of foster-mothers continued satisfactorily during the year. At 31st December, 11 children under the age of 9 years were in the care of 10 foster-mothers, 4 children having been received during the year. It was not necessary to take legal proceedings during 1947. In October, a panel was prepared of suitable persons who were considered by the Health Visitors to be suitable potential foster-mothers, and who would be willing to take charge, temporarily, of any children during the time that their mothers were in hospital for confinement, illness, etc. It is too early, yet, to report on the practical application of this scheme, but, at the time of writing, arrangements have been made for several children, whose mothers are expecting to bo confined in the near future, to be cared for by foster-mothers. 43 ADOPTION OF CHILDREN. 13 persons gave notice under Section 7 (3) of the Adoption of Children (Regulation) Act, 1939, in respect of 13 children. At 31st December, there were 3 children in respect of whom adoption proceedings had not be completed, and who were still under the supervision of the Local Authority. CARE OF ILLEGITIMATE CHILDREN. In addition to the special attention given to illegitimate children by the Health Visitors, cases are referred to the Rochester Diocesan Association for Moral Welfare, with whom this Department works in the closest co-operation. The Ravensbourne Home of the Association is situated within the Borough, and all necessary arrangements are made by the Sister-in-charge for the admission of the expectant mothers to the Home prior to confinement, transfer to hospital, post-natal care and advice, rehabilitation of the mothers, arrangements with foster-parents, etc. The care and attention given to these cases, both by the Health Visitors and the Association, is reflected in the low illegitimate infant mortality rate of 17.86 per 1,000 births (one death only). DAY NURSERIES. The continuing and increasing demand for women to return to industry has meant that the services of the Day Nurseries have become and will continue as an important section of the Maternity and Child Welfare service. The two Day Nurseries in Bromley have 39 approved places for children under two years of age, and 61 for children aged from two to five years. , At 31st December, 1947, there were 31 children under two years of age, and 66 children aged from two to five years on the registers, and there was a waiting list of 35 children. Draycott Nursery. The Matron's report for 1947 is as follows:— " The Nursery has had a very active year. The attendance has been at full capacity during the year, except for a slight fall during February and March due to the extremely bad weather, and again in June when 20 cases of measles were reported. " Since then, the health of the Nursery has remained at a high level. Regular medical attention has been given by the Assistant Medical Officer, Dr. P. Currie. " Mrs. M. E. Thompson resigned her position as Deputy Matron in April, and Mrs. E. M. Benge was appointed in her 44 place. Five Nursery Students were appointed during 1947. There are now three senior students.and six junior students studying for the Nursery Nurses Examination of the National Nursery Board. All are making very satisfactory progress, both in the practical work given at the Nursery and the theoretical work given at Sidcup Technical School for Girls, at which they attend on two complete days each week. "The children have responded well to the life in the Nursery, and there has been a marked development in the mental and physical progress of all the children. " The majority of parents have co-operated loyally and appreciatively with the Staff on all matters dealing with the Nursery and its work, thus helping to make the Nursery and its work an extension of the child's family life. " The year of work has, I think. been successful." Elmfield Nursery. The Matron reports as follows:— " The past year has been quite successful, and there is still a great demand for the Nursery, which has been full to capacity, and places have been made for the admission from the waiting list of the more urgent cases. All the mothers of the 40 children who attend the Nursery are in full-time employment, and, in some cases, the children attend from 8 a.m. to 6 p.m. " The general health of the children has been excellent. Regular medical examinations have been carried out by Dr. P. Currie, Assistant Medical Officer, who has expressed his satisfaction of the physical condition of the children. " At the commencement of a measles epidemic which occurred in the Spring, an attempt was made to immunise certain children, but, unfortunately, all children who had not previously had measles contracted the disease. Fortunately, all cases were mild in form. " An incidence of chicken-pox, which started in the late summer, continued for three months. None of the children seems to have been really ill. " The training of the students continues satisfactorily under the guidance of Sidcup Technical School, and the lecture courses have been improved by the addition of teachers for their nursery subjects. The attendance of students at the Technical School was found to be imposing a severe strain on the Nursery Staff, and the difficulty was overcome by the appointment of an additional nursery assistant. " The continuance of the life of the Nursery seems to be nrolonged so long as there is the need for women to take their places in industry." SECTION D SANITARY CIRCUMSTANCES OF THE AREA 46 SECTION D. SANITARY CIRCUMSTANCES OF THE AREA. WATER. I am indebted to the Director of Water Examination of the Metropolitan Water Board for the following information on the supply of water to the Borough during the year:— " The supply to the Bromley District during 1947 has been adequate at all times. The higher level is supplied from Shortlands well and by the Thames-derived filtered water; the lower level is supplied from West Wickham and Orpington wells with additional Thames-derived water during the summer months. " All the Thames-derived water is chlorinated as it leaves the works. The well water is also chlorinated, but any residual chlorine is completely removed before the water leaves the works. " Bacteriological analyses are made five times a 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 disinfected with chlorine 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 analyses are not un to standard. " Appended are the average results of the chemical and bacteriological analyses of the various supplies for 1947." Chemical. short lands West Wickham Orpington Thames-derived filtered water (Walton) No. of samples 4 3 4 253 Ammoniacal Nitrogen .008 .000 .001 .152 Albuminoid Nitrogen .029 .012 .029 .092 Oxidised Nitrogen (Nitrate) 4.8 5.4 6.5 3.5 Chlorides as CI. 19.5 14.0 16.4 25.5 Oxygen abs. from Permanganate 3 hrs. at 80° F. .21 .07 .17 1.28 Turbidity in terms of silica .3 .2 — .9 Colour, m.m. brown, 2 ft. tube, Burgess's Tintometer 2 1 0 21 Hardness (total) 313 291 312 236 Hardness (permanent) 107 92 113 70 pH value 7.1 7.1 7.1 7.6 Residual Chlorine Nil Nil Nil 0.5—0.6 Conductivity 475 475 500 450 47 Bacteriological. No. of samples 251 252 251 256 Colony count on Agar at 37 °C — — — 27.9 B. Coli test: — % of samples negative 100 ml. 100 100 100 98 1 B. Coli per 100 ml 0.0 0.0 0.0 0.031 DRAINAGE AND SEWERAGE. The Borough Engineer reports that the construction of 260 yards of 24 inch diameter surface water sewer in Princes Plain was completed during the year in connection with the erection of permanent prefabricated houses. CESSPOOLS. No new premises were erected with cesspool drainage, and the details of inhabitated properties in the Borough which are not on the water carriage drainage system are as shown in the Annual Report for 1946. RIVERS, STREAMS AND LAKES. The Borough Engineer reports that the length of 170 yards of the River Ravensbourne immediately north-west of the culvert under the builder's yard in Westmoreland Road was regraded, and 20 yards north-west of Hayes Lane culverted. Ten inspections and reinspections were made by the sanitary inspectors during the year, and an inspection was made of the pond in Church House Gardens following upon the receipt of a complaint as to its condition. Two samples of water were taken from this pond, with the following results:— Sample A.—B. Coli (presumptive) present in 1 c.c., absent in 1/10 c.c.s. Further tests showed that these were not typical B. Coli. Sample B.—B. Coli (presumptive) present in 1/10 c.c., absent in 1/100 c.c.s. Further tests showed that these were not typical B. Coli. There was no evidence of recent faecal contamination in either sample. SWIMMING BATHS AND POOLS. The sanitary inspectors made a total of 28 inspections of swimming baths and pools in the Borough, and 16 samples of water were taken for examination. The results of these examinations are as follows:— Four samples taken from the Corporation's Swimming Pool all satisfactory. Twelve samples taken from privately owned swimming baths and pools—10 were found to be satisfactory, and 2 were 48 found to have a high bacterial count which should be reduced by efficient treatment. In addition to the above examinations, the sanitary inspectors also take routine colometric tests for checking the efficiency of purification plants in swimming pools. The chlorine content and pH value is checked by a Lovibond Comparator. PUBLIC CLEANSING AND REFUSE COLLECTION. The Borough Engineer reports that the reconstruction of the 3 cell incinerator unit and combustion chamber No. 2 of the Refuse Disposal Plant was commenced during the year. SANITARY INSPECTION OF THE AREA. Table X in the appendix of statistical tables gives details of the work carried out by the sanitary inspectors during the year, and the following are the aggregate totals under the respective headings:— Housing Infectious diseases Food Premises Factories Sampling visits Trade Premises (various) Rodent Control Miscellaneous Total No. of Inspections and visits 11878 447 2538 391 282 493 7347 283 23659 Total No of Defects and Nuisances found 7345 161 131 59 516 78 8290 In addition, there were 1,791 interviews with owners, agents, etc., on site and at the office, in connection with the above work. Notices issued:— Preliminary: — Housing 4851 Food Premises 100 Factories, etc. 42 Trade Premises 58 Rodent Control 425 Miscellaneous 125 5601 Statutory:— Housing 3 5604 Food Condemnation Certificates issued: 1,589. 49 FACTORIES ACT, 1937. The administration of matters under Parts I and VIII of the Factories Act, 1937, continued to be carried out by the sanitary inspectors during the year, and Tables X, XI and XII give statistical details of the inspections made, and nuisances, defects, and contraventions found and abated. A total of 232 inspections and reinspections were made during the year, and 101 nuisances and defects were found, of which 92 had been remedied by the end of the year. In addition, 21 inspections were made of outworkers' premises, all of which were found to be satisfactory, and no nuisances or defects were found. SHOPS ACTS, 1912-1936. It is anticipated that the Shops Acts and the various relevant Regulations will eventually be consolidated. Mr. G. R. Woods, the Inspector under the Shops Acts, reports that the conditions of employment in shops in Bromley are good, and that employers are generally willing to make any improvements which may be suggested to them. During the year, 96 visits of inspection were made under the provisions of the Shops Acts, at which 39 nuisances or contraventions were noted. 53 nuisances (including those outstanding from 1946) were remedied. SMOKE ABATEMENT. Eight inspections and re-inspections were made by the sanitary inspectors, and two instances of smoke nuisance were remedied. VERMINOUS CONDITIONS AND UNCLEANLINESS. The sanitary inspectors made 132 visits to premises in connection with the eradication of vermin, dirty conditions and disinfection. The dirty condition of six premises was remedied, and 28 houses were disinfested. With regard to the Council's Housing Estate, the Property Manager reports that very little action, if any, was required or taken in respect of bug infestation. Verminous and unclean conditions of premises are very closely associated with similar conditions of the person. The 50 number of verminous children found by the School Nurses at their inspections (details of which will be found in the Report on the School Health Services) was 120 out of 13,381 children inspected, and I think I am justified in saying that, despite the adverse and unsatisfactory housing conditions which prevail at present, the very low incidence of verminous infestation and uncleanliness is most satisfactory. The complete survey and inspection of 12 selected areas, which was commenced in November, 1946, was finished in June, 1947, the normal rodent control staff of two rodent officers and one rodent operative being temporarily increased for this purpose. All properties found infested with rats or mice were treated, and excellent results were obtained. In addition, the sewers in the Borough were inspected twice during the year, and the necessary treatment was carried out where evidence of rats was found. The method of treatment is carried out strictly in accordance with the recommendations of the Ministry of Agriculture and Fisheries. It is evident that there has been a marked decrease in the rat population during the past two years, through the energetic activities of the rodent control staff, but continued and constant attention is necessary if this improvement is to be maintained. The following figures give an indication of the volume of work carried out, and include inspectorial and supervisory action taken by the sanitary inspectors:— No. of inspections made of RODENT CONTROL. (a) Refuse Tips (b) Trade Premises (c) Private Premises 3 3008 4336 7347 No. of infested premises: — (i) Found: (a) Trade Premises 183 (b) Private Premises 333 516 (ii) Cleared: (a) Trade Premises 147 (b) Private Premises 263 410 In addition, 53 sewer manholes were baited and treated. SECTION E HOUSING 52 SECTION E. HOUSING. The statistics given in Table IX. in the appendix give details of the work carried out by the Chief Sanitary Inspector and the district inspectors, and relate exclusively to the structural and other defects of the fabric of dwelling houses. The details of inspections and abatements of environmental housing defects are given in Tables X. and XI. The following extracts from these Tables summarise the statistics relating to housing. Housing Inspections and Nuisances and Defects Abated Inspections Reason for Inspection On Complaint Routine Reinspections Total inspections Nuisances found For Nuisances 4558 154 6504 11216 7170 Overcrowding 283 39 51 373 87 Verminous Conditions 33 25 58 13 Dirty Conditions 16 1 12 29 12 Water Supply 36 2 7 45 32 Cesspools 3 1 1 5 4 Disinfestation 18 3 24 45 6 Noxious Accumulations 8 5 5 18 7 Other Accumulations 19 — 27 46 14 Special Visits — 43 — 43 — 4974 248 6656 11878 7345 Nuisances and Defects Abated Drainage 1077 Dampness 876 Water Supply 1100 General Items 1717 4770 The total number of inspections carried out indicates that the sanitary inspectors have had an extremely busy year, and the receipt of 4,558 housing complaints, necessitating 11.21° inspections, has accounted for the greater part of this work. In addition to the normal type of complaint received, the fact that, until 31st August, a Certificate of Essential Repair, and, thereafter, a Priority Certificate, was necessary before 53 building materials could be obtained, has meant that requests have been received from owners and builders for housing inspections to be made in order that the necessary Certificate may be issued and repairs and/or replacements effected. This was further accentuated during the early part of the year, following damage to many houses as a result of burst water pipes, etc., consequent upon the very severe winter. The number of Certificates of Essential Repair issued by the sanitary inspectors from 1st January to 31st August was 3,027. The very large volume of work made necessary by the number of complaints and requests for housing inspections has meant that the routine duties of the sanitary inspectors have been, of necessity, considerably curtailed, and there is, in this respect, a great deal of outstanding leeway to be made up. This has not, however, been overlooked, but at the present the primary concern must be the rendering reasonably fit for human habitation of as many houses as possible. Of the 3,746 dwelling houses inspected during the year, 3,682 were found not to be in all respects reasonably fit for human habitation, and during the year it was possible to render fit 2,596 of these by informal action. The number of preliminary notices served for housing defects was 4,851, and it was also found necessary to serve three statutory notices. Rehousing. The acute problem of housing continued to cause considerable anxiety to the Local Authority during the year, and I am indebted to the Property Manager for the following information which gives some indication of the very considerable efforts made in the endeavour to remedy the unsatisfactory circumstances in which many families in the Borough are living. 26 families, comprising 112 persons, were accommodated in 20 permanent houses. 19 families, comprising 58 persons, were " permanently" housed in prefabricated dwellings during 1947, making a total of 325 families, comprising 997 persons, so accommodated at 31st December, 1947. 251 families, comprising 790 persons, were allocated accommodation in requisitioned property. At 31st December 412 properties were under requisition by the Local Authority, and afforded accommodation for 830 families, comprising 3,093 persons. 54 It will be seen, therefore, that during 1947 296 families, comprising 960 persons, were accommodated in permanent houses, prefabricated dwellings or requisitioned property by the Local Authority. The allocation of accommodation to applicants is decided by the appropriate Committee on a points system, and all cases are graded into one of seven categories. The number of applicants on the waiting list at 31st December was 5,281. The Borough Engineer reports that 47 permanent houses built by private enterprise were also occupied during the year. Nevertheless, in spite of all this progress, the problem remains acute. Families still continue to live in shared houses, having the joint use of the cooking facilities, in many cases with inadequate hot water supply, lavatories and baths. In many cases there is no bath. While this state continues, the housing problem will continue, and the danger to a happy and contented people is obvious. SECTION F INSPECTION AND SUPERVISION OF FOODS 56 SECTION F. INSPECTION AND SUPERVISION OF FOODS. FOOD SAMPLING. The vital necessity for ensuring that the standard of food supply is maintained at the highest possible level was never more important than it is in these days of limited supplies, and, to this end, the sanitary inspectors have made very full use of their specialist knowledge. The amount of deliberate food and drug adulteration is very small, and, in the majority of cases where samples have been found not to be satisfactory, the fault has generally been found to be due to defective packing, lack of care in preparation, or inadequate storage. In this last respect, the advice and assistance which the sanitary inspectors have been able to give to traders and retailers have been very much appreciated, and have done much to establish an excellent spirit of co-operation. In addition to those taken for analysis under the provisions of the Food and Drugs Act, 1938, samples were also taken for bacteriological examination, and full details are given in the following tables:— FOOD AND DRUGS ACT, 1938. Article Samples taken Result Remarks Genuine Adulterated Formal Informal Almond Flavouring — 1 1 — Almond Oil — 1 1 — Aspirin — 2 2 — Baking Powder — 1 1 — Basilicon Ointment — 1 1 — Bisurated Magnesia •— 1 1 — Boracic Ointment — 1 1 — Bread — 9 9 — Butter — 1 1 — Cake Mixture — 3 3 — Caraway Seeds — 1 1 — Cherry Cough Syrup — 1 1 — Chocolate Cup -— 1 — 1 See (a) Chutney — 1 1 — Cocoa Compound — 1 1 — Coffee — 3 3 — Cooking Fat — 3 3 — Custard Flavouring — 1 1 — Dessert Mould — 2 2 — Dried Egg Powder — 1 — 1 See (b) Edible Cake Decorations — 1 1 — Flour — 4 3 1 See (c) Fruit Saline —- 1 1 — Gelatine — 2 I i See (d) 57 Grape Fruit Squash — 1 1 — Hugon's Torox Cubes — 1 1 — Ice Cream 1 33 34 - Ice Cream Powder — 1 1 — Jam — 2 2 — Junket — 3 3 — Kipper Snacks — 1 1 — Lactic Barley Malt — 1 1 — Lemonade Powder — 3 3 — Linctus — 1 1 — Lung Tonic — 1 1 — Malted Milk — 1 1 — Malted Milk Tablets — 1 1 — Margarine — 5 3 2 See (e) Marmalade — 3 1 2 See (g) Milk 4 8 12 — Milk (Pasteurised) 3 19 22 — Milk (Dried) — 1 1 — See (g) Milk (Evaporated) — 9 7 2 Mincemeat 1 — 1 — Mustard — 1 1 ' — Nerve Sedative — 1 1 — Oats — 6 5 1 See (h) Orange Juice — 3 2 1 See (i) Orange Squash — 1 1 - Pepper — 1 1 - Potatoes (dehydrated) — 1 1 - Potatoes (tinned) — 2 — 2 See (j) Pudding Mixture — 4 4 — Quinine Tablets — 1 1 - Raspberry Essence — 1 1 — Sage and Onion Stuffing — 1 1 — Sauce — 1 1 — Sauce Powder — 1 1 — Sausage Meat 4 — 4 — Scone Mixture — 1 1 — Seidlitz Powder — 1 1 — Semolina — 4 4 — Soup — 5 5 — Soya Flour — 1 1 — Soylac — 1 1 — Spinach Puree — 2 2 — Sulphur Ointment — 1 1 — Sulphur Tablets — 1 1 — Syrup of Figs — 1 1 — Table Jelly — 3 3 — Tea — 1 1 — Tincture of Iodine — 1 1 — Tomato Sauce — 1 — — See (k) Tonic — 1 1 — Vaseline — 1 1 — Veganin Tablets — 1 1 — Vinegar 2 3 5 — Wheat Flakes — 1 1 — Yeast Tablets — 1 1 — Zinc Ointment — 2 2 — 15 198 198 14 58 (a) Inferior—? ingredients should be cocoa, wheat, starch and sugar. (b) Packet equivalent to 10, not 12 eggs. (c) The baking powder ingredient of the self-raising flour had been compounded without the acidic ingredient. (d) Inferior. Copper content rather high, but not enough to render article unfit for food. (e) Two samples had developed oxidative rancidity to a degree rendering it unfit for food. (f) Inferior, having a slight burnt taste. (g) Inferior. Two samples deficient 0.2% total solids. (h) Adulterated. Made from barley flour or flakes. (i) Sample fermenting and unfit for use. (j) Inferior. " Hydrogen swells (k) Bottle broken on receipt at laboratory. BACTERIOLOGICAL EXAMINATIONS Milk. No. of samples Un- taken Article Satisfactory satisfactory 47 Designated Milk 46 1 (a) 5 Ordinary Milk 5 — 11 Washed Milk Bottles 11 63 62 1 (a) The Phosphatase test showed that the milk had been grossly undertreated. Previous and subsequent samples were found to be satisfactorv. Ice Cream. Bacteriological No. of samples examination Methylene Blue Group taken Article Satis. Unsatis. I II III IV 64 Ice Cream 64 — 11 17 17 19 9 Ice Cream Mix 9 — 2 — — 7 3* Ice Cream 2 1 (b) 76 75 1 * Samples taken and examinations made prior to the introduction of methylene blue test. (b) Subsequent samples from the same source were found to be bacteriologically satisfactory. Chemical analyses of ice cream samples were also made, as a result of which it was revealed that those which came in the methylene blue test Group I had a fat content range from 0.2 per cent. to 16 per cent. and total solids 18.0 per cent to 38.5 per cent.; Group II, fat contents from 2.1 per cent. to 10.9 per cent., total solids from 24.5 per cent.to 35.8 per cent.; Group III, fat contents from 1.1 per cent. to 4.4 per cent., total solids from 19.0 per cent. to 26.5 per cent.; and Group IV fat contents from 2.4 per cent. to 10.8 per cent., total solids from 22.5 per cent. to 35.4 per cent. 59 The fact that samples of ice cream with low fat and solids contents have satisfied the methylene blue Group I and II tests, and those with higher fat and solids contents have been placed in Groups III and IV, together with the very wide range of fat and solids contents found generally, indicates the necessity for a legal standard being set up as soon as possible. Ice cream of good food value is manufactured by some firms, but it is obvious that, in the absence of a legal fat standard, other firms are making ice cream without regard to its adequate food value. Legislation is awaited whereby ice cream of a good food and bacteriological standard becomes a legal obligation on all manufacturers. It is felt that, in general, it is the wish of the ice cream trade to produce a satisfactory article, but there are difficulties at the present time in the obtaining of all the necessary appliances and ingredients for this purpose. It is also a matter of concern that the itinerant vendors of ice cream, who come from outside the district and sell only during week-ends and holidays, are not required to be registered with this Local Authority, and the Health Department are not aware of their presence and activities until they are observed. It is not always practicable to patrol the whole area for this purpose. SPECIAL ENQUIRIES. Following investigations into various complaints of suspected foodstuffs and into cases of gastro-enteritis, samples of the following foods were submitted for bacteriological examination with the results shown:— No. of samples submitted Article Satisfactory Unsatis. 2 Potatoes (tinned) 2 — 1 Potatoes (boiled) — 1 1 Gelatine 1 — 1 Tea 1 — 2 Water (drinking) 2 — 1 Dried Egg 1 — 1 Steak and Kidney Pudding 1 — 1 Biscuits 1 — 3 Spinach Puree 3 — 2 Luncheon Sausage 2 — 4 Jelly Crystals — 4 1 Beef Broth 1 — 1 Milk Powder — 1 21 15 6 60 MEAT AND OTHER FOODS. Slaughterhouses. There are seven slaughterhouses recorded on the register of the Local Authority. Apart from occasional slaughtering which is carried out at two of these premises in connection with local pig-keeping clubs, no slaughtering of animals is carried out in the area, as the war- time policy of centralised slaughtering continues to operate. Annual licences were granted to six slaughtermen under the provisions of the Slaughter of Animals Act, 1933. Inspection of Food Premises. Details of visits of inspection made to Food Premises are shown in Table X, from which it will be seen that a total of 2,538 visits were made, and 161 defects, etc., noted. A total of 175 defects were abated; this figure includes those noted in 1946 which were abated in 1947. MILK (SPECIAL DESIGNATIONS) REGULATIONS, 1936-1946 The following licences were issued by the Local Authority under the above Regulations in respect of designated milk:— Pasteurisers’ Licences 2 Dealers’ Licences:— “Pasteurised” milk 13 “Tuberculin Tested” milk 3 “Tuberculin Tested Pasteurised” milk 2 Supplementary Dealers’ Licences:— “Pasteurised” milk 6 “Tuberculin Tested” milk 6 UNSOUND FOOD. It is to be regretted that nearly 25 tons of foodstuffs were surrendered as unfit for human consumption, although in some cases it was found possible to utilise a certain amount for animal feeding. Included in the total 14,869 lbs. of fresh and dried vegetables are two consignments of potatoes totalling 6 tons which were damaged in storage by flooding from burst pipes following the severe frost in the early part of the year. The whole of these two consignments were able, however, to be utilised for animal food. 61 The same type of damage accounted for the majority of the 4,049½ lbs. of sugar and sweets which were surrendered. At the other extreme, the abnormally hot, dry summer brought the quantity of fresh and dried fish and also meat, poultry and rabbits to an abnormally high level. It was also noted that the total of 2,382i lbs. of fresh and dried fruits included a large proportion of citrous fruits, particularly oranges, which were in an over-ripe condition. 1,589 Food Condemnation Certificates were issued during the year in respect of the quantities of foodstuffs shown in the following table:— Article of Food Quantity containers Approx. weight.(lbs.) Biscuits 61 907 Bread, Cake, etc — 850½ Cereals — 828½ Coffee, Tea, Cocoa — 57¼ Egg (dried) 24 26½ Fats (Butter, Cheese, etc.) 113 183 Fish (canned) 492 393½ Fish (fresh and dried) — 7527 Flour and Flour Mixtures 2 347 Fruit (canned) 311 463¼ Fruit (fresh and dried) — 2382¼ Jams and Syrups 465 804¼ Meat — 6191 Meat (canned) 1424 2924 Meat (cooked) — 573 Milk (canned and powdered) 2429 2666½ Poultry — 2061 Rabbits — 917 Soups (canned) 469 570¼ Sugar and Sweets — 4049½ Vegetables (canned) 1170 1317 Vegetables (fresh and dried) — 14869 Miscellaneous 374 3273½ 541813 Total: 24 tons 3 cwts. 3 qrs. 1¾ lbs. SECTION G PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES 64 SECTION G. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Statistical details regarding notifiable diseases are shown in Tables XIII, XIV, and XV in the Appendix. SCARLET FEVER. 135 cases were notified during the year, representing an attack rate of 2.15 per 1,000 population, of whom 91 or 67.4 per cent. were isolated in hospital. The disease was mild in type, and there was no mortality. There were four " return " cases. The policy of home treatment has been encouraged over the past years and while the type of disease continues to be comparatively mild, the admission to hospital is of secondary importance to the admission of cases of measles and whooping cough. In considering the number of cases notified, it must not be overlooked that the milder the infection, the more likelihood there is of the spread by missed cases. DIPHTHERIA. Only one case of diphtheria was notified as occurring in the Borough during the year, the patient- being adult. There was, however, one death from diphtheria which occurred in the person of a child aged 14 months who contracted the disease and died whilst on holiday out of the area. The child had not been immunised. Diphtheria Immunisation. It would appear that the results of the intensive immunisation campaign are beginning to show themselves in the very low incidence in the occurrence of the disease. During the year, 711 children under 5 years, and 163 aged between 5 and 14 years received primary immunisation inoculations, and, in addition, 791 children received reinforcing injections. According to the statistics available, 47.9 per cent. of all children under 15 in the Borough have been protected against diphtheria, but this figure is known to present an incomplete 65 picture, as no details are available in respect of children resident in the Borough who were immunised outside the area during evacuation, or privately by their own doctors. A far truer figure is that obtained at a “Gallup” poll which was taken at 15 schools during the year, and which showed that 77.08 per cent. of children had received protective immunisation at one time or another. POLIOMYELITIS AND POLIOENCEPHALITIS. The incidence of poliomyelitis and polioencephalitis which occurred throughout the country resulted in 30 cases of the former disease and two cases of the latter being notified as occurring within the Borough, giving an attack rate of 0.47 and 0.03 per 1,000 population respectively. There were 3 deaths from poliomyelitis and polioencephalitis, all in adults. The first Bromley case of this distressing disease was notified in July. There is much that can be written and has been written on this infection and, as Bromley is not an isolated population, but contiguous with other Authorities similarly affected, any findings based on Bromley statistics would be fallaceous. It is noteworthy that in only two families were there more than one case. The infection was widespread and approximately 10 per cent. of infected persons were actually notified as confirmed cases. The great number of cases which did not advance beyond the initial stage of infection was one of the problems in the control of the infection. It was because of this that action was taken to keep from school for three weeks any child who had an undiagnosed illness. No case was traced to school infection. Notified and confirmed cases were admitted to isolation hospital for the first three weeks, and then transferred to general hospitals or home, as called for. PUERPERAL PYREXIA. Thirty-one cases of puerperal pyrexia, representing an attack rate of 23.09 per 1,000 total births, were notified during the year, of which 28 were institutionally treated, and 3 occurred at home. There was no mortality. 19 cases resident in the Borough were visited by the Health Visitors, and all cases made good recovery. OPHTHALMIA NEONATORUM. There were no cases during the year. 66 MEASLES. 533 cases of measles were notified during the year, an attack rate of 8.51 per 1,000 population. There was no mortality. The distribution of cases was fairly even throughout the Borough. While the type of disease was, this year, mild, there is no doubt that the subsequent debility which follows all cases of measles is a problem that has its effect on the health of the child, and one that must call for more careful nursing and prolonged convalescence. WHOOPING COUGH. 190 cases were notified (3.03 per 1,000 population), and there was, unfortunately, one fatal case. What has been said on Measles can, with equal stress, be said of Whooping Cough. The preventive inoculation was undertaken for a period, but was found not to be sufficiently effective to warrant the universal adoption as is the case in the prevention of Diphtheria. TUBERCULOSIS. Details of new cases and mortality during the year are shown in Table XV. Particulars of the recording in the Tuberculosis Register during 1947 are as follows:— Pulmonary NonPulmonary Total Cases M F M F No. of cases on register, 1/1/1947 288 259 80 99 726 New cases notified during 1947 38 28 3 3 72 No. of cases coming to knowledge after death 3 4 1 8 No. of cases restored to the Register during the year 1 1 — 2 Inward Transfers 14 7 — 3 24 343 299 85 105 832 Deletions (deaths, removals, recovery etc.) 63 42 35 49 189 No. of cases on Register at 31/12/1947 280 257 50 56 643 The number of deaths from all forms of tuberculosis during the year was 29 of whom 8, or one in 3.6, were not notified prior to death. The number of cases of pulmonary tuberculosis on the Register decreased-by 10, and non-pulmonary by 73, during 1947 67 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. It was not necessary to take action in respect of these Regulations during the year. PUBLIC HEALTH ACT, 1936 (SECTION 172). It was not found necessary to effect the compulsory removal to hospital of any person suffering from tuberculosis. TREATMENT OF TUBERCULOSIS. The Kent County Council is the responsible Authority for the general provision of institutional treatment, and they also administer the Tuberculosis Dispensary which is situated at 2, Park Road, Bromley. OTHER INFECTIOUS DISEASES. In addition to the infectious diseases already enumerated, there were 54 cases of pneumonia, 4 of dysentery, 5 of erysipelas, 1 of cerebro-spinal fever, and 3 of malaria notified. SECTION H OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT 70 SECTION H. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. DISEASES OF ANIMALS ACTS. 122 inspections were made by the Chief Sanitary Inspector in connection with the administration of the Disease of Animals Acts, of which 15 were in respect of routine visits in connection with suspected swine fever, 14 with regard to fowl pest, and 93 routine. During the year, many outbreaks of fowl pest occurred in England and Wales, and orders were made to restrict the movement of poultry to prevent the spread of this disease. The presence of fowl pest was confirmed on 12 separate premises in the Borough, and all necessary action was taken. REGISTRIES FOR FEMALE DOMESTIC SERVANTS. There are no special comments to make. PETROLEUM ACTS. 95 licences for the storage of petroleum and one for the storage of carbide of calcium were issued. 118 visits of inspection were made by the Chief Sanitary Inspector, who is the Inspector under the Petroleum Acts, and no contraventions were discovered during the year. RETAIL MARKET. The market tolls collected during 1947 amounted to £138 14s. 6d., a decrease of £18 on the corresponding figure for 1946. This was due, principally, to the severe weather conditions which prevailed during the first three months of the year. It is of interest to note that since the market is open on Thursdays, and as Christmas Day, 1947, was on a Thursday, the market was open for 1| hours on that day, thereby complying with the Royal Charter which was granted in 1205. APPENDIX STATISTICAL TABLES 72 STATISTICAL TABLES, 1947. Vital and General Statistics. TABLE I.—Summary of Statistics. TABLE II.—Birth and Death Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases. TABLE III.—Causes of Deaths. TABLE IV.—Infant Mortality—Causes and Age Groups. TABLE V.—Infant Mortality—Analyses of Causes. TABLE VI.—Infant and Maternal Mortality—Summary of Statistics, 1910-1947. Maternity and Child Welfare. TABLE VII.—Health Visiting. TABLE VIII.—Ante-Natal Clinics and Welfare Centres. Housing and Sanitary Inspection. TABLE IX.—Housing Statistics. TABLE X.—Summary of the Work of the Sanitary Inspectors. TABLE XI.—Nuisances, Defects and Contraventions Abated. TABLE XII.—Factories Act, 1937. Notifiable Diseases. TABLE XIII.—Wards Distributions, Attack and Mortality Rates. TABLE XIV.—Age and Sex Grouping. TABLE XV.—Tuberculosis—New Cases and Mortality. 73 TABLE I. Summary of Statistics 1947 Population (mid-year 1947, per Registrar General) 62,640 Birth Rate 20.9 Death Rate 11.7 Infant Mortality Rate 1911 Number of Births (live) 1,308 Number of Stillbirths 34 Number of Deaths 731 Number of Infant Deaths (under 1 year) 25 Death Rate of Respiratory Diseases 10 „ „ ,, Tuberculosis •4 „ ,, „ Cancer 1.9 „ „ „ Zymotic Diseases •01 Notifications of Scarlet Fever 135 ,, ,, Diphtheria 1 „ „ Pneumonia 54 ,, ,, Tuberculosis 80 Number of Deaths from Scarlet Fever — ,, „ „ „ Diarrhoea (under 2 years) — ,, „ „ ,, Child Birth 1 Number of visits by Sanitary Inspectors 23,659 ,, ,, „ „ Health Visitors 8,800 Number of Babies on the Nominal Rolls at the Welfare Centres, 31st December, 1947 5,168 74 TABLE II. Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the Year 1947. 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 :— BIRTHS— Live Births 20.9 20.5‡ 23.3 22.2 22.7 Still Births 0.54 0.50‡ 0.62 0.54 0.49 DEATHS— All Causes 11.7 12.0‡ 13.0 11.9 12.8 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 0.03 0.02 0.02 Diphtheria 0.01 0.01 0.01 0.01 0.01 Influenza 0.03 0.09 0.09 0.08 0.08 Smallpox — 0.00 0.00 0.00 — Measles — 0.01 0.02 0.02 0.01 NOTIFICATIONS— Typhoid Fever 0.00 0.01 0.01 0.00 0.01 Paratyphoid Fever 0.00 0.01 0.01 0.01 0.0l Cerebro Spinal Fever 0.01 0 .05 0.06 0.05 0.05 Scarlet Fever 2.12 1.37 1.54 1.37 1.31 Whooping Cough 3.03 2.22 2.41 2.02 2.80 Diphtheria 0.01 0.13 0.15 0.14 0.14 Erysipelas 0.08 0.19 0.21 0.18 0.22 Smallpox 0.00 0.00 0.00 0.01 0.00 Measles 8.51 9.41 9.13 9.58 5.29 Pneumonia 0.86 0.79 0.89 0.68 0.64 Rates per 1,000 Live Births :— DEATHS— All causes under 1 year of age 19 41† 47 36 37 Enteritis and Diarrhoea under 2 years of age 0.00 5.8 8.0 3.7 4.8 Rates per 1,000 Total (Live and Still) Births :— NOTIFICATIONS— Puerperal Fever 0.00 7.16 8.99 6.27 1 . 21 Puerperal Pyrexia 23.09 6.94 § MATERNAL MORTALITY— Abortion with Sepsis 0.00 0.10 Not Available. Abortion without Sepsis 0.00 0.06 Puerperal infections 0.00 0.16 Other Maternal causes 0.74 0.85 * A dash ( —) signifies that there were no deaths. ‡Rates per 1,000 total population. † Rates per 1,000 related births. § Including puerperal Fever. 75 TABLE III. Causes of Death, 1947 Male Female Total 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-Spinal Fever — — — 3. Scarlet Fever — — — 4. Whooping Cough — 1 1 5. Diphtheria 1 — 1 6. Tuberculosis—Respiratory 16 10 26 7. „ Other forms 3 — 3 8. Syphilitic diseases 4 2 6 9. Influenza — 2 2 10. Measles — — — 11. Acute Poliomyelitis, etc. 2 1 3 12. Acute Infectious Encephalitis — — — 13. Cancer—Buccal Cavity etc. (M), Uterus (F) 7 8 15 14. „ Stomach, Duodenum 8 4 12 15. „ Breast — 11 11 16. „ Other sites 45 40 85 17. Diabetes 3 1 4 18. Intra-Cranial Vascular Lesions 37 63 100 19. Heart Diseases 93 128 221 20. Other Diseases Circulatory System 13 17 30 21. Bronchitis 11 12 23 22. Pneumonia 19 9 28 23. Other Respiratory Diseases 4 7 11 24. Ulcer of Stomach or Duodenum 4 2 6 25. Diarrhoea (under 2 years) — — — 26. Appendicitis 1 2 3 27. Other Digestive Diseases 7 9 16 28. Nephritis 16 5 21 29. Puerperal Sepsis — — — 30. Other Maternal causes — 1 1 31. Premature Birth 2 3 5 32. Congenital Malformation etc. 11 2 13 33. Suicide ... 2 2 4 34. Road Traffic Accidents 2 3 5 35. Other Violent causes 3 12 15 36. All other causes 32 28 60 Totals 346 385 731 76 TABLE IV. INFANT MORTALITY, 1947 (Compiled locally from Registrar's Death 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 — — — — — — — — — — Tuberculosis — — — — — — — -— — -— Convulsions — — — — — — — — — -— Bronchitis — — 1 — 1 — 1 — — 2 Pneumonia — — — — — 1 — 2 — 3 Diarrhoea — — — — — — — — — -— Gastro-Enteritis — — — — — — 1 — — 1 Injury at Birth — — — — — — — — — — Atelectasis 1 — — — 1 — — — — 1 Malformation 9 2 1 1 13 — — — — 13 Premature Birth 5 — — — 5 — — — — 5 Marasmus, etc. — — — — — — — — — — Other Causes — — — — — — — — — -— Syphilis — — — — — — — — — -— Congenital Heart Disease -— -— -— -— -— -— -— -— -— -— Totals 15 2 2 1 20 1 2 2 -— 25 77 TABLE V. Analysis of Causes of Infant Deaths 1943-1947 1943 1944 1945 1946 1947 Total No. of Births (live) 901 820 872 1,176 1304 Infant Mortality Rate 27 39 28 26 19 Malformation 11 7 4 3 13 38 Premature Births 7 4 9 14 5 39 Respiratory Diseases 2 3 3 4 5 17 Marasmus and General Debility — 1 1 — — 2 Infectious Diseases 1 — — 1 — 2 Gastro Enteritis 1 3 2 — — 6 Convulsions — — — — — — Other Causes 3 14 6 9 2 34 Totals 25 32 25 31 25 138 78 TABLE VI. SUMMARY OF INFANT AND MATERNAL MORTALITY STATISTICS Sir quinquennial periods are shown with the years 1946 and 1947. 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 1947 1,304 19 25 15 5 5 — 1 The following facts are disclosed by the above Table:— 1. Reductions in Infant Mortality Rate. The fall occurs chiefly in the period over one week of age. The Infant Mortality Rate for 1947 is the lowest ever recorded. 2. Increase in the deaths of infants under one week of age. Rate 1910-1914, 28 per cent. 1941-1945, 59 per cent. 1926-1930, 38 per cent. 1946, 64 per cent. 1931-1935, 43 per cent. 1936-1940, 46 per cent. 1947, 60 per cent. 3. Increase in Maternal Deaths from 1910-1935. Rate 1910-1914, 2.7 per 1,000 births. 1931-1935, 4.5 per 1,000 births. 1926-1930, 3.3 per 1,000 births. Decrease in Maternal Deaths from 1936-1946. Rate 1936-1940, 3.3 per 1,000 births. 1946, 0.82 per 1,000 births. 1941-1945, 1.2 per 1,000 births. 1947, 0.74 per 1,000 births 79 TABLE VII. Health Visiting, 1947 Classification of Visits. Totals AREAS. 1 2 3 4 5 6 Primary Visits—Under 1 year 1,189 150 172 351 124 200 192 Re-Visits—Under 1 year 2,183 524 354 277 288 371 369 Re-Visits—1 to 5 years 3,44S 709 381 596 567 693 502 Expectant Mothers 57 9 - 2 12 34 - School Children 312 41 52 42 82 13 82 Special Enquiries—Stillbirths 34 8 7 9 - 8 2 „ „ Infant Deaths 13 3 - 4 2 — 4 Miscellaneous 25G 27 43 8 154 19 5 Net Total of all Visits 7,492 1,471 1,009 1,289 1,22'.) 1,338 1,156 " Ineffectual" Visits 1,308 261 255 328 100 158 206 Aggregate Total of all Visits 8,800 1,732 1,264 1,617 1,329 1,496 1,362 OTHER VISITS (Classified and Included in the above Tabulation) Diphtheria Immunisation 257 2 — 23 122 — 110 Boarded-out Children 40 6 7 12 4 4 7 Adopted Children 64 16 4 — 1 13 30 Totals 361 24 11 35 127 17 147 80 TABLE VIII. Ante-Natal Clinics and Infant Welfare Centres, 1947 Infant Welfare Centres CENTRE Nominal Roll of Babies 31/12/1947 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 Manson Hill 578 267. 62 4,226 2,182 5,891 100 93 1,332 6,117 Plaistow 953 185 34 2,100 843 2,658 51 48 539 2,870 Whitehall 1,271 213 43 3,722 1,925 4,947 100 89 1,289 5,049 Burnt Ash 597 147 29 2,028 767 2,576 51 46 394 2,735 Bromley Common 705 109 28 1,725 1,208 2,549 52 44 758 2,628 Hayes 1,013 160 43 2,391 1,430 3,513 91 60 618 3,638 Keston 51 22 9 70 37 87 10 8 26 95 Totals 5,168 1,103 248 16,262 8,392 22,221 455 388 4,956 23,132 Ante-Natal Clinics MEDICAL CONSULTATIONS CLINICS HELD BY MIDWIVES ONLY No. of Sessions held New Cases Examined Total Attendances for Medical Examinations Blood Tests (Rh. Factor, etc.) No. of Sessions Held Total Examinations by Midwives 102 404 772 323 50 305 81 TABLE IX. Housing Statistics for the Year 1947 Total number of inhabited houses, 1947 17,172 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) 3,746 (b) No. of inspections made for the purpose 11,216 (2) (a) No. of dwelling-houses (included under subhead (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 3,682 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 2,596 82 TABLE X. Summary of the Work of the Sanitary Inspectors for the Year 1947 TYPE OF INSPECTION. On Com plaint Routine Re Inspection Total Nuisances Found Housing— 1. Inspection of District Regulations — — — — — 2. For Nuisances 4,558 154 6,504 11,216 7,170 3. Overcrowding 283 39 51 373 87 4. Verminous Conditions 33 — 25 58 13 5. Dirty Conditions 16 1 12 29 12 6. Water Supply 36 2 7 45 32 7. Cesspools 3 1 1 5 4 8. Earth Closets — — — — — 9. Privy Pails — — — — — 10. Houses Let in Lodgings — — — — — 11. Disinfestation 18 3 24 45 6 12. Noxious Accumulations 8 5 5 18 7 13. Other Accumulati ns 19 — 27 46 14 14. Special Visits — 43 — 43 — Totals 4,971 248 6,606 11,878 7,345 Infectious Diseased— 1. Inquiry Visits (Nuisances found recorded in above table) — 247 61 308 — 2. Disinfection Purposes 2 93 — 95 — 3. Smallpox Inquiries ... — 40 — 40 — 4. Public Health (Aircraft Regulations) — 4 — 4 — Totals ... 2 384 61 447 — Meat, Milk and Other Food Shops — 1. Butchers 37 798 46 881 60 2. Confectionery 2 26 5 33 12 3. Dairies and Cowsheads 5 84 30 119 9 4. Fish 11 309 5 325 4 5. Fried Fish — 60 — 60 3 6. Food Hawkers — 8 — 8 — 7. Greengrocers, Fruiterers 4 97 17 118 7 8. Grocery 54 437 34 525 63 9. Ice Cream •— 122 24 146 2 10. Meat Regulations (Special Visits) 2 58 — 60 — 11. Milk Examined on Highway — 11 — 11 — 12. Retail Market — 81 — 81 — 13. Slaughterhouses — 27 — 27 — 14. Horseflesh Shops — 113 — 113 — 15. Mobile Canteens — 8 — 8 — 16. Works Canteens — 2 4 6 1 17. Cafes, Restaurants, ctc. — 10 7 17 — Totals 115 2,251 172 2,538 161 Factories, Outworkers, etc. 1. Factories in which Sects. 1, 2, 3, 4 and 6 of the Factories Act 1937 are to be enforced by the Local Authority 11 32 28 71 37 2. Factories not included in 1 in w hich Sect. 7 is enforced by the Local Authority 8 22 42 72 43 3. Other Premises in which Sect. 7 is enforced by the Local Authority (excluding outworkers' premises) ... 1 — — 1 — 4. Bakehouses (a) Mech. power 5 36 18 59 17 (b) Non-mech. power 1 20 8 29 4 5. Outworkers' premises — 21 — 21 — 6. School Canteens 15 14 9 38 9 7. Smoke Abatement 1 2 5 8 1 8. Restaurants, Hotels, Etc. 3 52 37 92 20 Totals 45 199 147 391 131 83 TABLE X. (Continued) Type of Inspection On Complaint Routine ReInspec tion Total Nuisances Found Sampling of Food and Drugs— 1. Milk : T.T. Certified 5 5 T.T. Pasteurised 18 18 Pasteurised 23 23 Accredited Sterilised Ordinary — 2 — 2 — Tinned 7 7 Dried 8 8 2. Other Foods 9 83 7 99 3. Ice Cream 80 7 87 Ice Cream Ingredients 4 4 4" Food Poisoning 3 — 4 7 5. Samples from : Milk past, plants — 15 — 15 — Samples of bottles — 1 — 1 — 6. Drinking Water 2 — 4 6 — Totals 14 246 22 282 Trade Premises Various 1. Under Shops Acts 3 50 43 96 39 2. Under Petroleum Acts — 89 29 118 — 3. Registry Offices — — — — — 4. Offices (P.H. Act, Sees. 46 and 91) 2 — — 2 5 5. Diseases of Animals Acts : — 4 — 4 — Movement Licences — — — — — Sheep Dipping — — — — — Foot and Mouth Disease — — — — — Fowl Pest — 14 — 14 — Swine Fever — 15 — 15 — Other — 73 16 89 — 6. Piggeries 1 9 — 10 — 7. Stables 3 7 4 14 4 8. Public Houses—Urinals 1 93 37 131 11 Totals 10 354 129 493 59 Rodent Control— 1- Refuse Tips — 3 — 3 — 2. Trade Premises 154 30 2,824 3,008 183 3. Private Premises 281 88 3,967 4,336 333 Totals 435 121 6,791 7,347 516 Miscellaneous— 1. Keeping of Animals 5 2 5 12 4 2. Schools 10 14 15 39 28 3. Drain Tests: Smoke 5 4 2 11 3 Water 13 51 10 74 7 Colour 7 2 — 9 3 Chemical — — — — — Mirror — — — — — 4. Tents, Vans and Sheds 1 3 8 12 — 5. Billets and Camps 2 — 6 8 — 6. Swimming Baths — 17 11 28 8 7. Accumulations (other than dwellings) 15 4 7 26 18 .8. Streams 7 — 3 10 7 9. Unclassified 1 51 2 54 Totals 66 148 69 283 78 Grand Tools 5,661 3.951 14,047 23,659 8,290 Interviews (in addition to above) 1,791 84 TABLE X. (Continued) Food and Drugs Samples Taken ARTICLE No. of Samples taken TYPE OF EXAMINATION Bact. or M B. T.B. Phos. Chem 1. Milk : T.T. Certified 5 5 — — — T.T. Pasteurised 2 2 — 2 — Pasteurised 33 11 2 11 22 Accredited — — — — — Sterilised — — — — — Ordinary 17 5 4 — 12 Tinned 9 — — — 9 Dried 1 — — — 1 School Milks (P steurised) 15 15 11 15 — 2. Other Foods 147 14 — — 133 3. Ice Cream 101 07 — — 34 Ice Cream Ingredients 10 9 — — 1 4. Food Poisoning 6 5 — — 1 5. (a) Samples from milk pasteurising plant 14 14 3 13 —- (b) Samples of milk bottles 11 11 — — — 6. Water (drinking) 2 2 — — — Totals 373 — — — — 85 TABLE XI. Nuisances, Defects, Contraventions, etc., Abated or Remedied in 1947 HOUSING Drainage Premises re-drained and connected to sewer — Cesspools abolished — Earth Closets abolished — Cesspools emptied ... 2 Privy pails, etc. abolished — Drains relaid or repaired 129 Drains unstopped 203 Inspection chambers provided 25 W.Cs. provided (additional or separate) 14 ,, buildings reconstructed 1 „ „ repaired 30 ,, pans renewed 423 „ ,, cleansed 1 „ box seats removed 6 Soil/vent pipes renewed or repaired 19 Sink/bath waste pipes renewed or repaired 76 Sinks renewed 95 Lavatory basins provided 53 — 1,077 Dampness Roofs repaired or renewed 363 R.w.p.'s, guttering, repaired or renewed 216 Vertical plinths provided 10 Walls rendered 21 Horizontal damp-course provided 6 Solutioning — Earth removed from walls 6 Walls repointed 37 Weather-board walls repaired, etc. 4 Sub-floor vefitilation provided or improved 26 Dry areas constructed — Brickwork repaired ... 49 Site Concrete provided 1 Miscellaneous 137 — 876 Water Supply- Drinking water service supplied direct from main 19 Fittings, etc. renewed 737 Separate or additional water supply provided 8 Supply reinstated 48 Flushing cisterns renewed or repaired 288 — 1,100 86 TABLE XI. (Continued) General Items- Rooms cleansed 347 W.C. walls cleansed'... 20 Entrance hall and staircase cleansed ... 39 Bathroom cleansed ... 12 Light and ventilation improved 18 Plastering repaired or renewed 265 Floors repaired or renewed ... 105 Windows, frames, etc. repaired or renewed 217 Sashcords repaired or renewed 26 Putty pointing repaired or renewed 15 Doors repaired or renewed 43 Stoves and grates repaired or renewed 187 Coppers repaired or renewed ... 16 Handrails repaired or renewed 1 Stairtreads repaired or renewed 3 Dustbins provided ... 103 Dirty conditions remedied 6 Overcrowding abated — Chimneys repaired ... 55 External woodwork repainted 168 Food stores provided 2 Food stores ventilated — Yard paving renewed, etc. 5 Houses disinfected ... 28 Accumulations removed 36 — 1,717 Total 4.770 MEAT, MILK AND OTHER FOOD PREMISES— Yards, floors, etc repaired 15 Shops, rooms, etc. cleansed/limewashed 42 Lighting/Ventilation improved 12 Drainage improved ... 8 Manure or refuse removed 5 Refuse bins provided 9 Floors, etc. cleansed 5 Cold storage improved 3 Water supply improved 2 Sinks provided 3 Miscellaneous 71 Total 175 FACTORIES, OUTWORKERS, Etc.— Want of Cleanliness (Sect. 1) 20 Overcrowding (Sect. 2) — Unreasonable temperature (Sect. 3) 2 Inadequate ventilation (Sect. 4) 1 Ineffective drainage of floors (Sect. 6) 1 Sanitary conveniences (Sect. 7) (a) Insufficient 4 (b) Unsuitable or defective 30 (c) Not separate for sexes 2 Other offences 32 Outworkers' premises — Smoke nuisances 2 Restaurants, Hotels, etc. (nuisances remedied) 31 Total 125 87 TABLE XI. (Continued) trade premises— Shops Acts : Ventilation improved 3 Temperature improved — Sanitary conveniences improved 19 Absence of statutory forms remedied 2 Unsatisfactory Washing facilities remedied 8 Meals rest interval contraventions remedied — Seats for female workers provided — Other offences remedied 21 Petroleum Acts contraventions — Registry Office contraventions — Offices (P.H. Act, 1930, Sect. 46) contraventions 4 Diseases of Animals Acts contraventions — Piggeries, cleansing, etc. — Stables, cleansing, etc. 2 Total 59 rodent control— Trade premises 147 Private premises 263 Sewers (manholes) 53 Total 463 miscellaneous— Animal nuisances 6 Tents, Vans and Sheds 1 Billets and Camps — Accumulations (other than dwellings) 11 Stream pollutions 1 Schools 9 Total 28 Grand Total 5,620 notices issued— Preliminary : Housing 4,851 Food Premises 100 Factories, etc. 42 Trade Premises 58 Rodent Control 425 Miscellaneous 125 5,601 Statutory: Housing 3 5,604 88 TABLE XII. Factories Act, 1937 I. Inspections for purposes of provisions as to health. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (a) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by the Local Authority 52 100 3 — (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 189 131 39 — (c) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) ... 1 1 Totals 242 232 42 — II. Cases in which defects were found. Particulars No. of cases in which defects were No. of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector 15 20 5 Overcrowding (Sect. 2) — — Unreasonable temperature (Sect. 3) 2 2 — — — Inadequate ventilation (Sect. 4) 1 1 — — — Ineffective drainage of floors (Sect. 0) — 1 — — — Sanitary Conveniences (Sect. 7)— (a) Insufficient 4 4 — — — (b) Unsuitable or defective 28 30 — — — (c) Not separate for sexes 1 2 — — — Other offences against the Act (excluding Outwork) 50 32 — 2 - Totals 101 92 — 7 — Outwork Nature of Work No. of Outworkers Number of Inspections Nuisances Notices Served Wearing Apparel 15 17 — Making of Paper Boxes 1 2 — — Lampshades 1 2 — — Totals 17 21 — — 89 TABLE XIII. Notifiable Diseases (Civilian) 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 135 23 21 15 33 11 16 16 91 2.15 Whooping Cough 190 47 18 5 31 23 31 35 2 3. 03 1 0.01 Acute Poliomyelitis 30 5 2 3 4 5 3 8 23 0.47 3 0.04 Acute Polioencephalitis 2 1 - — 1 — — 1 0.03 — — Measles 533 52 38 40 68 99 178 58 2 8.51 — — Diphtheria 1 1 - — - — — — 0.01 1* 0.01 Acute Pneumonia 54 9 4 4 7 12 14 4 30 0.86 28t 0.43 Dysentery 4 - 1 2 — — 1 — 3 0.06 - — Erysipelas 5 1 — — — 2 1 1 — 0.08 — — Cerebrospinal Fever 1 - 1 - - — - — — 0.01 — — Puerperal Pyrexia 31 1 — 18 5 2 3 2 27 23.09§ _ — Malaria (contracted abroad) 3 — — 1 — — — 2 1 0.04 — — Tuberculosis : Pulmonary 95 24 11 13 10 12 20 5 1.51 26 0.41 Non-Pulmonary 11 I 2 — 2 — 2 4 — 0.17 3 0.04 Totals 1,095 165 98 101 161 166 269 135 180 17.48 62 1.00 * Case occurred outside the Borough (not notified). t Includes Pneumonia (all forms). Notifiable types include only acute primary pneumonia and acute influenzal pneumonia. § Based on attack rate per 1,000 (live and still) births, and not population. 90 TABLE XIV. Notifiable Diseases, 1947 (Civilian) Sex and Age Distribution Disease Totals 0- 1- 3- 5- 10- 15- 25 and over Age Unknown M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Scarlet Fever 63 72 3 5 6 9 40 34 11 12 2 4 1 7 1 Whooping Cough 89 101 8 9 24 17 26 24 24 44 3 2 1 1 1 3 2 1 Acute Poliomyelitis 13 17 1 1 1 5 3 2 5 3 5 1 3 — Acute Polioencephalitis 1 1 1 – 1 Measles 284 249 2 4 60 42 73 59 126 119 15 11 4 5 2 8 2 1 Diphtheria — 1 — — — — — — — — — — — 1 — — — — 450 441 10 13 88 64 107 93 195 200 31 30 10 17 5 21 4 3 0- 5- 15- 45- 65 and over Age Unknown Acute Pneumonia 34 20 1 2 7 4 13 5 4 4 8 5 1 Dysentery 2 2 — 1 — — 2 — — — — 1 — — Erysipelas 3 2 — — — — 2 1 — 1 1 — — — Cerebro-Spinal Fever 1 1 – – – – – – – – – – Puerperal Pyrexia — 31 – – – – – 31 – – – – – – Malaria (contr'ct'd abroad) 3 – – – – – 3 – – – – – – – Tuberculosis— Pulmonary 55 40 4 2 5 3 38 34 7 — 1 1 — — Non-Pulmonary 5 6 1 — 1 1 2 5 1 — — — — — 103 101 7 5 13 8 60 76 12 5 10 7 1 — 553 542 91 TABLE XV. TUBERCULOSIS New Cases and Mortality during the Year 1947 Age groups 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 — — — — — 1— 5 4 1 1 — — — — — 5—15 3 3 I 1 — — i — 15—25 11 9 1 1 2 2 i — 25—35 7 11 — 1 6 5 — — 35—45 8 6 — — 2 3 — — 45—55 5 — 1 — 2 — i — 55—65 2 — — — 2 — — — 65 and over 1 1 — — 2 — — — 41 32 4 3 16 10 3 - *Inward Transfers 14 7 - 3 — — — — Totals 55 39 4 6 — — — — In addition one female (pulmonary) and one male (non-pulmonary) patients who had previously removed from this Borough, returned, and their names were, accordingly, restored to the Register. BOROUGH OF BROMLEY COMMITTEE FOR EDUCATION ANNUAL REPORT on the SCHOOL HEALTH SERVICES for 1947 K. E. TAPPER, O.B.E., G.M., M.B., Ch.B., D.P.H. Medical Officer of Health 94 Members of the Welfare Committee. Alderman M. Stafford Smith, M.B.E., B.A. (Chairman). Councillor H. M. V. Green (Vice-Chairman). Councillor H. Dorrett. Councillor A. L. Hill. Councillor G. H. Russell. Mrs. A. M. Howe, J.P. Mrs. E. J. Munn. Rev. F. W. Armstrong, M.A. Officers of the Committee. Borough Education Officer : H. W. C. Eisel, M.A., M.Litt., M.Ed. Assistant Borough Education Officer : A. C. Cleveland. Chief School Enquiry Officer : E. P. J. Wythe. Staff. The services of the Public Health, Maternity and Child Welfare, and School Welfare are joint services, and officers perform multiple duties. The members of the staff, as at 31st December, 1947, whose duties are concerned with the School Health Service are as follows :— Medical Officers. Whole-time : Medical Officer of Health Assistant Medical Officers Part-time: Orthopaedic Surgeon Ophthalmic Surgeon Dental Officers. Whole-time Part-time: Clinic Assistants Nursing Staff. Whole-time Dr. K. E. Tapper Dr. G. H. Stinson Dr. A. E. Orgler Dr. P. A. Currie * Dr. K. F. Hulbert * Dr. Eric Lyle * Mr. B. S. Birkhahn * Mr. Fairman J. Ordish * Mr. I. W. Ross * Mrs. W. Carrie * Miss F. E. Rolfe Miss M. Ellen Miss L. A. Brigcs Miss E. B. Crowe Miss F. L. Gray Mrs. N. M. Taylor Miss C. Hemmings Miss H. Hogger Proportion of time allocated to School Health Service ¼ 5/8 3/4 3/4 2 sessions a month 2 sessions a week 7/10 4 sessions a week 3 sessions a week Whole-time 7/10 1/6 (part-time) ½ ½ ½ ½ ½ ½ 95 Part-time: Masseuse Miss P. A. Williams * 5 sessions a week Ortboptist Miss P. Cope * 6 sessions a week Clerical Staff. Chief Clerk Mr. S. F. Judd 3/8 Senior Clerk Vacant 3/8 Grade I. Clerk Mrs. D. Cox 3/4 Grade II. Clerks Miss S. Potterton 3/4 Miss M. Kelly 3/4 Miss S. Rumph 3/8 * County Officers. Introduction. To the Chairman and Members of the Welfare Committee. Ladies and Gentlemen, The School Health Services have been carried out at full pressure during the past year, 3,234 individual children have been examined at school and 8,533 medical examinations carried out at the school clinics. The scheme is as laid down in the previous year's report except that there has been established a speech clinic at the School Clinic, Princes Plain. There have been certain staff changes during the year. We had the benefit of the full time additional services of Dr. Currie throughout the year, and we lost the services of one of the School Dentists, Mr. Glen, who resigned in October to take up a university appointment and whose vacancy we were unable to fill for the balance of the year. The Department lost a faithful and efficient colleague in the death of Mr. Lawley, who had been Chief Clerk for 26 years. For actual statistical details of the work during the year I would refer to the tables which are attached and not interspaced with the text as in previous years. General Information. School Roll 18 Primary Schools 4333 4 Modern Schools 957 2 Grammar Schools 1334 Technical School for Girls 374 6998 Further Education:— — School of Arts and Crafts. Building Department, Wharton Road. Technical Institutes:— Bromley Technical Institute (County Grammar School for Boys). Raglan Road Evening Institute. Burnt Ash Evening Institute. 96 SCHOOL HYGIENE. Two schools came under special report during 1947—viz. the temporary school premises of Bickley and Widmore Church of England School, and the Parish Church of England School, College Road. Both the school premises are far below standard. Otherwise the cleanliness and hygiene of other schools has been maintained. The investigation made into canteens in 1946-47 has been continued and considerable improvements have resulted. CO-ORDINATION. Closest integration of Public Health, Maternity and Child Welfare, and School Health Services has continued. The cooperation of Head Teachers, Welfare Officers and administrative staff has been all that one could wish, and the help given us by the County School Medical Officer has at all times helped to make the services efficient. The hospital services, and the specialists associated with the hospital, have given us full reports on individual cases and resulted in moulding the treatment and prevention of illness into one service. Likewise, the interchange of information on the environmental living conditions of children admitted to hospital has helped considerably in making the integration of Public Health Services and treatment services complete. It can be said, so far as Bromley is concerned, that even to-day, before the operation of the National Health Service Act, there is one service and not separate services for the care and welfare of the school child. MEDICAL INSPECTIONS AT SCHOOL. (See Tables I A and I C, and Table II A, cols. 2 and 3) 223 medical inspection sessions were made at the schools, the average attendance being 14.5 per session of 2g hours each. It is essential that if these routine inspections are to be thorough and complete, not only must the medical room accommodation and equipment be adequate, but that at least 10 minutes be given to each examination. Only 34 children of those called failed to attend by the year's end, an indication of the trust the parents place in these examinations. 82 per cent, of children attended with parents which in itself increases the value of the inspection. The higher percentage of children found with defects requiring treatment viz. 30 per cent, is to be noted. I am unable to dissect this without considerable research into the individual 97 schools and individual age groups. It may well be that the increase of defects is due to the continued unsatisfactory housing conditions, where so many of the families are sharing accommodation without adequate essential facilities within the home, or it may be that the additional and higher age groups inspected have added to the defects discovered. The increase in flat feet defect is more likely to be due to the difficulty in obtaining footwear than to the nutritional factor, when it has been proved that the height and weight of children in selected age groups have actually increased over the prewar years. SPECIAL INSPECTIONS. (See Tables I B, II A, cols. 4 and 5, III, Group I, and Table VIII) The extension of the clinic services to Hayes and Burnt Ash has increased the number of children coming under medical supervision of the School Health Services—some 4,708 cases calling for 8,533 medical examinations. These clinics are available not only to all children attending maintained schools but to the child under 5 years, cases being referred from routine inspections at school, by head teachers, welfare officers or direct by the parents. There are 15 special medical inspection clinics a week during school term. From these medical inspections the child is directed into the line of treatment required, and, in appropriate cases, to the School Nurse at the Minor Ailment Treatment Clinic. Cases requiring special investigation or certification for educational purposes are referred to the Municipal Offices on Saturday mornings, 155 children being so referred during the year. It is of some interest to note that 222 cases were referred to Farnborough Hospital for Pediatricians' and other specialists' advice and treatment. The link with this hospital and the Pediatric Unit is invaluable and I am indeed appreciative of the help given by Dr. Hackwood, Dr. Leys and Mr. Lipscombe, the ear, nose and throat consultant. With the increased clinical duties placed upon the Medical Officers and School Nurses, there is a danger that these duties may detract from the real purpose of the service, viz. maintenance of health. The practice of medicine can be divided into three main services: 1, the treatment of disease: 2, prevention of development of disease in its early stages, and 3, prevention of deterioration of health and advancement of the state of health. The School Health Services have operated during the past years 98 mainly on the first two fields, whereas our activities in the third sphere, the maintenance and advancement of health, have been overwhelmed by the need for activities in the others. There is no doubt in my mind that the provision of milk in school and school meals, and the development of physical training are playing the greater part at the present time in the maintenance of health of the school child than are the medical treatment services. There is, however, no doubt that we are, by means of routine inspections, discovering defects in the early stages, and, by our treatment, preventing these defects undermining the development of the wellbeing of the child. DENTAL INSPECTION. (See Table IV) A full programme of inspection was unfortunately incomplete owing to the shortage of Dental Staff in the latter part of the year. The endeavour is to examine at least once a year all children at maintained schools—3,986 children were inspected of whom 2,776 required treatment—viz. 69 per cent. Mr. B. S. Birkhahn reports:— " The regretted departure of Mr. J. Glen in the autumn to take up an academic post at Bristol University, following on his protracted illness in June and July last, tended to disorganise the working of our clinics. The routine school inspections were suspended, in part, to enable us to cope with the numerous direct applications for treatment and the special or emergency cases referred by school teachers and the School Medical Officers. " The splendid orthodontic scheme, so zealously built up by Mr. Glen would have suffered a serious set-back without the invaluable assistance of Dr. A. Buchan, the County Consulting Orthodontist. His regular weekly attendances at the North Clinic, where he worked a double session at full pressure, helped largely in maintaining this service in its high state of efficiency. " The Maternity and Child Welfare Service was, of necessity, also somewhat strained. For several months in 1947, one full session per week in both North and South Clinics was regrettably sacrificed by each Dental Officer for a reciprocal " gas' administration. However, the welcome appointment in midDecember, of Mr. Ross in a temporary part-time capacity, helped to ease our position. " Despite the many set-backs during a trying year, the 1947 figures of our overtaxed Dental Department are not altogether unfavourable." 99 VERMIN AND UNCLEANLINESS INSPECTION. (See Table V) Routine inspection of each child at school each term is made by the School Nurses who carried out 13,381 inspections. 120 children were found to have evidence of infestation. The responsibility of cleaning of children must continue to be the responsibility of the parent. TREATMENT. It is difficult to report on treatment as apart from special medical inspections at the clinics, for the two are linked together. Facilities for minor ailment treatment are provided at two ad hoc clinics and at two schools, Hayes and Burnt Ash. These latter were provided to prevent long distance travelling and much delay to the distressed housewife. Incidentally, they have both saved school time. Table III gives an indication of the types of defects treated—a total attendance of 15,795. As this work increases year by year, less and less time is available to the School Nurse for home visiting and much valuable public health work lost. In addition to the treatment of minor ailments at the clinic, special clinics are provided covering orthopaedic, ophthalmic, dental and speech defects. Cases requiring domiciliary treatment are referred to their own doctor, and those requiring hospital treatment to Farnborough Hospital. Maladjusted children are referred for treatment through the County Child Guidance Clinics. Tubercular children come under the control of the County Tuberculosis Officer through the Tuberculosis Clinic, Park Road, Bromley. ORTHOPAEDIC CLINIC. (See Table III, Group IV) This clinic was held in conjunction with the Royal National Orthopaedic Hospital on two sessions a month when the Orthopaedic Surgeon was available for consultation, and an associated massage and remedial clinic was held on five sessions a week at the North Clinic. In March, 1947, the service was taken over by the Kent County Council, who provide their own Orthopaedic Surgeon and Physiotherapist for the same number of sessions and consultations. In-patient treatment is also provided at the County Hospital, Pembury. 100 The number of cases seen by the Surgeon and the number of children attending the massage and remedial clinic have both increased by approximately 60 per cent., including children of under school age, and this service is of utmost importance when it is borne in mind that orthopaedic defects are most successfully remedied when they are treated as early as possible. The co-operation received from the County School Medical Officer and his staff has left nothing to be desired, and I am indebted to Mr. K. F. Hulbert, the Orthopaedic Surgeon, for the following report:— " The Bromley Orthopaedic Clinic was taken over from Mr. J. A. Cholmeley of the Royal National Orthopaedic Hospital at the beginning of 1947 by Mr. Mayer, the Orthopaedic Surgeon to the Kent County Council. " In October the Clinic was taken over by Mr. K. F. Hulbert who had come from the Royal National Orthopaedic Hospital to take up the appointment of Assistant Orthopaedic Surgeon to the Kent County Council. " During the year 22 clinics were held on the 2nd and 4th Fridays of every month. 299 new cases were seen and 652 cases in all attended for examination by the surgeon. There were 3,594 attendances for massage and exercises and 1,983 for ultraviolet light. " When inpatient treatment is indicated, the patients are admitted to the County Hospital, Pembury, but wherever possible minor operations are carried out at Dartford County Hospital and the patients are then sent home by ambulance in the evening. This arrangement is not of choice but of necessity owing to the shortage of hospital beds which affects the County Hospitals as it affects almost every other hospital in the country. " It is very gratifying to be able to see orthopaedic deformities coming up early at a stage at which correction by physiotherapy is usually fairly simple. Such things as scoliosis and flat feet if seen in the early years are almost all curcd by a course of exercises." OPHTHALMIC CLINIC. (See Table III, Group II) Dr. Eric Lyle reports as follows:— " This year has seen an increase in the number of Eye Clinics to two regular sessions per week. This has had to be done in order to keep abreast of the ever-increasing number of cases sent for examination and treatment. 101 " During the year a total number of 953 cases have been examined, of which 308 were new cases and 645 were reinspections. " Attendances have been good despite the adverse weather conditions in the early part of the year—a point which speaks well for the co-operation of parents. " A large number of cases of squint have been examined. Many have undergone operation for this defect at the Bromley and District Hospital. Full use has been made of the Orthoptic Department at the North Clinic; both pre-operatively and postoperatively. " One point is causing anxiety; that is the delay in the dispensing of spectacle lenses. This is due to lack of skilled lens-makers in the factories rather than to any fault on the part of the local dispensing opticians who undertake the supply of lenses. It seems that there should be some scheme of priority for children whose future may depend so largely on early and immediate attention. " In conclusion, I should like to pay tribute to the help and co-operation of the Orthoptist, the Health Visitors, and above all to the Administrative Staff of the Health Department, who work so hard to make the Eye Clinics run smoothly and efficiently." ORTHOPTIC CLINIC. (See Table VI) The Orthoptic Department is held on six sessions a week at the Bromley North School Clinic. All the cases for treatment are referred by Dr. Eric Lyle, and the numbers are increasing owing to the number of new cases being referred from the Orpington Clinic as well as from Bromley. The attendances during the past year have been good, and only three cases have failed to attend. The aim of treatment for all cases is to obtain binocular single vision, and this standard of cure takes a reasonably long time to be attained in the majority of cases. The standard of cure can be reached in some cases through treatment alone, but in other cases operative assistance is necessary to assist the treatment, and pre- and post-operative treatment will give the necessary cure. A certain number of cases can never obtain binocular single vision and these are treated with either operation or exercises or both, and are discharged as cosmetic results when they have reached the highest standard of cure possible for them. 102 EAR, NOSE AND THROAT CLINIC. (See Table III, Group III) The arrangements whereby cases for specialist treatment are referred to Farnborough Hospital were continued during the year, but no case was so referred without the child having been kept under prior observation at the special medical inspection clinics. The number of cases who received operative treatment for tonsils and adenoids shows a considerable decrease compared with the figure for 1946, and this is largely due to the discontinuance of this type of treatment during the outbreak of poliomyelitis (infantile paralysis) which occurred throughout the country during the year. The number of children awaiting operative treatment at 31st December was 137. No child was found to require treatment for serious diseases of the ear during 1947. SPEECH CLINIC. (See Table III, Group V, and Table VII) On 14th May, the Kent County Council established a Speech Therapy Clinic at the South Clinic, Princes Plain, under the control of Dr. G. Stableforth. Speech defects require very careful, patient, and protracted treatment, and the work which is being carried out at this Clinic, both by Dr. Stableforth and by Mrs. Planer, the Speech Therapist, is most necessary and valuable. I am indebted to Dr. Stableforth for the following report:— " The Speech Clinic in Bromley was opened on 14th May, 1947, for one afternoon session per week. The report covers a period of nearly six months, allowing for the interval for summer vacation when the clinic was closed for the month of August. " The periods of time required for treatment in cases of speech defect vary considerably, as a rough guide the following may be given as estimates. " Simple dyslalia—May need 3—6 months. " General dyslalia—6—12 months. Depending on intelligence of the child and co-operation of parents. " Multiple dyslalia—6—18 months. Depending on intelligence of the child and co-operation of parents. " Cases of paralysis—1—3 years roughly, these cases are usually of lengthy duration. " Dysphonias—6—18 months. " Stammer—Very variable. 103 " A great factor in increasing recovery rate is regularity of attendance for treatment and the assistance given by the parents in carrying out the treatment at home. In the early stages of a new clinic the intake and discharge of patients is always at a slower rate. " Each patient is given individual treatment and in the later stages work in association with other children is introduced in addition to the individual treatments. " In some of the speech clinics in Kent we have the assistance of Senior Speech Therapy Students from the hospitals, who help with the simpler routine treatments, working under the supervision of the Speech Therapist; this has proved most satisfactory, both in giving aid to the Students and in increasing the possibilities of the work in the clinics." EXCEPTIONAL AND HANDICAPPED CHILDREN. A special clinic is held at the Municipal Offices on Saturday mornings to which all exceptional children including those requiring to be certified as handicapped are referred. The total attendances during the year was 157. Details of all handicapped children are shown in Table VIII. CHILD GUIDANCE. (See Table III, Group V) The care of children requiring Child Guidance is the responsibility of the Kent County Council and all cases are referred to the County School Medical Officer for treatment at the Child Guidance Clinic at Chislehurst. 14 cases were so referred during the year, after reports had been received from the head teacher of the child's school and an environmental report had been received from the School Nurse. MILK IN SCHOOLS. The permitted quantity of milk throughout the year has been restricted to 3 pint per child per day, and a return to the Ministry of Education shows that on a single day in October the percentage of pupils receiving milk based on the number in attendance was 94 per cent. SCHOOL MEALS. During 1947 the raising of the school leaving age added to the difficulties of the service, but, notwithstanding the lack of proper facilities, the number of pupils remaining for the midday meal continued to increase. A return to the Ministry of Education showed that on a single day in October, 78 per cent, of the 104 pupils in attendance at school received a midday meal. Towards the end of the year the daily average number of meals being served in all maintained schools and Further Education Institutions in the Borough was 5,753. Despite the shortage of labour and materials it is satisfactory to note that some progress has been made with the Committee's proposals to provide separate kitchen and dining huts at most schools in the Borough. A new servery and scullery was built at Masons Hill School and taken into use in September and a combined kitchen and dining hut has been erected on the site of Keston C. of E. School. These buildings were completed in November. At the end of the year the foundation works for a kitchen and dining hut at Princes Plain County Modern and Primary Schools were well under way and it is hoped that before the end of next year several more huts will have been erected and taken into use. NURSERY SCHOOLS. There are no important changes, extensions or curtailments to report. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS 80 children (58 boys and 22 girls) were examined by the School Medical Officers in respect of fitness for employment out of school hours. Fit certificates were issued in all cases. JUVENILE DELINQUENCY. During the year 84 children appeared before the Court; an increase of 6 over 1946. The prevailing types of offences with which they were charged were larceny (51) and store-breaking (11). PHYSICAL TRAINING. Report of the Physical Training Organiser. General.—In recent years there has been a steadily growing realisation of the importance of physical activity in the education and development of the children and youth of this country. The approach to this question in our schools has given rise to considerable changes in the teaching of physical education which is now much more in line with the prevailing informal approach to the teaching of all subjects. The formal aspect of gymnastics and physical exercises that has prevailed for so many years is now gradually disappearing from the teaching of all branches of physical training in the schools. 105 A freer type of work is not only more acceptable to young people but is considered better training in movement and selfdiscipline. Straight lines and perfect silence in the physical training lesson are no longer the criterion of a good lesson, though definite formation is often used when it will serve a useful purpose. Much time that was wasted in this way previously is now turned to good account and devoted to individual activity, giving the impression of a very busily occupied gathering of children. There should, however, always be order during the lesson and prompt obedience to command. In the modern type and method of teaching, there is more scope for initiative and experiment on the part of the child and more help is given to pupils who, for different reasons, are physically backward and lacking in self-confidence. The work generally is made more objective in that the purpose of the exercise is explained to the child in its relationship with life. The child realises the connection between exercise and the movement of everyday life or with major games, dancing, or athletics and the effort produced increases accordingly, as to the child, it now seems more worth while. The teacher of physical training becomes more of a leader than an instructor, guiding the children in the full use of all apparatus and facilities available and helping them to build up their bodily skills and gain self-confidence. The ability of the teacher to progress more rapidly is very severely tested as there is so much more scope. Also the lesser skilled teacher is often prone to mistake the freer discipline for licence. Guidance and supervision for this work is essential but in particular for the newly appointed teachers with only one year's training, who have come into the profession from the Services. During the year an appreciable number of men teachers have returned from the Services and a fair number of new appointments—chiefly trainee teachers, have been made. There is an obvious need for the help and guidance of a qualified man organiser who could do so much to assist, guide and encourage these men teachers, many of whom have been out of school for many years or have just entered the teaching service. Infant and Junior Primary Departments: Physical Exercises. Young children left to themselves usually, jump, climb and run. They are anxious to climb ropes and ladders, swing on branches, walk along walls, balance on gates, pull themselves to the top of fences and perform acrobatic exercises on railings. In our Infant and Junior Departments, having recognised the value of free activity, we are now ready to introduce such informal apparatus as will allow of the aforementioned activities, 106 and though it was not possible to carry out a project of this kind during the present financial year, it is hoped that we shall be more fortunate in this matter during the coming year. Small apparatus training is being increasingly developed as the various items of equipment become available. It is an encouraging sight to see the delight of the child's adventuring into a world of physical activity and achieving in consequence a corresponding measure of self-confidence. Senior Modern Departments. The work of our gymnasia must of necessity provide a wide contribution to the education of the child, particularly regarding a sense of discipline, concentration and a quick response to command. Modern teaching methods provide objective interests towards which most of the exercises taken can have reference. On the boys' side, organised games and athletics seem to predominate and on the girls' side, major games, dancing and natural movement. Instead of emphasis being put on to the organisation of the class as a whole, emphasis is now centred on the smaller unit of ones, twos or threes, giving scope for more rapid development according to their physical ability. A higher standard of achievement . generally has been noticeable throughout this period of experiment and trial. This year we have experienced the introduction of fourth year pupils in our Modern Schools. Following up the line of interest of the individual, and guided by their leisure time activities, a more elastic scheme of work has been the means of approach to this subject. Physical Training Clothing and Shoes. A more regular supply of physical training clothing and shoes is now possible and is greatly appreciated. In order to make a more satisfactory allocation than previously a survey of school stocks and needs has been made so that in future, a fairer allocation might be possible. It is hoped eventually to equip each school fully with the following items:— (a) Junior and Infant Pupils below the age of eight years—Plimsolls. (b) Junior Pupils over the age of eight years—Plimsolls, Shorts and Singlets. (c) Senior Pupils, Boys—Plimsolls, Shorts and Singlets, Football Boots. Senior Pupils, Girls—Plimsolls, Sports Blouses, Shorts or Knickers, Hockey Shoes. If the children are to obtain the maximum benefit from the facilities provided, they must be suitably clothed whether it is for the gymnasium, the school hall or on the playing field. 107 Playgrounds and Playing Fields. Owing to difficulties of transport, it was not possible to arrange for playing field accommodation, for some of our Primary Schools. As these schools, small in number, have very limited playground space, it is hoped that the coming year will see this matter rectified. Playing field accommodation in the area is of very high standard and the work of the groundsmen on the whole is extremely helpful and satisfactory. Pitches must be kept well marked if the work of the teachers is to be educational and not just the means of providing a short period of exercises. Games must be well taught and well coached if they are to have the necessary carry-over value into after-school life. Summer games do not fare quite so well as the winter games, owing to the lack of tennis facilities, particularly for Modern Girls' Departments. In addition to cricket, tennis is also an asset socially for boys who do not wish to admit ignorance of this game when confronted by their more fortunate brothers in youth clubs and fellowships. Applications for the use of games facilities for youth associations have been more than doubled this year, with the result that with pitches badly worn, no further applications could be accepted towards the end of the season. Out of 270 occasions when pitches were available throughout the winter season, on one playing field alone only 33 occasions were possible when a pitch was not in use. Playground surfaces are gradually being restored to pre-war condition. Burnt Ash School has been severely handicapped by defective playground conditions for a very long period and has been in some degree confined to indoor space. Outdoor playground work can now be developed to the great satisfaction of all departments. Swimming. Through the kind co-operation of the Baths Department, it has been once again possible to make arrangements for swimming facilities for Modern Schools and County Primary Schools with senior pupils on the roll. Eleven classes for senior girls were possible at the Open Air Pool and six at Downham Bath. For boys, eight classes were arranged at the Open Air Pool and six at Downham Bath. It is interesting to note the keeness of children and staff at the Downham covered bath where application has been granted for similar facilities to be carried on throughout the winter season. This is actually the first instance of school swimming instruction 108 being given throughout the year in this area, and the schools concerned are to be congratulated on their achievement. Better proof of the advantages acquired by continuous teaching in a covered swimming bath cannot be stressed too strongly. For the satisfactory development of swimming generally in schools, the introduction of junior school swimming is essential. The sense of adventure in the child at this age gives a return of physical achievement that is often outstanding. Until we are fortunate in the possession of a closed swimming bath for the town, swimming achievements are bound to fall below what they might be. Alternatively, a small open-air pool with a low wall surround and a depth of water of about 3 feet to be used purely for school teaching purposes is recommended for inclusion in future Primary School proposals. Suitable arrangements for swimming instruction to be given to youth clubs (girls) in the area were once more available at the Convent Bath, where five classes were arranged and an instructress provided. Training Courses for Teachers. The further training of teachers is undoubtedly the most essential factor in all developments in Physical Education, no other branch of the Organiser's activities giving such good returns for the time and effort spent in this way. Training Courses for Men Teachers—particularly the men who have returned from the Services and Trainee Teachers, are very badly needed in the area. The lack of the services of a fully qualified man organiser is very evident when classes, which are so urgently needed, have to be postponed. During the year the following training courses were arranged for the various branches of physical education:— Women: 1. Two Advanced Courses in Modern Dance for Women Teachers in Modern, Grammar and Technical Schools, possessing facilities for specialisation in this branch of physical education. 2. A Ten-Session Course of Swimming Instruction held at Becken- ham Baths. 3. Refresher Course in Physical Education for Women Teachers in Modern or Senior Departments of Primary Schools. This Course was held in conjunction with the adjacent Sidcup and Chislehurst areas in order to obtain a sufficiently large number of entrants to provide a workable class. 4. Refresher Course for Women Teachers in Primary Schools held at Princes Plain School gymnasium for ten afternoon periods in June. 109 Men: 1. Refresher Course in Physical Education for Men Teachers in Modern Schools held at Princes Plain gymnasium for ten afternoon pefiods in July. Modern Dance. Though still in its early stages in our schools, modern dance is now showing very favourable results in classes dealing with the youngest to the older children. Classes of instruction are now to be found in our Secondary, Grammar, Technical, Modern, Primary and even Infant Departments. We hope in future to encourage definite correlation between the development of natural movement and mime, drama, music and other subjects on the school curriculum. The first Modern Dance Group for the County of Kent was inaugurated during the year in Bromley. We hope to continue the half-day courses that have previously proved so successful in other branches of physical education. Training of Part-Time Leaders of Youth Clubs. The response to suggested courses of training for leaders has been most disappointing. Arrangements for the following courses were made during the year and all clubs were notified:— 1. Half-day (Saturday) Course for Recreative Physical Training. 2. Sessional Course in Ballroom Dancing. 3. Ten-weeks Course of National Dancing and Games. 4. Ten Recreative Evenings of differing character. 5. Recreative Physical Training Class to be held in conjunction with the Diocesan Youth Organiser. 6. Advanced Ballroom Course to be extended to examination standard. Many of these did not materialise owing to lack of sufficient support. Recreative Evening Classes. As far as possible the needs of adolescents and adults of the area have received very sympathetic consideration, resulting in a varied programme of activities. This includes evening classes arranged in the following branches of physical training:— 1. Recreative Physical Training, Women and Girls. 2. Recreative Physical Training, Men and Boys. 3. Ballroom Dancing. 4. English Country Dancing. 5. Scottish Dancing. 6. Keep-Fit work. 7. Advanced Gymnastics. 8. Boxing. 9. Swimming. 110 Outdoor Activities for Youth Associations. Facilities have been provided for the following outdoor activities and these have been fully used throughout both the winter and the summer seasons:— 1. Cricket. 2. Tennis. 3. Football. 4. Hockey. 5. Swimming. 6. Sports. It would seem that extended facilities will be required in future for both football and tennis. Though the number of young people who attend organised classes is not large, we must not forget those who choose to spend their leisure time cycling, walking, camping, etc., and those who enjoy the love of open spaces. What opportunities are open to them in our area which is so full of attraction of this kind. Conclusion. A wide scheme of physical education includes all aspects of education that are related to the physical life of the child, including nutrition, housing and rest, etc. This report, however, deals only with the physical activity of the child and is concerned with his or her physical development and a closely corresponding mental and emotional development. The modern approach to the subject, encouraging the spontaneous activity of the child and the gradual effacement of the teacher, aims at establishing and maintaining the right ideals of healthy living, together with a wise use of leisure time and a love of exercise for its own sake. May I conclude this report with my sincere appreciation of the kind co-operation of the Head Teachers and their staffs, without which one's efforts would, of necessity, be severely curtailed. F. H. BENTLEY. Organiser of Physical Education. 111 BOOT CLUB. The Chairman reports as follows:— " The Bromley Schools' Boot Club has continued to operate sucessfully during the year ended 31st December, 1947, despite increasing difficulties of supply. Contributions received from members during the past year amounted to £436 18s. 3d. as against £408 5s. 7d. in 1946, whilst purchases of footwear amounted to £441 14s. 3d. nett during 1947 as compared with £427 17s. 8d. during 1946. "As will be seen from the above figures, there has been a slight increase throughout the year of the amount of contributions and the amount expended by members on the purchase of footwear, whilst it may also be seen that the fund has realised a deficit during the past year of £4 16s. Od. This is due to the fact that two firms on the list of retailers are unable to increase the rate of discount granted from 5 per cent. to 10 per cent whilst the rate of bonus granted to all members remains at 10 per cent. It is not proposed to reduce the rate of bonus at present as the fund still has a surplus in hand of £58 8s. 4½d. which it is hoped will enable the rate of bonus to be maintained until such time as the supply of footwear is easier. " The work of the Committee and the administration of the fund has continued uninterrupted throughout the past year and from information obtained it would appear that the services performed by the Bromley Schools' Boot Club Committee are still in as great a demand as ever." NUTRITIONAL SURVEY. An investigation into the weight and height of children prior to the war (1939), and after the war (1946) reveals that the increase in average weight of boys and girls in the " leaver " group (13 year olds) was 2¼ lbs. The boys showed an average increase in height of ¼", while the girls showed an average decrease of 1/3". The number of children under survey in 1939 was 421 (193 boys and 228 girls) and in 1946 was 344 (147 boys and 197 girls), and the comparative tables are as follows:— Boys Girls 1939 1946 1939 1946 Average age 12 7/12 12 7/12 12 7/12 12 7/12 Height 57¾ins. 58ins. 59 l/12ins. 58¾ins. Weight 851bs. 87¼lbs. 88½lbs. 90¾lbs. The above figures should be read in conjunction with the following tables where the weights and heights are divided into 112 three groups—low, medium and upper, and which give the percentage of children in each group. Height in inches Boys (average age 12 7/12 years') 1939 per cent. 1946 per cent. Wt. in lbs. 1939 per cent. 1946 per cent. 49—55 17.1 15.0 55 —75 21.2 17.7 551—61 73.0 72.8 75¼—95 60.6 59.2 Over 61¼ 9.8 12.1 Over 95 18.2 23.1 Girls (average age 12 7/12 years) Height in inches 1939 per cent. 1946 per cent. Wt. in lbs. 1939 per cent. 1946 per cent. 49—55 12.6 11.7 50 —75 22.3 18.8 551—63 78.5 82.2 751—100 59.2 56.3 Over 63 8.9 6.1 Over 100 18.4 24.9 In the intermediate group (8 year olds) the records of 574 children (310 boys and 264 girls) were examined in 1946, compared with 512 (278 boys and 234 girls) in 1939. The average weight of boys was increased by 1 3/8 lbs. and that of girls, ½ lb., compared with pre-war. There was no difference in the average height of girls, but the boys showed an average increase of 1". Boys Girls 1939 1946 1939 1946 Average age 8 7 11/12 8 7 11/12 Height 48½ins. 49 4/12ins. 49½ins. 49 4/12ins. Weight 551/8lbs. 561bs. 551bs. 551bs. It will be seen that the children examined in 1946 were, on an average, one month younger than those examined in 1939, and, in order that a true comparison can be made, an adjustment to allow for the age factor must be made. According to the statistics for London school children, those between 7 and 8 years of age should gain an average of half a pound per month. The average height of children in this age group should also increase at the rate of 2 inches per year. After these adjustments have been made, the true comparative tables are as follows:— Boys Girls 1939 1946 1939 1946 Height 48½ins. 49½ins. 49½ins. 49½ins. Weight 551/8lbs. 56½1bs. 551bs. 55½ lbs. The comparative weight and height distributions for this age group are shown in the following tables. 113 Boys. (Average age in 1939, 8 years. Average age in 1946, 7 11/12 years) Height in inches 1939 per cent. 1946 per cent. Wt. in lbs. 1939 per cent. 1946 per cent. 40—46 11.9 7.7 36 —46 9.4 5.5 46¼—52 80.2 80.9 461—62 75.5 79.7 Over 52¼ 7.9 11.3 Over 62¼ 15.1 14.8 Girls. (Average age in 1939, 8 years. Average age in 1946, 7 11/12 years) Height in inches 1939 per cent. 1946 per cent. Wt. in lbs. 1939 per cent. 1946 per cent. 40-46 7.7 7.6 40 —46 7.3 9.8 461—52 84.1 83.3 461—62 79.9 76.9 Over 52¼ 8.1 9.1 Over 62¼ 12.8 13.3 It was also possible to follow up the development of 198 children (89 boys and 109 girls) in the " leaver " age group. According to the statistics available, the average London school child gains approximately 50 per cent. of his weight as an intermediate, in the five years between 8—13 years. Of the above 198 children, only 10 (5 boys and 5 girls) failed to attain this standard, but, on the other hand 15 children (3 boys and 12 girls) doubled or more than doubled their intermediate weight in these 5 years. Comments. From the above tables, it will be seen that the boys in the leaver group have increased both in height and weight, and that there is a comparatively higher percentage in both the taller (over 61¼") and the heavier (over 95 lbs.) height and weight groups. The girls in the leaver group have shown the greatest proportional height increase in the middle group (558"—63"), but the highest proportional weight increase is to be found in the heavier (over 100 lbs.) weight group. The intermediate boys show a higher percentage in the taller group, with a slightly lower percentage in the heavier group, and a higher proportional weight increase in the middle (46¼—62 lbs.) group. The girls in this group show a slight proportional increase in both the taller and heavier groups with a corresponding lower percentage in the middle height and weight group. 114 I feel that we can conclude from the above, in spite of the comparatively small number investigated, that the post-war nutritional standard of the school child is slightly higher than in 1939. This is, in my opinion, due, primarily, to the increase of the provision of meals and free milk in schools, and also to a greater awareness of food values on the part of parents, and their determination to obtain the full quantity of rationed commodities to which their family is entitled. INFECTIOUS DISEASES IN SCHOOL. The usual infectious diseases occurred at the schools, Measles, Whooping Cough, Mumps, Chicken Pox—and caused the usual loss of school attendance. The absence of Diphtheria was again noted and must be placed to the credit of the intensive immunisation that has been proceeding over the past years. A Gallup poll taken at fifteen schools showed that 77 per cent. of the children had been immunised. An epidemic of Scarlet Fever in the Church of England School, College Road, caused some anxiety and is only now abating. It was mild in type and many missed cases were discovered in attendance. The most interesting infectious disease was the epidemic of Infantile Paralysis, calling for intensive investigations and controlling action. In no case was the infection traced to school contact. No child was permitted to attend school after absence for any undiagnosed illness or temperature, without a clearance certificate at the end of three weeks from a doctor, indicating that the case was not one of abortive infantile paralysis. I believe this was an important factor in the control of this infection through Bromley schools. ACKNOWLEDGEMENTS. I should like to place on record my appreciation of the cooperation which has been afforded by the Borough Education Officer, Mr. H. W. C. Eisel, and members of his staff, and also by Miss M. A. Isard, the Honorary Secretary of the Bromley Children's Care Committee. 115 SCHOOL MEDICAL SERVICE STATISTICAL TABLES—1947. TABLE I.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. B. Other Inspections. C. Pupils found to require Treatment. TABLE II.—A. Return of Defects found by Medical Inspection. B. Classification of the General Condition of Pupils Inspected during the Year, in the Age Groups. TABLE III.—Group I. Minor Ailments. II. Defective Vision and Squint. III. Treatment of Defects of Nose and Throat. IV. Orthopaedic and Postural Defects. V. Child Guidance and Speech Therapy. TABLE IV.—A. Dental Inspection and Treatment. B. Orthodontic Clinic. TABLE V.—Infestation with Vermin. TABLE VI.—Orthoptic Clinic. TABLE VII.—Speech Clinic. TABLE VIII.—Handicapped Children. 116 TABLE I. Medical Inspections of Pupils Attending Maintained Primary and Secondary Schools A. Periodic Medical Inspections Number of Inspections in the Prescribed Groups: Entrants 659 Second Age Group 890 Third Age Group 411 Total 1960 Number of Other Periodic Inspections 1274* Grand Total 3234 * Children aged 8 years, Children in their 13th year at County Grammar and Technical Schools, Children at the Occupational Centre. B. Other Inspections Number of Special Inspections 4708 Number of Re-inspections 3825 Total 8533 C. Pupils Found to Require Treatment Number of Individual Pupils found at Periodic Medical Inspections to require treatment (excluding Dental Diseases and Infestation with Vermin): Group For defective vision {excluding squint) For any of the other conditions recorded in Table II.A. Total individal pupils Entrants 13 164 177 Second Age Group 33 212 245 Third Age Group 45 94 139 Total (prescribed groups) 91 470 561 Other periodic inspections 126 304 430 Grand Total 217 774 991 117 TABLE II. A. Return of Defects Found by Medical Inspections Defect Code No. Defect or Disease Periodic Inspections. No. of Defects. Special Inspections. No of Defects. Requiring treatment Requiring to be kept under observation but not requiring treatment Requiring treatment Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) 4 Skin 36 4 700 19 5 Eyes— (a) Vision 194 150 66 10 (b) Squint 21 6 15 1 (c) Other 23 4 239 6 6 Ears— (a) Hearing 2 1 8 — (b) Otitis Media 1 — 71 — (c) Other 7 2 142 4 7 Nose or Throat 159 304 613 129 8 Speech 1 6 17 — 9 Cervical Glands 4 30 10 16 10 Heart and Circulation 21 57 24 34 11 Lungs 11 34 95 45 12 Developmental— (a) Hernia — — 1 — (b) Other 2 4 — — 13 Orthopaedic— (a) Posture 62 31 12 5 (b) Flat Foot 205 14 22 — (c) Other 115 23 171 26 14 Nervous System— (a) Epilepsy — — — — (b) Other 7 20 79 23 15 Psychological— (a) Development 1 1 — — (b) Stability 1 — 2 — 16 Other 221 67 848 171 Totals 1,094 758 3,135 489 B. Classification of the General Condition of Pupils Inspected During the Year in the Age Groups Age Groups Number of Pupils Inspected A—Good B—Fair C—Poor No. % of Col. 2 No. % of Col. 2 No. %of Col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 659 581 88.16 78 11.84 — — Second Age Group 890 692 77.75 191 21.46 7 0.79 Third Age Group 411 334 81.26 71 17.28 6 1.46 Other periodic inspections 1,274 1,067 83.75 194 15.23 13 1.02 Total 3,234 2,674 82.68 534 16.51 26 0.81 118 TABLE III. TREATMENT TABLES Group I.—Minor Ailments (excluding Uncleanliness, for which see Table V.) (a) Number of Defects Treated, or under Treatment during the year Skin. Ringworm—Scalp: — i. X-Ray Treatment — ii. Other Treatment — Ringworm—Body 8 Scabies 45 Impetigo 12 Other Skin Diseases 538 Eye Disease (external and other, but excluding errors of refraction, squint and cases admitted to hospital) 240 Ear Defects (excluding serious diseases of the ear, e.g. operative treatment in hospital) 180 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains etc.) 962 Total 1985 (b) Total number of attendances at the Minor Ailments Clinics, 15795. Group II.—Defective Vision and Squint (excluding Eye Diseases treated as Minor Ailments : Group I.) Number of defects dealt with Errors of Refraction (including squint) 270 Other Defects or Diseases of the Eyes (excluding those recorded in Group I.) 38 308 Number of Pupils for whom spectacles were (a) Prescribed 400 (b) Obtained 277 Number of Clinics held 93 Number of Re-Inspections 645 Group III.—Treatment of Defects of Nose and Throat Total number Treated Received Operative Treatment— (a) For Adenoids and Chronic Tonsilitis 54 (b) For other nose and throat conditions 1 Received other forms of treatment 45 100 119 Group IV.—Orthopaedic and Postural Defects (a) Number treated as in-patients in hospital or hospital schools 7* (b) Number treated otherwise, e.g. in clinics or out-patients' departments 299 Number of Clinics held 22 Number of attendances for consultation with Surgeon 652 Number of attendances for massage and exercises 3594 Number of attendances for ultra violet ray 1983 * Children treated at Royal National Orthopaedic Hospital up to March, 1947. All cases thereafter dealt with by Kent County Council at the County Hospital, Pembury. Group V.—Child Guidance and Speech Therapy Number of pupils treated— (a) Under Child Guidance arrangements 14 (b) Under Speech Therapy arrangements 8 TABLE IV. A—Dental Inspection and Treatment Number of pupils inspected by the Authority's Dental Officers— (a) Periodic Age Groups ... 3066 (b) Specials ... 920 Total (Periodic and Special) ... 3986 Number found to require treatment ... 2776 Number actually treated ... 2280 Attendances made by pupils for treatment ... 5876 Half-days devoted to (a) Inspection 17 (b) Treatment 6831 Total ... 700} Fillings—(a) Permanent teeth 1713 (b) Temporary teeth 833 Total ... 2546 Extractions—(a) Permanent teeth 765 (b) Temporary teeth 2033 Total ... 2798 Administrations of general anaesthetics for extraction ... 1022 Other operations—(a) Permanent teeth 1959 (b) Temporary teeth 103 Total ... 2062* * Including— ... Number of scalings and polishing ... 163 Number of dressings—(a) Permanent teeth 53 (b) Temporary teeth 64 Total ... 117 120 B—Orthodontic Clinic Number of children referred for orthodontic treatment 136 Number of orthodontic appliances (a) ordered 104 (b) fitted 104 Attendances for orthodontic treatment 808 TABLE V. Infestation with Vermin Individual Pupils Total number of examinations in the schools by School Nurses or other authorised persons 13381 Total number of individual pupils found to be infested 120* Number of individual pupils in respect of whom cleansing notices were issued (Sec. 54 (2), Education Act, 1944) — Number of individual pupils in respect of whom cleansing orders were issued (Sec. 54 (3), Education Act, 1944) — * In addition, 292 children showed minor evidence of uncleanliness. TABLE VI. Orthoptic Clinic Number of cases under treatment during the year 72 Number of new cases 42 Number of treatments given 1207 Number of cases on occlusion during the year 20 Number of cases awaiting or undergoing operation at the end of the year 6 Number of cases found unsuitable 8 Number of cases left area 2 Number of cases failed to attend 3 Number of cures 19 With B.S.V., 9. Cosmetic, 10. With operation, 10. Without operation, 9. 121 TABLE VII. Speech Clinic Total number of cases treated 8 Types—(a) Sigmatism – (b) Simple Dyslalia – (c) General Dyslalia 3 (d) Multiple Dyslalia 1 (e) Alalia – (f) Aphasia – (g) Dysphonia (i) Cleft Palate – (ii) Other Causes 1 (h) Dysarthria 1 (i) Stammer 2 (j) Stammer, with Dyslalia – Number of cases receiving treatment at end of year – 7 Number of cases discharged completely – — Number of cases discharged under observation – 1 Number of cases dismissed for bad attendance – 1 Case admitted for investigation from waiting list—no speech defect found – 1 TABLE VIII. Handicapped Children In special schools In maintained prim, and sec. schools In independent schools Not in school Total Blind 1 — — — 1 Partially Sighted — — — — — Deaf 2 1 — 1 4 Partially Deaf — 7 — 1 8 Delicate — 21 — 1 22 Diabetic — — — — — Educationally Subnormal 5 29 2 3 39 Epileptic 2 1 — — 3 Maladjusted 3 41 — 2 46 Physically Handicapped 2 4 1 2 9 Speech Defects — 14 — 2 16 Multiple Disabilities — 3 — 4 7 Totals 15 121 3 16 155 In addition to the above, 20 children have been certified as ineducable.